198 Bronnie Thompson

Mark Kargela: [00:00:00] Before we start this week, I have a question for you. Have you ever walked out of a treatment room thinking there has to be a better way to help people in pain if you felt the frustration of cycling through short-term fixes, if you're tired of care, that feels disconnected, disempowering, or just not enough pain practice OS was made for you.

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Now onto today's episode.

Bronnie Lennox Thompson: I think a lot of clinicians who, who come from a physiotherapy, you know, chiropractic, that sort [00:01:00] of the, the physical health end feel that as soon as somebody starts to. Be sad or angry or have some kind of big emotions. They fear that it's gonna get outta hand. I'm gonna open Pandora's box, and then what am I gonna do with all these things?

Am I becoming a psychologist?

Mark Kargela: What if the biggest barrier to delivering truly biopsychosocial pain care isn't the lack of knowledge but your own struggle with uncertainty. In this episode, I sit down with occupational therapist, coach, mentor, and friend, Bronnie Lennox Thompson, to explore why the biopsychosocial model gets so much lip service, but so little embodied practice

Bronnie is not just a leading clinician and educator, she's also someone who's lived with chronic pain herself. That combination of expertise and lived experience gives her teaching a depth and authenticity that few can match.

Bronnie shares why she's abandoned the term bio-psychosocial altogether in favor of a multifactorial model and why that subtle shift changes everything. [00:02:00] We dig into the clinician struggle with uncertainty. Why we search for certainty and techniques and algorithm when pain is inherently subjective and non-linear.

Bronnie offers a powerful reframe. Redirect your certainty away from treatments and towards the ability to develop strong therapeutic relationships.

You also hear about the psychological flexibility. Clinicians need, but rarely develop the essential role of motivation, interviewing and act and pain coaching. And why saying, I don't know, might be the most therapeutic thing you can do.

This conversation challenges continued education certainty, peddling culture, and offers an alternative, authentic partnerships, guided discovery, and the freedom that comes from embracing the mess.

Whether you're a pt, ot, chiro, or any clinician working with somebody in pain, this episode will give you permission to practice differently and the practical guidance to start

Announcer: This is the Modern Pain Podcast with Mark.

Mark Kargela: one of the discussions that's always goes around there is the bio psychosocial model that's been being discussed for who knows how long, quite a bit. And you've seen it [00:03:00] evolve over time from its angles, initial thoughts of it to where it is today.

And I still. Wonder where we sit with the biopsychosocial model? 'cause I think there's always some interesting debates on there. I'd love to hear where you feel like you think we sit with the biopsychosocial model and and truly embodying it in our practice.

Bronnie Lennox Thompson: I've stopped using the term actually because it carries so much baggage. So I talk about a multifactorial model. We have multiple factors, and in doing that, we, it, it avoids that, oh, there's a bit here and a bit. You know how bio-psychosocial can be. Here's the bio, and then when that doesn't work, we'll do the psychosocial as if they're not woven together from the beginning.

So the way I, I see it, um, if we think about. Pain is this whole person multifactorial experience. Then we can consider the parts that we can intervene with. There are some things we can't. Social stuff is [00:04:00] pretty challenging. Things like socioeconomic status and culture, and that's really difficult. But as clinicians, we can pay attention to the impact on individuals and and the people that we see, and then we can start to be more open.

To looking at people as people, I think.

Mark Kargela: I totally agree. 'cause it's, I think it gets. Cordoned off into these three things, which sometimes can be so nebulous and like there. It is so multifactorial and complex when it comes to, to people dealing with pain. For sure. Where do you think clinicians fall short from embodying this? I reflect back to me in my journey where initially, you know, I got all excited about, pain science and pain, neuroscience education. And again, it's been put in its probably proper perspective that it's not gonna be a standalone thing. And it can be maybe when a contextually appropriate, something that can be helpful for a person to maybe make sense of their situation.

But I still think. [00:05:00] Clinicians and just talking to 'em and, and being able to mentor clinicians. I, I mean, fortunately seeing some clinicians make some big growth, but also just seeing clinicians, you know, around where I think it gets a bit of lip service and a little bit of maybe a surface level, level skim.

But when it comes to some of the difficulties that are part of the multifactorial nature of pain, which are difficult emotions, difficult situations, difficult circumstances are people bring into treatment rooms. I don't know if I see clinicians having skills to be able to delve into that and make some positive, movements with people.

Where, where do you see the challenges clinicians have from maybe that surface level to more deeper application?

Bronnie Lennox Thompson: I think a lot of clinicians who, who come from a physiotherapy, you know, chiropractic, that sort of the, the physical health end feel that as soon as somebody starts to. Be sad or angry or have some kind of big emotions. They [00:06:00] fear that it's gonna get outta hand. I'm gonna open Pandora's box, and then what am I gonna do with all these things?

Am I becoming a psychologist? And I want to reassure people that that is not what we are doing in pain where. Being people, humans who connect with another human. And that means being willing to sit with somebody's distress because pain by definition is this unpleasant, sensory and emotional experience.

We can't divide the unpleasantness, the emotion or the sens sensation from that experience. So when somebody's. Um, angry or they're disappointed or they're sad. That's powerful. Course. If we are working with somebody who's, who's experiencing pain, that means that we don't need to psycho pathologize and say, oh, you are depressed, or You need to see a psychologist, or you [00:07:00] need to do, and.

