Beyond Traditional Healthcare: Insights from Pain Coach Richmond Stace

[00:01:34] Mark Kargela: Welcome to the podcast, Richmond.

[00:01:35] Richmond Stace: Hi Mark, great to be here.

[00:01:37] Mark Kargela: Awesome to have you out. We were talking before we went on. I it's, it's surprised to me that it's taken this long to get you on the podcast. Cause you're one of those people out there in the social media world, especially on X, Twitter, whatever we're calling it this day that I've, I've found myself following and really, you know, enjoying your, your perspective on things and we'll.

We'll definitely talk about it, uh, as we kind of move on, I want to get right into your journey because it's, it's interesting one, selfishly, as I spoke before this podcast, I'm interested in kind of moving into a similar space just because, you know, I think there's some barriers and maybe we'll talk about them.

What's, what's gotten you in your journey to get to the point where you're into this pain coaching space to where you're at right now?

[00:02:11] Richmond Stace: I could give you the sort of the short version or the or the long version Um, or maybe somewhere somewhere in between. I mean I I started Many years ago in health care as a as a nurse as an adult nurse um, and uh, then I was thinking well this this isn't for me, but it was an amazing amazing training But it was actually back then that I got interested in [00:02:34] pain My final project was, was all about that.

It was about why, why is it that people go into these, these same operations? I can't remember exactly what the operation was, but the same operations and they come out with all these different experiences. Um, you know, I was, uh, well, I started when I was about 18, 20. Yeah, I, you know, I didn't really know anything about anything.

Um, so it was an incredible piece of time and exposure to, to people and their lives and their, their suffering. And, and a lot of the work was with people with sort of chronic, chronic problems, not necessarily pain, but chronic problems. And I got amazing training. I had some amazing tutors that, that really introduced me to this sort of whole person approach way, way back then.

So this is like, uh, gosh, sort of early nineties, I suppose. Um, and I, but I knew I didn't want to be a nurse forever. There were other, other things. So I've ended up with sort of multidisciplinary background of, of [00:03:34] that and, and rehabilitation and sort of sports science and physiotherapy and pain neuroscience and coaching stuff and, uh, psychological stuff.

I mean, it's a real bag of things. Um, and, um, and, and that sort of led me probably, I'm not great on timelines, it was probably 15, maybe slightly longer years ago that I thought, well, do you know what this kind of coaching, coaching seems like a good way to go about things here. Um, and actually I got that idea because I, I coach cricket for many years. And I was, and I loved, um, working with the kids who, let's say, weren't as technically gifted, that sort of thing. I, I really enjoyed that. And, and what I found was that if you connected with them and gave them really simple instructions, and then you just repeated, Um, amazing things seem to happen. You know, they'd hit the ball or catch it.

I mean, there's nothing revolutionary about that, but, but the key was always the connection and that always stuck with me and that was really why coaching and particularly [00:04:34] the style that I then ended up, um, getting involved with via Mike Pegg, so strengths based coaching. So seeing someone's capabilities and where they are and seeing the person, um, seeing them as autonomous, you know, they'll make their own decisions and we're there to guide and support.

You know, that just all made sense to me. So sort of as I was going on the journey, these are always been strong themes. And then with the motivational interviewing side of things, which, which I've I started dabbling with many years ago, but I suppose in more recent years, I've really, really got into and doing some quite interesting stuff on that at the moment. Yeah, it just sort of led down this path of saying, well, what should we call it? Pain, pain coaching? Seems like a good idea. Yeah. I sort of stuck with it. I mean, there's upsides and downsides of calling it pain coaching, but yeah, that's, I guess that's the, the middle road story.

[00:05:25] Mark Kargela: Yeah, I'm wondering what you found as you're kind of journeying through health care when you kind of get stuck in like the nurse box or the physio box. [00:05:34] Um, we've kind of seen as pain, our understandings of pain have kind of evolved over time. I know definitely coming out of university, I came out early 2000s.

Um, and we kind of had our physio box that we were kind of in and it wasn't looked upon to where, you know, this whole person care. I mean, we had some things, psychology, psychology of disabilities, I think it was called. And when I went through school to kind of understand that piece, but really as a, as a physio, you were kind of going to focus on, you know, movement and you're going to focus on, you know, biomechanics, kinesiology, again, things that still have some value, but kind of greatly underestimate things.

Did you find yourself at all kind of boxed in with kind of, if you just really stuck in that kind of, mode of operation is that what spurred you, you think to kind of move into more kind of broad coaching, uh, aspects of your kind of practice.

[00:06:21] Richmond Stace: I often sort of said that it was kind of luck. I mean, I got obsessed with learning at school. I wasn't that interested in stuff, uh, much more interested in sport and, and, you know, probably having a good time. [00:06:34] Um, it was only after leaving school that I sort of found a passion and that was during the nursing, you know, I was, I was interested by all these different things.

