OTs In Pelvic Health

The OT Balance Beam: Elevating Client Care and Self-Care with Boundaries

• Season 1 • Episode 66

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Lindsey Vestal I have the honor of being joined by Lara Desrosiers today to talk about boundaries, boundaries in our personal life with our families and our friends and our neighbors and our colleagues boundaries in our professional life, specifically in pelvic health. It is such an important trauma informed perspective that Lara and I bring to the table today. I can't wait for you to hear our conversation. For those of you who don't know Lara, she is an attorney in Ontario, Canada, operating pelvic resilience. It has a mission of supporting individuals struggling with pain and pelvic health challenges to get back to living life. Lara mentors and teaches other clinicians who are interested in building stronger partnerships with their clients, building their psychologically informed practice and maintaining their own wellness and balance. I'm also honored to be partnering with Lara to be creating the very first ever trauma informed Pelvic health certification, which will kick off in January 2024. Please be sure to join the interest list. It's available in our shownotes. I can't wait for you to hear today's conversation. 


Intro New and seasoned OTs are finding their calling in Pelvic health. After all, what's more ADL than sex, peeing and poop? But here's the question What does it take to become a successful, fulfilled and thriving oat in pelvic health? How do you go from beginner to seasons and everything in between? Those are the questions and this podcast will give you the answers. We are inspired OTs. We are out of the box OTs. We are Pelvic health OTs. I'm your host Lindsey Vestal and welcome to the OTs and Pelvic health Podcast. 


Lindsey Vestal Lara. I always so excited.   When you're a guest on the OTs for Pelvic health podcast. Thank you for being here to talk with me about boundaries. 


Lara Desrosiers I always love being here. Thank you so much for having me. I'm so excited to talk to you about boundaries. It's such a, I think, a topic that is so important in Pelvic health Part one. It's hard to kind of develop concrete skills around. So I'm curious. I'd love to learn a little bit more about how you learned about them. 


