Revolutionizing Physical Therapy: Integrating Mind-Body Medicine and the Biopsychosocial Model

Welcome to the podcast, Matt.

Thank you, Mark. It's an honor to be here and speak with you and your audience tonight Appreciate the work that you're doing in the world to advance our profession.

Well, i appreciate that And I appreciate you. You've had an impact on myself. I've gotten to know your work through. We co-present it, i think, at the Arizona Physical Therapy Association one year And I've been able to see your work online and kind of you discussing what you do, really focusing more on the mind-body connection, but obviously a lot more complex than simply that. But I think you go deeper into the biopsychosocial model and somebody I think we can model ourselves after. So I really appreciate you spending some time with us tonight. I'd love to hear a little bit, if you don't mind, introducing yourself for the audience or maybe those who aren't familiar with you, and then we'll talk a little bit about what led you down the path you're on right now.

Yeah, sure So, Matt Erb. I trained my physical therapy at the University of Iowa. I've been out for I'm dating the fact that I just turned 50 recently about 25 years, 24 years And I worked up in the Midwest for many years. I'm now down here in Arizona, which is, i believe, where you're at in Tucson, but I work remotely for a nonprofit based out of Washington DC called the Center for Mind-Body Medicine, where we do population-wide and community-based stress and trauma relief work. We go into communities after natural disasters and we're headed to Ukraine next month on the ground training people in offering evidence-informed trauma support and trauma relief model for people who've experienced trauma. So that's just a little bit of introduction, yeah, yeah.

Yeah, i've read some of your work, or I've read some of your. We're going to link it in the show notes. We spoke about adverse childhood experiences a little bit before we went on and you've spoke to that I know, as you had your physio practice. Really that was a big part of how you would work with some of the folks with some of the complex conditions I'm sure that walked through your clinic door. I'd love to hear how you kind of led, what led you down that path to kind of focus on that. I know kind of the generic physio education I know, at least mine I've got to imagine in Iowa similarly, where it's not as the mind-body connection may not have been there, but maybe you had a professor that influenced you. I'm just curious, what brought you down that path?

Wow, complex question. You know right out of the gates, early in my career I was recognizing how limited my training actually was and supporting the lived experience of people, the psychosocial domains, the functioning, the emotional facets. So I took an interest in mind-body on my own. Partly that comes from years of involvement in the yoga and yoga therapy community, which I've trained in. Yoga is. One of my colleagues calls it a psychospiritual technology. It's fundamentally mind-body oriented, but also not just the interaction of our individual body, mind, but how that is informed by the environments that we're bathed in. So social environments, work environments, natural environments and so on. So I took it upon myself to dive in. I started taking a lot of training in that area, seeking it out, a lot of that interprofessional and transdisciplinary type training where I was taking CE that maybe the average PT wasn't but it was informing how I wanted to work with people from that whole person lens.

Yeah, no, and obviously you're doing some great things with that and very impressed with the work. Obviously, going to Ukraine, that's commendable, to be helping some folks that definitely probably could use some trauma-informed care over in that direction. Since I spoke to you before the podcast went on and you'd had listened to our podcast with a soft vice man, i just am curious. I'd love to hear your views because it's been a discussion we've already had from a lot of our audience members of like how can we say this is all biology And obviously you're taking into account the psychosocial lived experience of the people that you're working with and incorporating it very deeply into your care. I'm just curious where you stand or maybe some of the challenges you had with that discussion when we try to strip down, saying that maybe biopsychosocial models have kind of pushed us away from the main issue, which is finding these biologic treatments that we're going to be the solution to these issues. I respect ASOP And the beautiful thing we can have nice discussions with people and it doesn't have to get ugly and name calling and all the things that we see out there in social media But I'm just curious where your view is on it and what you think about this kind of demarcation of biology and psychosocial versus what we see with humans, where it's obviously very gray, complex, muddy and not able to be so neatly categorized, i guess.

