S2 E3: The Cost of Doing Business in High Stress Environments

CASAT Podcast Network

Welcome to season two of CASAT Conversations.

I am your host, Heather Haslem.

This season, we will explore the timely and complex topic of resilience for health care providers.

Within each conversation, you will hear from experts, clinicians and providers who will explore and share the latest research best practices and applications for how to be resilient.

Please enjoy today’s conversation.

We are so excited to have Kathy Kain here with us today.

Kathy has practiced and top body work and trauma recovery skills for over 40 years.

She teaches in Europe, Australia, Canada, and throughout the United States.

Kathy’s trainings cover various interwoven focus areas, including trauma recovery, somatic touch, self-regulation skills, and resilience.

These focus areas ultimately weave together into a unified somatic approach to touch, awareness, and relationship.

Her educational approach encourages students to engage an ongoing practice that deepens their skills and expertise as they gradually embody the work and make it their own.

Kathy has developed her Touch Skills Training for Trauma Therapists as a way to support professionals in more fully integrating a somatic and touch-oriented approach in their practices.

She also co-created the Somatic Resilience and Regulation: Early Trauma training program with Stephen J. Terrell, which was the basis of their book together, Nurturing Resilience: Helping Clients Move Forward from Developmental Trauma.

In addition, Kathy is a senior trainer in the somatic experience training program and was a senior trainer for 12 years in the somatic psychotherapy training program based in Sydney, Australia.

In addition to nurturing resilience, Kathy has co-authored the The Tao of Trauma: A Practitioner’s Guide for Integrating Five Element Theory and Trauma Treatment, as well as Ortho-Bionomy; A Practical Manual.

Welcome Kathy, we are so excited to have you here today.

I’m happy to be here looking forward to our cat.

So as we dive in, I’d love to hear How did you get into this work?

Well, as is true for a lot of people, I originally got into this work because of my own, um, issues in the beginning place.

It was because I injured my back and I was in the middle of my final exams in college and could barely sit still.

So I went to somebody to get some treatment for my back and that got me interested in First of all kind of maintenance for myself, but then evolving into Oh, maybe this is a way I could be helpful to other people.

And then I just got carried away and never stopped.

And here I am.

So it started like that at the very beginning.

That’s great.

It sounds like you just fell in love with it, and it became a part of who you are today.

Well, And then, of course, what happens for many of us is we meet people along the way.

That sort of redirect what we’re doing.

And that’s a piece of what we’ll be talking about today is how all these things started stacking up to be the equivalent of how you become an educator of different types of professionals.

Wonderful.

Well, let’s get started For anyone who may not be familiar with the somatic approach, can you please describe what it is for us?

Well, basically, it’s including the body and how we’re considering what’s happening for the person overall, including what might be happening emotionally psychologically.

Uh, so really, that’s what the term means is, including the SoMa meaning at not just the physical mechanical aspects of the body, but also the ways in which our body is another version of an instrument and responds to what’s happening for us emotionally and psychologically.

So we’re just being including it.

Sometimes that means including it directly with the use of touch.

But many schematically oriented practitioners don’t use touch in their practices, but there, including awareness and referencing back to the body as a source of information for us, a source of responsiveness and a source of change.

So that’s really how we consider a somatic approach that’s so cool.

I’m always struck by how, in our health care system, how non integrated Sometimes it is in, You know, we have clinicians who focus on psychological health and focus on the mind and our mental wellbeing.

We have doctors, nurse practitioners, PhDs who are focused on the body, and then they hone in on their specialty, say, a nephrologist on the kidneys, right.

But we are this whole large system that’s connected and how our experiences everyday impact our whole system.

So I love hearing about this, and to a degree there’s a practical reason for that, because how many years does it take to learn any one of those areas of focus.

So by splitting the professions, so to speak, we can focus in in a deep way in some of these elements.

But if we keep that split in how we’re thinking of the human being, it creates a division that is artificial for each of the individuals that we’re working with, where we are not living our lives separately, emotionally, separately, psychologically, separately.

Physically, it’s all of a piece.

So that is the problem that can happen with that division of care is we start considering these things as siloed and separate from each other when in each individual, they aren’t in fact, separate.

Mhm.

Um, can you describe for us as we kind of start to set the stage for the language that you use to describe trauma?

I think it’s an important part of the conversation today.

Well, it depends whether I’m talking to a client that I’m working with or a fellow professional and whether that professional is trained in certain versions of trauma.

So if I’m speaking with clients, I don’t usually use the word trauma.

I use really regular language about frightening things that have happened to us, things that have occurred in our lives that we feel we haven’t recovered from.

I’m just using normal vocabulary so that I’m not giving them a kind of a title for something that doesn’t fit for them in relation to their experience in the trauma models that I’ve learned their bio physiological model of working with trauma, in which case we’re talking a lot about what happens physiologically, what happens in the autonomic nervous system.

