Solving the Care Crisis: Restoring Humanity in Healthcare with Bronnie Thompson

Welcome back for another episode of the Modern Pain Podcast. This week we're talking with an old friend and past podcast guest, brani Lennox-Thompson. Brani originally trained as an occupational therapist. Since then, she continued to study at postgraduate level and her papers have included business skills, ergonomics, mental health therapies and psychology. She completed her master's in psychology in 1999 and started her PhD in 2007. She recently has finished her thesis and is now finished with her PhD. Congratulations, brani. In this episode we speak to the importance of active listening. We also discussed the necessity of caring compassion and not sacrificing this in the name of productivity and cost efficiency. Brani also discussed the importance of self-care and how clinicians can use ACT to help themselves and stave off some burnout. It's always great to talk to Brani. Make sure you check out the links in the show notes, as you'll be able to check out some of her blogs. She's going through the Hexaflex model of ACT right now and there's some great content. You're going to love it. I hope you enjoy the episode.

This is the Modern Pain Podcast with Mark Karjula.

Welcome to the podcast Bronnie.

Thank you for the invitation. It's a pleasure.

We were chatting before we got on. It's always good to talk with you. I've been fortunate enough to talk to you digitally and I was able to meet you in person at the San Diego Pain Summit. For those of you who are listening, that should be a conference you all put on your calendar. It's one that's a great one, that can really help your growth as a clinician, especially if you're working with anybody and pain, which the majority of us are. Brani, what's going on over there in New Zealand this time of year?

It's spring, first day of spring, and it's sunny actually, which is lovely. So my garden is, the freezers are out and the blossoms starting, so that's hay fever season as well.

Yes, that's the unfortunate thing that takes along with spring. We definitely get to share that in Arizona. Here we're begging for summer to be over over this way. But let's get into it, because one of the big things that I've really valued about getting to know you and just reading your content is your use of acceptance and commitment. You and Laura Rathbone and others have been huge impacts on my practice as far as helping me better grasp this stuff and, most importantly, giving me something that I can do to translate it to the practice, where it's not just like I read an article and it feels like this nebulous, vague concept out there. You put some content out there and we'll definitely put it in the show notes that brings it to a more real world clinical application. I'd love to hear kind of your developments as you know, kind of your training. Maybe your background and how can I act, came into your world as a, as an occupational therapist. I know you've done a PhD as well, so if you could just let the audience know it'd be great.

So I started working in pain management about 30 years ago now, which makes me feel really old and I'm not. I refuse to be. And at the time cognitive behaviour approaches were in and they still are the mainstay of self management for chronic pain, and it was a. Probably in the 90s, early 2000s, I started reading works by Lance McCracken and Kevin Valls, who were looking at this concept of acceptance, because in chronic pain we often say, oh, this person just needs to learn to accept their pain and it's kind of a sense of resignation and I'm just going to have to give up. And they brought this new way of thinking about what that actually meant and which is really about willingness to do things if it's worth it, which I that's the way I translate it to to people living with pain and myself. So I started training. I've done a whole heap of act courses over the years and written a few of my own, and I still struggle to kind of describe it and succinctly and maybe that's me, maybe that's act it's fluid, it's flexible and that's great, but it's hard to yeah, no, I think that's one of the things I think clinicians struggle with when they want this a lot of the rigid frameworks that are very fixed and you can have a very consistent.

You know, this is the what I'm going to do a, b and C and it's going to result in D and and I think that is the fun thing of act it can make it challenging clinically, but you're kind of you're flowing with the patients, with the conversation, with their thought process and how they're kind of responding and kind of talking to you about it. Which kind of brings me to another thing about clinicians. I know I've read this in your blog and it's definitely a struggle that I had is this transition from being the fixer, and that's kind of how we come out of school where we have patients, we're going to identify something. We're going to identify, fix it with whatever exercise or hands on technique, whatever it may be, and then obviously that doesn't always pan out. But there's still this struggle and I know for me it was a major struggle for to just put the fixing mindset aside and just say, hey, how can I guide somebody's just to the valued living that, with this pain, where I don't have to fix it. Maybe I can teach them that in you know, have some work on these acceptance and commitment therapy principles and start pointing them towards valued goals. I'm just curious what your experiences is with. I know you mentor a lot of clinicians. You've mentored a lot of physios and what's been your experience seeing clinicians with that kind of struggle?