Lindsey Vestal Yes, I love to go there. And you're right, It is so important in Pelvic health. And so I'm going to I want to talk about it a little bit from the perspective of being an pelvic health as someone that supports coaches in Pelvic health. But I think I also want to talk about it as an entrepreneur and as a parent, and I think it's applicable to all of those roles and and situations. I want to start off with actually sharing a definition of boundaries to kind of frame our conversation. It's one that I come back to a lot and helps me redefine, and I think boundaries are an ever evolving work, especially with different people in our lives and as we get older. So I always kind of come back to this one definition, and the definition is boundaries are the distance at which I can love myself and you simultaneously. Boundaries are the distance at which I can love myself and you. Simultaneously. And that is a quote by someone of the name Prentice Hemphill. And quite frankly, Lara, I learned them by trial and error. I am 100% a people pleaser by nature, and I'm sure many people listening on today's podcast can can relate to that. And maybe they are as well. And quite frankly, I just got exhausted. I definitely wasn't taught about boundaries. It wasn't a conversation we had growing up in my house, and I kind of feel like I had to hit rock bottom in order to find the merit and the value of boundaries. And so when I when I think about that, I kind of think back to my early days of being an entrepreneur. I opened up my private practice in New York City. I think I was the first O.T. practitioner to have a pelvic health private practice there, and I was on cloud nine. I loved my work. I was doing house calls. I was running all over New York City, all the way up from the Bronx down to the financial district. And I was exhausted. I loved every second of it. But at the same time, I had a two year old and a two month old at home. And I would show up 100% to my clients. And literally I had nothing left for my family at the end of the day. And I just remember thinking, there's got to be a middle zone. I there's got to be a way where I can continue to thrive and love what I do and feel like I have more to give. And I don't just want to lay on my couch for the rest of the evening. I know I want it to be so much more part of my children's lives and I want it time to work out. I want it time to try a new coffee shop in the city. Like there was just so many things I felt like I was leaving behind that were very important to me. So I started becoming obsessed with boundaries. I read everything I could. In fact, I still do. Sitting next to me right now, next to my microphone is a book that I'm reading, which is called Set Boundaries Find Peace by Network Over. I'm probably going to mispronounce her last name. It's Taub, and I'm going to be referring actually to her book quite a bit today because it's just inspired me so much. And I want to just personalize this a little bit more and kind of share like two particular two particular experiences, both from a family point of view as well as a professional point of view that I think were like truly the wake up calls for me because to be exhausted wasn't enough for me. I knew I was supposed to be exhausted. I was a brand new entrepreneur. I had two young children. I was living in New York City. Like that was the epitome. I was supposed to be hurried. I was supposed to be tired. And so two particular stories that come to mind are a really simple one first, which was we are a no shoes in our house family. So living in New York City, you see some of the worst of the worst on the streets. And, you know, I'm not an incredibly, you know, neat, organized, clean person, but that is something that's very important to me, is that when someone comes into my home, I ask them to take their shoes off. And I remember feeling very uncomfortable about this. It was definitely important to me. It was a strong, like, non-negotiable. But any time a new person came to my home, I felt I had such a lump in my throat to be able to share with them in the kindest way possible. Could you please take off your shoes? And part of it was just like the moment, right? They just got there. There might be bringing me something. They might be handing me me something. We're super excited to see each other and for me to stop that moment, it was like a record in my brain. It felt like a record scratching moment. It was like for me to go, sorry, Wait. Take your shoes off. I felt really at odds with this, and I ended up actually getting sick one year and had to be hospitalized. And I had an infection in my foot that I picked up when I was at my daughter's swim lesson. And so this is when I became very like, wait a second. Like I why am I foundering with this? This is now, to me, a health issue for me. I need to feel more at ease with this. So that's like a simple family story where it like really caused me to to shift and to reorganize the way I was feeling uncomfortable around asking people to take their to take their shoes off. And then the second story that comes to mind for me was I ran what I guess I would call a concierge service in New York City, the Functional pelvis. We would go to our clients homes. It was typically pre and post partum people. And my clients had my cell phone number. Right. It was that was the main business line. And I always spoke to my client before I saw them in person. So I was the one answering the calls. And I would do a discovery call, which was actually a requirement for me. Like I had to talk to you before you could book it because you could only book through me. I didn't have like an online booking system. And I would also text messages with them about their exercises through that same phone. You know, I invited them to reach out to me. I wanted their experience to be so comprehensive with me and so different than any other health care experience that they had. Right. So I would invite them to text me or call me with questions. Now, many people can take you up on this, right? They're just you know, it's human nature. They think I'm not going to I'm not going to bother her. Others will overuse it. And when the moments came where people did overuse it, it was a wake up call for me. I there's this one time in particular. I was on the playground with my two year old and my two month old, and I was answering texts and it was a Saturday, you know, and I wasn't present. I just I simply wasn't present. And my daughter Avery, who's now 11, got hurt and I didn't even know she got hurt because I was on my phone and a father of another kid brought her over to me. And it was a wake up call. How was I going to provide preeminent service but not be available on my phone? But how could I be there when my child is happy and my child is sick and my child is hurt? And it felt like such a dichotomy for me and I couldn't figure it out. So I started thinking, what do I do here? Right? And and I basically started giving them my number and I clearly told them. So I am only available Monday through Friday from 9 to 4. That's when I pick up my kids and I don't see clients on the weekends. So if you send me a message during that time. It may be 24 hours. 48 hours. I will get back to you, but it will be during the next window of time when I have phone hours. And they loved it. I never got anyone to bark. No one ever told me like, I'm not going to stop working with me. And I felt so much better. So these are just two examples at my home and at my work where I figured it out and actually felt better because of it. And I think it's because when we have strong boundaries, when we make our own schedules and we create, we are in the end, we end up creating space for creativity, for health, for passion, right? And then we're creating space for ourselves in relationship to the people that we actually want to care for. I wanted to care for my clients. I wanted to care for myself. I wanted to care for my children. And it wasn't until I could create boundaries that I could do all of those things simultaneously. I think that many of the clients that I talk with about those theaters that I support, you know, they have a negative association with boundaries. And I just think I get that. And it's just such a crazy cultural thing because we may learn how to start our own businesses. We teach our children life skills. I mean, we could become the president of a company, right? But there is no class on how to become a person who prioritizes themselves by setting boundaries and boundaries enable you to walk through life with such a different mindset instead of avoiding people or responsibilities because you're so tired. Right? Which basically is a compensation for people who don't have boundaries is just like utter fatigue. You will see that you clearly determine what you say yes to and what you say no to, and you will be at peace with those decisions. A question that I often find helpful for to ask myself or my clients is what is going to fit on your life plate? There is a finite amount of space and I mean energetic space as well as temporal space on that plate. And I will always prefer to fill mine with healthy food that like provides a sustenance for me versus depleting foods. So what is going to fit on your life plate is a way for me to see that boundary between where the plate ends and where everything else begins. People can't read our minds, and being direct with what you need facilitates closeness. It doesn't push people away. It actually brings them closer to you because instead of having them, guess what you need? Telling them saves time and energy and absolutely brings you closer. 