What happens in the physical systems in response to stressing events.

And not all professionals are trained in that model, so that has a very particular vocabulary of looking at sympathetic arousal.

For example, those kinds of things and not everybody is on that map in terms of how their understanding trauma.

So then I might be talking to other professionals, depending on what their practice modality is.

If I’m talking to a neurologist, for example, I might just be talking about how the person that we’re sharing care for has been impacted by what’s happening and how we’re working to resolve the symptoms that they’re experiencing so very often it’s a kind of a symptom conversation about how what’s going on.

Or maybe we’re working with somebody who is working with a difference so that we might be talking about how the addiction behaviours that might be seen could be understood from the history that that person has related to trauma.

And if the if that practitioner is educated in the adverse childhood experiences study, for example, then we can have very particular conversations of the risk factors that go with exposure to developmental trauma, too early trauma that happens in the first years of life.

And then this thing that I’m sure we’ll talk about shortly, which is dis regulation in that sort of climbing of the Ace Pyramid, where we start with disruption neurologically and in the autonomic nervous system.

And then we start to see behavioural impacts.

So then I might be having the conversation about trauma that’s more related to things like high risk behaviours that addictions, smoking things like that would go in there but also unprotected sex.

There’s all sorts of other things that come in behaviorally that stack on top of disruption and things like exposure to violence.

So what you’re hearing from me is the way I talk about it.

Depending on who I’m talking to is trauma is a huge umbrella and different people have different jobs underneath that umbrella about how they’re working with any individual.

And what I’m trying to do is speak to the symptoms they’re working with.

Speak to the quiet populations are working with and where they fit in their knowledge of different categories or different versions of considering trauma.

Mhm.

Thank you.

And can you describe for us the somatic effects of trauma?

Well, the one of the main places that we now have very clear information about that is the adverse childhood experiences study.

It’s not framed like that.

That’s not the vocabulary that is being used.

But that study, which is now a huge study that’s been going on for 20 something years.

And I don’t know how many people are involved in all the peripheral secondary, the secondary versions of research now that are affiliated with it.

It started in the Kaiser Permanente system in San Diego, but eventually the CDC took it on as a because it was considered to be so critical for public health information.

And that whole study originally was about the relationship between exposure to trauma when we’re young and they used the lifespan up to 18 years and the development of adult diseases.

And that’s where we really clear clearly.

See that kind of transfer across.

If we’re using the word somatic to include anything to do with the physical self, the somatic or physical self, we see a straight line between two things.

One is trauma and the development of adult diseases and resilience in the prevention of adult diseases.

So we see, after we had the adverse childhood experiences, questionnaire was getting used more.

There was an apologies for not remembering the citation on this, but there was a resilience questionnaire that was developed as a reciprocal, so we could be considering.

How does exposure to trauma undermine or health psychological, emotional, but also cinematically.

And how does do the resiliency factors?

What are those factors for young people particularly?

And how does resilience inoculate us against the development of any of these things?

And that its wide ranging as we know with a study, we see an increase of a huge increase in the addictions, for example, to as I mentioned, other high risk behaviors but also things like emphysema, heart disease, diabetes, there are the toll is very heavy, and we’ll talk in a moment about Allostatic load, because that’s one of the ways we understand the toll.

That trauma, for example, takes on the SOMA, but also then the protective mechanism of resilience.

That and does some of that tall or mitigates against some of that toll.

So it’s it’s really now.

We have so much information that we see this really this straight line between trauma and the impact on the body.

And it is any of the chronic diseases that we might consider, or the high risk kinds of behaviors addictions, smoking.

They directly relate to exposure to trauma more so and for the young person for a child and a young person.

But we’ll see the same thing in adults.

Can you describe for us the Allostatic load and how your work made to apply to health care professionals in alleviating their Allostatic load?

So the term al aesthetic load, of course, is the technical term that basically looks at the toll that is taken by the need to adapt to stressors.

And that’s something that happens every single day.

And the stressors are not always bad stressors.

They could be physical demands for exercise for example, so any demand that we place on our physical systems requires those systems to respond in some way to try to bring equilibrium back into place to kind of use to return to homeostasis, meaning that we’re using the smallest amount of energy that we can from whatever we’re doing.

Steve parties, who developed the poly vagal theory that’s related to the autonomic nervous system, uses a kind of a friendly term, and this is how I talk about it.

If I’m speaking to clients, he just names it as the cost of doing business.

Everything we do has some cost affiliated with it and that cost physiologically are things like sleep and, um, nutrition and responsiveness in the immune system.

That’s what helps us recover from whatever the cost of the toll that’s taken.

So we expect that on a day to day basis, and then we have The recovery phase is where we’ve paid this price through our day, and we’ve taken some kind of toll on our physical systems, warned them down a little bit, and then, in theory, we’re taking in nutrition oxygen rest and we’re doing tissue repair, and we’re replenishing our nutritional stores, and we recover from that daily Allostatic load Now, over time as we age, that accumulates more, and our ability to recover is going to be somewhat limited.