We instead can say you're a person who's dealing with a really difficult, uncomfortable, unpleasant experience that's invisible, gets misinterpreted. And hey, as a normal everyday person, I can just be kind and compassionate and give you some space to feel what you feel. Um, emotions come and they peak and then they e away.

We make room for that. To be in the room to acknowledge, to validate that that's what you're feeling, and that's okay because that's pain. Then I think we do an awful lot more for people than if we suddenly try and bundle it, shut it down, or ignore it, or kind of. Put a patchwork over it. Oh, there, there, dear.

Um, which can come across patronizing. It can come across as [00:08:00] really dismissive and doesn't invite people to then go on to tell, to really trust you and to tell you how they're feeling about what's going on for them. And that's a missed opportunity because then they'll go away thinking they don't really care.

I can't really trust them. And so now what am I gonna do? Which is kind of unfair. I suppose the worst thing that can happen with people who experience big feelings is that they cry a lot. So we might need to have some tissues handy. Um, just something to mop up the tears and that people can get angry and sometimes they direct that anger at us because we represent health professionals and they've been deeply, deeply disappointed by health professionals in the past.

And so I think when we roll with that. We say, yeah, I hear you. That was pretty awful. And no wonder you're [00:09:00] feeling distressed and just validate. That goes a long way to diffusing, um, that person's anger at you. Instead, we're kind of pointing out the situation sucks. Um, hey, it's quite nice if you're going through a rough patch for someone to say you are really going through a rough patch.

That sucks for everybody. I don't see that as being psychological. I think that's being good clinician who's listening and making that safe space for somebody to talk about how they are.

Mark Kargela: It just reminds me of our friend Keith Meldrum, and when he just, I believe you was the, or we believe you. Um, the physicians said to him, and that really diffused a lot of the anger he had mentioned how it really, he had already raised himself up and was ready to, you know, put this doctor in the same, you know, category of all the other past people who've kind of dismissed him.

And it was, you know, such a transformative experience for him that set him on a [00:10:00] different path. I'm wondering, like with clinicians, it seems like there's a. A search for a perceived level of certainty in an encounter like where we can. And I, and I definitely spent a good 10 to 12 years of my career search, searching for certainty through my hands and you know, manual therapy, being able to like identify specific impairments, dysfunctions with my hands.

And that was gonna solve all this complexity. 'cause that was a lot easier for me to, you know, I could study it in a textbook. I could try to make some sort of objective. Determination of it. Yet we deal with subjective, chaotic, nonlinear experiences that are pain. I'm wondering what, what. Clinicians struggle with that uncertainty, right?

They want certainty. Like how do you, I mean, I'd love if you could speak to that tension and like, how do you feel like as clinicians, because I think OTs are great at it, kind of more naturally than, than, uh, physios. 'cause you, you can kind of get into the person's life and [00:11:00] really kind of get to see where they want to go much more right off the gate than, you know, PTs have physios and chiros and others tend to want to have this like perceived.

Guiding, like we're gonna not necessarily guide, we're gonna kind of steer the ship the in our bias direction. I'm just wondering if you can speak to some of that difficulties with uncertainty and how clinicians can start making the move to be okay. That it's gonna get messy and chaotic and nonlinear and make space for it.

And in fact that it, when you do that, it opens up a whole lot opportunity for people to get some experiences that they haven't gotten healthcare prior.

Bronnie Lennox Thompson: How do you, how do we do that as clinicians? I think, I think if we recognize, first of all the, the relationship with the person probably counts for much more than anything that we actually know. Um, and we've got some really good research showing that those, those, what do you call them? Um, I'm gonna [00:12:00] say a meaning response.

The kind of experience, the relational parts of, of what we do as clinicians, that that seems to have a huge impact on how somebody responds no matter what. And our certainty can be really off-putting. If we come in and then we find out that it didn't work, then we probably blown it. Whereas if we say things like, I wonder, let's try this.

Let's have an experiment. Um, I wonder what it would be like for you that adding that curiosity to discover. So that we don't have to come in with and be the experts because we are not the experts in this person's pain. Only they can experience it and they can tell us about it, but words don't really capture pain and what it feels like very well.

So we can't directly experience what it's like, and so we [00:13:00] don't know what's gonna happen if we apply said treatment, whatever that is. So. Really running an end of one experiment. Every time we're working with somebody, we start with best guesses because that's, you know, we have theory and we have kind of ideas about what might be going on, but essentially we are testing a hypothesis and we don't know what that's going to result in.

So I think that might be one way to maybe come back to thinking about we are generating these theories, these clinical theories, and then we want to see and explore and be curious about how well they fit for this person, because we don't know. And then we let them do the thing, or we ask them to do the thing and then we ask them.

How, what happened? So we're curious about what happened, how did it work, what worked well, what didn't go well. And in doing [00:14:00] that, we're actually putting ourselves as collaborators, not leaders, not top dog. So we partnering with people and yet we've, we are reassuring by the very fact that we are there and we're prepared to be with them as they experiment.

Um, maybe our certainty should be about, about how we can develop a really good working relationship with the person rather than our certainty about the theory or the treatment or what the next best step might be. So redirect our certainty towards, what I am certain about is that when I get on well with you and you and I collaborate, then we have power.