Lara Desrosiers I love that so much, Lindsay, And I love thinking about kind of self love and the drive to take care of ourselves is kind of the foundation to support connection, right? To support communicating what our limitations are with folks. And, and the fear is often that it will drive disconnection. But it does it truly when people understand us and what we do and don't have the capacity for it eases the relationship in so many ways, doesn't it? 


Lindsey Vestal Yeah, it absolutely does. I mean, that's that's been my experience and I have ups and downs with it. And some days are easier than others because I do believe it's a constant work in progress. But when I can look back to the shoe story or the playground story, it does help recalibrate and help me remember why boundaries matter. And I go, I had success with that right there. Success there. So can I continue to find success with this? And the answer is always yes. 


Lara Desrosiers Yes. Yeah. And then the other beautiful thing, I think from your example of setting those time boundaries with your clients and when you might be available to them is I think it models that the importance of boundaries to them, too. Right. One of the things where we often are wanting to support our clients with is taking care of themselves, taking care of their own nervous systems. And a big piece of that is is helping them find that plate right. That balance that that works for them. And I think modeling that helps, like being really clear about what we have the capacity for and how we can and can't support them. 


Lindsey Vestal I want to share a little bit from that book that I mentioned that I'm reading, and she talks about a list of some areas where self boundaries are helpful. And I'm just going to read that list just because I you know, I gave a couple examples, but I think there's like so many other areas in each of our lives where we could think about maybe like just starting boundaries in one of them so that then we could see and get a little bit of success and go, Wait, this worked? Okay. Are there other areas I want to try this in? So this list says finances time management. Self-care. The treatment you allow from others. Your thoughts? And it says, yes, you can stop talking to yourself in an unkind way, just like you might stop someone else from being mean to you. And then she lists your reactions. And lastly, she talks about the people that you allow in your life. 


Lara Desrosiers Yeah. So I didn't share that. The first time I really learned about boundaries was when I was in school and we had to begin her mental health placements. And one thing that was sort of instilled with us when it came to understanding professional boundaries was that it was kind of like this wall we needed to put up between ourselves and our clients, with the idea being that we needed to sort of protect ourselves, but also not give clients too much personal information about us. So there was this rule around disclosure. And that never really sit well with sat well with me. When I got into my mental health placement and then when I graduated and started working, I started to observe my colleagues with a lot more experience in mental health than I had and could see the clinicians that had these really strict boundaries with their clients. And I see boundaries with more. This idea of a of a wall of what we've learned in the textbooks of what a boundary should look like. Whereas then I saw these other colleagues that were willing to walk alongside and build personal connections with their clients. And I just that resonated with me. That approach resonated with me so much more, and I saw the value and the importance of human connection in terms of the care that we provide people. And so I really struggled with this idea of boundaries through my transition as a new grad into working. What does this mean? I really didn't think the textbook definition jived with me very well, and I dove into one of my first jobs, which was in an intensive outpatient mental health program where we were with folks that were incredibly disenfranchized in a lot of ways for a really long time. And a big part of why our team was so valuable is because we were able to build these human connections with. So I drove right in and I found that's so fulfilling. And then I became a mom. Well, I was in this job and it's so interesting, Lindsay, because I so resonate with this idea of, okay, so after my maternity leave was over and I had to go back to this position, it became very quickly apparent to me that I did not have the capacity to pour all of my empathy and compassion towards these relationships that I was building with my clients. I didn't have enough left for my family. At the end of the day, I found myself being short with them, being irritable with them. I just wasn't able to give them the same connection that I was giving to my clients. So I very, very quickly kind of decided or learned that I couldn't navigate both. And I really needed to find some ways to set boundaries and find this balance, this tricky balance between connecting with our clients and having some healthy boundaries around what I have the capacity for because. We get stretched so thin, right? 


Lindsey Vestal Yeah, So that's so interesting. Lara, I hadn't heard that story before and I didn't realize that we both had had similar experiences of kind of being at our wits end in both important areas of our life, which really became a catalyst for us to go. There's got to be another way. So thank you for sharing that. And I also really loved hearing how like very early on in your career, you kind of felt a disconnect with that kind of more, I guess, rigid approach. And I love that you were able to kind of step in to finding that that rhythm for yourself. By the way, one of the things you said I wanted to say really reminded me of this quiz at the end of the table book that I'm reading, and she's got this really cool quiz where, you know, you can kind of self-assess your own boundaries. And the three types that she mentions are porous, rigid and healthy. And so I just want to bring that out because I think we often maybe think of the of the two or the extremes, you know, of just poor, thin and rigid, but like that or Yeah. Or imagine ourselves being rigid when we're actually being healthy. And so that's like finding that that middle line between. And then one other thing I wanted to say was you and I both had that fatigue, but there are some other signs that she mentions that we need boundaries. So there's a sense of overwhelming being overwhelmed, that there's feeling resentment towards people asking for your help, which I know I have when I was at my bottom, I definitely felt that. 