Where we get into problems is when we move into the transition that’s referred to as Allah static overload, which means the stressors are so severe that our recovery phase can’t undo the damage.

So there just isn’t enough rest or enough nutrition, or we don’t have access to them.

We’re busy.

We’re working 14 hour shifts or 16 hour shifts, and then we’re stressed.

Beyond that, we see this with people who are in kind of where we are now in terms of the pandemic.

It’s a mass disaster.

So what we see is people within that are themselves subject to the thing that’s happening while they’re also providing care and treatment.

So we would see this, for example, in first responders in medical professionals in social workers, we would see so many professions that are impacted where we get this double load, so that would be a common place where this would occur.

We’re seeing this now, so we have background stressors that are individually personally are taking their toll, and then our work that we’re doing is taking an additional toll, and we don’t have access to or sufficient time for the recovery phase.

And once we hit Allostatic overload is in.

This relates back to trauma, but also normal stress can do the same thing.

We begin to see the physical systems, the psychological and emotional systems breaking down to a certain degree.

In most care, providers of any kind are experiencing that and have been experiencing it, maybe for an extended period more than a year now.

For many people, their immune systems aren’t working great.

But here you are, sometimes in a hospital environment where you have greater exposure, which then increases the stress.

There’s fatigue, There’s emotional exhaustion, compassion, fatigue.

We start to wear out.

We’re running.

We’ve been running on fumes for so long.

Something is going to pay the price.

That’s the idea of cost of doing business.

We’ve run our tanks dry.

Now we’re going to start feeding off of our reserves, and that could be the breakdown of the social system.

So then we don’t allocate enough time to loved ones, so they begin to pay the price because we can’t be available for them.

Our bodies maybe begin to break down our motions breakdown where we don’t feel as resilient and able to respond.

Something that we would have taken in stride in our professional life now undies us and we begin to fall to pieces.

So this whole idea of Allostatic Load and Allostatic overload is not only about trauma, normal stress, but that accumulates over extended periods of time and is stacked up where we have personal stress, work, stress, family stress, economic stress, all of those things, each of them have a cost.

And what’s true for many people right now, the cost exceeds the reserves.

We really so we see burnout where we expect to see in these kind of environments, as we saw, for example, after 9 11, an increase of suicides in first responders.

So the toll on mental health, the inability to recuperate emotionally or socially, takes its toll.

So we begin to see an increase in all of these things.

Things like suicide increase in addictions.

Uh, increase in health issues increase in disruption in the family divorce.

Um, there’s an epidemic of domestic violence that’s been happening in the pandemic from very early on, we started to see that huge increase in domestic violence.

Huge increase in disruption for Children The family is not stable and able to hold their own kind of emotional resilience, and so Children are acting out more feeling unsafe.

So that’s the toll that Allostatic load ends up taking, and it will have an effect on anyone, any professional.

But in the professions that have the job of responding to people who are in stress, you’re going to get this doubling and tripling, quadrupling up on the Allostatic load.

And it’s been a very, very long haul now.

It was a war all for the first six months, and now we’re coming up for some people to 18 months, Uh, working under these kind of circumstances with very little break from that toll that gets that cost of doing business has been high for an extended period of time.

So, Kathy, what can we do to help our bodies recover?

So it’s through any of these layers.

It’s basically the rule that we use in terms of resilience, and any access to regulation is some is better than none So it is true for many people that the magic of being able to have vacations and time away and time with family and time for self care and somewhat limited.

So then you’re looking at incremental accumulation that offsets some of that cost of doing business, and we are getting more and more information now.

This is the pandemic has also put pressure on research for recovery from this kind of load.

So we know one of the big ones is access to green space, a daily walk, even 10 minutes getting outdoors, getting in some places.

It’s not going to be green in a desert environment.

It’s not going to be green, but outdoor access to the outdoors.

To nature, a substitute might be pets, but some version of having an exposure to something that isn’t inside at work indoors.

Dealing with stuff is important, so a little bit of that can go a long way.

The we look at in the adverse childhood experiences study.

The original questionnaire could be seen as an inventory of lack of safety and belonging, and the reciprocal of that that we know.

One of the things that builds resilience is access to safety and belonging.

So anything you can do that increases now.

Some of this means institutions should be responsive for increasing safety.

So we saw this certainly at the beginning of the pandemic where people didn’t have adequate access to PPE s.

So now you have somebody who’s feeling unsafe at work all of the time, and perhaps unsafe around other people that they could be infecting other people.

We’re doing a better job of creating that sense of safety at work for some professions.

So how do you create some version of that for yourself in whatever places you can?