Yeah, well, first, i really appreciated the discussion and I appreciate challenges to everything because it challenges us into looking at our own epistemic humility, and for me, part of that is also cultural humility, which is a topic that we have done a lot of work on in my job at the Center for Mind Body Medicine, i think. For myself I tend to think of both and non-duality. So I don't see the psychosocial domains of people's lives as distinct from their biological state, and so by addressing them it's contributing to potentially positive shifts. So if it's done well and is person-centered and aligned with what people are seeking, it has the potential to create those positive shifts. One example that I would use is Naomi Eisenberger's work at UCSF demonstrating that social engagement co-regulates inflammation. So the social environment and the quality of that social environment plays a profound role on inflammatory state in the body. So that's just one example. It's the same thing where, when I talk about mind body medicine which of course is some people look at mind body medicine from the lens of causality, but I tend to look at it as a strength-based way of creating positive influence on the whole of one's physiological state, both at that individual level of mind body processes but at the level of doing what we can to support the person's environment. I know some of that is outside of our control as clinicians. We can't change at least not in the shorter economic inequality, for example, which would carry a profound influence. And so by taking this both-and approach and looking at the idea that all things that we categorize as mind, we basically check every delineation of things that encompasses our sensitivity, regardless of your neurophilosophical opinion on the origins of consciousness, right are represented by biological or physiological patterns and states that you know, thoughts and feelings are represented in brain-body physiology. One of my earliest learnings was from Candace Pert, who used to be on the board of our work but she discovered the Mu receptor as an aside, had that recognition stolen from her in the patriarchy of the scientific world, but she talked about the work that she did and how the immune system, the inflammatory state, is directly influenced by what's happening at that level of mind in terms of our thought processes, our belief systems, our expectations, our prior conditioning. You mentioned trauma in our paper on ACEs. I look at this every day in terms of the relevance of how the past, what we've lived through, is informing the present, and that's part of why I got into it is because I had a pretty traumatic, rocky upbringing and a pretty high ACE score. You know, from the base ACEs test to the expanded ACEs I had a pretty high number and that theoretically could predict my death, according to the research. Yet there's also epigenetics that tells us that what we're exposed to, the positive childhood experience, is the things that offset, that can create a counter-balancing effect. And I just yesterday looked at a study that just came out in JAMA on how epigenetic DNA methylation is directly associated to aging processes and that's predicted by adverse childhood experiences. And so the incentive for writing that paper that you mentioned was what can we do to offset that? How can we affect the? if someone's in a state of prolonged or high threat appraisal from alterations to the development of the HPA neuroendocrine axis or to autonomic functioning Early in life, and that's informing how they cope how do we effectively address that by what we offer in the clinic? So that's sort of the way that I tend to think about it. I'm not sure if I'm getting off on your question but, i, tend to get off a little bit.

No, no, that's great. I'd love to kind of go further into that discussion because I think we see these complex conditions and definitely as you practice more and you might be senior clinicians in your clinic where you're going to see some of these complex presentations. Where we got IBS on board, we have Ehlers-Danlos, we have POTS, we have all these kind of systemic dysregulatory things And then as you start getting to know these people, you're here, often a very challenging past and a challenging and trying to connect those dots for people in a healthcare system that is not really good at honoring that story, even bringing it to stage, to where it gets to be told, especially in the biomedical world. You're a biomedical being and the mind is not part of the body oftentimes, unfortunately. I'm curious what you think we can do as physios to at least get a baseline skill set to do justice to some of that unique story and the unique lived experience that each of our patients bring to the table. Because I think we talk about biopsychosocial and how we need to do these things, but I think there's still a gap of talking about it and then doing it at a level that at least gives people, like I said, the validation that they deserve when they're, and bringing those factors into a treatment encounter versus. We can talk about that, but then let's just get to the body-based work where we're going to do the mobilizing, manipulating and all those type of things. But I'd love to hear your thoughts on that.