Of the treatments look like in the end.

Mark Kargela: I like that. It's a great way to put it. Recently, there's was an article that came out relatively recently of active versus passive and, and as usual, it's, [00:15:00] it sparked some, some interesting dialogue online. This type of discussion makes me wonder, like, I think it's hard. For passive care to allow for this discovery process, this experimenting process when you're doing it for the person.

Right, and again, before I get the comments, I, it can have its place. The massage therapists do some amazing. Passive work, but can also weave that into some planning and some, some different things with a person to, to help them navigate life off, off the table. So I'm not saying they're that passive care can't have that 'cause you, you can have a place, but I'm just wondering if you see like that sometimes when, when we get stuck in passive care and, and a lot of our clinicians we know get people off tables.

It's not just on tables. But do you think that sometimes misses the opportunity for someone to have the ability to. To, to maybe experiment and kind of discover some things on their own. I mean, obviously with our guidance and with our coaching with, when you look at passive care,

Bronnie Lennox Thompson: I think we could probably [00:16:00] do more active guided discovery, even with passive care, with hands-on care. So we do hands-on care, but we don't feel what the person's feeling. We can't. So we could ask them, Hey, what do you notice? What do you notice when we do this before? What do you notice when after we've done this?

And what's it like for you when you go away from here? Can you recreate that feeling? Um, what are the things that, you know, bring you that sense of ease and comfort that might come from a hands-on treatment? So I'm not sure that we need to. In fact, I don't think we need to eliminate this hands-on stuff people like and want Nice touch.

Whatever that looks like, whether that's massage therapy or manipulations or whatever, people like and want it, it's an essential part of being human. But what we could do is think carefully about asking the person, what did you [00:17:00] notice? Being curious about, how was that for you? Can you tell, um, can you do different movements?

Now let's explore that and get the person to be guided in two different movements. Maybe before you do your hands on, do your hands on, then afterwards, and then ask the person what differences do you notice so that if, if we are thinking about the form of, of treatment, whether it's hands on or hands off, always coming back to this person, this person that we are working with is gonna have an experience and let's understand what it was like for them.

What do they, what do they notice? And how can they make sense of that rather than putting words into their mouth and giving an explanation, perhaps asking them, what, what does that mean to you? What does that say to you? So it's a really different way of working with people, um, that isn't about sort of, I'm gonna fix you, [00:18:00] but I'm gonna, we are gonna try this thing together.

Part of this is hands on. Now you tell me. What was that like? What do you, what did you find out? I don't know. Might be another way to frame that idea of passive care versus active care.

Mark Kargela: I think that whole guided discovery piece within. A passive intervention can be very helpful for people to start noticing and not of what, what's happening when some of these things go on and, and maybe what that opens up space to do. And then obviously, ideally it opens up space to start plugging in some things that are meaningful and valuable to that person, um, in front of us.

Bronnie Lennox Thompson: Because they could be invited to, to even try. So you've had this experience here. When you go home, can you find some ways where you can recreate that same sense? That same feeling in your body that you've experienced here, what do you think might help you do that? So we're not just drawing on [00:19:00] the, in the clinic work, but we're working with the person to identify other ways that they've been able to have that same sense of freedom, lightness, flexibility, confidence in their body, and do that in their own world because we can't, as.

Patients we don't wanna spend our time in, in a clinic. In fact, we don't. Most of the time, people who live with pain are outside. People who seek treatment come in. They have what, a half an hour? An hour with somebody, and the rest of the time they're on their own. So if we can guide those people to work out ways that they get that same sense in their own world, that builds on whatever we've done inside the clinic.

I think that is probably more powerful than, than we recognize perhaps.

Mark Kargela: Hundred percent. I'm, I'm wondering 'cause you know, the passive care can have some, you know, like you said, some great changes [00:20:00] and can make, you know, people notice some, some significant, you know, openings of some abilities to. To do some things, but then people entered. I, and this is what I talk with the students we mentor as far as in clinic, is these four walls are the most like supportive, you know, four walls.

It's where people get outside these four walls where their life exists, and that's where some difficult situations, stress, emotions, financial concerns, work concerns, contextual concerns, cultural, whatever it may be for that unique person. How do you help people? Like how would you recommend clinicians?

When they're trying to help people plug into the noticing of when difficult situations arise, do they notice things change in their body and things like that. Because I think I, I love the noticing part with the, the hands-on care. 'cause it can help people see that there's ability to change and that, that their body can change.

But then I think it's also helpful to have them leave the clinic and show well, when do you notice that leaves or when it, when it changes? Is there [00:21:00] anything that. Shows up when, when you notice this kind of going away, is any, I'm just wondering if you could notice what's going on around you. I mean, what do you think of that?

Because I think sometimes I, there can be this misperception maybe from a patient that something mechanically was altered in their body and there's this, the key is this mechanical issue and that's where healthcare's narratives around pain, we know biomedical theory has its limits with that can be very important.

Of course, I'm not saying it doesn't have its issue or doesn't have its utility, but. How do you help patients or how do you recommend we help patients notice more than just the internal interceptive components of their experience and maybe some of the more exce, extra receptive components of what's coming from, you know, their, their environment and in their world, and, and some of the things that can trigger emotions and difficult feelings.