If that’s at work, if that’s at home, if that’s in the transportation from work to home, wherever you do a little bit of an inventory to say, Actually that feeling that I can take a deep breath and say at this point in time I am safe, then that tells you where you might need to put a little bit of effort to change that.

So you have greater access to safety, then this sense of belonging is a combination of being appreciated.

So where can that happen if it’s again not happening?

Institutionally, that gratitude is being expressed to the person.

Maybe it’s not from your patients.

Maybe it’s not from supervisors, that kind of thing.

Can we do it for each other?

Can we offer that?

As I see you, I get that you’re contributing here.

I get that you’re struggling.

Is there any way I can help or when you have a little bit of reserve that you make that offer because the offering of help also gives that sense of belonging.

So there’s some sense that you’re part of a bigger or something for some people that might be taking time for religious activities.

For others, it might be meditation or yoga groups.

It doesn’t really matter.

It’s really again for you.

Where do you get that sense?

Here’s Here are my people that have rings of that that might be at work.

It could be at home, could be the neighborhood.

Wherever it feels like I have a place where I am valued and I value the other people that’s really important, and then just getting it, that the body does pay a price for all of this.

So very often, the self care stuff is more about our mental health, which is, of course, critical.

But we also need to be paying attention to the ways that our body is calling out for help when we have sleep disruption when we can’t manage our own diets.

So one of the ways, for example, that we know that dis regulation is happening is when we can’t rely on things to kind of take care of themselves, and we’re starting to put a lot of energy.

So now I’m eating all the time as a way to try to calm myself.

And so I’m going to food for the caretaking that maybe in the past I did for myself by taking time for myself or being with family or what have you.

So we’re starting to use.

As you know, in the nurturing resilience book we call these defensive accommodations, I talk to clients about them, called the Management Strategies.

We’re now having to be really active in managing our responses and managing the toll that’s being taken and that, in and of itself is diagnostic.

The more we’re having to put effort into that kind of thing, or the more we see ourselves being out of control is, it’s not enough for me to have a food that I like.

I’m eating the whole container of it and still at the end, realizing I’ve been just, like, numb and shoving this into my mouth and not actually feeling any sense of satisfaction from it.

That’s a big alarm bell or I’m drinking until I fall asleep because I can’t fall asleep naturally.

So any of those places where we notice ourselves not being able to just kind of naturally rely on our own social systems.

Our own physical systems are an emotional systems to kind of take care of ourselves.

That should be a red flag to say Here I could put a little bit of energy, maybe a little more energy in having healthier food on hand so that when I’m going for soothing, I’m doing it with foods that support my well being rather than make me not sleep, for example, it’s a common thing that we would see either through food or through, uh, computer use.

So staying up late at night watching YouTube videos, and we know that exposure to that screen disrupts our sleep cycle.

But I can’t stop myself from spending those hours because this is my time.

This is my special time.

So can find something healthier to do.

It’s those kinds of things that can be actually really small.

But if we do three or four of them that begins to lift that Allostatic load and refill our tanks, how do we refill our tanks?

Basically, is how we find those places where we can be helpful to ourselves.

I love thinking about how can we help support resourcing ourselves to increase our resources so that we can show up more fully for the people in our lives, as well as the people that were caring for and how critical it is.

As I read your book, I loved reading about interception, extra section and your assumption for anyone who may not be familiar with these.

Can you please explain the processes and how they may impact a health care professional?

Yeah, So these the extra reception, basically is how we perceive the outside environment.

So, using our eyes, our ears are our sense of smell or taste.

How do we get information about what’s outside of us?

Interception is theoretically what’s inside of us.

Um, but it gets a little bit tricky because we have things like our skin that give us information about both the outside and the inside so we could have pain on our skin that feels the same as if something is hot and touching us, but it might be arising from inside.

But the basic thing is that interception is our somatic referencing system that we use to gather information about our state of being not so much about how the outside environment is, but how are inside environment is and these things get developed over time.

This is one of the reasons why early trauma can be so damaging is these systems are developing simultaneously to our social and emotional systems.

But they are a primary referencing system that we use for gathering information about things like safety, and that’s where the term neuro section comes from.

That was coined by Stephen Porges, who I referenced earlier, developed the Pahlavi go theory and basically neuros option is the idea of how we use these systems are intercepted, and extra receptive systems, combined with past experience to allocate, are meaning, making around how we differentiate between safety and threats, and your reception is really specifically about noticing both.

Some people talk about it and say, Oh, it’s about noticing safety, which is true But it’s also figuring out how to differentiate between safety and threat.

So in the face of early trauma, just as the first example if we’ve only had exposure to pretty high levels of danger, we’re developing a referencing system that’s pretty much skewed towards the danger side.

We’re not developing a lot of somatic information or extra receptive information about safety.

What does safety feel like?

Look like that kind of thing?

So are referencing system by default is going to filter for danger, and our extra receptive systems will cooperate with us in that.

So I feel anxious inside.