Well, there's a lot that informs what I personally feel needs to happen for our profession to better support that. I'll start by saying that we recently group of five of us obtained recognition at the APTA in terms of advancing PT and mental health and that's already recognized by World Confederation, or it's now World Physical Therapy, but in the subgroup of IOPTMH, the International Organization of Physical Therapy and Mental Health, and there's a lot of questions about physical therapist capacity and what is scope and what is smart, safe care in terms of supporting people in the psychosocial aspects of their life, including if you're working with people with comorbidity. I mean, my practice is clinically oriented, mostly referred by psychiatrists and physicians, a lot of including integrated health physicians who have an understanding of the mind-body process, and so when you're working with people who are experiencing, you know, have a high ACE history or PTSD, we have to, at a bare minimum, have trauma-informed care and understanding of what supports that. Then we have the whole model of physical therapy. Right now I call it assembly line therapy. I'm an outspoken critic of four patients for hour and shifting off to wrote. You know, exercises on a script by attack and all this sort of thing. My whole career I've had an hour per patient 25 years. I've had an hour per patient my whole career. It's a luxury according to some people, but it can be a sustainable model. So we need time and then we need comfort, we need training and mentoring and we need a model of clinical supervision and mentoring that helps people understand how to support the narrative like a narrative medicine. If you take a little extra time to hear what's happening in that person's life, then in my opinion the research supports that that is therapeutic. And then it is actually, if I want to use a code neuromuscular reeducation, because if it's a just in autonomic central state and tone is shifted bodily tone, for example, holding or guarding patterns, breath regulation, which influences heart rate variability So we need to create this a better model of supporting people and knowing how to do it, how to do it safely, how to stay within the scope of our profession. So I hope I'm getting somewhat to what you're asking you.

No, 100%. I think and that's a great point you bring up And I fully support I remember you talking about this in our state meeting about this is neuromuscular reeducation. The hard science is there, like having bringing somebody's narrative and supporting them and the changes you can see physiologically with that activity is real And I don't see why we're so skittish to I don't know how to bill it. I mean, there's hard research and science to show that we are making physiologic, biologic change by having this narrative brought into the room and supporting somebody and having them validated, having them heard and being able to kind of express some of the challenges that they're going on in their life. We also have research that shows us what people want. I can't remember us at the Hall of Pine and Study in Finland where they looked at what are people expecting from. I might be confusing names and studies, but what do chronic pain patients want from it? I think it was 60% of people wanted to discuss issues they're having in their life. So whether we like it or not, people are wanting to offer these things. And I'm sure we can all relate to sometimes where we're not expecting to hear some of the things that people offer and they offer you like whoa. That's deep. And you also touched upon something I think worth discussing as well as far as the scope of practice concerns that a lot of PTs have and physios have on. You know, i'm not a psychologist. I don't want to step outside of my scope of practice, but I and I've talked to this when we spoke with Puro Sullivan and others about how we've created these professional boundaries, when we understood pain as a very biomedical process and where we could just chunk people into these nice little categorical buckets of the physical, the psychological. And. But we all, obviously, you know science has long, you know, blurred those lines as far as what pain is, what's involved in pain with people. But I'm curious where your thoughts are on where we should be serving patients and while still making sure we're maintaining that professional scope of practice and not not infringing you know. The last thing I'll say too is Peter O Sullivan said you know our psychology colleagues are often more than happy to have us chipping in on that effort And we can make some great relationships with them, like you've made with some of your mental health colleagues. I'm just I'd love to hear your thoughts on it.

