When a Client Rebounds After a Session

• Lindsey and Lara Desrosier's Trauma Informed Certification Communication List
• Lindsey's OTs in Pelvic Health Facebook group (where OT Empower Hour replays are)

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Transcript

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 O.T. 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 I was thinking about what I would have loved to have listened to my first couple of years in practice as a pelvic floor occupational therapist. And honestly, I don't think I've ever heard anyone roleplay the interaction between a client and a therapist. And I thought, how much fun would this be? I want to lean into a topic that's a bit challenging that I don't think we talk about enough, and that is rebound. And so I partnered up with Lara Desrosiers, a an incredible occupational therapist out of Canada, and we decided to role play for my OTS and Pelvic health Facebook community. We have close to 5000 notes on there that are so curious and so supportive and always want to find a way to up their game to be the best practitioner they can be. And I just love that. I just love that it inspires me every single day. So I went to LA and I was like, Let's do some roleplaying around rebound. And so that's what you're going to listen to in today's episode, I'm going to be the client, and Lara is my pelvic flair for occupational therapist, and I'm essentially coming to her, sharing with her that I had some tension, some increased tension after our last session together. So we did some manual therapy work together, did lots of education. I experienced as the client a protective response, and it was a flare up that scared me as a client. And so that's the stage that I want to set for you. And what you're going to segway now is into this role playing. I apologize if the sound isn't as good as it usually is. I extracted this from our own power hour, but I just felt it was so valuable and I heard from so many on our Facebook group. I just like how interesting it was to be a fly on the wall, listening to an interaction between an attorney and a client who says, I basically had a flare up and it scared me and I wasn't sure what to do. So Lara has some incredible, incredible follow up exercises and tools that she leads me through as the clients. And yeah, I can't wait for you to hear it. This lens appeals to you if you like this sort of consent driven, trauma informed perspective that really puts the client in the driver's seat. I hope you'll consider getting on the communication list for Lara and I's upcoming trauma informed certification. It is the first trauma informed certification in Pelvic health. And I have to tell you, I think it's about time. And of course, it's occupational therapy lead. All right. Let's dive into the conversation between Lara and I as the client and the therapist. 

Lara Desrosiers Hey, Lindsey, It's good to see you again. 

Lindsey Vestal Yeah, yeah, it's great. It's good to see you, too. I had a little bit of trouble. Yeah, go ahead. Please, go ahead. I was. I'm sure I was about to answer your question. 

Lara Desrosiers Yeah, that's exactly it. I just wanted to check in and see how things have been and how you felt since our last session. 

Lindsey Vestal Yeah, it was so interesting. Like, I. You know, we did. We did some hands on work together and initially, like, so I went on the subway home and right when I sat on the seat of the subway, like I felt contact with the seat in a way I've never felt before. Like I actually like, you know, we talked about Sitz bones last time and kind of like how the pelvic floor muscles are in there. And I like actually felt for the first time, like I wasn't sitting on a wreck, like I really felt that. And then, you know, I had to go. I had to go because I had a really important court date that I was heading off to. So I get to the courtroom. And Lara, I was so I was so I was so struck that like actually during the courtroom session and after I had more pain than I had had before. And I started wondering, you know, like, did I do something wrong? Like I was thinking about that subway seat show. I have not sat down. You know, my brain started going to all these places. But it was really weird because I went from feeling like quite open in and like in present with my body to, to then feeling really tense and quite, quite scared. 

Lara Desrosiers Right. Yeah. Fair. I appreciate you coming back and, and sharing all of that with me. Lindsey And I'd love to just ask you a few more questions, if that's okay. Just sense what that experience was like for you so we can decide together what direction we want to take you with the session. Can you tell me a little bit more about where. And you sat down on that subway and could feel that different sensation of what that felt like for you. What was that like for you? What did that feel like physically, emotionally? 

Lindsey Vestal I mean, to be honest with you, this is going to sound really weird, but it was kind of scary. You know, like I. Wow, this is good. This is progress. I'm feeling the seat for the first time. It's not like numb or detached, but at the same time, I was like, so I want to feel to see like, you know, like I knew it was progress, but some other part of my brain wasn't sure. 

Lara Desrosiers Right. Yeah. Yeah, I think that's totally fair. So it sounds like there's this there was this combination of a sense of accomplishment. Okay, we're making progress here. Things are moving forward, but also, like a little bit of vulnerability, almost like a little bit scary in terms of a good word for it. Okay. So in terms of feeling like your body didn't have the attention that it's used to having, it's unfamiliar and uncomfortable. 

Lindsey Vestal I was used to that, like keeping things together for me. And now all of a sudden, I wasn't sure if I could keep it together anymore.