Lara Desrosiers Ditto. Yeah, 100%. We chose. 


Lindsey Vestal Absolutely. Another one is avoiding phone calls and our interactions with people you think might ask for something. Making comments about helping people and getting nothing in return, feeling burned out frequently, daydreaming about dropping everything and disappearing and hearing yourself. Hearing yourself say things like, I have no time for myself. 


Lara Desrosiers You know? I love that. Those are huge kind of signposts, I think, for us, because I think a lot of learning about boundaries comes from this like trial of error or of finding ourselves in depletion. And then in hindsight, kind of noticing where our boundaries might not be healthy right now. And I, I wonder, I think one of my favorite books where I dove into boundaries a little bit where is Emily Nagorski is burnout. Have you read that one? Yes, I love that one. Yeah, I love her. Period. That one's a great one because they think one of the things that I have learned and I'm trying to do more and more is understand that the my body and my nervous system is such a great source of information about where my boundaries lie, right? Resting and getting curious about when there are uncomfortable sensations coming up. When someone asks me to do things or in a client interaction. Right? If if my spidey sense or my gut is tingling, I really try to get curious about that so that it helps me to now tune in to where are my boundaries here? And we're just so often I think, living in our heads that we don't check in with our bodies enough. And so I often think of the foundation of developing these strong boundaries is really, I'll use Deb Dana's term, befriending our nervous systems. Right. And getting curious about the wisdom that's there. 


Lindsey Vestal Yeah. And then being able to either get, you know, help direct you into where you need to go next in terms of your relationship with this other person or maybe asking yourself, why am I feeling this way? Because very often for me, it's pointing back to something else I need to learn about myself. You know, that at me had nothing to do with the other person at all. But it was like, wow, this was this was something I'm I need to dig into a little bit more and figure out. It's kind of like my next evolvement or my next, like, life lesson, right? 


Lara Desrosiers Yeah. Yeah. 


Lindsey Vestal So speaking of work and trauma informed, which I love that. And you know, I've got the distinct honor of working on the very first Pelvic health Trauma Informed certification with you, Lara, which we're going to be offering January of 2024. I'd love to know, like what are some practical ways that we can establish those healthy and connected boundaries that you're talking about? 


Lara Desrosiers Yeah, I think the the first thing is, is that idea of really befriending our own nervous systems, right. Because when it comes to trauma informed care, one of the things that we know about the experiences of trauma is that they stem from an individual feeling disempowered and disconnected. And so in order to be that source or container to kind of promote healing, we need to. I love the idea of the spectrum of boundaries. From the book you shared, Lindsay, that we need to find this middle ground where we can be flexible to really connect in a human way with our clients, but still be able to contain kind of where we end and they begin. Still be able to tune in to our own bodies and our own nervous systems and give ourselves some space. And so one of the ways I think that can be really helpful to do that, that that I use is having transitional routines. And so when I try to have a bit of self-care or grounding practice between each of my clients, so not only am I working on healthy boundaries within the relationship, but creating a healthy boundary to contain our session together. Does that make sense? 


Lindsey Vestal Absolutely. I want to know more, though. This sounds incredible. 


Lara Desrosiers Yeah. So the the idea with sort of creating a so I now instead of thinking about a boundary as a wall, I think about it as creating safe containers for the different parts of my life and for even the different components or aspects of my day and bookmarking that with kind of a transitional routine like we know sometimes it works really well with our kiddos can be so helpful to employ for us. So when it comes to my clients sessions, one thing that I do is that I find really helpful is to feel the boundaries of my body. So to do like a routine where I'm tapping or rubbing the boundaries of my body before a session with a client just to remind me that I am a distinct being. I can be there. I can hold space for this person, and I am a separate I'm a separate person with my own stuff. And then after this session I depending on what came up, because our nervous systems are inevitably going to be impacted by the people that we work with. That's just the nature of being human. And I sort of tune in to what my body is looking for. I might do a little bit of movement and try and kind of shake it out to be able to kind of book and that session and transition and give my next client a bit of space. And then I love to do that at the end of my day, as I as I come home to to sort of bookend my day and transition to to intentionally be fully present with my family. That's so incredible. I actually do something really simple. Do you do? Yeah. You tell me about it. 