Yeah, well, i think I would start by saying that there is a really a worldwide shortage of mental health support and the rate of mental health challenges is skyrocketed, especially since COVID. But in general, you know I was working on it, one of the trainings we do today and someone mentioned that in some regards and I don't want to misuse the word trauma in any way, but trauma is a spectrum In modern day life in some regards, at the bare minimum, carries a very high level of stress that can keep people in heightened vigilance, heightened threat appraisal, and then we have that whole spectrum up to, you know, big classic shock. You know they call it big T trauma. And so, in recognizing that, when I, when I look at a stepped care model so I recently worked in our work for Ukraine in looking at what's what's happening out there in the public health system in terms of stepped care for meeting fundamental human needs, i mean we're all human and, in my opinion, no therapy profession, be it OT or PT or psychotherapy, has a license on human expression or cognition or the fact that we all feel, including in relationship to what's going on in our body. So how do we support that within scope? But what I think we need adequate training. I've taken extensive training and had been working in this field for long enough that you know I kind of have that background. But if people ask me for a simple frame, i say we're not diagnosing. It's not really our job to die, put diagnostic labels on mental health. We're not analyzing. I'm not here to psychoanalyze someone. I'm not giving life advice. I'm not saying, hey, you should leave your spouse. I might provide a forum where the person might arrive at decisions like that on their own through the, through the experience or through the messages of their body or whatever. But it's not telling people what to do. It's not regressive. I'm not intentionally taking people into the past. I sometimes joke a little but I say look back but don't stare. The past has informed the present. But if it's influencing the present, we work with that by coming up with the best possible relationship and response to what's happening right now. And I want to be a guide to support you in getting whatever your needs met are through this whole person model of support. So non regressive. But that doesn't mean if you know I mean what yoga teacher or massage therapist or stuff comes up. You know when you touch someone's knee. What am I actually touching? I'm touching their life. I may be touching past trauma events And so if emotions, if trauma memories come up, you need to have a space and not just say, oh well, oh gosh, you know, become uncomfortable and you need psychotherapy, because that's marginalizing, it's shaming. It may be that they need a resource. It may be that they need additional mental health support, but that's through invitation. It's not me telling them you need that. If you'd like additional resources or support, please let me know I can. I can can help you identify the appropriate level of support. So, to summarize non diagnostic, non analyzing, non advising, non regressive these are things that are important to me in smart, safe care and trauma informed care, and it's all provision of choice, and the research shows giving people two max of three choices supports autonomy and choice through choice. So I'm I'm trying to provide things through choice as part of trauma informed care. I don't know what that brings up for people or for you. I welcome, you know, questions concerns And because this is something that we, our profession, needs to define clearly.

Yeah, no, i am 100% with you. I think, um, you know the we have, as I mentioned already, like a healthcare system that often just glazes over this unique human in front of us and just wants to categorize them into means and standard deviations and things to to make clinical decisions And, like I said, very normative based communication styles where the narrative, uh, and things just kind of are missing, and oftentimes our clinical encounters. For, for some of the earlier career clinicians who are grappling with this because it's always a struggle I'm sure you probably can reflect back to your your training days You've obviously recognized a hole in your practice where there was a subset of patients that were you were felt woefully unprepared for. I can definitely relate to that And you know my path went down. I was just going to get super complex with manual therapy and realized that was not the complexity I was missing, it was just the complexity of unique humans and the experiences they have and all the things that you've already kind of alluded to today. But for some of the early career clinicians, i'm wondering you know what your thoughts are on how to kind of get grounded in an ability to start having these narrative based communications with patients and to be able to, you know, bring these things into the room safely. You've spoken to it a little bit, but I'd love to hear your advice to some early career clinicians who are kind of trying to figure out, you know, a path forward to start being, you know, gaining some skill in this.

Um, i think I would start by saying um, there are simple ways to open the door. So even just asking someone, what has this been like for you, how is this impacting your life? Or if they come in in pain, as you're experiencing you know these painful sensations in your body does it bring anything up for you? It's opening the door to affective labeling. Just uh Lieberman is his name, has published a lot on affective labeling. Just when people say you know, this experience is making me feel sad. This experience is frustrating me. That labeling is associated with neurocognitive processes, top down inhibitory path signaling. Prefernal courtesies into limbic and autonomic association regions can be turned on just by giving the people the option to label it. For me, that's not psychotherapy, that is fundamental. What is this like for you? It's part of, for my stance, any good therapy model is giving people those simple openings to express their interior.