Lara Desrosiers it sounds like. So from there, you went off to the courtroom. Can you tell me a little bit about, like moving into the courtroom? Where was your focus? Where was your attention and where were you at in terms of your your nervous system? We've talked a little bit about the nervous system. Where were you at? 

Lindsey Vestal Well, based on what you what we talked about last time, like, I was definitely really scared. This is a case that's very precarious. And to be honest with you, like I don't have a handle on it. I'm supporting my client the best I can. But honestly, it's ever evolving and I'm not quite sure we're going to win this case. So I was at very high levels of tension and anticipation for for what was going to happen in today's session. 

Lara Desrosiers Right. And and then you notice the tension and the pain flare up in the courtroom is that when it started to flare up for you again. 

Lindsey Vestal Is so weird. It was literally the moment I stepped foot in the courtroom. 

Lara Desrosiers Okay. Okay. And then. Emotionally, how did that feel for you when the tension flared up in the courtroom? 

Lindsey Vestal Well, part of it was like, like this is actually what I'm used to between my sits. Bones, you know, is a bit of familiar territory compared to what I was feeling when I was at the subway. But at the same time I was like, am I almost felt like I needed to to kind of curl up because it was so intense and I couldn't hear. I am, you know, having to to represent my client. And that wasn't an option for me. So it was this back and forth between feeling familiar, but wondering like, was this going to become unfamiliar in the opposite direction? Was it going to be more painful? 

Lara Desrosiers Right. So there's a little bit of that fear that it's escalating more than it was even before we had our last session together. And I think I heard from you, correct me if I'm wrong, when you were first sharing this experience with me, a little bit of like frustration, right? Like this. We're making progress and then this. Is that fair to say? 

Lindsey Vestal 100%, yes. 

Lara Desrosiers Okay. So I'm curious, based on some of the conversations we've been having about the pelvic floor tension, the connections with the nervous system, do you have any hypotheses or any ideas around what might have been going on for you through that whole experience? 

Lindsey Vestal Yeah. I mean, if I had to guess, I would say that maybe, you know, like we, we opened up some things and so I was feeling more of my the support system that I had sitting on that subway seat than at the same time. That's not support I'm used to. So maybe, maybe that's where I felt a little bit unsure about this new this new sensation. And then I, I really just went right into work. Right. And very tense case. So, I mean, my guess is, like you told me how the nervous system is connected to, to feeling safe down there. And so my guess is like because I wasn't sure of the way I was going to be able to represent my client, that like that openness that we found maybe did it close back up. 

Lara Desrosiers Yeah. I'm wondering if if maybe a piece of the puzzle is going right into like something really intense, ramping up the tension again. I'm also wondering, Lindsey, if that that vulnerability, as you described it, that's a piece of the puzzle to that that isn't quite feeling as safe and comfortable for you just yet. So maybe maybe working a little bit around that that sense of safety with this new sensation that you haven't had before, right around around finding some length in your pelvic floor muscles, I'm wondering if you'd be willing to do a little experiment with me with that. Sure. 

Lindsey Vestal Yes, of course. 

Lara Desrosiers See if this will help us wrap our head around some of the options we could have moving forward to support you with continuing to make progress. We're finding that length, but it sounds like also we need to focus of attention on starting to feel safe with that letting go of tension. Is that fair to say? Yes. Yeah. Okay. So I'm going to invite you to make a fist with one hand, make a really tight fist. So we've talked quite a bit about how the pelvic floor muscles really tense up when we're feeling threatened or when we're in that really go, go, go stage. The pelvic floor muscles tend to really tense. And based on our past experiences too, this is a really protective response right to to tense up. So we're going to imagine this closed fist is our pelvic floor muscles that are protecting us and keeping us safe. Now, what I'm going to ask you to do is with your other hand, staying with the experiment, try to open your fist. Try and see. If you can imagine that the job of this other hand is to get that fast open. But in staying closed. This fists are pelvic floor muscles is trying to take care of our safety. Notice. What happens is you're engaging in this experiment in your breath and in your body. As you're trying to get that fist open. I wasn't breathing. Okay? All right. I want you to shake that out. Should that part of the experiment experiment out? And we invite you to do the same thing. We're going to take that first. In a close. A tight. It's there to protect us. Now I'm going to invite you with your other hand to see if we can bring a kind, loving, curious attention to that hand. And when you're ready. Place, that hand underneath that closed fist. It's holding it lightly. Seeing if you can communicate. With your touch. Something to the effect of Good job. Or. Thank you. Thank you for protecting me. Thank you for keeping me safe. I'm here for you. I'm here with you. And just being with this experiment, notice what that feels like for you and your body. In your breath. In the first. Take a moment just to notice the impact of that. Compassionate hand. And when you're ready. Shake it out again. Right. Can take a couple more moments to just notice that. Notice the impact, the difference that those two experience. I'm curious what that was like for you and what you noticed with those two different experiences. 