So actually during the nurse training, I'd go and spend time with, with all sorts of, uh, people and departments. Um, I just tried to see as much as I could and spend as much time with different people as possible. And I also spent a lot of time, uh, working, supporting myself, but I worked as a, it was called nursing auxiliary then, um, which is basically the nursing assistants on the ward.

And I, I used to do quite a few shifts. So I had a lot of hours, I clocked up a lot of hours. Um, doing all these different things. Um, and so I guess that was my framework, really. That was, that was the soil from where I grew just thinking, well, it's quite normal to get this really wide background. So actually, as I went through other trainings, um, and people had sort of just done one thing, I don't want to be disrespectful to that at all.

You know, that's, that's fine. But I, I sort of was like, Oh, [00:07:34] well, how, how can we be really helpful if we've only kind of got one type of. and, and now, you know, when I think about pain coaching and what it is, and I see that, you know, when I first used to Google it years ago, you didn't really see much.

There wasn't much written about it. Now, you know, more and more people are calling themselves pain coaches. Various companies are offering pain coach training. And I look at it and I don't really know what they're doing. I'm not sure what philosophy they're working to, I want to set the standards really, really high because these people's lives, you know, they're suffering, they're vulnerable.

Um, but you know, and they, they often need help and guidance. And we need really, really high standards to, to work to, to help. It doesn't mean that if you don't have a multidisciplinary background, you can't work. I mean, that would be ridiculous. So, you know, we've got to set the standards really high because, you know, these are people's lives and we're here to help them in the best way we can.

And with pain and being human so complex and, you know, such a complex dynamic. I just feel that the pain [00:08:34] coach needs to be multidisciplinary, which doesn't mean that if you're not multidisciplinary that you can't help. You can't be helpful. It doesn't mean that at all. But that's not pain coaching in my view.

Now, it hasn't been standardized yet. There's no, you know, official qualification or anything like that. You know, maybe that's a dream and aspiration, a huge amount of work. But maybe that will be worth it.

[00:08:55] Mark Kargela: With you saying that, I'm just curious. I have visions of what I would see, like the ideal pain coach, the skill set that a pain coach, and I know you mentor and coach, uh, you know, clinicians who are trying to move in this space a bit. What do you feel like is that kind of, skill set, like if you were to, I mean, obviously there's a, probably a myriad of things, but what are the main kind of skill sets that you think someone who's going to kind of enter into this pains coaching type mode of operation, what do they need to have?

[00:09:23] Richmond Stace: Yeah, well, where I'm at at the moment is, is that multidisciplinary bit that I was, I was just talking about. Um, I, I think you need a really good understanding of where we are [00:09:34] with pain, uh, the science of pain, the philosophy of pain. I think that's, that's very important. Um, but you need the skills to connect.

Um, you need the skills to have caring conversations. You need the skills of accurate empathy and genuineness and acceptance and authenticity. So, you know, it's really about your way of being. And now I talk about pain coaching more as a, as a way of being with people, because when you're connected with them, that's, that's part of the therapy, if you want to call it that.

And it's interesting because we know that, um, You know, that matters more than any particular technique or therapy. So I must admit, I try not to get frustrated, but I do get frustrated. I suppose, cause I, I do care about this immensely. Um, you know, when you see, Oh, this therapy for pain will use ACT or CBT or whatever for pain.

And to me, that's imposing a protocol or a framework on someone rather than finding out about them [00:10:34] first. clarifying what their needs are and then starting together on this journey, finding and following a path together where we're a guide, uh, we're an encourager and we're there to, to help in, in any way that we can for this person to grow.

And I very much see overcoming pain as, as human growth. And I'll always use the word meaningful change as well, but there's, there's sort of a subtext with change that which I think sometimes it might be seen as, well, if I need to change, I'm not good enough or something like that. And I think growth because we can all grow.

And we, by creating the right conditions, and that's our work with that person in collaboration, we're, we're creating the conditions for them to grow, i. e. their life to get better. Now, that can be from whatever standpoint or start point. So, for example, you know, some people might come back at that and say, well, You know, what about if it's some condition that isn't going to get better?

And of course, there are many conditions like that where pain is a feature. And my answer to that [00:11:34] is that if we can keep the measures of success, the measures of making your life better broad, rather than it's just about pain getting better or pain going away, well, then you're going to find many ways to get better.

That your life is improving, and that's got to be a plus that that's us trying to make things better or getting better or overcoming pain is another way that, you know, it's another term that I use when people say, what do you mean? And that needs to be clarified with, with the individual, because it doesn't necessarily mean no pain, but it means that it's not the predominant thing now.

