Trauma-Informed Is Not a Protocol: It’s a Lens

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Transcript

Lindsey Vestal

Welcome Brooke to the OTs and Pelvic Health Podcast. I'm so excited to have this conversation with you today.

Brooke

Thank you. It's absolutely an honor to be here. Been a fan for years of listening to the podcast.

Lindsey Vestal

Thank you so much. I really appreciate that. I want to start off with something super exciting, which is the fact that you did some advocacy recently, which landed you into being the first OT in your department. You currently work at Urology Austin. Congratulations. And tell us a little bit about how that came to be.

Brooke

Thank you very much. Yeah, I went into OT school knowing that I was going to work in pelvic health. I didn't know how. I didn't know when, but I knew I would make it happen.

And when I was in the capstone phase of my doctoral program, I was partnered with Urology Austin, and the director there brought me on as her mentor and and trained me like she would train any other PT student honestly, so I completed my my capstone work there, and then I was hired afterwards, and I went straight in after I graduated as as the first O.T.

Lindsey Vestal

Oh my goodness. That is phenomenal. I very much can relate. I also went into OT school knowing that I wanted to do pelvic health. so that is just music to my ears. Congratulations on that. And hopefully I have no doubt they're going to want to hire and just staff it with a ton more OTs.

Brooke

Oh, absolutely. We already have one more and we are, you know, obviously always looking to bring on more as we move forward.

Lindsey Vestal

Oh, that's fantastic. I love that. Okay. So the other conversation I was really excited to have with you today, Brooke, is that you recently graduated from the level two trauma-informed pelvic health practitioner program.

And you shared a case study with us, you know, as part of you know, the getting the certification, you have to submit a case study. You were also, though, you took that one step further and you actually shared your case with us during our graduation call. And your so much of your story and your experience and your approach really resonated with Lara and I. and I'd love to know if you don't mind sharing a little bit with everyone here on our podcast about this case study, about this client, including kind of like what stood out to you about this client when he first came in.

Brooke

Yeah, I had shared an initial evaluation experience that I had with a client about approximately 30 year old man being referred to me for unspecified pelvic pain.

And I had in my initial chart review, I remember looking through, you know, I have access to doctor visits, notes, tests, results, et cetera.

And as I'm preparing for the day, I note some things that stand out to me, like the sudden onset of symptoms, the severity of symptoms. Again, I'm just reading through documentation. I haven't even met this client yet.

But the onset of symptoms, the extensive amount of testing that he had gone through, I looked at that and of course I don't automatically make assumptions reading someone's chart of, oh, this person must have trauma or must be traumatized by this. But instead I look at it as, okay, this is objectively a lot for someone to go through and I know I need to approach this as I would with any client through a trauma-informed lens, understanding that, 

Hey you know Medical events, diagnoses, pelvic pain itself can be traumatizing to a nervous system. But again, and don't go into session assuming someone actually has trauma ingrained, but acknowledging that could be.

And I need to support my role of supporting them and keeping an eye on their nervous system and how it how they respond in session and being mindful of language. But initially, when I started my session with this client, he did present to me.

The body language is was obviously uncomfortable. I would even go and say distressed, honestly, to be there in the treatment room with me. Initially, he was withdrawn.

Body language that I'm looking at is no eye contact, head forward, slunched over. And throughout the session, noticed we weren't really having a true conversation right

Lindsey Vestal

Yeah, yeah. I think that um it is so important to pick up on these cues as a trauma-informed provider. And as you said, you did the chart review. You certainly were aware of his background, but then the person in front of you really shaped what you did next.

And so, one of the things that really stood out to me when you presented your case study our graduation was you talked about mirroring his language and watching his body language closely. Would you mind walking us through what that really, what that looked like? You know, I'd love to demystify this to anyone listening who isn't quite sure or completely comfortable with how to do it themselves.

Brooke

Yeah, so typically, you know, but before the training that we went through and and furthering my trauma-informed care lens, I would have approached my subjective intake with my questioning in almost like a protocol sense. Like, okay, I need to ask these questions and I need to use the language that I am trained to use. So what happened in session when I was asking about the the nature of symptoms and the regions of pain I noted that the client was evasive and hesitant to explain where pain was coming from. And I had thought, you know, okay, let me just use my anatomical terms because that's the most professional thing. 

