Ep 64: Calming the Bear: A Guide to Easing Your Pain w/ Jason Therrien DPT

Meet Jason Therrien, a holistic physical therapist and health coach who specializes in treating individuals with chronic and complex pain conditions. He earned his Doctor of Physical Therapy (DPT). He is a Certified Therapeutic Pain Specialist (TPS) and Certified Health and Well-being Coach (CHWC).

Jason has a passion for understanding and treating pain, as he has seen the devastating effects of persistent pain on his patients and loved ones alike. His approach to helping those living with persistent pain is multidimensional and incorporates education, coaching, and psychologically informed practices. His ultimate goal is to empower his patients with knowledge, strategies, and tools to more independently manage and reduce their pain while restoring function and quality to their lives. Jason aims to share the pain insights that have helped so many patients with other healthcare practitioners and wellness professionals in order to minimize the unnecessary suffering that exists in this epidemic of chronic pain.

Connect with Jason: https://www.insightempowers.com/classes

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Chronic pain can feel like a raging bear inside you. It's loud, scary, and all-consuming. But what if there was a way to calm the bear and find some peace?

In this conversation, Jason Therrien and Destiny Winters explore the concept of pain as a complex experience, influenced by physical, emotional, and psychological factors. 

Jason is a Doctor of Physical Therapy, Certified Therapeutic Pain Specialist and Certified Health and Well-being Coach, and Destiny Winters is a Licensed Professional Counselor and Certified Rehabilitation Counselor.

They discuss a different approach to chronic pain management – moving away from the traditional "find-and-fix" mentality and instead, highlight the importance of understanding your pain, rather than just getting rid of it without real awareness first.

Waking the Bear

Jason uses the metaphor of a bear to describe chronic pain. When someone pushes their body through exercise or daily activities, it can be like waking a sleeping bear, resulting in a flare-up of pain.

People who experience chronic pain often have a history of pushing through discomfort. This might be due to various reasons like needing to work, take care of family, or simply a desire to avoid limitations.

However, this pushing through the pain can worsen it in the long run and avoiding all activity isn't the answer either. Jason suggests a more balanced approach:

• Poke the Bear, Don't Wake It: This means gradually reintroducing activities while staying within a tolerable pain limit. It's about finding a balance between avoiding activities altogether and pushing yourself too hard.

• Understand the emotions underlying the pain: Many people with chronic pain push themselves through pain because they fear what will happen if they stop. Jason acknowledges this fear but suggests exploring its root cause. Often, it's a fear of losing function or independence, but this fear is usually not going to become a reality by moving your body.

Recognizing Your Inner Dynamics

Jason shares a poignant observation: "When I start poking the bear, I start holding my breath. So there's some fear coming up, some anticipation." This metaphor illustrates the initial resistance and fear we often experience when confronting our pain. Jason emphasizes the importance of recognizing these reactions, suggesting that many of our responses to pain stem from younger, more vulnerable parts of ourselves. These parts didn't receive the care they needed in the past and thus, react with fear and resistance.

This idea aligns with concepts from internal family systems, attachment theory, and interrelationship focusing. Our pain is often intertwined with emotional vulnerabilities that we may not be consciously aware of. Recognizing and nurturing these parts of ourselves can be a significant step towards easing our pain.

Practical Steps for Easing Pain

• Acknowledge Your Feelings: Recognize and accept the fear and vulnerability that accompany your pain. Understand that these reactions often stem from younger, more vulnerable parts of yourself.

• Practice Reparenting: Provide yourself with the care and attention you needed as a child. Seek out models and support systems to guide you.

• Slow Down: Take the time to be present with your emotions and physical sensations. Avoid rushing to fix the pain and instead focus on understanding it.

• Embrace the Journey: Recognize that each step in your healing process is valuable. The journey itself is the goal, not just the destination.

• Apply Insight: Use experiential learning to understand how different practices affect your pain. Develop wisdom and awareness to guide your healing journey.

• Cultivate Compassion and Grace: Be kind to yourself. Understand that making mistakes and facing challenges is part of the process. Practice self-compassion and allow yourself the grace to grow. Jason assigns "coming homework" – exercises that encourage people to connect with their body and pain in a compassionate way.

• Trust the Process: Have faith in your ability to navigate this journey. Trust that you have the wisdom and insight needed to find your way.

By integrating these principles into your daily life, you can begin to ease your pain and improve your overall well-being. Remember, the path to managing chronic pain is not always straightforward, but with patience, compassion, and self-awareness, you can find your way towards a more comfortable and fulfilling life.

• Episode Transcript

  This is a rough transcript created with Artificial Intelligence (AI) technology. Any mispellings and sentence errors are a result of imperfect AI.

  Jason Therrier DPT: [00:00:00] when a person experiences persistent or long term pain in a part of their body, it's very common that when they push their body, whether that's an exercise, even physical therapy exercises, or Like working in the yard or clean house, that when they push their bodies in that way, um, it can often result in a flare up or an exacerbation.

  This is what I like to call waking the bear.