It's really hard because you're taught that if I do this, this will happen. And then we meet the real world and real people who don't follow the rules. Perhaps we can't understand the causal mechanisms of their pain. What's actually going on? And lots of our pains are like that. Fibromyalgia is a really good example. We really don't understand what's going on at the bio level. Even if we do, we're still not dealing with the elbow or the hip. We're dealing with a person who's living their life and they're bringing their history, their culture, their, their own goals and values into a conversation. And, unlike surgery, where you are doing something to a thing, a body part, we are always in our kind of allied health therapies, working with a person. We will spend up to an hour with that person in a session and then they're going to go away. What are they going to do? What are they going to take away with them to do? And that thing that we get them to do is going to have to fit into their existing life. That's not very easy. Even taking a medication is actually really hard to do, to remember to do if it's foreign to you and you've never done it before. And so, with lots of our movement kind of practices. We are asking somebody who usually doesn't do a lot of movement stuff to do this hard thing without our support, without us there in their own environment, when it hurts and when they've got this competing life stuff in the way, and then we wonder why it doesn't work right. And so the shift is about thinking two people experts in our own stuff, experts as a clinician and what might go on in tissues, and experts perhaps in exercise prescription but the person is expert in their life, what matters to them, their habits, their routines, their values, the current, their experience and if we don't treat that relationship as unequal footing, they're probably going to ignore us or they'll do it while we're there and then they'll just abandon ship. And I think that's the shift we're moving from I'm doing things to you and, as Diane Jacobs has always said, from an you know this operator to an interactor. That's what the power dynamic shift is.

Yeah, and that's a challenging one because you bring up some good points and I know we chatted about this a little bit before coming on here, about exercise and this, and I think in the US especially I can't speak for New Zealand and Australia and over that way but the big push to strengthen conditioning principles and everybody should be picking up stuff off the floor and doing all this things, which I think in its general like help for healthier lifestyles. I think the general purpose behind it I think is good, or the thoughts behind it, but then again, fitting it to unique people is where it becomes trouble or a challenge, I guess, and may not always land well with a person where exercise is nowhere where they are nor where they want to be, and, like you said, when they leave the context of a clinic where maybe they can lift things and push and do these exercises, yet in the context of life it doesn't fit. I'm wondering where you think clinicians can do better to kind of prescribe movement into a person's life, where it doesn't maybe have to be rigid, protocol-driven exercise and maybe something that points people more towards valued goals, valued living, versus I need you to hypertrophy your quadriceps or whatever the thought process is and again, I'm not saying that's always bad, because there can be some good things about it, but it does miss the mark for a lot of patients.