Bronnie Lennox Thompson: I think one thing that we do as humans really quickly is we are really good at detecting threat trouble, um, stress, and [00:22:00] sometimes for people who are really sore, um, it, it kicks from. Being relatively okay to suddenly, oh my God, out of the blue came this ouch. And now I'm really feeling stressed. So I dunno that detecting the times when things are difficult is as much of a.

Thing is it is to guide people to experiencing when they're feeling better, checking in with their body regularly to say, I wonder how my body is right now. Um, we can call this present moment awareness. We can call it mindfulness. We, I don't really care what you call it, but checking in with your body regularly might be one way to start to bring attention to.

To what is happening. And if that checking in with your body is accompanied by um, some kind of breath or some [00:23:00] downregulation strategy, and then people can notice what that's like, that might help people to. When you check in and notice that your body's revved up already and you have a solution or a way that you can help calm it down a bit, that might be even more valuable.

In doing that at random times, or I like to pair this with things that people are doing in everyday life anyway, like cleaning your teeth, waiting for the kettle to boil at the red at the traffic lights. Um, anytime you're going in and having a pee. Those sorts of everyday sorts of things that, um, um, opportune, opportune times to just check in and monitor.

What I find is that people very quickly begin to notice that, oh my, my pain does change. My [00:24:00] body does change over the course of the day, and I didn't know that. And if we can help people catch that quickly, like before it escalates into something wild and and horrible, perhaps that might be a way. Paired with this ability to now downregulate a couple of breaths can help, might be a way for people to start to tune in a little bit more carefully, um, to what is going on in their bodies.

I think people can. Quickly tell you places and situations where they don't feel comfortable. Um, it can be, I'm doing this thing and somebody's watching me, or I'm at work and I'm under the pump. I'm, I've got a deadline to meet. Um, or I've come home and the kids are in uproar and I'm stressed and my partner's making a meal and, and grumpy and I just want some space and that.

Those are times that people, [00:25:00] most people will notice that they're getting a bit tense and tight and maybe their breath changes and maybe their shoulders raise and maybe they're gripping on to things. Um, so I think they're not as difficult to notice what is more difficult. 'cause our bodies are, our minds are really good at better safe than sorry, seems to be the, the, the rule.

So when we know that, then. Identifying times when it's going to be we are under threat is comparatively simple. When what we probably need to develop are these little OACs as little moments where we are just checking in, not changing it necessarily. Just checking in so we can monitor and then we can use those downregulation things regularly.

Um, maybe it will stop that wind up.

Mark Kargela: Yeah, it makes sense. Where do you think that, do you think that's just a universal human [00:26:00] struggle where life is chaotic and we're so disconnected from our body? 'cause we're, we're fielding all of this. Chaos of our existence, our day-to-day existence where it just to even like stop and catch your breath and even notice anything for some, and I, I definitely have my issues with it myself at times.

Um, I'm, I'm wondering, do you see that just kind of as a universal human struggle, this, this struggle to be present, especially in modern society?

Bronnie Lennox Thompson: I think that we have, we are so busy, we're constantly told to be productive, to strive to achieve, to tick the things off the to-do list that just being isn't. As easy or valued. So we don't do it. So we get into autopilot or we get into, um, that sort of anticipating trouble and remembering problems and perhaps not noticing that right now, in this moment, actually things are okay when you start [00:27:00] to notice regularly that things are actually okay.

Even if it's just for 20 seconds, then that starts to build that sense. Well actually life is not always a hundred percent, you know, fast. We can connect a bit more. I mean, if we can build into that enjoyable, pleasurable activities, things that we get into the flow state, um, that might. Help to build a sense of positivity in the, in the body and flow.

Um, so driving, for example, some people really love driving and they get into flow as they're driving and they're really relaxed and that might be for them a good way to connect in. Oh, I'm feeling really quite calm right, right now. That's cool. Other people, it's the opposite and they're gripping the steering wheel and stopping at the traffic lights is a great opportunity just to.

Let go of the steering wheel. Let go of the [00:28:00] steering wheel, pull the shoulders down, breathe out. So I think, um, life's busy and we live in our heads a lot and we have a lot of pressure to, to tick the things off the list. And so we have to thoughtfully create those moments where we just, we are just being.

Um, and that takes practice and. It can be a bit scary actually because if you, as soon as you stop, if your drive has always been, I've gotta achieve, I've gotta achieve up pops the mind reminding you of all these things that you have got yet to do. You haven't got around to doing this. This is sitting on your list.

Um, and so it can sometimes be. Just checking in with yourself and just being can bring up more concerns and more worries as the mind reminds you of all the things that you haven't done. So as a [00:29:00] clinician, it's quite useful to let people know that that can sometimes happen. It'll pass. Your mind will probably keep nagging at you.

That's the job. That's the job of your mind is to remind you of things, tell you to do things, to have an opinion on absolutely everything. When we are in the present moment, what we're trying to do is get the mind just to, just to take a back step just for five minutes, perhaps not even long that long, just to take a chill.

Mark Kargela: this is all getting to the heart of kind of some acceptance, commitment therapy type, you know, principles and psychological flexibility where we can be present with the chaos of the world in the difficult thoughts and emotions and feelings and sensations and stay present.

