Why aren’t clinicians taught self-regulation?

My musings after noticing the rising tension in my body as the week progresses…..

A MASSIVE part of supporting individuals with pain and other discomforts (#pain #pelvicpain #urgency #prolapsesymptoms #diastasisrecti #painfulsex #pelvicgirdlepain #backpain #incontinence) is understanding that these are primarily nervous system events. Outputs/alarm bells influenced by a multitude of inputs from the bottom (our bodies), from the top (our brain – emotions/thoughts/beliefs/expectations) and from all around us (our environments).  The opportunity to effect change in the experience of these discomforts in different ways, with different tools is, in a word, AMAZEBALLS! #nervoussystemoutputs #notjustpain

What if we wrap our heads around the fact that our nervous systems are also designed to interact with, influence, and be influenced by the people around us? We are social beings hared wired for connection! We are bound to be influenced at a nervous system level by our clients and them, by us.

When folks seek our clinical “expertise” for their symptoms, their nervous systems are primed to be influenced not only by what we have to say (shaping how they feel about their symptoms, their beliefs about their symptoms, their beliefs about their capacity to recover and be an active participant in the process) but also by HOW we say it (influencing their state of arousal and receptiveness to the chosen treatment at a more primal level). Our own arousal levels will influence our choice of language, our tone of voice, our quality of touch, our capacity to truly be present and take in the stories that our clients need to tell us. This stuff really matters!

The development of skills to foster our own self-awareness and examine how we ask questions and deliver information is not typically taught to the health providers in these “expert” roles. In fact, these skills are often referred to as “soft skills” and dismissed as not as important as “hard facts” or “evidence-based tools”.

But what if we are too caught up in the specific tools and explaining to our clients why they hurt, why our tools are superior and how we can “fix” what ails them?

The tools do matter but supporting our clients with engaging their tools optimally, that is, in a way that promotes connection to their bodies, connection to what is meaningful to them, confidence in recovery, and self-efficacy in recovery is where I believe the magic happens. A lot of this comes from HOW the tools are packaged and delievered….the “soft” (let’s change that to essential?) skills.

Also, WHY are we so caught up in our specific tools and explaining to our clients why they hurt, why our tools are superior and how we can “fix” what ails them?

I recently listened to an interview in which a leader (a clinician) in this field acknowledged that there remains a ton of uncertainty when it comes to pelvic health and core rehabilitation. She was asked by another leader (a researcher), why aren’t clinicians being honest with their clients about this uncertainty? Her response was that despite not having the answers, “we can’t tell them, we don’t know”. We have to give them a reason or they’ll go elsewhere. Hmmmm….

Will they? Or is this an assumption that we hold as clinicians who have been nested in an educational and health care system that is largely intolerant of uncertainty?

I have found that when people have been struggling for a long time with their symptoms and have experimented with clinicians who claim to have THE answer but that answer addresses one piece of the puzzle, symptoms may linger AND the individual may begin to internalize their lack of progress as something inherently wrong with them. “The expert told me this would resolve things, things aren’t resolved, therefore there must be something wrong with me.” I often find that after such a journey, when an individual connects with a clinician who is honest about the layers of uncertainty that remain in this domain and the multifaceted nature of health, there is a sense of relief. There is often liberation involved in taking on an attitude of curiosity vs. control. A process of guided self-discovery is often refreshing.

Also, when we, the clinicians, have biases towards creating rules around movement and behavior in order to limit or prevent uncertainty about the impact they may have, these biases can be expressed explicitly in explanations and prescriptions as well as in body language that conveys fear/discomfort. Our clients’ brains take on those rules and their bodies take on that learned fear, discomfort, and rigidity in movement and behavior. Perhaps, not the intention of the clinician but, given the social nature of our nervous systems, an inevitable outcome when these biases and their impact go unacknowledged.

This leaves me wondering…how would our health systems change if health providers were taught how to…

1. notice our own biases/beliefs/rules along with learning how to tune into our clients’ and reflecting on how these factors may influence our clinical decision making and their recovery?
   Can we eliminate our biases? No. We all come with experiences that are going to shape our lens. But being more aware of and acknowledging our beliefs as such can help us to invite some curiosity into practice, thereby promoting more flexibility in our approach and intention in our language.
2. notice and regulate what’s going on in on in our own nervous systems in the treatment room and beyond to help us stay present with our clients and be intentional in our care but also to disconnect afterwards, reset and address our own needs as our nervous systems are hard wired to inevitably take on some degree of the pain and distress that shows up with our clients?

Lara Desrosiers OT Reg. (Ont.)