I think the first question is to question our assumptions. Is this person actually unfit? Do they need to increase their cardiovascular capabilities? Is that really the problem? And is it about the muscle-length strengths? No, that physiological thing that we are working on when we're prescribing exercise. And my reason for saying this is I've worked on three-week pain management programs where people have entered the program being very deconditioned, not got off their bed, have done very little, and, with video, people at the beginning of the program and they'd be walking very slowly and they'd be guarding, and then at the end of three weeks three weeks that's all they are suddenly doing and they're walking fast, they're looking up, they're swinging their arms, their motions are fluid and they're giving each other high fives. How cool is that? Now, that's not about muscle physiological change. It can't be in that short period of time. So what is it about? And if you have a think about what a program represents, it's a social setting with other people in the same boat and that cheering you on, including the clinicians. The clinicians are there to make sure you're safe, so that helps people engage. So something about it's okay to do this, you're safe to do this, other people are celebrating with you and giving you that encouragement and doing it repeatedly are some of the ingredients that make for change. So, if we think about broader exercise and movement practices for people in their lifestyle, absolutely it's a really important part of health. But is it medicine or is it about healthy moving and being generally healthy and relishing what our bodies can do? And my argument is that I love to do movement, but you're not getting me to lift heavy things Unless it happens to be a sacchar compost and I'm putting it on my garden right. So what I need, and what most people need, are an increased repertoire of what you can do for movement. That fits into this importance. That matters to me. My garden really matters to me that it is something that I'm confident I can do and that other people looking at me will encourage me to do. So that confidence thing is possibly one of those things we need to think about. So I think movement is a wonderful thing, but it comes in so many different forms it's not necessary about lifting heavy stuff. There's that lovely book called Exercise by the guy Lieberman Lieberman, yeah, and he's looking at these original tribes and showing that they live in the forest or they're in underdeveloped, non-sophisticated, non-western cultures. These guys are fit but they spend a lot of the day doing nothing, sitting, just like we do. What they do are little bouts of infrequent you know, frequent bouts of movement that they have to do, to do daily life, and I kind of think well, isn't that interesting. Why can't we use that for what we're doing with pain and people who are in rehabilitation? And as an occupational therapist, of course, I'm going to say that daily doing is important. So my movement practices are walking while I'm going, fishing, gardening, taking the dog for the walk, lots of jiggling about in my chair, getting up and doing my little movement snacks through the day, because these are things that fit into my life. Dance is a really important thing. That's me. Now, you can't get my partner by dancing. We can, but he's got to have quite a lot of alcohol. But what he does, he likes to go for a walk up the hill and he will do that. He doesn't run because he hates it, but he does that. He walks the dog, he does the gardening. We both go fishing. So the way that we express our movement repertoire and the things that make our bodies feel good differ, and that's important, because movement and having movement optimism, lots of options. That's really where we're going for that people can choose. So when we have a lockdown, as we did through COVID, and you can't go out and do your walk or your exercise or your gym, what else can you do? And so that introduces to me the notion of trying to help people develop movement practices, a range of movement practices, so that over their lifespan they can continue to evolve and develop and add and remove things that fit for them. That's my recipe.

No, I love it because I think it really is a great example of fitting it to the unique person in front of you and not to the clinician bias that I, like I said, struggled with mightily, where you research articles and, well, this muscle group's weak, we should work this muscle group and all these different things. And, yeah, exactly where it's very protocol driven, it's very clinician centered ways of looking at it and it just kind of misses the mark, obviously, with patients and having probably not to your skill level looked at this same type of approach with patients, where how can we fit this into your life? Well, what do you like to do? I have a patient right now. She has horses, she's out with her horses, she's doing things, she's getting back to hiking something she hasn't done and it's just a strip in the rules of like, well, you need to walk with the posterior. I mean, I remember doing this stuff clear as day early in my career where I would not yeah, exactly where I now refer to it, when I used to put people in movement, jail of having to move in these certain specific ways and with these like catastrophic mindsets that I cringe thinking of what I told people in the past, but I'd like to bring it to some of your blogs and, like I said, we'll link those in the show notes because they're great, as always, and I think folks will get a lot of value out of hearing your thought process on a few things. And, selfishly, I'm going to probably ask about a patient I'm working with right now. We will keep it health information de-identified, so no names will be used. But mindfulness. This is always one thing that I and it's a thing that I try to incorporate my practice and I'd love to hear your perspective and how you see that. I know you're unpacking the whole hexaflex of you know the, the act model and being present in present moments, mindfulness being a big part of that. I'm curious if you can kind of unpack that a little bit. You know, obviously, the blog, you're going to great detail on it, but where does that fit and where do you see it in that?