Do what matters when it comes to the things that are, bring us meaning and joy, like the things you spoke about. One of the fascinating things, just being able to hang out with you and be on coaching calls with you with some of our students and things, is to [00:30:00] see how you foster that in clinicians. 'cause I think that's a big, I think misunderstanding of like, I think clinicians, I know I have this misunderstanding that I'm just gonna be doing this kind of psychologically informed care for, for.

My patients and the people I'm working with, the people I'm, um, trying to help with pain. And I found myself really first off, it has helped me personally significantly in my life. And, and as I've gotten more and more aware of what it truly means to be psychologically flexible, I mean, realize how. As clinicians, we really struggle with that.

And there's a lot of things that can make it hard for us 'cause there are difficult sensations and feelings and emotions that we deal with as clinicians. I'm wondering if you could speak to some of the things you see with clinicians and some of those common struggles that we have as clinicians to deal with some of that difficult stuff that we deal with.

Bronnie Lennox Thompson: Yeah. I mean part of it comes from our ideas about who, what kind of a clinician are we, we're evidence-based, awesome practitioners who know what we are doing, right? We have a sense of [00:31:00] self that, that, you know, as a clinician, I've gotta be the expert, and then we step into this space where we don't know what's gonna happen next.

We can't predict. Ahead of time, how something's going to land, how this person's going to experience it. And that can be quite threatening to us, our sense of self-identity, um, or self-concept. And so I think psychological flexibility is about responding in a values based direction. Doing actions that take us towards those values.

So if our value as a clinician is that we want to be able to create this safe space where people with pain can feel okay about feeling what their body can do, part of our, our work as clinicians is to remember that we don't know. That's goes back to your uncertainty, ambiguity. We, we don't [00:32:00] know. And if we're looking at, um, how do we handle that when we go into a session, we have in our minds what we're going to do, how, what the session is going to look like.

We're gonna do these exercises and we're gonna move that person along to the next step. And they come in and it didn't work for them last week. So the exercises that you gave them actually were horrible. They didn't enjoy them. How do we as clinicians handle that? Most of us will have a mind that will say, well, you shouldn't have done that.

You did that wrong. And our self is concept of saying, well, you're a really lousy clinician. What kind of a clinician are you? You're not very good, are you? You didn't come up with the goods. So our mind's really, really strong. And then we have this sense of unwillingness. We don't want to feel like we're all at sea.

We don't want to feel like we don't know what we are [00:33:00] doing. We don't like that sense of uncertainty, and this is where applying acceptance and commitment therapy to ourselves is probably the the bit that we need to work hardest on because when we start doing things, we are, the person becomes the expert and we are fostering that curiosity in them and us.

We don't know the next step, and so we need to lean into feeling vulnerable, not knowing how, what is this person gonna say about the way that they have experienced those exercises? And can we put our mind to one side? So our mind is saying, oh, lousy clinical reasoning should have done, the algorithm, should have done it this way.

You're just useless. At least my mind does that. Um, given noticing that that's what my mind is telling me and the uncomfortable feelings that [00:34:00] come with that and the sense of. Do I know what do, what kind of a clinician am I? Am I really, do I really know what I'm doing? Am I stepping out of my scope into some kind of dark zone?

Um, we can take some time in a session to notice that that is what is happening. And you know what? Telling people, Hey, I'm just. I'm trying to work out what I should do next. Would you mind if we took a moment just to pause and I just wanna come back into my own body so that I can feel, you know, be present with you Might be.

A, a way to start moving into that flexible way of being. Because if we go into autopilot mode that says, oh, I know what to do. We're gonna do this, this, and this and this, and meanwhile we've got that mind telling us that we are just useless and we shouldn't have [00:35:00] done it this way. Why can't we go back to the tried and true 'cause?

That's what an expert therapist does. Are we stepping into this weird stuff? We probably could do with just taking a moment to be okay to sit with it, to lean into that discomfort of not knowing. And the, you know, the weird thing is that patients don't mind us telling them that. They actually think, oh, they're listening.

They're willing to be guided by what happened for me. They're not blasting on regardless of how it worked for me. And that and in turn, builds that sense of, of trust. Which I think is invaluable in these sorts of, um, ways of working with people to be a coach, to say, oh, we tried it that way. Didn't work out quite so well.

Maybe I wonder what would work better for you? And using as clinicians using that person's own [00:36:00] invaluable lived experience to guide the next best step because they know what it feels like. We don't.

Mark Kargela: hundred percent. And to me it's been the, one of the more freeing things is to just be okay with that uncertainty and the, I don't know. Just speaking from my own experience, I do feel like there was this surrendering of this status in the, in the, where I didn't feel like I was the expert. And then it's just, you know, we have the whole, you know, self-esteem, you know, imposter syndrome and all the things that come along with not.

'cause you, you struggle with sometimes feeling like, okay, I have to show myself as I know my stuff. I'm the expert I, this person should, should trust and believe me, but being just a good. On the same level of human being goes so much for me further. Um, especially when you have those difficult situations where it didn't go the way you wanted to.

And, and you can just be honest, like, man, I'm sorry that that's happened and definitely not something you had attended to. But [00:37:00] I, if you gimme a second here, let, I'm gonna get, get present with myself. And I'm like, let's think about what might be the next best first step for what do you think that might be.