  Destiny Winters LPC CRC: Who are you? Who do you work with? And why do you love doing what you're doing right now?

  Jason Therrier DPT: Uh, okay. Who am I? Uh, I'm Jason. And Yeah, so I I'm a physical therapist. That's where my training starts in the professional world. But, um, over the years, I've added other facets to my way I work with people like coaching practices and self care practices, psychologicallyinformed practices. So, uh, I am, [00:01:00] I like to focus on the treatment of folks who experience chronic pain.

  That's been my specialty or my. focus clinically for the past, I guess, eight years now. 

  Destiny Winters LPC CRC: Wow. 

  Jason Therrier DPT: Yeah. I, I, I found the, the possibility of helping people with chronic pain in new ways. Really fascinating. I was turned onto a couple of thinkers and teachers in the area of pain science and mind, body medicine. And there's something in that, that really sparked a lot of interest for me.

  I already, I've always been interested in, um, the nervous system, and that's a big part, and I'm sure we'll get into that. I also have always enjoyed helping people who are enduring a great deal of suffering, and that suffering is causing them, their ability to engage in life to be very [00:02:00] limited. So, in other words, I've never been the kind of PT who's inclined to work with someone who recently sprained their ankle, and then that can be really hard for that person, but I've always been more inclined to helping people who've been struggling with a long term condition, uh, that is really in need of some kind of, um, foothold or, or reason for hope that this can get better for them to improve their quality of life.

  Destiny Winters LPC CRC: Yeah. 

  Um, so I'm curious when you even just just to think back, maybe how you used to practice. And how you practice now with that evolution has been like, 

  Jason Therrier DPT: yeah. Um, so for the first four years that I spent out of physical therapy school, I was working in skilled nursing and I saw, I worked with a lot of patients who experienced pain often for many years and, uh, lots of places of their body.

  But my main role in [00:03:00] that. That setting was to help restore mobility and safety and function, um, so that people can get back home or be able to maximize whatever their functional mobility is. Um, when I left that setting and moved into the outpatient orthopedic setting, I wasn't there for very long before I realized that I was just not well equipped to work with people who have chronic pain.

  Um, I, I was rolling out a lot of the things I did learn, things that I learned in school, things that I picked up along the way, things that the other professionals I worked with recommended and 

  Destiny Winters LPC CRC: it helped. Can I ask, does that mean you were getting a lot of patients with chronic pain and you were just constantly feeling like you were falling short?

  And helping them. And so then you decided to get better, better training basically. 

  Jason Therrier DPT: Yeah, it was actually it kind of fell on my [00:04:00] lap. It's really kind of weird how it all ended up. My initial goal when I went into the outpatient setting was to work with individuals who had different neurological conditions, things like movement disorders like Parkinson's disease or had endured things like strokes, maybe even brain injuries or spinal cord injuries.

  I've always, again, I've always been interested in the nervous system. But I think, I can't remember who recommended it, but someone just recommended that I watch this one video and that's where it all started for me. It was, uh, some people might be familiar with this name. His name is Lorimer Mosley. Uh, he's kind of pain science physiotherapy rockstar.

  He's kind of well known across the world for that, for that reason. And I remember watching this TED talk he was giving, and it just opened my mind in so many ways to, uh, Understanding [00:05:00] pain differently and what we can do for it. And from there, the interest just continued to build and I quickly moved away from wanting to work with neurologic conditions, and I still have an interest in that, uh, to wanting to work almost exclusively with chronic pain or chronic pain and chronic illness.

  Destiny Winters LPC CRC: Was it that mind body piece? For you, 

  Jason Therrier DPT: uh, the mind body piece kind of came in a little bit later. Interestingly. So it kind of, it started a little bit more nuts and bolts. E, if that makes sense, it was more about trying to affect the nervous system and trying to change things in that way, but it didn't take long before, you know, once you start down that path, you start realizing the impact of things like stress and the emotion centers and, um, excuse me.

  Let me, can I start over on that one? Yeah, 

  Destiny Winters LPC CRC: yeah. 

  Jason Therrier DPT: Okay. Um, so you [00:06:00] were asking about the mind body piece. 

  Destiny Winters LPC CRC: Yeah, that's kind of where, like, what grasped your interest? You know, you watched Lorimer Mosley's video, and he was talking about the nervous system, right? What happened next for you? Like, what, what was sparked next for you?

  Jason Therrier DPT: Yeah, so, It didn't take long, uh, once you start down the path of learning about pain and how it works from a fresh, modern, scientific perspective. Uh, first you realize that our whole human experience is housed in the nervous system. And once you go down that path a bit, you start realizing that there's a lot of, um, a lot of things that coexist with chronic pain, like chronic stress and, uh, individuals who, Experience chronic pain can often experience other things like anxiety and depression.

  And, um, again, once you start learning more about these pieces, you start getting more and more of [00:07:00] appreciation for how a person's psychology can affect their physiology and how it affects their body and what they feel. Uh, and then. Through some personal experience, I started realizing that the stronger and stronger connection between the mind and the body, and that once that part opened up for me, all sorts of new interests came in, like, um, things like mindfulness, meditation and, uh, learning how to, uh, reduce stress in new ways through different kind of self care practices and psychological, um, approaches.