So there are. It's an integral part and they're two. I'm I'm choosing two different forms of mindfulness. There is the formal mindfulness practice that we know helps with down regulation. It helps to decouple certain parts of the brain so that the experience of pain is not as distressing, we can experience a sensory nature of it, without the associated thoughts and emotions, and that is a really useful practice, and it takes time to develop skills and to extend your practice, and some people hate it. So the other form of mindfulness is this present moment awareness that we use. That helps us cue into what is my body feeling like right now. When somebody's got pain, they often are living in their heads and they're either anticipating if I do this it's going to hurt, or they're remembering last time I did this it really hurt, and so they're not really in the moment and noticing what their body is actually feeling like in this moment. So I think one of the skills that movement-based therapists in particular can can employ is helping a person to notice what their body feels like as they experiment with different movement forms, different practices. You know, maybe it's just nudging around to see what kind of positions can my shoulder get into hey, isn't that interesting and what feels comfortable and what doesn't. What if I just do it on one side? What if I do it on the other side as well? What's the difference between the two? And so the out of this, though, is in not giving the person answers or guiding the things that they should notice, but asking the person what do you notice? What are you noticing right now? You might guide them to their breathing, or you might guide them to feel the contact with the sort of support service, but really we want one of the reasons for using this is we want people to develop confidence in what their own body feels like, so they can use that as feedback instead of verbal rules, the things that we tell them. And so my favorite example of this is if somebody's been taught to, you know, tighten their abdominals, because you know, of course, strengthening it's so, so important and then we ask them to do to bend, to go and pick up something like pick up their shoes, or maybe twist or something, and they're trying hard to do that. First of all, they're doing a rule that may or may not be useful. Secondly, they're losing touch with what does it actually feel like? Do I trust my body? Because, while they might do that with us in their play in our place, then they're gonna go and they're gonna do their grocery shopping and groceries. It's a noisy, busy environment and the packages that you have to carry are all sorts of shapes and sizes. You do it at different times of the day, a night, you're doing it different paces and you've got to put them into the car. And if you have to use a verbal rule and you don't know what it feels like to feel what your body wants, it makes it hard work and people lose confidence. So our job is to guide people, to notice what goes on in their body, to say what, to them, feels good and what doesn't.

Yeah, no, and so I'm gonna bring in my selfish component of this, where I have a patient right now and she's got very chronic six-year history of it was basically upper back right-sided pain, but really had, you know, life got really small for a period of time, struggling, doing. She's doing much, much better, really getting back to traveling and doing all the a lot of things back with her horses, back doing a lot of good things. But she's got this really struggle with she's. She owns a business, she has to be behind a desk and just with anything with a mouse in her right hand just triggers like is it is a trigger like, and we get her into like where I've just like let's just try to do it, and we got put her in front of my laptop and you know we've, I've tried to call attention to what's. What do you feel in your body right now, and she can feel like tension, the almost like that flight or flighty feeling that comes on because she's just had such a. This is that's like her dragon that's left to slay for this whole thing. But I'm curious what kind of haul you might, because again, it's just putting it in their hand context of a special chest. She's kind of avoided it. She mows with her left hand forever but it's becoming a little bit of a hindrance. She'd like to get back to it. We're trying to nudge back into it and see if we can. She's having some success. But I'm curious how you might lead somebody through maybe an exercise or like a mindfulness-based thing or maybe different thoughts you'd have, maybe you'd use different approaches with it. But somebody who's having that kind of severe, contextual, almost like it almost reminds me like a phobia, like of like man. It just triggers, like just the context of it just triggers these like visceral reactions. There I'm just curious what your thoughts would be.