And it's to me, for me to say that early, my, oh, I couldn't have done that. 'cause it was just like, well. I'm the one that's supposed to know what that should be. And it's just this hard tussle. But I think it, especially when you let that lived experience, 'cause it, like you said, it has a, a lot of wisdom in there and a lot of, if we just give it a stage to be listened to and, and validated, I think you can, you can go so much further with people, but I think that's a, it's a hard transition for clinicians to, to make, don't you think?

Bronnie Lennox Thompson: Yeah, it's, um, it's about leaning into this person's experience, their life. They bring huge amount of, of knowledge with them and, and if they, if we've suggested, say an exercise that didn't land very well, didn't work for them. They've learned something from that. They will already have their own ideas about what might [00:38:00] help, what might work better and what might not.

So let's draw on that because it's their life in the end, and they're going to leave us at some point, and we want them to learn the process of learning. Of figuring out. And what we are doing in clinic is we're helping them develop that skill of being able to learn for themselves, test things out, try them out, see how it works, review it, tweak it a bit, have another go.

Um, if we can remember that, that's part of our job in clinic. Um, it, it's to. Help people get to the point where they can do that for themselves, because we can't anticipate every single situation that that person's going to go into. We can't, we can't for the, even for the next 24 hours, let alone for the next five years or 10 years, that somebody who's got a back pain might.[00:39:00]

Have to live knowing that at some point their back pain could flare up. So if we can model, hey, it didn't work that well this time I wonder what might work better. Let, what do you think? Then we are giving them, um, a, like we're modeling the process that I hope people will take away with them and do again in their own life when they have a flare up in the future.

Isn't that, um, a bit of a treasure? Rather than having people feel like they're broken, we can help them figure out what might help.

Mark Kargela: And it makes for such more rewarding clinical encounters, in my opinion. It's just like where you truly are getting to know the person and problem solving with them and let. I think when given one, sometimes people are like, what are you handing these reins over to me for at first? 'cause they're not used to it.

Man, when you, when you give it to 'em, it can be so empowering. And then, you know, there's some people that have difficulties and there can be diff different reasons for that. But I, for the most part, I, [00:40:00] to me it's what invigorates my practice and what's kept me in practice for over 20 years to, to see people do that.

And it also gives you, you're always working with unique humans with unique experiences. So you're, it is, it's like a snowflake that's, there's not one, you know, everybody's different. So it gives. Your clinical life, so, so much more.

Bronnie Lennox Thompson: And it's not just this individual, but this person as they change and develop over the years. So we, I'm hoping that when we work with somebody who has pain, that we're not just thinking about, oh, at the end of this six weeks that they're with me, then they, they go off and life goes on. But that we realize that probably for most people, they'll have encounters with discomfort, pain, maybe in the same body part, maybe elsewhere in the future.

That could be two years from now, it might be five years from now. What they learn with us, they'll take with them and they may at that point [00:41:00] say, Hey, I think I'd like a bit of bit of a hand and come back to you. And that is amazing. Or as I've found, I've had some, um, emails from people who I saw, say five years ago who said, Hey, remember me, um, you know, I'm, I was this and now I'm doing this.

And you think, oh, good. I could never have anticipated that you could do that. And there you are. How, how limiting if we only think of. Our treatment and at the end of this program, you're gonna go away. Um, and everything's gonna be the same. Life's just not like that. And how much more rewarding to see that this person's gained the confidence, both in what their body can do, but also in their own problem solving, their own ability to find ways to manage stuff.

And one of those ways might be to come back and ask for some more support and what a privilege that is. [00:42:00] Somebody trusts you enough to come back after a break and say, let's, let's have another go. I need a wee bit of a booster.

Mark Kargela: Yeah. And just a testament to the work you can do with somebody when you see after that six weeks and you don't see 'em for three years, but you planted a seed of just self discovery to where they can experiment and guide and look where some people go. And just like you, you take the shackles off of this.

You know, rule driven healthcare system and you give them some structure and some guidance to start making their own way, knowing some concepts and ways to know their body and to know when things are moving in towards their values and when things are moving away from them, whereas how far people can go.

I think, um, sometimes I think we put artificial barriers on people when we have some of this very rule driven algorithmic healthcare, when it can be a lot more creative. Driven by a patient. And again, there's be many roads that get there and unique people are gonna probably take unique paths for sure.

Bronnie Lennox Thompson: Yeah, I, I like to think of things like now movement's really important for, for [00:43:00] wellbeing generally, and particularly for pain. It doesn't take away pain completely. Um. Doesn't do a lot of stuff, but the way that people can adapt and change and do different things as part of their movement practice over a course of a lifetime amazes me.

And the more we can help people discover that, Hey, you could have a go at this and maybe try that. And that is where life becomes life instead of a series of gym exercises, which to me is a means to an end, not necessarily an end in itself. About being confident to say, Hey, I might go do some, um, I don't know, high, high walking on the, in the treetops, you know, those wire rope things or

Mark Kargela: Zip lining.

Bronnie Lennox Thompson: Yeah, zip lining, or I'm gonna go paddling and uh, maybe I'll jump on a, on an e-bike.