Lindsey Vestal So with the first one, not only did I hold my breath, but I felt so much tension in my neck and in my shoulders and in my chest. And actually, I did feel my jaw like we talked about last time. And my pelvic floor might get even, even tighter. Almost like to brace an impact or something. And when you walked me through the second exercise, I actually dropped a chair and just felt. Felt like maybe if I hadn't rushed to that courtroom and actually held myself, instead of trying to pry myself into that next part of my day, that maybe maybe I could have appreciated it and savored and even breathed even more and maybe even expanded our work even more. I had had had that compassion, compassion for myself because that was a really great exercise, like just thinking about how to approach and experience that tension in my body. And I think sometimes the way that my background is, I just want to pry it open. I just want to get to the other side of it. So yeah, it was it was a really good contrast for me. 

Lara Desrosiers I mean, I don't think you're alone in that. I think it's very human, right? And even me, I find in our work together, I want to support you with achieving your goals. Right? I want to help you find a way to relax those muscles so that it's not impacting you quite so much. But maybe this is a really good reminder for us that we need to maybe shift how we're approaching this a little bit so that we can slow down a bit. And so we've got a couple of options as to how we can move forward. I really like what you're saying. I think there's so much wisdom there. Maybe a really great strategy we can experiment with is looking at how we're scheduling our appointments to make sure you've got that time and space to really sit with that new sensation and take care of your nervous system through that new experience. I mean, I think that's a fabulous idea that we can we can start with right away. And I want to leave some other choices up to you in terms of how we spend today. We could put a pin in some of the manual work for now and really focus on giving you some tools and strategies to take care of your nervous system from this more compassionate lens so that you and to manage kind of that frustration that might creep up as you ebb and flow and have flare ups from time to time. So we could really focus our attention on caring for your nervous system and building up some strategies for you there. We could come back to the manual work also, if that's really what you're wanting to do and see if we can take just a bit of a slower approach to it, trying to bring in this gentle, compassionate hand to be a little bit more present through the experience instead of trying to force those muscles to relax, let's take a curious approach to it and slow down and see how it's feeling for you throughout. What are you feeling like? Are you feeling like you want to move forward with some of that manual work today or put a pin in it for now? 

Lindsey Vestal Well, I am meeting with that client after today's session, so is there any way we could use some some non hands on work today? And then what I'll do is is schedule my next to point with you to where I have some space where I can I can hold my do myself a little bit more compassionately and kind of see see how that's different than what we've been doing. 

Lara Desrosiers Yeah, I think that's a great idea. So today we'll, we'll just chat, we'll chat a little bit more about some of those strategies that you can care for your nervous system, maybe see if we can build up a toolbox of, of things you can do when you notice those flare ups happen. 

Lindsey Vestal That sounds great. Lara, thank you so much. 

Lara Desrosiers My pleasure. Awesome. That was so much fun. Yeah, I enjoyed that. 

Lindsey Vestal Lexi said that she really loved the the closed hand experiment. She said, what a beautiful way to make something abstract, more concrete and relatable for our clients. Right? Because I think this idea of there even being tension in our pelvic floor is eye opening. And again, it's as you as Lexi said, it's a it's an abstract part of the body. So, I mean and I don't I don't know about you. I'd love to hear. Jess said she's so her heart is so full after this role play. She's excited for the training this. 

Lara Desrosiers Both this this more. 

Lindsey Vestal This is in store but but I mean I'd love to hear Jess Lexie anyone joining make if you had the profound experience I did because I really that was a genuine tear that that dropped down. And of course it was my own story of my recent back injury. And it was also just thinking about all of my, my past clients and how we can do so right by them and empower them so much with these simple, simple yet but not. What was the quote. 

Lara Desrosiers Lara Yes, I just think it's for you. It's trying to remember. It's simple but not insignificant, really. An impactful, simple but not insignificant. 

Lindsey Vestal We had this conversation. You. Yesterday about this quote and I forgot it yesterday. So thank you for Bridget that that this work is is simple sometimes, but definitely not insignificant. And what a beautiful shift that you were able to to demonstrate for us in this role played together. So that was so much fun. Well. 

Lara Desrosiers I first encountered that practice, I'll say, from David, 11, who wrote a wonderful book about trauma informed mindfulness practicing. And so I took a course that he was a guest instructor in, and he put us through that exercise. And I had a very profound reaction to it as well. Yeah. And what I noticed for me and I still notice every time I do it is that, that that's protecting hand really just sort of softens when I bring that compassionate hand to it, which is really cool, right? Versus trying to pry open and it wants to tighten up even more. It's a great analogy and I really love that practice. 

Lindsey Vestal I'm Well, thank you so much, Lara, for for today and for everybody who joined us. If you feel comfortable, let us know what your experience was with that amazing exercise that Lara walks us through. 

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 health podcast.