That means there must be something dangerous in the environment.

And so I go looking for it and you know, it must be that dog over there.

And now I’ve got a phobia about dogs because I feel this anxiety and I see a dog and I think they’re linked so we can kind of make these allocation errors.

So the more chronic our exposure to things that are dangerous without an offsetting referencing system that says yes, there are dangerous things and there are also safe.

Things are safe, environments are safe people.

We’re going to have this tendency to do a heavy filtration that allocates more of our system to perceiving danger.

And we need our system to be able to do that.

We need to be able to notice danger and kind of differentiate with it.

The trouble is, when we are in, this is relevant, really for the pandemic, because this isn’t only about developmental trauma if we are in fact serving combat force, if we’re in a medical environment like we have had during the pandemic, where it actually is dangerous to be in that environment where we work a lot in the prison system or with clients who are violent.

And so our system is saying, actually, the world is pretty dangerous because this exposure on a regular basis, our neuroceptive system starts to really over emphasis.

The danger.

When I’m talking to clients about it, I talk about them having a very well developed danger map and an underdeveloped safety map.

So the referencing about safety starts to be vague or not so available to us.

There’s technical stuff that’s going on in terms of the brain and how the amygdala is telling the hippocampus to remember these important events and really dangerous things get allocated as this is important to remember, when I go looking in the future for something similar, I’m in this situation.

And what do I know about this?

These the indicators of the situation?

I go looking for my referencing system that says, Hey, I have something I remember that’s very much like this and we need that.

But if we’ve got I talk about it is like a file cabinet.

If the our file cabinet is full of files that say this is dangerous when that neuroceptive system is looking for a reference to say what’s similar to this, that it’s gonna find danger.

So through professional exposure, too dangerous environments, we can start to skew that system that even things that aren’t dangerous because they’ve got some similar qualities to them as the things that have been dangerous to us.

We keep putting them in the dangerous Been.

If you kind of back out, we’re going to see that around human beings, and we have concerns about that with Children.

We’ve got young Children who have pretty much in their lifetime memory now because it’s been 18 months.

So for little kids, they may have been getting the information that humans are dangerous to each other, and they may mostly have been seeing people with masks on.

So some of us professionally have been doing the same thing.

And so humans have become more dangerous for us.

And that way we sort about danger in humans is a little bit different than it might have been prior to this.

So and but referencing systems, for the most part are not happening in a conscious way.

That’s the thing to understand about interception, particularly.

It’s subtle.

It’s non specific.

We have, like a felt sense of or a feeling of.

We’d be hard pressed to say, Why did I think that?

Why did I think that was dangerous?

And it’s going to be kind of difficult to name the things so suddenly Suddenly, over time, our professional environment or personal environment can be skewing that referencing system without us noticing.

And now that alarm Bell is ringing a lot, and that’s how we get that link back to Allostatic load.

I’m spending a good portion of my day feeling unsafe.

My body is cooperating and marshalling my resources and raising my heart rate, causing my breathing be more rapid, bringing a lot of sugars into my system to say, Hey, we’re going to need this because we might be running for our lives.

And then we start to see that toll coming in.

At the health side of it is that making sense, how they interface and linked together there.

So we don’t typically talk about Allostatic load and a reception together.

But they belong right together.

Yeah, it makes perfect sense to me on how they’re connected and how they influence one another.

Um, how do you help offset or increase that safety map?

So I would say I work in a dangerous job and I’m continually, um, exposed to danger on a daily basis.

And then I go home.

How do I start to influence that interception if there is a way there is.

But you have to be purposeful in my experience because this is a responsive system.

The thing about any of these interception and extra reception we are responsive to the environment, internal and external, so it will retune itself.

So if we don’t work to give it exposure to other things, it’s going to retune itself over towards the danger side.

So we need to do a few things.

One is to have respite.

And this, for example, with when I was teaching a program in Washington, D.

C.

About 80% of the people participating worked with returning combat veterans, and many of them were active duty service members and they were going back into combat.

And so this is a question for people who work first responders, people working in hospital settings.

It’s a question for a lot of professions of it’s going to remain dangerous for me.

It’s not like, you know, going to be rainbows and sparkles and whatever.

So how do I stay?

Prepare to respond to the dangers that are in my environment, but at the same time not kill myself from those exposures.

So the first thing is, respite is you need a break from it.

You need ways where you can have some genuine access to safety.

If it’s possible, this would be the same conversation you might be having with someone who was experiencing domestic violence.

For example, how do you get some safety for yourself other than for some people, it’s all or nothing if I have to leave the relationship, but how do we give you some respite so that you can?

Your brain starts to work better and you can make better choices.

It’s kind of a similar process for people who work in dangerous environments or dangerous situations.

How do you create respite for yourself?

What is that going to be?

So you get a break from it, then you also need to work with these systems.

You’re introspective system.