You know, I live a meaningful life and there is pain at times, but I know how to deal with it so I can focus more on what I want rather than what I don't want.

[00:12:12] Mark Kargela: So you mentioned that, you know, it's hard to impose a framework on a patient before you kind of step back, get to know the patient, find out where they're at and what they need. Yet it sounds like you have some, you know, that what you just said sounds, you know, pretty familiar with act, like being able to like focus on valued living versus.

A pain contingent lifestyle where, you know, life doesn't, you know, return [00:12:34] till pain goes to zero. I'm wondering what have been the more influential things. It sounds like you're more eclectically pulling from different, you know, modes of operation, be it, uh, CBT act or, or maybe other type of, you know, pain neuroscience education, be it what it must.

Um, I'm wondering, is that kind of your thought process where like, Hey, I'm not going to immediately. You know, pigeonhole somebody into a specific mode operation until I get to know the unique person in front of me and exactly kind of what their needs are and where they're at. Uh,

[00:13:01] Richmond Stace: Yeah, I need that clarification. I need to know them. I need to understand their beliefs. I need to understand what's, what's driving them, what works, what doesn't work, you know, what's going on in their life, what's going on in their inner world. And, um, and they'll reveal that if, if they feel safe to do so.

And that's the caring, that's the caring conversation. But yeah, you know, people quite often say, well, what, what techniques do you use? And I'll say, well, I don't know. Right. I don't really think about it. And actually, when I write about this, sometimes I sort of say, look, you've got to learn your techniques.

[00:13:34] You're going to learn stuff. You need your knowledge. You need your skills and all of that. Of course you do. You're crazy to say otherwise. Um, but then forget them and be you. And that comes with experience, obviously. Um, because you've got to get out of your own way to be present. You know, you, you can't be in the room per se.

It's that state of flow or state of presence where you're there. You're truly there. Um, and able to hear that person. And, and from that, just spring the, the ways forward, the, the suggestions. And it is, it is a suggestion because they will ultimately decide. I can't tell people what to do. I mean, sometimes people say, oh, I tell me what to do.

Well, you know, and I'll just do it. You know, that's an invitation, isn't it? Sometimes that happens, but, but usually it's a little, you know, it's a little tap on the door. Hey, um, I've got some suggestions based on what you've told me, you know, would you like to hear? And they'll answer. Yes, please. Usually not.

Um, and then you, you can offer. So you're [00:14:34] going through this kind of process again of connecting and showing this respect for the person that they're going to decide what to do because they will in their world. When you think about adherence, all the stuff about, you know, do your patients adhere to their exercise programs and this kind of stuff?

Well, that depends on the connection you have.

[00:14:50] Mark Kargela: yeah, there's no doubt about it. I'm wondering, as you mentioned, you know, just to kind of get in these techniques and then kind of, you know, putting them aside and being present like in the room and maybe being able to pull from these things, but more importantly, being present and being purposely curious with the patient and, you know, all these things that are important where it was a challenge for me to be there, right?

I think sometimes you feel like you need to have this skillset to be worthy and there's this whole issues with imposter syndrome as a clinician yet you I've really found the pressure to come off a bit from being some sort and obviously we know Technical, you know, we're not humans aren't machines. We know all that good stuff but I'm wondering where you see the barriers in clinicians to kind [00:15:34] of take that approach of Maybe some of it is this whole imposter syndrome and feeling like you need to have Uh, display this expertise and, and will and worthiness in this encounter.

But I'm wondering what you've found when you've worked with clinicians or kind of seen from your perspective, the barriers that clinicians face to kind of take this kind of approach with people.

[00:15:52] Richmond Stace: I think the first thing to say is, is I've been there. You know, I've, the, the ego, the, so I, you know, I'm the expert here. I'm going to tell you what to do. You know, I've, I've, I've done that. I've been there and that, and that's really why I'm now not there because I realized that it didn't, it doesn't work or, or, or not often.

I mean, does it, I don't know, it's difficult to say, but, but essentially. You know, this, this kind of idea of fixing people and, and telling them what to do in, in the type of people that we're talking about here with, with chronic pain and more complex, uh, conditions. It, it just needs to be a collaboration.

Um, So the barriers are going to be your own beliefs as a clinician [00:16:34] about what you're doing and how you're doing it. Now, this is not a blame thing, and I don't want to sound blamey at all, because I don't mean it that way. You know, everyone's received their training, and they've had their various experiences, and they're going to be influenced by that.

They're going to be shaped by it. And, um, you know, most people listening here will be listening because they want to learn stuff and they, they want to grow, you know, there's a, there's a desire to grow, but then you meet your own resistance, don't you? You kind of go, Oh, well, I'm sure about that. And that's really interesting.