Yeah, yeah, no, no, no, no, and that interior oftentimes it's. it's interesting when you open the door for some of those. I am by no means what I would. I consider myself as skilled with you at having those conversations, cause that's the one thing I kind of preached over and over when I teach is that you should look at conversation as an intervention, like your words are an intervention with somebody, and how you choose them and how you again open a door for the patient to express themselves. That is a very skillful thing. What have been the big influences for you? I know you kind of touched upon narrative based medicine. We've been fortunate to have John Lorner on the podcast and he's a big proponent and has written a lot about narrative based medicine. I know you've spoken about your you know your yoga background and different things where you know the mind body connection. I'm just curious you know what have been some big you know influencers on your ability to gain that skill of conversation? Cause obviously, just listening to you and I've listened to you speak elsewhere and it's impressive to hear kind of some of the ways you you navigate some of these challenging situations with patients, but what would you recommend or what were the things in your past that really put you know, you feel were things that strengthened your skills in this, in this area.

Yeah, i'm happy to answer that. One other thing came to mind just on the last question I want to touch back on, and that's when I invite people into that. it's always body-based. So I really work a lot with sensation, present moment, awareness. When people are telling me their story, even if someone tells me about their recent accident, I say, as you just told me that, did you notice anything happen in your body? I'm trying to frame self-awareness, self-referential processes and then ultimately tie that back to self-regulation. So when we can teach people how to shift their physiological states, i do a lot of biofeedback. I'm trained in heart rate variability and EMG, down training and up training and thermal biofeedback, eeg, neurofeedback. I've taken all those courses and I use some of it but not all of it in the clinic because I try to keep it pretty accessible, practical. But what I found is that when we provide people experiences that shift their overall level of arousal, their physiological state, oftentimes the answers that they need, the feelings that they wish to express, come up all on their own. But I'm keeping it all body-centric, all at that level of embodied. In terms of my influencers in this area of mind-body processing. I would say that the work that I've done with the Center for Mind-Body Medicine has taught me a lot about what I now, using lofty words, call a phenomenological heuristic. It's enabling people to come to their own answers, their own self-understanding, their own choices, as opposed to me assuming that I know what they need or what they're experiencing, and so it's that non-fixing. I came out of school and I thought I had to fix everything. I should know the answer, i should know how to fix it. There's very little humility in that approach, and so it's taking that stance of it's not that anything goes, but it's providing that space. And so, through my experience with them, i've learned more about the types of open-ended questioning that give people permission to share, to uncover, as opposed to making assumptions. And so all of the different I mean I've worked with our model as a community-based public health model. It's got evidence published on children, adolescents, adults with PTSD, and it's got a lot of publications on burnout and healthcare providers. But it's really about that being with people instead of doing to. And we have psychologists, physicians of all kinds, psychiatrists, family medicine, we have nurses, we have social workers, we have clergy, we train teachers, we do social, emotional learning in schools. So I've learned from all of them like being in that type of environment and has taught me most of that, and then the yoga therapy community and just self-study on my own.

Sure, sure. There's this belief too of clinicians that this isn't for everybody. A lot of the patients that come in to open this space, there's this belief sometimes that it's a little bit more too spiritual or it gets way off of the path of what some physios may be comfortable with or they don't think their patients are going to be comfortable with it. I'm curious with you is that more of an us issue? I mean, i'm sure there's some people who there might be some challenges and maybe you can speak to. That too is like have you had challenges where people are just not able to or just putting up the guard and they're just not ready? This is physical therapy. Why are you talking to me about my feelings and all these things? I'd love to hear your thoughts with that and again, some of the barriers that you think we have as physios maybe not even just physios, chiro's massage therapists, whoever of being willing to just give this opening for people to express and use these open-ended questions into this discussion style. I feel like it can fit nicely within a more traditional rehab process, because even traditional injuries, acls and things, there's a mind and feelings and experiences and beliefs and all these things behind it that it just helps to have a stage to me to more comprehensively rehabilitate somebody versus just looking at what their quad ratio is, but I'd love to hear your thoughts on that.