Lindsey Vestal Yeah. So? Well, what in particular I do is definitely was, especially when I was living in Paris. And I know I could have benefit from this in New York City, but I didn't have this tool yet. Is contacting my skin very similar to what you had you had said. But I was taught this by this incredible practitioner, by the name of Galena Denzel. And she basically, before I would go out onto the busy streets, which would often sweep me up and I would often feel like I would I would basically kind of feel or get a sense of what people on the street were, were experiencing. And it would often come in to me. And so basically I would I would put my hands on my skin and I would say everything inside is mine. Everything on the outside is someone else's. And it almost became like a little bit of a of a jacket or a of something that enabled me to realize I didn't have to be so porous, you know. And and I did something similar when I was seeing clients that just wasn't. I didn't have, like, a verbal cue. I did what you did. I would do this sort of tapping. But I found even like walking down the street, sometimes I needed something. And so this practice of the touch with that verbal saying like, really, really helped me. 


Lara Desrosiers I love that so much. I think anything we can do, even just the imagery I find of a container, right, sometimes helps me to sort of be willing to be a bit more open and maybe actually even a bit more porous within my session with a client. But then to sort of close off those pores at the end so that I can. And that might include kind of that practice of shaking it off or being able to allow that experience to move through me before moving on to the next client. I love the idea of a mantra. I think it's all about finding what works for you to be able to create those healthy spaces and that definition that you gave. Like the distance right between. Yourself and the other person so that you can love. Love both. 


Lindsey Vestal Yeah. No, that was I mean, that was that was the general essence of it. And, you know, so you share it a little bit, you know, about that first, that job experience that you had where you weren't quite in alignment. And so I'm curious, in your opinion, Lara, what are we taught about setting boundaries? And in your opinion, does it contradict with what we know about trauma informed care? 


Lara Desrosiers Yeah. And so I think I do think in terms of the lessons and maybe maybe it's shifted. I went to school many, many moons ago and maybe it shifted sense. But in terms of the lessons I was taught around boundaries being more like these walls in school, certainly what I observed kind of going into practice was that when clinicians have these really strict walls and I worked with a few psychiatrists I can think of that had these really strict walls with their clients. The power dynamic difference was just amplified, right? How can we expect our clients to open up and share and trust us if we're not giving a little bit of our human cells to them as well? And how can we expect them to feel safe with us, which is the essence of being trauma informed, right? Is to create this safe relationship and safe environment that supports healing rather than reinforces a sense of being unsafe with with another. And so I think healthy boundaries are critical because we have our own nervous systems. We're human, and we need to know where our boundaries lie or get curious and discover where our boundaries lie. But we need to balance that with with connection. And so for me, what I found was I couldn't I just didn't have enough capacity to be in that intensive outpatient mental health team. I, I knew what the clients on that team needed. They needed those relationships. They needed those long term relationships. They had incredible histories of trauma. And it was a team that would continue to support them in the long run that help them make strides towards meaningful living. But I knew I just didn't have the capacity to be that person at this stage in my life. And so I had to put that first and find something else. And that's actually what prompted me to become interested in maternal health and women's health and pelvic health. But then but I stayed in mental health as well, where I just found a position where I could have more. I could provide people with mental health support and connect with them. But there were clear boundaries about it being really short term support. And within that I create safe relationships. And I think a big part of that is being really transparent from the get go with our clients when it comes to trauma, informed care around what our care is going to look like. And here's where it starts and here's here's where it's going to end. And within that container, we we are really transparent about with folks, we can build a safe and trusting relationship.  