But are you able to flexibly look at that and examine your own experiences and say, Hmm. All right. That could be holding me up. Um, I mean, this is actually no different to the person suffering pain. You know, what are their beliefs? What's, what's the resistance there? And so working with our own resistance is a real, is a real skill.

I think there's a real lack of, of mentoring. Um, and, um, and supervision in, in physiotherapy, you think about psychology, um, again, you know, I've, you [00:17:34] know, I'm not a fan of the silos of this is psychology is because I think there's big overlaps in, in what we do, but, but they have, you know, supervision and counseling and have supervision, but we, we don't. We don't and I've always puzzled over that because I really valued the people that I've worked with and the mentors, but I've gone and found them myself and been incredibly lucky with those, those guys. So particularly Mick Thacker and Mike Pegg and there are others as well. So that self awareness, You know, these things could be built into our training or, you know, the, the, the guys coming through now build it into the training where you have that self awareness and that, that reflection and, and able to take that forward.

And I think that there's, there's still in, in healthcare, you know, lots of. You sort of see mistakes and when things don't go right and failures as being a bad thing, as opposed to learning. I mean, you know, there are consequences of that, of course, I'm not demeaning it, but, you know, that's learning. That's learning.

So we need more openness, more discussion. We need [00:18:34] to be aware of unintended harm. The words that we use, um, and, and what we do and our actions and our, our behaviors, you know, we mean well, most people mean well, I, you know, I truly believe that. But, um, unintended harm is a, is a biggie, particularly with pain, the types of things that are said.

So these are all the, these are all the kinds of barriers that I, that I see, but they're not ones that can't be, um, overcome. I think we can, we can sort these out for sure.

[00:19:02] Mark Kargela: Yeah, no, I would agree. I think, you know, some of these barriers, um, are definitely ones that, and I know you're working with a lot of people to, to help, help them navigate that. I'm wondering if we could kind of get into a little bit of what drove you to kind of write your book. Cause I, I definitely think that's a value for some folks and we'll, we'll, we'll talk about it and maybe you can kind of give folks an idea of kind of where to, where they can get it.

Okay. But. Uh, it, it seems like there's just a lack of guidance for folks to kind of help take [00:19:34] this type of approach. You mentioned like some of the siloing in, in healthcare and I still see it in healthcare education. I'm in, you know, university, I'm more of a clinical professor, so I'm seeing patients and helping mentoring students in clinic yet we see how academic, you know, education is still pretty siloed.

And even though we have big multidisciplinary pushes in our university and things, there's still kind of this. You know, kind of categorizing of what we do and, and it to me limits a little bit of how we're going to be effective with people, but getting back to your book, how, what kind of drove you to write that and what, what was your purpose in, in putting that together?

[00:20:08] Richmond Stace: Well, there's only one of me, um, and, you know, reaching out to people. Uh, and I'm looking at all sorts of ways of, of doing that. Um, and the book was one I love writing. I, you know, I love sort of sharing these messages and, um, uh, in, in the written form and I write every day anyway. So it was just a, Something that I've wanted to do for a long time and, and just felt that was the right time.

You know, I felt I [00:20:34] had something to say at that point that could be useful for people. And, and it's just the beginning of, you know, sort of lining up other, other titles and other ways of, of sharing this, this information, uh, for people because everybody learns in different ways. You know, reading a book is not going to be necessarily for everyone.

Um, and I've, I've sort of been thinking quite a lot recently about how people can best use the book as well. Um, you know, it doesn't need to be read from, from start to finish, you know, some people prefer to, to dip into the practices first and try a few things and then go back to the sections to, to really understand their pain.

Although I do believe that understanding your pain is a really important part of getting better because then things start making sense. It puts meaning to one's experience. Um, and, um, You know, the understanding of pain now is very different to well, what we know about pain is very different to what's largely spoken about still in society and healthcare, you know, it's still way, way, way behind where we are.

And, and if there's ways of reaching out to as many people as possible, then, [00:21:34] then that's great.

[00:21:34] Mark Kargela: Yeah, a book definitely has the opportunity and, and you're right. I think there's just definitely a lot of ways. Some people are audio book and then, you know, the written word and then videos. It's, we live in a society definitely where, you know, There's opportunities in different modes of communication that we can kind of leverage, especially in the digital age.

You mentioned our understanding of pain, you know, really far ahead of what's still being communicated out there in clinical practice and in society and culture in general. Um, with that whole pain neuroscience education, um, part of this, you know, that that's been an intervention that's kind of blossomed as part of this, our better understanding of it.