And because life doesn't look the [00:44:00] same over your lifespan. And if somebody's got that. Um, confidence that they can play with some movement that's got to be really healthy for people anyway. And for people with pain who've lost a lot of confidence in their body, how empowering is that to know, oh, I can, I can experiment and I know how to figure it out if it doesn't go the way that I thought it would, or I can come back and ask this person who was willing to stand by me and let me go and have a go.

That that is true. Um, pain rehab to me. Pain coaching.

Mark Kargela: Yeah, let 'em scrape their knee and, and find ways around it and if

Bronnie Lennox Thompson: Yep.

Mark Kargela: problem solve and come together. Mm-hmm.

People come up with their own answers. Right? And I think that's, that's can be so huge and so empowering for people that then can take that, like you said, and start making a journey that on their terms and with some of the knowledge of how to [00:45:00] respond to their body and some of the difficult things that going on that they can still move in some pretty directions. I wanna bring it kind of full circle to, we've kind of spoke to this a bit, but I'm wondering like, what do you think are like key skills? For a clinician. 'cause I know as, as a physio, that we don't get taught, you know, some skills in school to be able to kind of take this. We're, we're very much the expert of, you know, positioning as, as a healthcare, uh, professional where this whole guide coaching role is, is kind of a transition.

I'm wondering like what skills you think are, like the key skills for someone to be able to really, you know, do this kind of coaching, guiding style of care, you know, well.

Bronnie Lennox Thompson: I think the first point is to know that you're not the expert in this, in this person's life. They are. That would be the first thing. So being a bit humble about how much we know about this person in comparison with what they know. I think in terms of, um, particular skills, [00:46:00] motivational interviewing would be one of the key, um, skills that I think can be learned to.

Help shift away from, I need to tell you what to do, to, I'm gonna help you figure out what your next best step might be. Um, and I say this because motivational interviewing is about what this person can choose to do. Knowing that we can tell somebody to do something, but unless it's something that they believe is important to them and they're confident that they can actually do it, they're probably not going to do it.

So it. Kind of is important not to waste our effort to try and bludgeon somebody into doing a thing just because we think it's a jolly good thing. And so I think motivational interviewing brings that stance into clinic in a set of, um, skills like open-ended [00:47:00] questions, like reflective listening, like rolling with resistance and realizing when we've gone too far, too fast, coming back and being able to regroup.

Helping people weigh up the good and the not so good about anything that they choose to do. So that the decision making isn't about us telling people, but helping people work out for themselves what they want to do. Um, I think that's been, was transformational for my own practice. And I'd been using cognitive behavioral therapy for quite some time.

But learning, motivational interviewing really, really changed my perspective. And then of, of course, I'm gonna say acceptance and commitment therapy. Um, because ACT is, um, it just builds into that flexibility. It, it gives people, starts people off on what they really want, what really matters in their life, and then figures out ways to help [00:48:00] 'em get there.

Our job is to know that there are some things that get in the way of making changes, of being able to respond to what life throws at at the person. Pain might be one of them, but often it's also that, um, doing responses that worked once, but keeping on doing them, even though they're not working this time, we can help with that.

So I think using learning those two sets of skills are probably uppermost in, in my mind. Um. Guiding people through setting goals, what matters to them. And I like to do that by, by asking them what, what matters to them in their life? Um, what do they, what do they enjoy doing? What brings meaning? What are the values that their, their life is, is built around the things that they want to be remembered for?

What kind of a person they want to be remembered for? And then what does that look like? So that then the, [00:49:00] what does it look like are the actions, things that, that people do. And then as clinicians, we can help people start to do those very things, um, through things like problem solving and, um, breaking the task down into smaller goals and, um, helping people become more confident in.

Because we start at a low level and we start to progress all the very basic kind of things that we probably learned in the rehab part of our, of our training where we learned about goal setting and we thought smart goals and, and then we promptly decided, well actually, I can help tell you the goals that you should set instead of asking the person what matters to you and how can we get there.

Mark Kargela: Yeah.

the, the combo of motivation reviewing, enact, I totally agree. It's been massively transformational for me 'cause it becomes much more of a. It equips you with the, excuse me, it equips you with the skills to be that [00:50:00] guide. 'cause that's motivation ing and, um, acceptance, commitment, have that kind of guided discovery, communicative kind of approach where it's more this kind of collaborative conversation, not this just one sided conversation, speaking downhill, that sometimes unfortunately healthcare, um, can be.

A skill that is definitely one that's been transforming. Like I said, for my practice, huge, massive, but also personally, right? It helps you learn skills that are just darn good human skills to have to, that you can start seeing. 'cause they're, we have difficult things, bro already alluded to it, that we deal with as some of the mental, the voices and the inner critic that beats us up as clinicians when.

Things don't go the way we planned and people flare up and all the things that happen. I think the more you realize that these are all voices we all deal with and you just have to have some skills and strategies to be able to navigate them and still move forward in a way that helps you help somebody.

'cause it's hard to help somebody when you're stuck in your own head. Um, playing tug of war with some difficult thoughts, which I definitely found [00:51:00] myself, um, doing that. I'm wondering with that all said Bronny, 'cause one of the biggest things I think has been helpful is having you around. Having you help guide me through some of my struggles and you know, coach and, and mentor me, where do you feel like, because I mean I'm biased here 'cause obviously we provided a little bit and there's many, many ways you can get coaching and guidance beyond just modern pain care, of course.