Lindsey Vestal Wow. That is that is absolutely incredible. And I love the way you defined trauma informed work. And in in the book, the book that I'm reading now, you know the set boundaries find peace. It actually like it very much overlaps with what you're saying. So some of the examples that she talks about, about how to set boundaries are to be clear and direct. So she says, like you either are giving a statement of need or request in response to to when you share your boundaries, you're either giving you're telling someone something you need or you're requesting something or you're saying no. And that when we share our feelings, we're not actually communicating a request or an or an action item, right? It's about your response to their action. And the other thing that really hit home for me was that we're not trying to control the other person. And I think that's what sometimes people think boundaries are. So a really beautiful example is let's say you go out with a friend and you have seen perhaps that that they enjoy a couple glasses of wine and that your particular boundary is that just one glass is is what you feel comfortable with. So an example would be saying something like if you have more than one drink, I'm going to call an Uber. Whereas some people might think a boundary is you can't have more than one drink tonight. So one is more of an example of like attempting to control the other person, the other one. It's a request. It's saying if you do this action, this is what my action will be. I, I feel more comfortable calling an Uber. Another example for a client facing would be I answer emails and texts within 48 hours Monday through Friday. Kind of like what I said earlier. If you write me in the off hours, I'll reply during my open hours versus Please don't write me when my window is an open right. So it's about your response to their action versus what you don't want them to do. And I think that also is a, it's it's it that helped me feel kinder about it because it wasn't like I was getting out my whip and telling someone to do something. You know, it was like, actually, this is kind of like where I'm the most comfortable. I remember I where I lived before, before Arizona, I had a neighbor that would stop by like pretty, pretty often, pretty unexpectedly. And I basically I was working from home and I and I really needed that time. And so I in my brain, I was saying, please don't stop by unexpectedly. But instead I reframed it to say, If you stop by unexpectedly, I may not answer the door. Right? 


Lara Desrosiers Yeah. I think one of the other things I love that so much because it, it does it, it communicates to the person what to expect from us, which again, drives connection. Right. It helps to build trust when we can be transparent and clear. The other thing, Lindsey, I've learned that I've noticed in myself as a fellow people pleaser is historically the drive to over explain myself. If I needed to set a boundary right, like if someone were to ask me to go to an event, I felt like I needed to have a reason as to why it was maybe an event that I didn't want to go to. And so then I would come up with a little white lie as to why I couldn't go, or a long winded explanation as to why I couldn't go. And so I forget who told me this, but one thing I started to do was just say, Unfortunately, I don't have the capacity for that right now. I'm being really clear about my boundaries. But acknowledging that sometimes when I get into over explaining things like people don't typically care. They just want to know yes or no. Right. And I think it can be the same for our clients. And the examples you gave about how to set boundaries with our clients. It's like, here's what to expect for me, which is what our clients want to know. They don't need to know necessarily the ins and outs of why our own personal reasons for why we have these these limitations of when and how we can reply. And I find I have to check myself some time. Do I have the urge to over explain? Is this going to be helpful to the client for me to offer an explanation as to why this boundary is in place? Or is it more about me and my guilt? And if it's more about me and my guilt, then I need to put a pin in it and just communicate to them what they need to know that will help them. 


Lindsey Vestal I am so glad you brought this up because I feel like this is something I am still still wrestling with. I definitely always feel like there's a reason I'm supposed to tell them why and I over explain. And so I think there's just something so easeful and beautiful to just say I don't have the capacity for this because you're right, they actually don't don't actually care or want to know or have the time. And here we are like profusely over explaining that one really hits home more for me. 


Lara Desrosiers Yeah. Yeah. It's something I'm still working on, but it it is, I think, helpful. I find that question of is this is this about my guilt or is this is this going to be useful to the other person? It helps to guide. I kind of think. 


Lindsey Vestal Yeah, I'd love to give a little nod to the boundaries categories again, just because I was just thinking like there's even, like I mentioned, like financial and all those other things, but then like in terms of categories. So for instance, the first one I gave was about more family, the, the shoes being off, right? So for family, I like to think about like domestic tasks. So, for instance, my husband Doug, is an amazing cook. I am not. So for the 18 years we've been married, he cooks, I clean. It's. It's very much like we. We know. We know our roles there. The other family category that comes to mind for me as children. So one of the like some of the examples that I think of for boundaries are setting a bedtime for small children, monitoring online or TV usage even you know, interruptions you right So I work from home indefinitely during Covid and maybe even if I have to, you know, record a podcast late at night or do some work or on the weekends, I take momentum calls for O.T. pioneer students, you know, letting them know that these physical spaces are off limits is something that we we talk about. We mentioned for the professional category a little bit already, like emails and text during non-work times, what to do for when you're on vacation, you know, sitting in out of office. And even I think there's a lot to unpack around accepting and doing unpaid work. You know that putting boundaries in place for that, especially if there's any students listening to this call or listening to this episode. And then in terms of personal and. Thinking, like communicating time around exercise or involve volunteer activities or social events or even romantic time with your partner for electronic. I'm thinking like news and social media, you know, being able to clearly, you know, especially I think during Covid, I'm thinking about just like I at some point I couldn't listen to the news anymore. Like that was a boundary of mine. I had to I had to turn it off. And then what we've already been touching on is emotional, which is like the people pleasing. Handling difficult coworkers. And then also, like, rehashing past failures in your mind. You know, that's a boundary that I think we often have to put in place for ourselves as well as like, Wait, I've already been thinking about this over and over again. I'm not making any more progress on this. This is something that I need to find a way to, to tell myself. We no longer need to have these thoughts or I need to journal about them or whatever it is that that you need to do. And then one last quick thought in terms of professional, I just want to mention that at the recent OTS and Public Health Summit, Susie Grantski shared her boundaries form with us. So she works with a lot of clients that have penises and she enters every therapeutic relationship with a boundaries form. So it's a form where she the client signs it, she signs it, they talk about it, and it very much defines her roles and their roles. And she explains it that it's absolutely comforting and beneficial not only for her but for them. And she kindly shared that with with all of us at the summit. And I love that. I love seeing more and more examples specifically in Pelvic health, because all of these things we can read about and be inspired by. And this conversation alone, Lara, is incredibly inspiring for me, but I'm also really thankful for like when we have concrete form, things like this that we can just immediately put into place in our practice so that we can really walk in with confidence to to the person we're treating. 