The extras accepted system will tend to kind of come along for the ride if we get no reception retuned.

So what I’m doing with my clients is what I also recommend to professionals.

Take your time to notice the things that are about pleasure, about feeling settled, about noticing some sense of satisfaction.

It could be the food you’re eating.

Pick something.

And that’s kind of what I was recommending before, where people are eating to try to calm themselves.

If you’re going to do that, eat something that’s really satisfying and do that thing, don’t eat while you’re in front of the TV eat something where you can go.

Oh, that just hits the spot and you can savor it and really notice It might be five minutes, but really notice.

This is what it feels like to have something that’s for me that is pleasurable.

That’s satisfying.

So you need to spend a little time in the day.

And if you can do it during work, even better to take a few moments of noticing.

It’s not all danger all the time.

There’s other things that I can pay attention to.

What does it feel like to feel my breathing?

What does it feel like when I get into bed and it feels comfortable to me?

Or I’m giving my child to hug and I’m sitting and reading five minutes of a little story, really take a few moments and literally can just be a few moments.

Notice that information.

One of the questions I asked for clients is how do you know when someone wishes you?

Well, what tells you that?

Do you have people in your life that do wish you well?

Take a few moments to notice what it feels like when someone is not dangerous to you when this other human being is actually on your side.

Cares about you is expressing that caring.

What does that feel like?

That’s a different referencing system than the filtering for.

Is this person a danger to me?

Are they going to become violent?

Do they have the virus?

Do you know, like whatever version that we’re having to pay attention to spend time paying attention to the other markers so that you don’t forget cinematically and in your brain recognition system what those markers are?

And, of course, that means some exposure to them.

So sometimes what happens for people is I realise, there’s nobody in my life.

It feels like they’re on my side, and maybe you need to start finding some more folks that do that for me because I’m spending all my time with people who feel dangerous to me or in environments that feel unsafe to me.

And I haven’t found environments that feel safe.

So where can you find that?

Where do you build that?

In and again, it’s the same rule.

Some is better than none.

You don’t have to change your whole life to start making differences in having better access to this sense of safety versus threat, not only threat.

And every now and then I elbow aside a little bit of this tiny feeling of safety, but that we’ve got both happening for us.

I’ve done some work around organisational well being where we’ve gone in and done focus groups to understand what employees want.

And, um, in one organisation, what rose to the top in every focus group, which was so interesting was they asked for a sanctuary space.

And so they wanted a space on their organisational campus where they could go and just have some respite and have, you know, time away from the noise, time to relax, whatever that might look like, which was really interesting to think of.

But it’s speaking to where is this safe space for you at work at home?

That’s right.

We need to have some place or some way to quiet the alarm bells again.

Our bodies are so cooperative, we will marshal a response if that demand is put on us.

So if we don’t find a way to have that demand be lessened so that we can put our attention on ourselves and put our attention on whatever may be a moment of grieving for the day so that we let go of that day and the awfulness of what happened and leave that behind whatever we use that space for, whether it’s a physical space or time for us is so critical to keep that burnout from just putting us literally under the ground.

And one of the things I see with all of this is we lose our most experienced providers when we don’t have these remedies for this severe burn out, the people who have been at it for the longest end up leaving the profession.

They just can’t do it anymore or their health is so compromised.

So it’s, I think of it as kind of the same thing on your computer with this automatic do a little bit of a reset.

It’s almost a day to day thing that we need to do.

It’s not in my experience.

It’s not enough to have to wait for a break after six months or, you know, we’ve paid the price to assert by that point.

So can we build this?

I think something like a sanctuary where people can take time out of their day.

That’s the kind of daily thing that might be small but makes actually a huge difference.

Uh, yeah, and I What’s running through my mind right now is, um, how people who go into the health professions are trained, and generally speaking, it’s a pretty high stress, intense environment.

Um, and so I would imagine that some of these bodily processes are kind of taught to be turned off in in these environments so that you can be high performing.

Is that accurate ish?

Yes, and I don’t know that that’s always helpful.

I think there’s a certain amount of that that’s going to be necessary.

We also know that for people on the front lines, practicing what you need to do has a certain level of inoculating yourself against your own stress chemistry because you’re just doing it and you feel confident of what you’re doing.

Your heart rates don’t go up in the same way.

For example, um, so some people actually at a colleague that, um, was having heart issues, and so eventually they put a 24 hour monitor on him and he was a physician, and his heart rate went down when he set foot in the hospital.

It was like the world that was so difficult is coming to work, and being in the hospital setting where he knew what to do was actually really calming for him.

So there’s ways in which it’s really helpful to do that.

And then there’s ways in which it stops being helpful for us if we don’t get a break from it.

So if we are face to face with suffering, if we’re face to face with death, I think it’s unrealistic to consider that’s not going to have an impact on us.

So then what do we do with that again?

For some people, it’s a spiritual practice.

It’s there’s different ways that people attend to that.