It's a great question. I've spent a lot of time wondering the answer to that question myself. I can say that I have a personal belief and I'm thinking about Joan Halifax. She is a PhD medical anthropologist but also a Zen Roshi, and she wrote a paper on an inactive model of compassion and six ingredients that have to prime for the emergence of greater compassion in people. And kind of. Where I'm going with this is, i think that we have to embody the principles of whole person ourselves and how we relate and respond to our health to be able to take people, other people, into that realm And this is how we teach people. At the center is we take them through the model and invite people to apply it to their own life, to their own lived experience, in a sense to kind of do the work themselves. I'm not sure why there is. I would hope that there would be more interest in supporting people at that whole person level In our profession. It's been a hard nut to crack. Honestly, i'm not sure. In a book that I put together in the chapter on narrative medicine I listed out, we put together like this pie graph of barriers to engaging in more whole person care and narrative type medicine And one of that is that self application. There's others, so there's lots of levels of consideration, time reimbursement, not knowing how to code or document or bill, comfort level, because it wasn't as much in the training My training we had a course on psychosocial aspects of patient care, three hour course. Yeah, you know what's that gonna do I mean, other than to just touch it, but it's still very reduced. Our profession, in my opinion, is overly reduced in how they're working with people.

Yeah, no, i couldn't agree with you more. I think we still are way too physical of the physical therapy And especially when we know the physical is so impacted by the mental, the psychology, the lived experience, the society, the things. I think you've touched upon it as well, as far as we have a lot of systemic barriers. I share the same frustrations of how does somebody express themselves or have any space to express themselves when they're with four other people at the same time and getting maybe a brief conversation here or there with somebody. Obviously, natural history can hang out in a lot of environments and get better. So that's where I sometimes think we as a profession in those settings entertain natural history as humans do what humans do when they recover. But there are definitely people where that nice neat recovery process doesn't occur. The reductionist part in our profession, like if you were to have the ability to say here's what I think our curriculum could be We're gonna pretend cappedy barriers aren't there. We're gonna pretend other professional barriers. I honestly think there should be a lot of professionals that meld together to create a super professional, like a superhero or something. But I'd be curious what you would like to see in curriculum and what you think should be just some base things that, as physios who are gonna navigate and they're gonna see these people in clinicals when they're on clinical, they're gonna see these folks definitely throughout their career. It would be nice to have them prepared for it because, i agree with you, we are grossly underprepared to deal with the complexities of the pain experience and some of the narratives that come in our door that we give stage to, because I remember having people tell me horrible things that have happened to them past and just feeling like shell, shocked and like, well, let's get back to talking about your knee Cause I didn't know how to respond to that. Now I feel, through you and others, i feel a lot better as far as being able to give that a space and obviously help it with connecting them with other professionals as need be. But what are your thoughts on curricular holes that we have in our curriculum, of what you'd like to see in there?

Well, the first thing that comes to mind is that the DPT programs or PT programs are tasked with teaching the test. So the test has to. There has to be a commitment at the level, at that level of deciding what it needs to be part of core education in our profession, building it into the test and tasking programs with having to teach it. And for me that is more of a challenge. And I call it an integral approach to the biopsychosocial model, or I'm a fan of the word integral as a derivative of integrative. I know there's a lot of criticism of integrative medicine but for me it is a both and. So here at the University of Arizona, which is one of the largest academic centers, research and teaching centers for the integrative health model in the country And I've been immersed in that. You know, every month I attend a patient conference where the fellow physicians, fellow family medicine physicians, present a case situation and different professionals from come in and share their lens on it. That type of model in education can help people start to look outside that reduction to see what are the other facets, what are the other variables. So bringing in some sort of integral whole person framework, you know that's part of why I put together the book that I did on the foundations of whole person care. What are they? What do we actually wanna address? that's fundamentally human and at least a basic competency. It may be that you're not gonna specialize, like I do, in physiotherapy for mental health. You know which is where we're getting this recognition here, as one of the many countries around the world that's already steeped in that. So I don't know how that's gonna come about other than continued advocacy and moving beyond lip service. You know I remember Dr Craig, the former editor of PT Journal, said the time has come to yell about the need for this. And here we are, you know, 10 or 15 years after that was written, and we're not seeing much changing at the level of the DPT program, because they are in fact tasked with teaching the test and getting people licensed into the field.