I've spoke about it on this podcast a few times as far as my, my bumps and bruises with pain neuroscience education. I don't know. I'm curious if you've had some of these same things where you kind of get this new information and feeling like, Oh man, I have the tools to, to educate people in this, you know, just the explanation their pain was going to make this massive shift.

Now, occasionally you'd get some patients with [00:22:34] some major ahas. I'm not saying there wasn't some benefit of it, but it was a, I guess, a non nuanced, like I was just coming with the pain neuroscience education. If you had a pulse and some pain, that was usually going to be. You know, my deciders that if I was going to give it to you, use that intervention.

How has your view on pain neuroscience changed from maybe it's kind of early days of where it was kind of, I know, and maybe it wasn't as popular in your practice. It became a very biased intervention for me. And then how have you seen that kind of evolve maybe in your practice and in the profession of pain, you know, treatment as a whole?

Yeah,

[00:23:08] Richmond Stace: I mean, I got excited about it when, um, I think it was, yeah, it would have been Mick who, who first talked about it at a lecture. He was talking, um, that would be, oh, I mean, that's still in the 90s, I suppose. And yeah, I did. I got really excited because actually what, what the science showed, um, sort of quite basic now compared to where we are, but, but nonetheless showed that the kind of the whole person thing again.

And it sort of brought me back, [00:23:34] back round, because I went through sort of, you know, the working in the sports field and all that sort of stuff, which was again very biomedical, um, and still is. And that's probably another conversation. But, um, yeah, so I, you know, went through that and excited and explaining to people and this stuff.

And then I sort of thought, well, hold on a minute, you know, do people really want to know the detail of what all these different receptors and things are doing? You know, what difference does that make? If you're in agony, you know, some really horrible pain thing going on, CRPS or something else, you know, you're not going to be thinking, well, hold on a minute, what receptors, uh, is going to be doing what, you know, it's not.

So it just put it into perspective. It's got to be useful. It's got to be useful and it's gotta be at the level that that is meeting the needs of this person. And some people do want to know, and, and sometimes I have amazing conversations with, with, uh, with people, you know, about the philosophy of pain or, or the, the science of pain as, I mean, I don't necessarily separate the two.

Um, and, [00:24:34] um, you are like, wow, this is, this is great and really interesting. Then other people, you know, they just need some basics of understanding, you know, how things are going and, and why they are where they are. And then road mapping where, you know, they could be going, but knowing that you're here, that's always key.

Be here now. And, and so it's, again, it's tailoring it, but meeting the, the person's needs. I know there's a lot of excitement and, and people are sort of studying p, p, and E. We love three letter phrases, don't we? It's always three. Oh, no, so mi's for two, I suppose, but there's a lot of threes. And, uh, and that's fine, you know, but again, we've got to see the limitations, um, and, uh, and to say, just make sure it's useful for, for, for the person, it's got to have some meaning.

How's this helping?

[00:25:19] Mark Kargela: it's, you know, I think it obviously we get excited interventions that we think might help, you know, a person and there was a lot of promise with that. And then we had studies come out. And I think most of us have that have really invested a lot of time kind of trying to apply to kind of have [00:25:34] recognized that.

It's limitations, especially when, you know, we kind of force feed it and we get blank stares coming back at us and, you know, it just becomes this, this, uh, again, intervention that is non nuanced. It's just kind of pushed, pushed versus invited in and, you know, maybe some curiosity from the patient or, or, you know, other people.

Asking permission or offering the information, like you said, and seeing if it's something that fits the situation at hand. Cause there are times where, you know, understanding, you know, sensitivity versus damage or different narratives can some really makes some people maybe less fearful, you know, kind of more able to go, you know, engage in exposure based treatments and different things like that.

Um, so it can definitely have its place. I'm wondering being a physio myself, I'm wondering where you think our education. of, of physios, you know, if you could change one thing, I mean, I'm, I've probably changed more than one, of course, but if there was one thing that, and it, maybe it's not just physio, maybe it's healthcare, professional education for folks that are, are, are treating with pain, but what, what would be one thing [00:26:34] that you'd really get after to, to better help clinicians entering the professions where we're going to be working with people with some complex pain issues to be better able to, to manage that.

[00:26:43] Richmond Stace: Yeah. Yeah. I mean, it's, it's difficult to narrow it down to one, um, but, uh, but I do want to say that. You know, I say, I do believe that, you know, people are doing their best. They, they really want to help, um, and that includes the people that are designing the courses to, to educate all healthcare professionals, you know, um, but that examination of how and what you're doing.

I mean, again, going back to the nursing, you know, we looked at all sorts of models of nursing and I really analyze them. I remember all that. Lots of self scrutiny and realizing where the limitations were and being really comfortable with that to say, yeah, this is great. And, you know, maybe this needs updating and that sort of thing.