But where do you get that moment to be?

The human being that says That was really hard.

Are those moments made available to you?

Are you reprimanded?

If that happens for first responders, that’s one of the reasons that we see an increase of suicide is in certain places in certain professions.

This idea that you’re showing weakness when you show emotion becomes actually deadly when you don’t have a way to let go of that thing that that person you were trying to save did not survive or your face to face.

I spoke to someone who is a SWAT officer, and what he said is, I’ve seen 10 people killed and I’ve killed some of them.

And there was no way I was going to go and see the psychiatrist that I was given the opportunity to see because none of my team members would trust me again.

That sense, where we make the meaning that asking for help or showing that you were impacted by something means you’re weak and can’t be trusted is a very dangerous part of that whole bigger system.

So where do we provide permission for people who are doing important work but are also human beings?

To let the human side of them do the thing it needs to do?

That’s that’s where the interface needs to happen.

As far as I can see from the people that I’ve worked with, when you don’t have that opportunity to sit down and have a good cry or to pound on something or whatever is like the frustration, there is no place for that to move through.

That’s again that al aesthetic load and that’s some part of us.

The body emotions, whatever begins to pay the price for that accumulated, whatever it is accumulated grief, community, frustration, just the stress of it all.

Um, that’s where is that outlet?

That’s that incident for me with that and the other is really helpful that the training is very helpful to just get down to business and do your job, and you help people.

But once your beauty, what do you need?

Mhm.

Yeah, bringing, figuring out ways to integrate the self as a human being in these difficult jobs.

That’s right.

That’s right, which feels sometimes, I’m sure, like an impossible task.

And then there are structures in place that make that very difficult.

So of the challenge that any of us have as individuals is if the institution, whatever that is, even could be licencing requirements, are there certain ways that we don’t get?

We’re not supposed to share information about ourselves or whatever.

Put some inhibition for us.

We still have to find a way for ourselves individually to work within that.

If we can’t change the system, which is sometimes the case, at least temporarily.

How do we find those places within those structures that still let us take care of ourselves or each other, even if that’s a trusted colleague that we can have a meltdown with and we give each other permission for that.

I’ve had people come to me to say I just need someone who’s not going to decide when I am like this that they should never refer a patient To me, there’s often so much fear amongst professionals that showing those weaknesses are showing their hard days is going to mean their fellow professionals will decide they’re incompetent or incapable of standing up in the moment or whatever.

As long as that fear is there, that’s a bit of a challenge.

So can that goes back to safety?

Can I find even one other person that I can be genuine with about my struggles and not feel like there’s going to be these professional consequences that can make it more difficult for me to do my job?

So for that SWAT team member, who do you get to talk to?

Do you have a colleague that maybe works in a different department or write another city or something that you can have those conversations with.

So you have an outlet that doesn’t feel like it puts you at risk professionally, even if we have to go outside the system, so to speak.

Sometimes that’s what we need to do to take care of ourselves so that we can stay in the profession for many people there in this profession because they love it.

And that drew them in for the reasons that you’re saying, wanting to care for people and if we have to leave the profession in order to take care of ourselves, that’s a heartbreaking decision for people to be forced into.

So what are the things that you can do for yourself that head that off?

Sometimes it takes a certain creativity around working around the structural impediments to doing yourself.

Yeah, absolutely.

We touched a little on the pandemic and the intensity of that for health care professionals, um, and specifically people on the front lines.

How can a somatic approach benefit them?

Well, it goes back to what we talked about originally is we have done this division of care, but to a degree, we’ve also and I’m talking more about the majority culture in North America because in some cultures.

This isn’t so much the case.

We’ve separated our idea of the psyche from the body or the emotional self from the body, and they aren’t separate.

We just really we have so much information that says they aren’t separate.

So I’m a strong advocate for including our bodies in the source of information.

As I said at the very beginning is the somatic approach gives us a way to notice what’s happening that isn’t so obvious.

If I’m really looking for my emotional responses or the way I’m thinking about things, to give me information about what’s happening, I’m missing a huge source of information for myself.

How does my body feel?

How does my breath feel?

Can I feel myself and my number to myself?

Can I notice?

Am I present everywhere?

Can I feel myself everywhere?

So we have the SoMa as a source of information for us.

It’s also one of the ways that we respond and so that that sense of having our body capable of supporting can my breath.

Can I take a moment as we talked about with the respite I take a moment and I feel my heartbeat and I feel my breath and I feel myself settle into my legs, and I feel what I’m sitting on.

That is that responsiveness that’s happening at the somatic level that gives us a feedback loop.

For example, when we talked about safety, how do I know I’m safe?

It’s a big alarm bell for me.

If someone only tells me about the outside world, I’m safe.

When I’m at home and all the windows and doors are locked and I have this my big dog next to me, then I know I’m safe.