  Destiny Winters LPC CRC: Yeah, that makes sense. Are you, so you did have a personal experience or. Like, yeah, personal experience with this that kind of connected your passion for it. 

  Jason Therrier DPT: Yeah, um, indirectly. So, uh, there's a person in my life who, with [00:08:00] whom I'm very close, who has experienced pain for a long time and it's taken this person out of their career.

  Uh, they went down the path of, The more conventional route, more conventional methodologies for treating pain, like medication and injections and more standard traditional physical therapy approach, multiple physical therapy approaches, massage therapy, and it really wasn't making the difference. Um, it helped some, but it was rarely everlasting.

  And, uh, when this person that I'm close with, Um, try to get back to doing things, it would almost always result in more pain and flaring it up. And then I just, I've met some really interesting people along the way. And one of those people is a, um, is a physician who practices in the mind, body spirit of, of treatment and looking at how things [00:09:00] like emotion and and personality and things that have happened to us even in our past and how that can affect.

  Uh, or even set up a person for developing more lasting or persistent issues with things like pain and yeah, from that point, like I said, I was, I was already pretty interested and then I got super interested from that point because this was potentially an avenue for helping this person I care about.

  Destiny Winters LPC CRC: Yeah, I, yeah, I love that. Obvious, like, it makes sense when we have like a personal lived experience, but I love when there's a connected, like, you've seen someone you love go through something and that sparked a passion for what you're doing. Um, so what is, what is your practice look like with either patients?

  Because I know you have your own practice now, right? And so you have, um, you and you have, do you have, um, clients in your private practice now? [00:10:00] I do. 

  So, does your work look different there with them than it does at your clinic? And if so, what's the difference? 

  Jason Therrier DPT: Yeah, that's a good question. Um, I have a couple of clients right now, um, through my private business called insight, physical therapy and coaching.

  And these clients are coaching clients is how. Um, the interaction is framed in, in our, the nature of our work together, but coaching is something I've been integrating into my clinical approach at, at the pain clinic where I'm currently working. I've been doing that for a long time anyways. Uh, so it's, uh, there's a little bit more freedom because.

  Instead of integrating in the coaching into a, into different sort of physical therapy treatments. Um, a lot of time is just spent on that coaching element, which coaching is 1 part of it. There's also a lot of education involved. [00:11:00] There are certain practices that are taught in that space. Um, and again, I do a little bit of that already wherever I'm at, wherever I'm working.

  But I feel, yeah, I definitely feel like I have a lot more freedom to go into these issues, particularly on the education side of it and helping people not just intellectually understand, um, the nature of what they're enduring, but also on a personal level, how, um, different things in their. There are all these different contributing factors to a person's experience, including, um, how well they sleep at night, their diet.

  But the areas that I, I like to focus on the most are the impacts of, of stress and not just stress, but also one's relationship with their body and their symptoms and their health condition that they, they have picked up over the years. So once they start realizing more [00:12:00] clearly. On their on a personal level and develop the insight of how they resist or their relationship to their pain will then affect their pain.

  Then I think it creates a lot more possibilities for improvement for them. So, yeah, that's a little different. 

  Destiny Winters LPC CRC: Yeah. Yeah, that makes sense. Um. You're, you're educating about the relationship piece to one's body, um, probably touching a lot on fear. And, um, do you still incorporate any movement with your coaching clients?

  Jason Therrier DPT: A little bit. So, so far the clients that I have worked with have been previous physical therapy patients. 

  Destiny Winters LPC CRC: Okay. 

  Jason Therrier DPT: So a lot of them already have those tools. They know which ones to use more or less. So I might need to refresh their memory a little bit on, on which ones to use and how. But [00:13:00] most of the work, and if a person decides to opt for the more coaching The coaching path, uh, it's, it's more about becoming more consistent in applying those things and integrating those practices, whether that be movement or self care practices or stress reduction practices, or if you want to frame that, um, in a way that will set them up for more autonomy over their condition or whatever their challenges, um, and, and hopefully more quality of life and vitality as a result.

  Destiny Winters LPC CRC: Yeah. Yeah. You're individualizing it. Um, what, what are some of your favorite things to educate clients on? 

  Jason Therrier DPT: Yeah, there's a lot. Um, so I'll just, I'll share a couple with you, couple major topics that come up very early in the process. Uh, [00:14:00] the one that, is kind of the most fun to talk about is the bear, and the bear represents a metaphor that I've been using for many years.

  Um, the idea is when a person who experiences persistent pain, whether that's pain all the time or pain in an area, it's intermittent, but they've had it for a long time. So like, let's say it's back pain. It's not every day, but it's Maybe a couple of times a week, or maybe they'll have it for a few weeks at a time, and then it subsides and comes back later.

  But anyways, when a person experiences persistent or long term pain in a part of their body, it's very common that when they push their body, whether that's an exercise, even physical therapy exercises, or general exercise, or with exertional activities like Like working in the yard or clean house, that when they push their bodies in that way, um, it can often result in a flare up or an exacerbation.