So, you know, that would definitely be part of it. And I guess you could put that under an umbrella of, um, Starting with, with me, you know, where, where am I on this, that, that self awareness and [00:27:34] developing that ability to update my beliefs, bringing that flexibility. I mean, we know for example, that to be well, you know, one of the things that we need to be able to do is to update our beliefs.

Uh, I often use the analogy of it's, it's, it's like having a, You know, having Google Maps versus going down to your local library and getting a map from a hundred years ago. You know, we need these regular updates of what's going on because things are changing all the time. And as a matter of experience, we only ever experience the map, not the territory.

So we've got to keep updating our maps. And it's really that. And so it is, as you said, it's really exciting when some, some sort of seeming new stuff comes that we can do. But I think we need to move away from the, I'm doing it to someone, for sure, as opposed to we do it together. Um, but again, that's, that's that whole self awareness piece.

And, uh, so I think that, that would be the one thing, if there was one thing, it would be that, that cultivating that beginner's mind, that might be a way to put it. The Zen notion, the beginner's mind, [00:28:34] um, in the mind of the expert, there are few possibilities. In the beginning with the beginner's mind, there are many, you know, that that sort of thing.

I haven't got quite quite right, but um, It's uh, it's it's that

[00:28:43] Mark Kargela: Yeah, no good points. Um, I'm wondering if you could take us a little bit through your process with a patient. You've already alluded to it a bit and spoke to kind of how you kind of interact with a patient. But I'm just wondering if you could kind of Speak to kind of how, you know, obviously there's no one size fits all approach.

I think if there's anything we've learned with the complexity of humans, that there, what, there is no one size fits all for that, but I'm just wondering how you, what is your process then with that in mind to kind of really meet that person where they're at and start offering some things that hopefully moves them in a positive direction.

[00:29:17] Richmond Stace: you probably have to ask them

[00:29:18] Mark Kargela: Very

[00:29:19] Richmond Stace: um I I'd like to just bring myself to the room. Um, and yeah, I just try and be largely who I am. And, you know, I like a bit of a joke. I'm very, I'm pretty relaxed, I think. But in my mind, it's, [00:29:34] although I'm not thinking this when I'm not thinking as they come in, right, I want to connect with them.

I just want to connect with them. I, you know, they come in, with all their ideas and experiences and thoughts and beliefs and expectations, this whole bag of stuff. And I want to make them feel really comfortable. I want them to have value in, you know, this is their time. And that's just a real honor that they've come to, to see me.

And I, I feel humbled. You, I mean, you mentioned imposter syndrome. I mean, I get that. You know, I sometimes think, gosh, come see me. Why have you come see me? Um, and you know, that, that sort of keeps your feet on the ground, but essentially I want to be there in the room with that person and to, to hear what they're saying and I want to be able to validate it, I want them to feel heard and cared for and that every moment that they're in there, that they're useful.

I want to be someone that they want to talk to. Someone that they think, yeah, I want to go and spend time with him because I think I can learn and Make my life better. So if they're if they're [00:30:34] thinking that then that's that's great and the practicality I mean There's zillions of skills and strategies and tools and all that stuff It's loads of things funny enough Most of it not pain related because we're angling towards what they want rather than what they don't want In other words, they want to be fitter, stronger, more mobile, play with the kids, go back to work, you know, whatever it is.

So actually a lot of the strategies are, are really, well actually probably 99. 9 percent of them, not pain related and all not pain specific. I mean, even the things that you can do to ease your own suffering are not necessarily specific to that form of suffering. Um, and people are sometimes surprised by that, because we know that, you know, essentially, I mean, it's anecdotal, I suppose, but, you know, this is my observation.

The more you focus on, on the pain, I mean, it's like saying, don't think of elephants as a start point. The more you focus on the pain and sort of reduce it to the bit that hurts the worse the outcome. The more you focus on the person and what they want to achieve in their life and the practical steps to take.

from being here right now, the better the [00:31:34] outcome. And they feel better because they're essentially living to get better. They're living themselves better because that's the bulk of what this is their life. How do I do it? So don't wait for some thing to happen to you to get better. Start right now. Let's do it together.

Let's go.

[00:31:49] Mark Kargela: Yeah, we, we live in such a healthcare culture where, you know, oftentimes people are put in this position where life can't resume until this thing is fixed or taken away. I'm wondering how you address that and how you, cause I'm a hundred percent on board where it's the getting back to living that's going to, you know, sometimes it's a living, a valued life with pain.

And sometimes there's possibilities where it. Where that pain completely resolves and, and I'm wondering how you deal with and manage some of the struggling narratives that come in where, you know, people have pretty much been say life's on hold until we get this pain zero. And there's just a lot of interventional bodies and machine type interventions that are going on in people's lives.