If I don’t hear any referencing from the inside of how they feel it inside, then I know they don’t have deep ownership of that experience.

So when things really land in the body and we have access to it, there’s this quality of ownership and direct access to it that I’ve learned to really trust.

So that, to me, is it’s a bringing together that split that we’ve made that says that our emotional self is a different self than our physical self, and they aren’t different.

We fully we’re inhabiting all aspects of ourself, including our somatic self.

That’s how I write.

So we make a different emotional self.

We’re going to make a different body to match it, and vice versa.

So if our emotional self is fraught and under stress all the time, we will make a stressed and not very well functioning body and vice versa.

So it’s another minutes, another communicator.

It’s another source of change.

I am a mindfulness meditation teacher, and so I leave people in body scans and different body awareness meditations.

Right?

And so I’ll often say, the body speaks to us in the language of sensation and the more that we can become aware of, you know, how is the body speaking to us?

What does it need us to know?

I have found it incredibly helpful in my own life for sure.

Well, and sometimes our body is ahead of us.

This is the thing about interception.

We are already responding to introspective information before our cognition has caught up.

And why so?

Very often our body is the first responder in terms of knowing when there is a problem when something good is happening and if we leave it out, we’re getting kind of behind.

By the time we kind of cognitively consciously notice things Sometimes we’re a few steps down the path, whereas our body has been giving us information for a long time about what’s to come.

So that’s the other thing I noticed with folks that spend time in mindfulness practice in becoming more connected to their body.

They find out about their feelings about stuff.

Do I like it?

Do I not like it in my feeling?

Safer, unsafe.

You find out about it actually sooner they usually know it a little bit before our brains do.

The thing that I’m always so amazed about the body is just how smart it is.

It’s so much smarter than I think we are.

Sometimes if we can just learn to pause and listen, that’s right.

Yes, yes.

So as we wrap up based on your research and your vast experience, do you have any recommendations to support resilience for health care professionals that we haven’t already covered?

Well, I think I would just come back around to this idea of needing to practice it.

We know from a lot of resilience research, and we’ve got so just take a moment to say we’ve got this kind of split also in the resilience research.

We have resilience, research that’s really focused on things like ageing and how to limit the toll that the natural ageing process takes so that we stay physically and, um, emotionally resilient through our lifespan.

And then we have.

The study of resilience is more considered as psychological and emotional, and but what we see is they transfer across.

So someone who uh considers themselves as being resilient, emotionally and psychologically, actually heels tissue more quickly and heels from injuries more quickly and actually has a healthier immune system.

But people who have had those physical experiences that they’ve overcome hit higher marks on psychological and emotional resilience.

So we actually transfer the skillful nous of resilience across, so to speak.

But also what we know is that we need to practice it.

We have these factors that are more likely to make us resilient, But some of those factors is putting some attention on things like noticing the positive things, like noticing How did I overcome that?

That was really hard for me, but actually I met that demand and even though it was really difficult, I did do it.

And what about that makes me feel like I have a deep kind of well within myself.

It’s that bringing attention to our own capacity, our own skillful nous, our own resilience that actually builds more resilience.

So it’s a it can be a daily practice or some kind of a practice.

It’s practicing, it deepens it.

And that’s one of the things that I loved so much when I first started looking at the resilience.

Research is, the more we practice resilience, the more resilient we become.

And then it means that we’re less prone to the side effects of stress and so then are practicing of resilience, makes us more resilient when when we overcome our stress, were even more resilient.

It’s just so fabulous that this thing builds on itself in such a wonderful way when we start putting attention on it, which, of course, admittedly, is hard to do When the in the middle of what feels like a crisis, we practice it when we can and when we’re not in absolute crisis mode.

That’s been one of the challenges because this is all gone on so long.

Many of us have been in crisis mode so long, we’re getting pretty worn out and We haven’t had that chance to turn our attention to it.

So we may have to set aside some of the things that do feel somewhat urgent to finally begin to put attention back where it needs to be so that we don’t we’re going to have.

We already have now the side effect of the challenge to resilience that the pandemic has been and really, what we want to be doing as soon as possible, as mitigating that by people being able to put their attention over to those factors of how did we overcome it?

What are the things that are helpful for me, and how am I taking care of myself?

And that actually will increase resilience.

And again, those are things we can do in little increments that will make a big difference.

I love thinking about, you know, someone who’s been on the front lines in the pandemic, uh, taking time.

Who’s may be listening to this to reflect on how they’ve developed their own resilience in this pandemic, Um, and sort of their own resilient story from it.

So thank you for highlighting that.

How can people learn more about your work?

They can The easiest way is just to go to my website, which is somaticpractice.net and they’ll see what is on offer there.

Awesome.

We’ll make sure that gets in the show.

Notes Kathy.

It’s been a delight to talk with you today.

Really appreciate your time.

Thank you.

It’s been great to have a chat.

Thank you.

Thank you.

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