It depends a little bit on the type of pain. So if this is a neuropathic pain, and when she's got her hand in that position she is actually putting compression through the nerve, then kind of makes sense that that's gonna hurt and from a workability perspective, pushing at that thing is probably not the best option for her. If it's not, and it's really just that it's become her practice and she doesn't like doing it nobody likes to do stuff that hurts then I would begin by looking at a graded hierarchy. So I start with you know, is just resting your hand on the mouse and not doing anything, just resting it there? What does that feel like? And can you shrug your shoulders and can you lean and can you twist with your hand on the mouse? What do you notice when you do that? And while you're there, are you able to now bring your mind to what your body feels like sitting? What are you sitting on? So helping people consider that pain in the one part? There are other experiences that the mind can also attend to, and minds are really cool, but they are a bit simple. They can only really focus on one thing at a time. If you're anticipating that, this is ouch, I'm going to hurt. Probably your attention is either focused on that area of potential hurt or it's remembering the last time and it's probably not paying attention to the other bits that don't hurt at that moment. And so helping the person consider what does it, my other hand, feel like? What does my butt feel like? Where are my feet? What's happening with my breathing, and not trying to change it, but just to make awareness of what it is feeling like, and then you can move up the hierarchy. So initially, just rest your hand. Then you might want to say let's just move the mouse left and right, and perhaps you might want to look at different types of mouse Mouses. Then you're occupational therapist for that, because that's our expertise. But yeah, perhaps I, you know, trying to do little movements, then do fast movement and just playing with bringing that same mindful attention. Because when we're doing rehabilitation we're really simplifying the structure. Initially we're using a framework that says we know the real world is really busy, chaotic, not complex and not consistent. So in rehabilitation we try to simplify it and make it a little bit easier. Sometimes we never go beyond that and we stick with the gym exercises because that's safe and it's easy and we know what to do. But in a case like this, sometimes starting with that position is enough and then we want to start to. Then I'd suggest perhaps this person has a go at work. Just rest your hand and just notice. Don't try to use it, just notice. Do it a few times through the day and experiment and play with that sensation, what it's like just to have your hand resting on there, and then you can gradually progress the challenges and you know usual strength and conditioning things like how often, how fast, how slow, how much pressure, all of that stuff, how long for all of that kind of stuff. Add to it.

Well, thank you for that. I have some ideas, I think some of it. I feel like I was a little bit on the path, but I think maybe I jump in too far forward with her. But yeah, no, I'll definitely be employing some of that.

It's probably also not the pain. That's the other thing that you she, may actually just still experience pain, and what we're doing with the mindfulness is noticing that it's there without adding that layer of oh, and I hate it, and all this is going to be hard. We're just attending to what it is like in here and now.

Not with any prior, any priors or futures cloud in the mix, just trying to be present with the sensation and the presence at the moment. Okay, Very nice. You had also wrote a blog and I thought it was interesting because it is definitely the same thing I felt you had reflect, talked about the self as a con context, difficulties and probably one of the more misunderstood or difficult to apply concepts of ACT. I really enjoyed the blog, but I'm wondering if you can talk about because I think you summarized it very well in there how you see it. It makes a lot of sense to me. Then maybe we can chat about how this kind of comes to a clinical level with patients.