Lara Desrosiers Yeah. And I think having those templates right and we are going to be providing so many different templates within our, our trauma informed care certification as well that we as clinicians that can take and adapt based on where our boundaries are set in our practice, right and adapt to make it work for us. And it's so helpful to have those templates and discussions with our clients early on and care about this is how I work and this is how how I can support you. And I think one of the reasons for that is that when someone has a trauma history that's related to attachment and relationships in our health care relationships there can come up a lot of push and pull in the in the power dynamic or a lot has if someone one of their protective responses is more kind of that fawning behavior or they're wanting to please you as the clinician, they might take a more passive approach and kind of look to you as your expertise. So one of the things that I include in my contract and discussions with clients from the get go is that my role is to be your guide. You are the expert in your lived experience to really make clear what that dynamic is going to look like so that we can anchor back to it. If some of those protective responses and that back and forth about the power dynamic or frustration perhaps from the client, that you don't have that magic bullet fix for them, you can anchor back to that early discussion around this being a bit of a of a trial and error process and us figuring out together what's going to really have the best impact for you and your symptoms and helping you to move towards your goals. 


Lindsey Vestal I am so excited about those forms. And even, you know, we meet a lot during the trauma informed certification and we're going to be doing a lot of role playing and discussions. And I absolutely think that boundary setting and setting that example is so beneficial for both us and our client. First of all, the example you just gave around being able to refer back to that, I think that as people pleasers, which many of us are being able to refer back to that is. Is really it gives us that confidence that we often need to be able to to clearly reinstate that. And so just walking in with that is is to me so much clarity. And then the second thing is I definitely believe that the modeling that we're able to provide by by structuring our sessions with these boundaries are so beneficial. I know myself, I learn so much better by example versus being taught something or told something. And so when someone that I'm working with and I'll be very transparent and say that. Lara you absolutely, absolutely do this in your own life, I mean, I've had the privilege of working I mean, I think over a year now on this certification with you and you are so clear with me and so just kind and direct around when you do need some space or you do have the capacity or that you don't. And that gives me the confidence to continue to to share that back with you. But that also ripples over into other areas of my life because when you can see the grace that it can be done with and how I felt closer to you every time you did that, it was a living proof to me how how effective and beautiful it can be. 


Lara Desrosiers Yeah. Thanks for sharing that. Lindsey and I felt the same with you. Certainly. And I love bringing it back to how that can drive connection, right when we're really clear and transparent at it supports rather than separates us from people and helps us to create that those safe relationships with folks. Thank you for tying it back to that. I think it's so important. 


Lindsey Vestal Or is there anything else that you want to for me to ask you or for us to chat about on this podcast? 


Lara Desrosiers So one question I think that comes up quite a lot, Lindsey, when folks talk about boundaries and trauma, informed care is what do we do when our clients are feeling really heightened or overwhelmed in session with us? And that leads to kind of us starting to feel really heightened and overwhelmed alongside that. Do you have any strategies for how you have navigated that? 