  And [00:15:00] when the pain flares up, this is what I like to call waking the bear. And from the very beginning, a lot of people who, who are referred to see me have been hurting for a long time and have had physical therapy before, and it did flare up their pain, not always, but often. So there's already a degree of fear and hesitation about movement and about getting started.

  So I, I like to tell them that that's not, that's not our priority to start with, that the first project or the first path down which we need to travel is what can we do to calm the bear or what can we do to help better reduce your symptoms? And then that's where other conversations open up. Um, but step one, you might say is to calm the bear down, but then That's probably not going to be enough for them to get back to doing the things they care about.

  And for that, we will need to challenge the body, build it up, build up some strength, endurance, flexibility, coordination, balance as appropriate. But [00:16:00] to do that, and to challenge the body, we might have to poke the bear a little bit. We just don't want to wake them up. So that's my silly way of trying to explain having a more partnership strategy with their body.

  So being body partner, being more responsive to their body. So, for example, if they're trying to build endurance, we might start with a walking program. Most of the things that people who, uh, are, have been limited by pain want to get back to doing will require some, some degree of walking. So we'll, we might start with a walking program and in that walking program, it's okay to push into a little pain, but not to the point where you're paying for it and you're feeling worse the remainder of that day or the next day.

  So that's what I can, that's what I mean by poking the bear. Um, but it's not uncommon for a person who experiences persistent pain to have been pushing through it for a long duration of time.

  Um, [00:17:00] just simply because they've got things to do in their life, they have to, they have to work, they got families to take care of, or they just don't want to be held back by what's happening in their body. So they'll push through and then that just causes the bear to wake up more quickly and get louder and play with that metaphor you want.

  So that route over time has a shelf life and doesn't work to help maintain the activities that you care about, but it also you can't just avoid. Right? And that means not just stopping things because they hurt either. So this poke the bear, don't wake them up. model is learning how to slowly wade into those activities again and learn to be a good friend and partner to your body along the way.

  So that's one of the bigger educational topics, but there, there are some others. 

  Destiny Winters LPC CRC: No, that makes sense. I, um, it's, it, it like really beautifully encapsulates the pain fear avoidance cycle. And flaring up faster, [00:18:00] right? So for people who are like pushing through, yeah, it, that goes into the kind of neural signals that are saying, hey, like, last time you waited until, like, Yeah.

  Five hours into cleaning your whole house, top to bottom. Like we waited five hours to tell you you're in pain. You pushed all the way through that. And so now we're going to tell you in four hours, like it's time to sit down. And then three hours and two hours. And this is how we get to a state of inactivity or again, just like you keep pushing through, but you're hurting like 10 minutes into an exercise or an activity rather than five hours later.

  Jason Therrier DPT: Exactly. And, you know, a couple points about that that I think are worthy of addressing. One is, but there are some things where it's just worth it. You know, I like to make the, use the example of, let's say [00:19:00] you get invited to a wedding and it's that niece that you care so much about and you're going to wear those shoes and you know which ones I'm talking about.

  And when that song comes on, you're going to be cutting a rug like you're 20 years younger. Uh, and you know. So even at the time, likely that you're going to pay for it probably wouldn't do anything different. And that is understandable. And I feel like it's important to, to really, you know, honor that autonomy, honor, honor their agency and pushing in those moments.

  But it's the, I would say it's the majority of occasions when it's just not helpful and it doesn't help them maintain what it is that they care about for the medium to long term. Um, so there, there's that part. And there was one more part about that. I wanted to share, uh, but it escapes me. So I apologize.

  Destiny Winters LPC CRC: No, that's okay. Yeah, I talk about that too with people, like, when people talk about, [00:20:00] um, just this fear that they're going to miss out on everything in their lives. Like, no, you can go on that vacation. You can go, um, for, uh, an important hike or the wedding, right? And dancing . But then there's the recovery time after is one part of it.

  One part of it is like, it's just worth it. Like it's just worth it to do certain things that are meaningful to you. But you're right. Like, don't do that every single day while you're doing the dishes. Don't do that every single day while you're doing something at work. Like. We're trying to figure out, you know, how you can navigate that on your day to days and then eventually over time hoping to that you can get back to the things you love without pain.

  But for right now, this is where we're at. And we're while we're learning how to poke the bear, not wake it up. We have to play this little game with ourselves. 

  Jason Therrier DPT: Yeah, yeah, it came back to me what I wanted to share about that, and I think [00:21:00] you just touched on it really nicely. Um, so before I try to be too prescriptive as to how to enact this bear strategy, uh, or this bear approach to things, I think it's more important that we realize why you're up to what you're up to.

  So what's underneath this? This urge to push through. Um, so 1, 1, just kind of pet peeve. 1 of many we might get into that. You see, in our health care system, including with my field, my profession of physical therapy is the presumption that people who experience persistent pain, um, have. Either low pain tolerance or aren't being honest about what they're feeling and that they, uh, They just, they ought to just push harder and that's not the majority of people, but it's, it's definitely a lot of that out there.