Yeah, it is a really difficult concept and I think this is my interpretation. It may not be correct To us, to ourselves. When we think about who we are, we feel like we're the same person or our lifespan but we're actually. We change a lot. Four-year-old me was as different from me today. Along lifespan we acquire these kind of stories about who we've been the social self. I'm the black sheep of the family, or I'm the messy, untidy one, or I'm a physiotherapist or I'm an athlete. These are forms of our social self that we kind of acquire and hold on to. They help us to simplify how we express ourselves. Sometimes they cannot be very helpful. There are also the other way we can think of self. As context is when we're thinking about me and other people. There's me over time, there's me and this other person, and it's about perspective taking. If you were thinking about what you might say to a neighbour who was in the same position as this patient is in, what advice would you give that person? It's kind of nice, because people are generally harder on themselves than they would be to a friend or a stranger. That gives the person the chance to perhaps think there might be another way of seeing myself slightly less judgmentally. Then there's another form and it's kind of fallen out of my brain right now. Just picking on those two types, though when somebody comes in with a pain problem, they're still bringing the idea of this is who I'm going to be, this is who I am, and this thing that's happened to me has kind of disrupted this whole sense of who I am. It's particularly profound if the person hasn't got a label for it. They don't know how long it's going to last, and it's had lots of impact on how they go about daily life. There's sense of who I am kind of falls over, but they still want to hang on to who I want to be, who I am, and yet I'm not. That's a really hard place to be in. People describe it as being in limbo, as just not knowing who they are. In qualitative research there's been really a lot of studies showing that people want to regain the sense of who they are. I want to be me again. I found that in my PhD study of people living well with pain. My PhD student, grace Griffiths, has found the same thing with people with complex regional pain syndrome. They start saying I just want to get back to being me Now. The problem is if that me is still the super athlete who could do everything, or the me now. Is me as a patient, a victim of pain, I'm a sufferer neither of which are going to be very workable for that person Long term. I'm a victim means that the person sees themselves as unable to influence what's going on. Being a super athlete when you actually can only walk to the letterbox and back it's going to make you feel pretty crappy. Actually, when we're thinking about perspective taking, one step for the super athlete is to say well, what were you like at your worst when you first came in for therapy? What was life like then? How much progress have you made? And use that self that you were at the beginning of your journey as the self that you use as your reference point not the super athlete and mourn and grieve for the loss of that super athlete's self, because it's real, but at the same time, notice that when you were at your worst, you've moved on from there and that means that you are becoming a new person, which is awesome, and it may be that you eventually get back to being that super athlete, but it's likely that it'll always be tinged by a knowledge that you were vulnerable, you lost it all, and that means you might treat that super athlete a little differently and maybe be a bit more compassionate towards yourself for having gone through that With a person who sees themselves as a victim. I think it's about helping them start to see what they can control. What can you achieve? What are you in charge of? And we're only really in charge of our own actions. Can't change emotions very easily, can't at all. Actually can't say just go be happy. If you go be happy, be angry now. It's not a switch. So we want to help the person have pro-social, positive experiences of achievement and accomplishment in the here and now, and we might also ask them to consider if somebody else was looking at them, what would they see? Who are you? Yes, you still have pain and you've been this victim, but actually people around you see as a really competent parent you do it differently, but you're still a parent or they see you as somebody who has become an advocate. So the way that we view ourselves isn't always the way that other people see us, and we can use that to advantage in using ACT, because it says hold on, what is your reference point and can you take this, take another perspective and just loosen that kind of how much you hold on to that one sense of self?

No, it absolutely is. I find it very challenging. You know, I always think Gilletta is probably one of the people I know. We're both been lucky enough to get to know Gilletta and her identity being firefighter and badass woman, and she's got a great blog too. We'll link in the she's on Substack. Now I just found out but yeah, yeah, yeah, noo, noo, yeah, and it's yeah. So I mean it's, it's so interesting to just, you know, it's just tough when folks are in the midst of that struggle of like kind of this. I've also heard a term, biographical suspension, where, like what they've known as their biography has just been suspended and they're in this, like you said, limbo land of of of different things. And I like what you talk about self compassion, because I just see people who are so hard on themselves and such the harshest critics of themselves and I love the perspective taking approach. I'm gonna have to definitely do that as far as, like you know, if you were to, if this was your neighbor who was in your shoes, well, how would you speak to them? What would you say to them or how would you look at them? That's an interesting approach. I'm curious what other maybe things, because I think self compassion again greedily. Would like to know some other thoughts of how to help patients with this, because any other things you use to help patients have a little bit more compassion to themselves to when they're going through some of these massively you know life altering struggles that that pain can bring.