Lindsey Vestal That definitely happens to me. That is that is a fairly common occurrence for me, just because I tend to really kind of feel or meet the energy of the of the person that I'm with. And I think for me, I actually do something that Marty Smith talked about in her keynote address at the TS and Public Health Summit, which is essentially when I feel that happening or when I witness it happening, and then I feel myself matching that energy. So let's say it's an upregulated energy and this person is, is, you know, getting getting quite anxious or nervous or feeling really tense. And I can feel myself meeting that energy. I don't make any apologies around letting them know that I need a moment to downregulate that I and I actually articulate what it is I'm feeling because in my system, really trying to build into reception and what it is being able to recognize when your body is giving you those signals. And I think a lot of our clients, a lot of my clients have a challenge with picking up on that and detecting it early. And I find that when they can build that sense, that's a game changer. So I actually stop and I articulate what I'm experiencing and what I'm feeling and tell tell them that one of my favorite tools is and for this example, I'll say extended exhalation. So I will visibly take a moment and I will do a minute or so of expanded exhalation. So my exhale is longer than my inhale just to regulate myself. And then I'll check back in with them and I'll say, you know, how are how are you feeling? What are you noticing in your body? And that is essentially like in so I'm modeling, but I'm also what Marty Smith talked about, which was not meeting the energy. Right? So if they need help, if they if they need some downregulation coming into that session with it. And so instead of doing it covertly or excusing myself or going to the bathroom or maybe just doing the breath under under while the conversation is happening, I actually verbalize what I'm experiencing as a way to also potentially ask them to prompt and check in with what they've got going on. 


Lara Desrosiers I love that so much. And I think it's like you're mirroring your mirror. You're giving them the gift of being able to mirror them where they are, which I think Marty talks about, like helping people to feel seen and heard. Right. When we can meet them where they are. And you're also giving them language, right? Like to add in some ideas to see when we can meet them with that energy and give language to how it sits in our bodies and our nervous systems. We are prompting them to check in and helping them to build the skill, to check in with themselves as well. But I think what you're also doing with that strategy, Lindsay, that I that I think is so beautiful is you are putting kind of giving them a container, right? Like it sort of interrupts the spiral and helps to kind of contain it and get grounded with some so that we can then kind of decide together how how we want to proceed with the time that we have or what will be most helpful. Right. 


Lindsey Vestal That's incredible. Yeah. Yeah, I love that. I'm curious, do you have any strategies that you really like to do, Lara, in those situations? 


Lara Desrosiers Yeah, very similar. I really love that transparency. And so this can be, I think what you described, Lindsay, can also be really helpful when it comes to trauma disclosures. Like if our clients are telling us about their birth experience, if we can monitor kind of their capacity to stay present as they're sharing their birth experience, we can sort of monitor for if if they're becoming kind of get overwhelmed by it and gently kind of press pause and validate like it sounds like this was an incredibly overwhelming experience for you and do what you just said, Lindsay, of kind of being transparent around feeling the experience from what they're describing and invite them to just press pause from that for a second so that it doesn't become incredibly overwhelming. Right. And then one thing that I find that can sometimes be helpful is is checking in with the person around. And I wonder if going into all of the details of what that was like for you, would that be helpful right now? Or what about the experience? Do you really need me to understand you don't feel the need to share all of the details, but they do have the opportunity to share what's really important to them about what what they want you to understand about what that experience was like for them. 


Lindsey Vestal That's so beautiful. I love that. Lara, this has been such a wonderful conversation where we went back and forth between our own personal experiences and growth, as well as bringing into our clinic setting. And I just got to tell you, I am beyond thrilled to be able to offer this certification out there into the world. I know that we are going to learn so much from the students that we are have created this for. And I'm just excited to be able to bring these trauma informed this concrete information and a trauma informed lens and perspective into the Pelvic health world. So thank you for the opportunity to work alongside you and to birth this together. 


Lara Desrosiers Yes, I'm just so honored and excited myself. Lindsey I can't wait. I always love these conversations and I can't wait to continue digging deeper into this with our students as well. I agree with you. They're going to be just such a wonderful source of wisdom as well. 


Lindsey Vestal Amazing. Thank you, Lara. I look forward to talking to you again soon. 


Lara Desrosiers Take care, Lindsay. 


Outro Thanks for listening to another episode of OTs and Pelvic health. If you haven't already, hop on to Facebook and join my group OTs for Pelvic health, where we have thousands of OTs at all stages of their pelvic health career journey. This is such an incredibly supportive community where I go live each and every week. If you love this episode, please take a screenshot of this episode on your phone and posted to IG Facebook or wherever you post your stuff and be sure to tag me and let me know why you like this episode. This will help me to create in the future what you want to hear more of. Thanks again for listening to the OTs and Pelvic healtOTh podcast. 



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Lindsey Vestal

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