Yeah, yeah, there are definitely some barriers in that front and I agree, the licensure exam And you know I don't know how you would like, i almost think there needs to be. Like you know, i wish I would have had the opportunity to get, like you said earlier, about some mentoring and having somebody supervise. We just had, you know, peter O'Sullivan with his restore back trial and you know, cft, you know, has some definite, you know whole person, you know components as a big whole person components, because that's often a big chunk of why, you know the thought is why all these the back pain issues you know, are continuing to, you know, obviously be an issue, despite medical advances and all these new ways to intervene. Yet you know, back pain and chronic pain numbers get worse. I wish I had the solution as well. I just feel, like you know, that mentoring piece is so huge and it's not an option for a lot of folks. But what would you like say? like obviously, you know, not everybody's gonna be able to call Matt or Urban, say, hey, matt, would you mind just kind of let me bounce ideas off you on cases and stuff, but what would you recommend for students who are, you know, trying to find their footing with, like mentoring, what would be like, especially in this space? maybe it doesn't even have to be specific people, but where would you look like to find to have people who can help them start opening these windows of discussions and starting to better handle these difficult discussions that will face them in the clinic? hopefully they can feel more prepared earlier in their career than I know I felt, but I'd love to see what or what you think about that.

Well, you know my network. I have a fairly sizable network of people who are doing mind, body type integrated care models, whole person care models. I'm not sure how, how, the best way to organize that, and I really wish that our profession had a More rigorous standards for clinical supervision and mentoring, especially for people going into specialization areas, but even basic competency. We go through our clinicals and then you're out on your own and If you get mentoring, by chance of landing in a really good clinic with someone You know, great, but you know there's a handful of us out there, i think, who are Wanting to see more of this. You know, when we finish that, that book on whole person care I tried to Spread the word about it that many of the authors that contributed to that, from a variety professions You know, sort of expressed yeah, people are seeking mentoring in the area of whole person care. You know I'm available. We haven't seen a lot of use of that because I think the uptake is still rather slow, you know, and I think the work you're doing here and other some of the other forums that are that are out there on the online world or Setting up models of clinical mentoring. I think, though, that we need to be mindful of how that interacts when it's, i guess, conflict of interest and disclosures, you know, like when I offer mentoring but I also tell people that it's sliding fee scale and I've put an emphasis on Jedi with justice, equity, diversity and inclusion in terms of Offering pro bono mentoring and mentoring to the underserved and people who are racialized and minoritized, and stuff like that. I think, trying to aim for a model that's inclusive For our profession but that also sort of brings together a network of like minded people who are really working to advance this. The last thing I'll say I know it's a lot, but I I'm thinking a lot about David Nichols I don't know if you've interviewed him, but if you haven't, please bring him on The death of physiotherapy and physiotherapy otherwise, in terms of looking at a sociological view of our profession and how that can inform What's needed for us to move ahead.

Yeah, david and I have traded emails. I'm a huge fan of David's work as well. I think he has some, some great points That I think, again, if we need to open our eyes to some of these issues and look beyond just the traditional, you know, i still sometimes see what is to. Instagram and Twitter have to hold about the latest weekend course and it seems like we're still beaten the same That horse of the next way to intervene and fix things. Granted, there's some, definitely some better movements, but, yeah, i agree, i think David's David's an amazing resource and somebody we could all learn a lot from, so hopefully we'll have him on soon. I want to respect your time tonight. I really appreciate it, but if there's anything you want to discuss, as far, you've already talked about what you're up to. Maybe there's an issue that that really is one you feel like we need to, we need to chat about tonight. I'm happy to give you the floor of anything you feel like you need to discuss, but also work in folks if they want to see your work, or or and I will I'm gonna bother Matt to pass on some of the links to some of the studies and some of the folks that he he spoke about tonight. We have a copy of his book. Highly recommend it. It's a great book but floors yours or anything else. You feel like you. You feel like we need to discuss And then, like I said, if we can get an idea how to get a hold of your C online.