I think opening Pandora's box a little bit, as a as a clinician. It's asking the person what's it like to not be able to do these things? Slow down, rush this period and ask the person and give them that space to say what it's actually like and probe and allowing the person to feel feelings, and I call as bearing witness. It's about being the person who is there to stand by and bear witness to this person's grief. We don't like talking about it and almost all of our treatments are about where are you going to, your future, your goals. But people tell us often that they need to let go of stuff and if you've ever had to let go of something, it involves grieving. It involves letting that thing the things of Maori, condo and hiding Does it spark joy? If it doesn't spark joy, put it away. If it doesn't spark joy, thank it for its service and put it away, and that thanking it is the same idea as grieving for acknowledging that was what it was like and right now you don't know where you're going to be and I think the pace of speaking about this is really important. If we do this in a crisp business like approach, people aren't going to feel comfortable to express what it's really like and they probably haven't actually talked to anybody much about it, particularly in those early stages of recovery where you get an athlete and they really want to get back on doing the thing and they have to sit on the sidelines, and that's the moment when feeling grieving is important. I keep thinking of those Olympic athletes who had to not go because of COVID restrictions, who felt constrained, who couldn't do all those competitions prior to competing and what that meant for them. That's actually sad. It's respect that moment and allow them, and we're in a fabulous place as movement therapists because we're the ones that spend time with them. It doesn't have to be a psychologist, just be human.

Yeah, and that's what I've told, because I definitely had a struggle with just opening that Pandora's box where you might have some significant emotions coming out. You might have people having to unpack some really challenging losses and grieving processes that they have. But I agree with you, if you can just be comfortable to just not have to rush to let the person express it, even let there be some silence as they're pondering their thoughts, which again was very challenging for me. I always felt like I had to fill silence with something because I can't not talk or do something. But I just find that letting folks let that off because I do think we don't give people that space at all Sometimes they feel so hard to give that space because they're the mom, they're the superhero of the family who can't show weakness and they just don't have a place anywhere to let that emotions go. And I've seen some people make some big jumps when they kind of start unpacking that.

They might express it as anger, or they might express it as I'm not going to do that. They refuse to do stuff and I think what we can do when somebody starts to express difficult emotions is validate it by saying that was really tough, it's so hard and it's okay to feel really bad. And empathizing, reflecting what you see it gives that person permission to feel and actually doing that research shows that that actually reduces the amount of time that you need to spend in a consultation. Not addressing these feelings takes longer and they probably won't do what you want them to do. So letting if the person gets angry because you've raised it, that shows that they're feeling okay enough to trust you to be this vulnerable with you. Anger is about expressing energy, about feeling bad, and if we can give you know, if we can recognize when somebody's angry at us, it's probably not us, it's probably their situation, and just validate you're feeling really pissed off and you know what I'd be too if I was in that position. So it's not going to keep them mulling and brooding on it. It actually allows, by speaking about it and experiencing it, gives some room between the immediacy of that emotion and how they're then going to reprocess that. So it's a really healthy approach and it's not psychotherapy, it's about being human.

Yeah, it's just like you would do it to a family member, like how are you doing? Like this must be hard for you, you know it's it's, but we have to have this, like you know, paternalistic. You know I'm the hero, you're the, I'm going to save you, save the day for you, and I get, I get it's motivated on good things. We want to help people, but sometimes that help that to take control and just wrestle control from the patient on the encounter and move. You miss so many opportunities to help somebody. You know, experience some things and movements and a much better direction, because healthcare has its struggles with that. Of course, and this is a question I always like to ask folks because it's it's one eye-ponder as well Like if we were able to and if Brani could wave a wand and she had control over a health system. There was no financial burdens, there were no constraints politically in any of the stuff that we know drives some of the challenges we have. I mean, how would you draw up like a healthcare system to better give people a stage to be heard, to be listened to, to hopefully again they talk well? The best place to prevent chronic pain is treat it well acutely, but there are some things in life that we're not gonna be able to perfectly prevent. I'm just curious what your thoughts are like. If you were to have the ability to really shape a healthcare system. How would that look for patients who are not even, maybe, patients of pain? But obviously that's where our focus is.