  A lot of, a lot [00:22:00] of PTs thinking that way. And, uh, I, I strongly disagree to put it lightly. Um, I think that is totally misguided. There's the majority of people that I work with. Like I said, have made it a, a, a way of being or a way of, of operating in the world to push through challenging experiences like pain over and over again.

  Um, and underneath that, without the 

  Destiny Winters LPC CRC: resort without support, right? I think that's a piece to like, and sorry to cut you off, but I think like, what we're to push through over and over and over again, when you just said that, what came to mind is like. Someone just breaking eventually under all this pressure.

  It's like how hard you work day in and day out to push through this experience and you do it. Every day until one day you just can't anymore and you like break and crumble. But when you have supports around you, whether it's emotional, physical, um, just whatever is supportive [00:23:00] to you. And that's something that I'm sure you figure out with your clients.

  I figured that out with my clients too. When the supports are there, you can push through it without it debilitating you. 

  Jason Therrier DPT: Yeah. So I agree. I agree. And I think that's external support piece. Is so incredibly valuable, but so often missing, whether that's on a personal social level or a professional level with health care providers or, um, yeah, it's just, it's often not there.

  So, so much of what I do. Is about empowering people to not go it alone, but to have the resource for themselves to be more supportive of themselves. So, on this notion of pushing through 1 thing that I've come to realize about that, or what seems true. And and. is validated in the conversations I have with patients is there's a lot [00:24:00] of fear underneath that pushing through and it's like, well, wait a minute, you know, the idea that I was once given or was at least the way I interpreted it is that fear and pain is, uh, like they're, they're the fear avoidance cycles about people who avoid things that hurt, but that's never really, that's not, And that's been the experience for me.

  It's it's been the other way around. People continue to hurt and push through. But what are they afraid of? Well, they're afraid that if they were to stop doing what they're doing, that it can be a slippery slope to not being able to do anything. Um, that if they give into their pain that they won't be able to.

  Do things they care about or need to do, uh, in life. So there's a deep seated fear underneath that. And I try to help folks recognize that first by just noticing their habits with breath holding and tension, particularly when they're doing something. So going back to the walking example, it's very often the case that when the bear starts getting poked, let's say you're having back pain.

  If you walk [00:25:00] for three to five minutes, that they'll start to speed up. And that's because there's a part of them underneath, maybe unconsciously or semi consciously, that is desperately looking for a place to sit down. So there's, there's this undercurrent of fear and instead of telling a person, okay, just stop pushing through so often or stop, you know, flaring up the pain.

  It's like, let's get to know where that urge or motivation is coming from and what that represents about, um, a part of you inside. And once we do that, then that opens a lot of other, um, pathways for personal understanding. And I think it's from that personal understanding that the person can then make the choice for themselves.

  So are they going to continue status quo or might they try to do things a little differently with that deeper understanding of themselves and why they do what they do? 

  Destiny Winters LPC CRC: Yeah, yeah. [00:26:00] That's a good example of you start hurting so you speed up more. 

  Jason Therrier DPT: Yeah. And hold your breath and start to get tense. 

  Destiny Winters LPC CRC: Yes. Yeah.

  And When I think about the pain, fear, avoidance cycle, which for I don't think I've done a whole episode on that, but the pain, fear, avoidance cycle in the literature has a lot of cognitive component pain, catastrophizing and like, it kind of puts a lot of the faults on the individual, but the way that I conceptualize it.

  And this is why I want to do and I'm sure you can, I would love to hear your thoughts on this because I know we think a lot alike in this way. Um, there's I use a strong attachment component in it. So when you're so, like, you, when you in that example of the person walking what they're fearful of is what you just explained, right?

  Either like, not being able to. They're going to miss out on what, what their family's doing. Right. They have to like, keep walking. So, but they're fearful of [00:27:00] also slowing down what will happen if I slow down. And so they avoid slow down. That's what we're trying to write rather than I think a lot of pain, fear, avoidance cycles are like, oh, you're avoiding walking and we just got to get you walking again.

  And it's like, we got to get you walking again, but we got to get you walking slower and more intentionally. Or faster if you're like, it depends on your body, right? Um, what we're doing. So I just see it through, um, more of like the emotion. What, what emotion are you avoiding? And then that leads to some of the avoid the avoidance behaviors that are actually going to help you, um, reduce your pain.

  Jason Therrier DPT: Yeah. Um, I totally agree. And those realizations about themselves, I think are really It can be really revealing and interesting, um, and beneficial to them. So, yeah, I'm glad we're talking about this because this is, this is kind of, I think the centerpiece of what I do now is [00:28:00] to help folks realize their relationship to their experience, to the pain that they're having and.

  On the surface, the most tangible or palpable feeling is, is resistance and anger and fear that, you know, I've got this pain coming up and it's slowing me down. I'm just going to ignore it or try to tune out and disconnect from my body or focus on other things. Or, uh, I don't want to, I don't want to miss out.