Yeah, you know something that has been on my mind lately and just in looking at my own health journey because I myself Remember hearing a soft mention his you know his chronic pain issues I've had a number of chronic health issues also, have navigated PTSD myself And as I've worked through the best of the biomedical, the best of integrative and complementary health and sort of sorted through What works, one of the things that's been on my mind lately is is this larger frame of of you diamond and sleuth agenesis, which is this sort of helping people cultivate foundational aspects of how they relate and respond to life and living? You know concepts of impermanence and some of the wisdom traditions and I've been thinking a lot about That. What does it look like to support people you know as they are, where they are, in terms of that which is their belief system, their culture, even that which is new menace? you know, this sort of that carries something more on the metaphysical and what I want to say about it is that What's his name? Scott Miller, dr Scott Miller, who founded fit feedback, informed therapy. I don't know many people in our profession don't know much about it, but he talked about that. He's not really interested in debating the reality of metaphysical phenomena, but it's much more pragmatic. And that what can we better do to engage people in health and healing processes And what actually informs health and healing? And so where I'm going with this is that there's an old study that was lost I was in the early 80s by ions, the Institute of New Edic science, and they looked at 80 or 90,000 people who had spontaneous remission of chronic illness And they looked for what were the patterns, what did the people attributed to? And they were Belief systems, facing, facing the, the crisis instead of avoiding it, moving from a sense of dependency to a greater sense of autonomy, having strong social relationships, having faith or belief in something larger. So this is the other area that I just want to. I'm just naming it because it's. I mean, this is a whole nother show mark. But Sure, this idea of how do we support people at, you know, at this level. Scott Miller did a study that came out last year on the use of psychics and they compared People satisfaction with psychics, psychologists, physicians and family, and guess who performed the best Psychics?

I was just gonna say psychics, i bet yeah.

Yeah, so, and again, not debating the that reality It's more pragmatic is what is not getting met in people's health care.

Yeah, fascinating stuff. I'll have to dig into some of the studies been lost. But it is interesting because I think sometimes we have and you're well aware of the pet peeve we you know I have as far as, like you know, we are great at having conferences and Getting around tables with fellow clinicians and then this is what patients need and this is what patients need. And Rarely are they ever in the discussion of like well, what do they want? like well, why don't we ask them in stuff? and it's interesting when we do some of these studies and we see, man, that is not what we thought, like you would think, well, the doctor is going to be the person that they want and and And respond best to. But it's interesting of that unmet need and I think we're still not meeting we're meeting a pride better than we used to. I know you know through you and others, i feel like I'm doing better to meet that need. I'm. I've really appreciate your work and I look forward to hearing what you're up to further. I you know. Again, i commend you for what you're doing Ukraine. It's amazing work and I'm thankful we have folks like yourself doing it, really appreciate all that you've done for our profession and can't thank you enough for your time tonight.

Yeah, thank you, mark, and people can reach out In body or mind, although, please know, i have an update of that website in like five years. But it's got my contact information. You want to reach out to me and I'm not sure what you include in the show notes, but I can Include links to my published work if people would like to see that. Yeah, well, we'll put.

We can put as many links in the show notes as we we want. Especially, we had some good discussions on some of the The books and some of the you know research and some of the things you spoke about tonight. So we'll link those on the show notes will link matt's website. We don't we don't get to pick you on web design here. I mean we're just happy you're online and the people can reach out to you and get a hold of you. So that's, that's that's out of our critiquing purview here. But again, thank you for your time tonight. For those of you're listening, don't forget those Subscribes for our channel on YouTube. If you're watching this on YouTube, if you're listening to on the podcast chance, it would help us a ton if you leave a review so we can get more of this information out. Folks like Matt need to be heard and hopefully you can help us do that by by spread the message. So I will leave it there tonight. I really appreciate all your time and you guys giving us your attention and listening to us this far. I will talk to you next week. Thank you everyone.