But I had noticed that the language I was using in my questions was making him increasingly uncomfortable, going from a withdrawn state to almost fidgeting and rocking back and forth like self-soothing. And I immediately stopped myself and thought, I am making this person uncomfortable or this person is having a response to what I am asking.

So I need to pause here. And I was picking up that the language I use, the anatomical terms, were making him uncomfortable. So what I did was I decided to use the words that he chose to describe his body with. So instead of my agenda of how I need to talk about body parts and symptoms, let me shift to how is he describing his body?

Because that's where we're going to meet. We have to meet them where they are comfortable and support further disclosure and talking to each other. So in that way, mirroring his language, literally just using how he was describing himself in my conversation and my questions.

Lindsey Vestal

So beautiful. And, you know, if people listening, it may sound really simple, but I think you actually queued it up really well in the sense that you said, well, this is language that I'm familiar with as a trained professional.

It makes me look more professional. It's vocabulary that my mentors have used. It's something you may go back to a colleague and yeah and and the thing is you you knew in that moment that you didn't need to prove anything. You didn't have to be the expert in the room.

You just knew and saw so visibly. You were so attuned and you used co-regulation to really pick up on that. And it's a brave moment to be able to go, all right, I'm going to use this person's language. And when you did, what happened?

Brooke

You know what? Within a few sentences exchanged, I noticed a huge change in body language. So a drop in the shoulders, starting to make eye contact, even shifting body language to be oriented towards me versus away from me.

Lindsey Vestal

That's huge. It is absolutely huge. Amazing. Another question that I think a lot of people may have is,can you tell us a little bit about how you knew when to pause, when you knew to respond, when you knew just to sit in silence? Because I think in our society, we're really conditioned to think that silence is awkward and that we're always supposed to fill this space. particularly when we're in a role of quote unquote, hosting someone, being the professional that they're paying to see. Can you tell us a little bit about how you know when to do these things, pause, respond, and potentially just sit in silence?

Brooke

I like that you have pointed out that we think silence is awkward. And that's it totally is. So I've been working on challenging myself of sitting in the awkward. Because when you sit there in silence after someone tells you something about themselves, whether it's a true adverse experience or a traumatic event, or they're telling you something that clearly is is important or meaningful to them,I had learned that being silent sitting in the awkward ends up not being awkward because you're quite literally leaving room for someone to share further thoughts about it and that was absolutely, that was a principle that was brought up throughout our course and i think it helped me continue utilizing that in session. and So essentially if someone discloses something about themselves, sitting in the silence is the go-to.

And it does make me think about just whether or not you're someone who understands what the trauma-informed care lens is. Just think about conversationally. Imagine when you tell someone something that bothers you or is that upsetting.

Do you want them to immediately respond with a, oh, well have you tried this? Or or you know a response of them trying to fix. No one likes to hear that. We just want to be heard, right?

And something, internal dialogue that goes through my mind and someone discloses a traumatic event or an adverse experience is listen and and don't fix, right? We don't fix things. We facilitate.

And listening is therapeutic on its own.

Lindsey Vestal

and percent And I don't know about your experience, Brooke, but I find that when we do kind of sit in that silence, it allows the client to sometimes reflect in a way they haven't been asked to before.

And they often generate a response, an idea that's going to be so much more fruitful than anything as the facilitator can come up with. Because It's authentic to them, even something as simple as when do you think you'll be able to make time for some of the practices we've discussed today.

You know, not letting that be something that is automatic or assumed that the client can figure that out. I find that just kind of asking some of those questions and allowing them to even imagine themselves doing it in their own home. at the time and place that they choose is something that is so, such an underutilized art to therapy. And I think it's those silent moments when a lot of that comes out. So I applaud you for that. Being full aware of how quiet can be awkward, but also understanding the therapeutic value in it is huge.