[00:32:34] Um, what's been your approach? Maybe sometimes patients are coming to you where they've exhausted all that, but is that something that, uh, you're able to kind of steer people away from or how do you, how do you deal with that kind of narrative that, that comes in your door?

[00:32:47] Richmond Stace: They steer themselves, um, you know, within the conversations that we have. And this is the beauty of motivation interviewing is that, you know, you become curious about it. You know, I'm not there to judge or tell people, Oh, you know, you shouldn't do this, you shouldn't do that. You know, if they say, Oh, I'm going to have this intervention or that medication.

Which to me, in my mind, actually drugs and intervention, you know, medical stuff is optional. It's not a popular view with some people, but they're always optional. You don't, you don't have to have those to get better, to make life better. Um, but I'm not there to judge. I'm there just to, to sit and listen and be curious.

And to make suggestions at the right time, which to some can sound like really passive. What do you mean? You just kind of sit there, you know, you don't have to do anything. Um, but the magic really comes when someone has a [00:33:34] realization, when they, they, when the insight comes like, ah, right. Yeah. And they start vocalizing it themselves.

There's, there's often ambivalence. And certainly resistance. You know, that's what you are asking about this kind of resistance that comes up. But surely I need, you know, this thing to, to fix me. Um, and then you can talk about their own experience or ask 'em about their experiences so far and, and what's worked and, and what hasn't.

And usually fine that these things haven't worked 'cause they wouldn't be there otherwise. Um, ask ' em about their own ideas about, well, what, what do you think is gonna help? Why, why do you think that's gonna help? Because that reveals the kind of, the model, the beliefs they're running with. And if they're still into that way of thinking, then, then they're probably, they've probably got some deeper beliefs that, uh, would fit more with the biomedical approach.

Um, so you, you know, that again, if you meet resistance and push it, it'll, it'll push back even more. So, and that's just human nature. They're not doing it on purpose. Yeah, the whole idea of a difficult patient, they're not doing what they're told. I mean, I hear this quite a lot from [00:34:34] patients when they go into, you know, situations.

There was one fairly recently, a patient was telling me that they went to a pain clinic and essentially was told, well, medication is what you must do. And they said, yeah, but I've tried the medication and actually I've reduced it and my life's a lot better and I'm much more active. So I see taking medication as a step back because I've already been down that path and come through it and now I'm much more active and I have a better life already. And they essentially said that they were being non compliant. Uh, you sort of think, well, okay, that's a, an interesting sort of perspective. Um, that they're being non compliant when they're essentially saying to you, my story is I was on medication, it helped a little bit, but I've now reduced. And life is better because I've learned stuff, and I'm using skills and strategies, and I'm building, and I'm on that path.

And then to react that way. I just find that a baffling way of going about it, because that's clearly not helping. I mean, that's unintended harm. I mean, fortunately, this patient had the insight to realize what was going on. But that's, that's, you know, that's [00:35:34] not an uncommon scenario. Or told that you must have this surgery or intervention and da da da.

[00:35:39] Mark Kargela: Yeah,

[00:35:39] Richmond Stace: It's uh, it's tricky.

[00:35:41] Mark Kargela: it is. I think there's just, yeah, some, some puzzling reactions that healthcare has had. And, and, you know, I won't declare myself perfectly innocent early in my career when, you know, My understandings of what was going on and why aren't they doing what I'm telling them to do. They're difficult, they're non compliant where I was just not even meeting them anywhere near where they're at.

I was trying to pull them where I was and that they weren't ready to make that journey. And now obviously it's a more, more nuanced approach. With that said, I'm wondering, you know, if you can put yourself back in it, you know, fresh out of university physio and that discomfort of how do I transition to where I'm a little bit more in the, with the ability to meet somebody where they're at.

Because I think A lot of us come out where, you know, we're, we're, we're at, we're uncomfortable. We don't have a lot of confidence where we're trying to get, you know, our footings in our profession and feel like we belong. And, you know, there's probably even a more massive dose of imposter syndrome when you're at that stage of your career, what would be your [00:36:34] advice to, to somebody who's in that stage where they're trying to kind of get their bearings in the profession and feel like they're making a difference with some of these challenging situations with the complexity of pain.

Yeah,

[00:36:46] Richmond Stace: it's trying to get a good mentor, um, and to have people that you can talk to. And again, going back to, you know, what you, what you were saying a minute ago, you know, I've been there as well, you know, the, why are they not doing what they're telling me? You know, it's sort of going through that to realize that it doesn't work.

And then, and then here we are, and you've used the word nuance a few times, and I'm totally with you on that. There is. You know, this ability to, to develop that nuance way. And, and I have, you know, when you think about the way rehabilitation is done, it usually lacks that, that nuance, it lacks that personalization.