  And then you hear people talk about it, like, you know, my, my back is angry with me or my neck is killing me. So you hear this dynamic that's occurring already. It's like right there about this very, uh, tense and, and, and friction laden relationship with their body. Um, but underneath that, this is the part that is more theory, but.

  Continues seems to be true. [00:29:00] Is that the thing that they're most or not most afraid of per se, but the thing under about the pain that might be the most threatening to their system is the vulnerability that comes with it. So their bodies feel vulnerable, and that's makes a lot of sense. If you have like a.

  fresh injury. I mean, if you break your leg, that's a vulnerable body part on a, on a real physical level. And when there's persistent pain, it can feel like there's persistent damage and injury. And which is rare. We can talk about that if you're interested, but what's more interesting to me is that the pain that they experience in their body evokes a feeling of vulnerability and fear.

  And they, As a result of that, develop a, a, again, non accepting, resistant attitude towards that body part and towards the pain. And to go deeper, not only is it true that [00:30:00] they resist the vulnerability related to the pain, it's often the case, not always, that the people that I work with Of our resist feeling vulnerable and always and this is where we start talking about attachment and trauma and personality and how these are all, um, in many ways connected and tied that if you, if your relationship with pain is fear, it's not uncommon that there's a fear in relationship to emotional pain and emotional vulnerability that you might have been carrying for a long time.

  So I can give you some more examples about that, but I just wanted to illustrate that for a moment. 

  Destiny Winters LPC CRC: Yeah, please do feel free to go deeper into that. 

  Jason Therrier DPT: Okay. Um, so, like I said, I, I try to, I don't. I don't start with these topics, but they're just informed in what I do. Um, so [00:31:00] I first want them to understand that their relationship with their pain will affect their pain.

  Um, and that pain relationship for anybody, most people, um, if not everyone, is at least on some level resistant. It's like, I don't want to be in pain right now. I'm getting it. Uh, some dental work done. This is very uncomfortable. It's very unpleasant. And that's totally normal. Uh, it's when pain becomes more persistent that, uh, that resistance can become more and more substantial or, or, or, uh, contributory.

  It can, it can affect the experience of pain more and more. So, um, If your relationship with your pain will affect your pain, then resistance to the pain will make it worse. And the reason why, and I can use experiential examples and scientific ones. So, you might notice that when your pain level is worse that you hold your breath more and your [00:32:00] body is more tense.

  And I'll use another metaphor, uh, the fist. If you walk around making a fist all day, how's your hand going to feel and not going to feel good. It's going to feel tired. It's going to feel weak. It's going to feel tight and it's likely going to hurt. Now, just imagine that your body was making a fist around those body parts that hurt, which is what tends to be the case.

  Um, and, and I can give some evidence for that from the research, but. Just through working with people and teaching them how to relax these parts of their body. They can feel the difference. They can feel the More often than not a decrease in pain intensity, which again reveals to them that there's a lot of resistance Towards this experience that they're having so 

  Destiny Winters LPC CRC: yeah, let's start But yeah, yeah, like when you when you let when you first learn to stop bracing there is an increase in In pain almost instantly.

  And then very quickly, if you stay with that process very [00:33:00] quickly, you do notice a reduction. And so I think that it's, and that's where like my lived experience with chronic pain, I think helps me so much is because in my, in a practice around mindfulness, because when that minute little millisecond of a moment happens, I'm aware of it.

  And that can be for good or for bad. I mean, I think. The heightened awareness to everything that's happening can also cause a lot of issues. But when you learn heightened awareness with relaxation and how to reduce the fear and non attachment to the outcomes and all the things that we are talking about here and, and on this podcast, yeah, that's, that's like the ticket.

  It's, it's all of those things have to work together. The mindfulness and the relaxation. But also the ability to become charged again, you know, we're not trying to just stay in a relaxed Zen state. Your job is not to be a monk, like monks train [00:34:00] their entire lives for that. And that is what they do from like birth to death.

  That's not our job and that's not what we're meant to do. We're not supposed to stay calm all the time. So yeah, it's finding that balance. 

  Jason Therrier DPT: Yeah, and you said something a moment ago that really stuck out and that's about going back to the fear part and how fear has such a significant role to play in our nervous system and things we feel.

  I like to remind people it's called the nervous system for a reason. Uh, it's not exactly why it's called the nervous system, but you know, it runs on fear is what I tell people and I think it gets a chuckle, but it kind of makes sense is that it's more dialed up in a protective way when there's more fear or threat in perceived in the environment.

  Um, but to go back to how to work with that. You know, I mentioned this relationship piece, and when you're talking about [00:35:00] relationships, you're talking about more than one person, usually. So this is where the language that I use might resonate with some and not others, and I think about things, and I've come to accept things in, uh, parts language, and that makes a whole lot of sense to me, and it's very useful.

  So, so let's say you've got back pain. And you really don't want to be in back pain. You don't want to have back pain and there's resistance and fear and anger in relationship to it. Um, and it could be directly towards the body part or it could be the failed surgeries or the bad treatments or the lack of care that you've gotten over the years.