But where do you feel the role of like mentorship, supervision, lies in this? 'cause I, to me, I think it's the, it's the thing that allows you to be good at it. You can say it on a service level, but to like do it in practice and get feedback to me is like, what makes it something that you become skilled with.

Bronnie Lennox Thompson: Yeah. I think supervision or mentoring, I, I'm gonna talk briefly about supervision because as an occupational therapist, that is part of our practice. So we have supervision. Not to say, are you doing it right? But how can we help you develop? How can I be your, your partner in developing your [00:52:00] skills as a clinician and that in is, is invaluable.

And then mentoring is more, um, often around, uh, there's some specific things I'd like to help you develop. Here are the specific skills or strategies, what, having somebody else look at your practice with you, where you can bring a case and you can talk about it. What it does is it stops you just seeing what you can see.

Somebody else can see the same information, but see it differently, and that stops some of our, you know, we have normal human cognitive biases where we can't see anything other than what we've already fixed on. That's just being human. So bringing somebody else in who can say, oh. I wonder if you'd thought about it this way really helps.

It also helps when you have a really frustrating experience and you [00:53:00] just need to offload to somebody who's not gonna say, well, you did that wrong, but to somebody who's going to be a, a coach. Say, Hey, how did that happen? What went on? How are you feeling in yourself? What do you think you could do differently?

Supervision and mentoring is very much like being a coach. Um, and, but we are applying it to ourselves. It's, it means that we don't have to be. Perfect and expert in everything. And it's been some of the most wonderful experiences for me, mentoring, um, the people who've been part of our ACT program has been listening to how they've tried something out, oh, it worked really well, or, oh, it didn't work so well.

What could we do differently? And have people come in with, oh, look, this is the way I did it. Or, Hey, had you tried this? What, um, what an amazing way to extend and develop and [00:54:00] expand your repertoire, um, without feeling like you've done it wrong, being judged, and you know. Peer review feels a lot like, well, here's the standard.

Did you meet it? Whereas mentoring is saying, how can we help you grow? How can we develop you? Um, here's a, here's a situation. What else could we do? So much more enriching. I really love it.

Mark Kargela: No, it's been some of the most enjoyable, um, experiences so far for me doing, you know, continue education courses and different lecturing and things like that. But to me, the whole coaching and guiding things and just watching people interact and, and grow, like you said, and, and like have some, some epiphanies, have some struggles and seeing others who, who come in, that's where I think the community learning piece is so helpful when you have folks that are all.

In the struggle with each other. We're all in the struggle and different, you know, you know, experience with the struggle. It's a consistent, it's a human struggle that we're all [00:55:00] working with. And I think, um, just having a different set of eyes and ears that can kind of, because it's hard, like you said, we're, we're wired to see things the way we're wired to see them.

And it, to have a, a outside pair of eyes and ears that can kind of listen and, and look at what we're up to. It can, can be so transformative. So I would highly. Encourage you all to think about finding those type of situations that you might have clinicians local in your area. Obviously we'd love to have you.

We're, we're looking to move this type of care further and more mainstream. So if you, we'd love to have you join our programs if it works for you. But there's so many options probably locally for you. Um, you just gotta seek out people that are doing it. Look for the people that you know, who are being willing to say, I don't know, then are willing to get in the mud with patients.

And I used to. Unfortunately early in my ego driven PT career, you know, the people that said, I didn't know, I would've just thought, oh gosh. But they don't know what they're doing. They obviously don't have the expertise that I'm looking for. And now I look back, I'm like, those are the people I should have been grabbing onto right away early on.

'cause [00:56:00] they, that's shows such wisdom to me of being able to like navigate that and successfully with, with patients that are very appreciative of it as well. So, Bronny, I wanted to thank you a ton for your time. I know it's, we could probably talk for another two hours on this topic. I always leave fired up and ready to change the world.

So I wanna thank you for your time and thank you for all the great things you're doing.

Bronnie Lennox Thompson: It's a pleasure. Thank you so much. It's been wonderful to be part of this, um, this group and watch, watch these clinicians grow and change and gain in their confidence to the point where they're beginning to answer their own, you know, their peer questions and teaching others. It helps you learn. And I think that's how our community starts to really develop where we can show that we can learn from one another in this really organic way.

Um, it's just a, it's a wonderful privilege to be part of. Thank you.

Mark Kargela: Yeah, happy to be a part of it. I'm just happy to play a [00:57:00] small role in it and looking forward to seeing it grow and hopefully impact, if we have more clinicians like this around the world that are able to deliver this care, it's gonna be a, a, a better world for the folks in pain that are trying to navigate.

Had some struggles, so we're gonna leave it there this week. Thank you so much for listening to the podcast. If you're interested in, uh, jumping in any of our programs or getting in more information, jump in the show notes. We'll have links for all that. If you wanna check it out, make sure you subscribe to the podcast.

That will help us get more of this information out to clinicians who might be struggling with the, I don't know, in their practice. Uh, we'd love to see if shared if you think somebody could benefit from it. But we will leave it there this week. You all have a great week. We'll talk to you next week.