So, you know, this is, this is the system, you know, these, these people are coming out of their training and then they go and you don't have huge amounts of confidence with what you're doing and actually you shouldn't because. you know, the confidence comes with, with having these experiences, but they [00:37:34] just need to be supported in, in the right way.

And I think there's a lot of basic things that, that could be, uh, fed into training and, and post grad, you know, early years training as well. Um, you know, like, uh, what do you call it? Provisional sort of time. You have, you know, you, you qualify and then you maybe have, you know, I guess it's called junior physio here.

Uh, but you, you know, you have this provisional time perhaps where, you know, you are then developing the nuance because you've got all these models and ideas and excitement. And let's face it, you know, that's amazing time, you know, these, these, you know, um, undergrads who are, who are out there on placement and then they, they post grads, this enthusiasm, this energy, they love it.

We've got to tap into that because they're the future. They're the future. And, um, you know, we've got some amazing people. They'll be brilliant. They can be absolutely brilliant. But they, but they need the support to be able to develop in the right kind of way. We've got to create those, those conditions.

Um, and I'd love to sort of have [00:38:34] more sort of conversations with people about it. But, you know, it's, it's not always easy to, to have those. Not everyone's sort of open, everyone's open to it. Um. Which is sort of the nature of the problem really, isn't it?

[00:38:44] Mark Kargela: it's kind of that, uh, unconscious, unconscious incompetence that we all carry as we're, as we're, uh, you know, navigating our journey towards expertise, um, throughout time. And it's, we don't know what we don't know. And it takes a while. Maybe it takes a few lumps in, in the, in clinical practice for us to realize it did for me.

I think, uh, you know, I probably came out thinking I was a little bit more prepared than, than I was. I think a lot of us, a lot of us do have that. Yeah. Uh, I want to respect your time, Richmond. I really appreciate you joining. We could probably talk about this for hours on end. Um, cause I know I've greatly enjoyed the conversation.

I'd love to hear kind of where, what you're up to currently right now, and then where can folks who are listening kind of, um, get in touch with you. I know you're on a few different platforms, so I'd love if you could share that with people.

[00:39:30] Richmond Stace: Yeah, no, absolutely. No, I love chatting about this stuff because I think it's [00:39:34] important and I, I hope it comes across in a, in a positive way because I, I think there's so many cool things we can do. I mean, this podcast, for example, you know, you're sharing people's, you know, ideas, uh, in a, in a really positive way.

And that's the way we've got to, we've got to move it. So no, it's been great to chat. What am I up to? Wow, gosh. Um, I've had to skin down my next sort of set of book ideas from about 12 into two. So I'll actually start them. So there's a couple of things there. One, one's going to be around running. And another one's going to be around motivational interviewing there.

I've said it now. So that's out there. So now I've really got to stick with it. Um, so those, those two I'm working on, um, I've got the, uh, the online retreat coming up. I'm big into self care, which sort of ties into, you know, some of the things we were talking about there about how we look after ourselves and how we build this, this self awareness.

Um, but that's, that's not just for, for clinicians. That's, that's for anyone because. You know, self care is fundamental to be, to be [00:40:34] well, and I'm doing it with a friend of mine, Jeff Way, who, uh, who's a brilliant guy. So that's, that's a lot of fun. So we're putting that together at the moment. So that should be cool.

Uh, the daily writings on Substack, Instagram, uh, Pain Coach. I put stuff out every day and people can sign up to, to that. And then I fiddle around on Twitter and LinkedIn. So I've got a, you know, a regular social media presence and I, I share a lot of stuff. I, it's all, you know, I pump it out there so people can, can see it and have access, um, to that.

[00:41:05] Mark Kargela: Yeah, it's, uh, you do, you, you, you are impressive with your activities on social media and you obviously can tell you have a passion for writing. You, you communicate some great ideas. So I'd highly. Recommend those of you watching or listening to, to check it out. We'll link it in the show notes so folks can get a quick access to, to your stuff.

Uh, again, I want to thank you so much for all you're doing out there, Richmond. I, I've, it's good to know we have other folks in the world who are, who are really pushing, um, to improve how we kind of better understand and help people in pain. So thanks a [00:41:34] ton.

[00:41:34] Richmond Stace: No, thank you. Mark's been brilliant.

[00:41:35] Mark Kargela: All right. For those of you watching on YouTube, we'd love if you could subscribe so we could get more reach to other folks who might be looking to see how they can better improve their practice and better help some folks in pain. For those of you who are listening, we'd love if you could subscribe on your podcast provider and maybe even leave a review that's really helpful for us as well, but we'll leave it there at this, or leave it there this week.

Have a great rest of your week.