  But there's a lot of a feeling, a lot of resistance wrapped up in the relationship to that body part. So I would recommend, I would help a person noted. I would try to help them feel that emotion arising in their system, in their body. And Again, I invite them to consider that that is a part of them that's really upset about the pain.

  Really doesn't want it to be here, want, wants to, uh, [00:36:00] resist it. And there's nothing wrong with that. This is a protective part of you. This is a part of you that's trying to protect you from the pain, embrace against it, keep it from getting worse, or maybe go to go, go to war with it. So it's, uh, like a loyal warrior in that way.

  And for some, just making that. Recognition that there's a part of them inside that really doesn't want to be in pain all the time and is resisting it very strongly. Um, and then this is where it might sound a little weird for some, uh, talking to that part. Um, you know, we talk to ourselves all the time.

  That's what we call thinking. You tell me who the audience is. If you are having a thought, then you have to be talking to yourself. So I invite folks to talk to themselves on purpose. There's a part of me and it's showing up right in here. That's really angry about this pain and just let it know that you see it and say, Hey, I understand why you're feeling this way and I'm here with you.

  And I'm really sorry you're having that big feeling right now. And that the pain is giving you so much. [00:37:00] Um, is is activating you so much or whatever you want to say, and I might make some recommendations on how to start that conversation, um, usually to acknowledge it to support it and and show a commitment to getting to know it.

  And then I 

  Destiny Winters LPC CRC: like that last piece, because the commitment to getting to know it, because most people, when they hear this as like a quick tip, you know, it's like. It sounds like, okay, great. I told my pain. It's okay. What now? And it's like, no, it's, it's, it's not about placating. It's about soothing. It's literally you're, you're soothing yourself, which again, this goes back into kind of attachment issues.

  Um, but if you weren't taught how to soothe yourself, and if when you were in pain as a kid, or. You know, even like, if you're older now, like, in the 1st, 20 years of your career, you had a terrible work environment. Like, you could have had a great childhood, [00:38:00] but that work environment can also affect your, your attachment to the, to your body, to yourself.

  So, I just think that's always important to say, because we therapists love to talk about the childhood, but sometimes it's like, the 2nd, 20 years of your life can be just as impactful. So. Yeah, um, yeah, if you were always told, like, okay, we don't have time for this. Come on. Let's move on. Like, okay, great.

  Like, then you're going to talk to yourself the same way. 

  Jason Therrier DPT: And 

  Destiny Winters LPC CRC: now we have to try to rewire that. 

  Jason Therrier DPT: Yeah, so I might have a slightly different. Uh, word to describe that getting to know you and I think I think about it as attending and not resolving. It's more about just getting to know it. And from a mindful perspective, learning to have a, an acceptance that there's a part of me that's really freaking angry about this pain all the time.

  Um, and. What's interesting, and there's so many [00:39:00] paradoxes in life, and one of those is that the more accepting we are of different things that we notice inside of ourselves or in the world around us, the less impact those things tend to have. So, for example, This is one of the cooler parts of this work that I do, and I call it coming homework, and I can explain why I call it that.

  But when they recognize that, okay, they're having back pain, and the back pain is about yay big. So if they were to map it out, it has size, it has shape, it has color. Or sometimes it has color, not always has temperature usually feels hotter or colder, um, hard, soft, all these things. And then there's, so you get the sensation, the direct experience, and then you have the relationship to it.

  And that relationship is, like I said, often resistant and frustrated or sometimes angry or rageful. Um, but underneath that is, is a lot of fear and threat associated with the pain. So just by just temporarily not focusing on the [00:40:00] pain, I'm not asking people to say, Hey, I accept that the pain is here.

  That's, I think, a little too much to ask. I would say, accept that there's a part of you that really doesn't want the pain to be here. Like, you know, don't resist the resistance, except the part of you that is really freaking angry about this. So once they do that and they tell it, Hey, I understand why you're feeling this way and why you're threatened by this pain.

  Um, And I'm really sorry about that. So maybe offering up some sympathy or compassion and again, that commitment to wanting to get to know it, the paradox is just doing that can not always, but have an immediate effect on the amount of pain that they're experiencing, which illustrates a couple of things illustrates how emotions factor into their pain experience, but also their bodies tend to relax a little bit when they accept the resistance that's arising.

  And then after they do that part, the [00:41:00] real juicy part that comes next is bringing the attention back to the body part and learning to how to be kind to it because your back didn't choose to hurt your head. Didn't choose to hurt and I know people's like, well, of course it didn't choose to hurt. But at the same time, we still ascribe blame and fault in the body part for having for the feeling or experience that we're having, even though we know that the experience, uh, it does not reside in the brain, but it comes from the brain.

  So our experience comes from our brain. Um, so the body part. I believe deserves kindness and compassion, but I don't start with that. Again, I'll be clear. I mean, we want to reduce resistance. That would be the nice target. But first the paradox is by accepting that there's resistance, the resistance starts to subside a bit because we're validating that, that fear and frustration underneath our experience with the pain.