Good question. I think I don't have a recipe because I think different things suit different contexts and the needs of somebody who's perhaps lower socioeconomic area, of a different ethnicity to me, different culture to me and different lifestyle are gonna be different from my female European, well-educated, comfortable lifestyle. So I don't think one size fits all. I think if health professionals were more comfortable using so-called soft skills and took the focus off the hard skills learned these learned there about their own self-regulation, because often the reason we don't go there with these difficult conversations is because we don't feel comfortable and partly that's because we don't do it and partly we're worried we're gonna do it wrong and partly we're a bit afraid if somebody's gonna cry or we're gonna make it worse, and it's not and it's something we don't have sort of skills to deal with. So I think some one of the reasons I really like using ACT is because it applies equally to the person and to the clinician. If you're feeling distressed or bothered by this person's emotions, take a moment to be mindful, connect with your own sensory experience. Give yourself a moment to breathe. It will shut you up, which is probably not a bad thing, but it also helps you to notice what is it? Am I feeling tense Because I'm running out of time? Am I feeling underskilled? Am I worried that I'm gonna do the wrong thing? Am I in my head and not actually hearing this person Because I'm thinking about the next thing I've got to do? I have never heard a patient say they listened too much not once. And 30 years of practice. So we have these. We think people have expectations of what they're gonna get from therapy and sometimes we're wrong and perhaps we may need to do some things that meet the person's stated expectations, but what they always want to know is that you're listening and you care. That's throughout almost all of the qualitative literature in particular. So that would be what I would give is more skills to clinicians for themselves and more time to be there with the person.

This quest for cost containment and efficiency and productivity and things. Sometimes it seems like humanity gets lost. But I know there's folks like yourself I know you're doing things in other healthcare systems. We've had Megan Oskar Doyle who I know she's OT, who's doing some great things trying to help her healthcare system, where she's at, incorporate a lot of this stuff as well. So, brani, if folks wanna get to or touch base with you online or where can they find you? I know you have a blog and where else are you active online?

I'm not so active on X anymore, but I am able to be found there under a DMS free. You'll see that. You'll put that up on the notes you can. The Exploring Pain group on Facebook is where I post regularly, as well as my health skills page, the health skills blog. I am actually on threads, but I don't do very much. I'm learning about threads it's getting better and my Instagram. You will see me as me, not paying person, me and all my glory with where we go, what we do, how much beer we drink, how much gin, what the dog's doing, and I welcome those sort of contacts, so do get in touch. And then there's the University of Otago website where you can get hold of me through. For my professional self, we're on the postgraduate academic coordinator for studies in pain and pain management at the University of Otago.

Yeah, yes, yes, and, like I said, we'll have this all linked in the show notes and, as I mentioned, you definitely spend a good afternoon or morning reading a Brawny's blog If you want to get into really seeing how ACT can be incorporated into well, into pain care and bring in a clinical spin on it. It's great information. It's definitely helped me hugely in my quest to better apply ACT in my own practice. So, and on myself, as Brawny said too, it's been a helpful thing to kind of both as the clinician and also trying to help patients. So I want to thank you for all the work you've done, Brawny. You've obviously had a great impact. I mean, I know many others who I we really respect your work and then hope you continue to do the great work that you're up to.

Thank you so much.

This has been another episode of the Modern Pain Podcast with Dr Mark Karjula. Join us next time as we continue our journey to help change the story around pain. For more information on the show, visit modernpaincarecom. Also visit the Pain Masterminds Network on Facebook for free education and resources. This podcast is for educational and informational purposes only. It is not a substitute for medical advice or treatment. Please consult a licensed professional for your specific medical needs. Changing the story around pain this is the Modern Pain Podcast.