So one of the other things that you shared with us, which I was so impressed with, is that you created a somatic practice on the spot with this client. And I'm so curious, was there any framing from your training, any frameworks from your training, any other life experiences that really helped you feel confident and improvising in the moment?

Brooke

What I wanted to do for our treatment session with that client was I wanted to help support this person get into a more regulated state right because I had watched this wave of what I perceived as hyper and hypo arousal, but we weren't within that window of tolerance. And of course, those are all principles which I felt confident in even perceiving or understanding from our program, for sure. 

But I had introduced the diaphragmatic breathing plus kind of my own version of progressive muscle relaxation or distal to proximal relaxation.

My intention was to get that parasympathetic side of the nervous system activated. And to create a sense of safety in the body. I think that was the biggest thing. Because here was someone in front of me who is not feeling safe in their body. They have described a lifelong sensation of tension. Maybe not pain, but tension in the pelvic region. That's not someone who feels safe.

Safe or comfortable in their body. So using the somatic lens of let's bring some awareness from the bottom up, right, versus top down, like let's move the body, let's bring awareness in to feel, what do I feel here? And what amount of tension can we release potentially?

Lindsey Vestal

So fantastic. I love that. I love that you took, I love that you combined the things in the moment. You're clearly a very intuitive person. And i think that that type of improvisation is so client centered and so lovely. So I am so proud and impressed with that.

Brooke

Appreciate it

Lindsey Vestal

I'm curious, there was a moment when your client turned to you and said, you seem safe. What did that mean for you as a therapist?

Brooke

First of all, that meant, that means everything to hear, right? But um specifically that that signaled to me that we achieved a safe space for disclosure.

Because he said, he had mentioned this to me second before describing adverse experiences in early life, which he thinks, you know, it is a part of his story, part of the nervous system, which absolutely is. And I so much appreciate clients who share things with me that are hard to talk about because they're coming from a place of knowing, hey, I think that this person's here to help me. and I think she needs to know this because it's a part of me.

But Anyways, it it did signal we've created a safe space and rapport and trust.

Lindsey Vestal

What do you think helped build that sense of safety in a relatively short amount of time?

Brooke

I honestly, I think it was sitting back and leaving space, like our, you know, not jumping to respond. when someone discloses a traumatic experience, not changing the subject or being uncomfortable. and that does involve the self-regulating strategies on the side of the therapist, right?

That means that I need to, when someone is speaking to me, I need to make sure that I'm not tense. I'm matching my breathing with theirs, which is that co-regulation that you spoke of earlier is I need to be a calm nervous system to facilitate someone else's.

Lindsey Vestal

Yeah. Is there anything else about this client or this experience that you really were hoping to share today

Brooke

Yeah, I would like to share a big takeaway is that the sense of safety in the nervous system and being attentive or aware of someone's nervous system states needs to happen to create a foundation for healing.

And in that way, we want to help support our clients to be in a regulated state because that's truly that is the foundation for moving forward. And it makes me think about all of the different interventions, hands-on exercise, et cetera, that we can throw at someone that we can go through. But that might not be enough if we haven't paid attention to someone's nervous system. So it was a reminder of this is the groundwork for what we will do in the future to promote healing.

Lindsey Vestal

Could not agree with you more. I think that was so perfectly said. Amazing. That was such a pleasure to not only support you through the program, but to hear you speak at our graduation, to hear you share your experiences now. I admire so much the type of therapist that you are continuing to become and really like such an honor for Lara and I to to witness and to support you and to be a part of this journey. So keep that advocating, all the advocacy that you're doing for our profession and for your clients on their behalf. It's was such a joy getting to speak with you today.

Brooke

Yes, I'm so thrilled to be here. I appreciate you and everything you both put together to train therapists. And I do want to say that not only are you both through this program affecting the lives of of all these therapists that go through the training, but you're touching the lives of like thousands of clients who then come in contact with us. That is so important.

Lindsey Vestal

Thank you. As you had said earlier, that means everything. That means everything to me. So such an absolute pleasure. Thank you so much today for being with us, Brooke.

Brooke

Thank you, Lindsay.