  Destiny Winters LPC CRC: Yeah, that's exactly right. That's how it works. [00:42:00] It's how it works. I feel like, um, Yeah, like just compassion alone. I mean, can make such a huge difference. Um, but even still, there can be a lot of resistance to that because again, like, as a kid, or in a really terrible job you had, if there was any amount of compassion, it would be followed by danger.

  You know, like someone yelling at you or, um, like, or compassion just wasn't even there to begin with. Like it wasn't allowed at all. And so you just have no, no marker for that. Um, but yeah, it's such a different experience when you allow for that resistance, allow for the anger, allow for the frustration. I think that's a big misconception about this work is like anything around mindfulness or anything like that.

  Is that You're supposed to learn how to be calm, and then that's what makes the pain [00:43:00] go away, right? And because you can't learn to be calm, you have failed yet again. Another program. And it's like, no, you're not like, you're not feeling that's, that's not something we're supposed to be even, 

  Jason Therrier DPT: that's very common.

  I would, I would totally agree. Um, it is very common for folks to, to get that message. And even, even when it comes from a mindfulness based practitioner, um, in my opinion, if you really follow the roots of mindfulness and where it comes from, it's the, the, the things that are called mindfulness. Often don't really represent that those roots.

  Um, so what I mean by that is, you know, mindfulness isn't a relaxation practice. It can lead to relaxation, but it's more about clarity and insight and being fully aware of and present for the unfolding of your moment to moment experience, including the things [00:44:00] that You wish were not the way they were that you resist, and that includes your relationship with your body.

  That includes the challenges you might be having in other places. Um, again, it's a paradox. I call it the I like to sometimes called the parasympathetic paradox. Most people who experience chronic pain, uh, have maybe worked with health professionals and have learned about their sympathetic nervous system, their fight or flight response.

  And there are many very well intentioned healthcare providers out there who want to try to, in, in, in kind of a Western mindset, Uh, nudge the system out of that sympathetic response into the parasympathetic, and they do that in a variety of ways. Uh, breathing techniques are probably the most common. Now, I'll be honest, I mean, I, I use breathing techniques a lot, but it's just one part of the treatment.

  But the reason why I call it the parasympathetic paradox is when you try to [00:45:00] make your system, force your system to be more calm and relaxed, there's an underlying message that I, I believe your system is hearing. And that is things are not okay right now. I need to calm down. Things are not okay right now.

  I need to calm down that this experience should not be this way. I need to relax. So it might force the system temporarily into a more relaxed state by deepening the breath or extending your exhale, but it still doesn't create the sense of safety with their experience when it isn't the way they desire.

  And the paradox is by learning to be with what's here as it is and focus on the breath without trying to change the breath, which is where mindfulness of breathing would come in or mindfulness of bodily sensation. Then Without trying to change things they start to change the most and I, and I think that's an interesting phenomenon that most people are Never, it's never even never occurred to them.

  It's never been explained to them So [00:46:00] that's how I incorporate things like meditation is to really emphasize that point There's a time for calming and there's a time for relaxing and that's going to be really important in this process But I think for the lasting changes that you desire, or that most people desire is, is to really build more mindfulness with what it, what their experience is more non resistance and more awareness of their, of their inner experience.

  And we use the word earlier, lots of compassion, but you can, again, you can't start with compassion. 

  Destiny Winters LPC CRC: You 

  Jason Therrier DPT: got to realize first, or you don't have to mean it's important to realize that there's a part of you that isn't so Compassionate towards you or towards your body. And then can you have compassion for that part?

  Destiny Winters LPC CRC: Yeah, the 

  Jason Therrier DPT: part of you that doesn't want the pain or doesn't think you're doing good enough or that you aren't good enough. You know, can you have compassion for the critic inside or the judgmental parts of you and then start to care for these more vulnerable hurt parts that might show up as, you know, as a result of that, uh, inner exploration.[00:47:00] 

  Destiny Winters LPC CRC: Yeah, I am working with someone right now. I'm not a therapy client. Otherwise, I wouldn't be talking about their story. But this is a coaching client that is helping me basically build out like a program. Um, and she was so surprised. I think I guess I said something like, um, compassion is not the end goal.

  It's just a tool that we use to get us to the end goal. And so she wrote me a follow up later that week. And she was like, I don't understand, like, what's the end goal then? If it's not to be compassionate and it's like the end goal is whatever you want your life to look like. And compassion is a tool that helps us get there.

  Jason Therrier DPT: I was curious to know what your answer was to, well, what is the end goal? 

  Destiny Winters LPC CRC: Well, that, that was it really. The end goal is like, yeah, whatever you want. Like, 

  Jason Therrier DPT: yeah, I think that's true. I think, uh, you know, that's where the coaching part is so important. And I think all, one of my many. So boxy kind of takes on things [00:48:00] is every health care professional should be a better coach.

  Um, and that's not a cheerleader. That's a, a person who will ask the right question, share, give the right feedback, give the right knowledge, um, and reflections to help the person in front of them move in the direction that they already desire. And utilize the tools and strengths that they already have and do so in a way that will set them up for long term success, a little bit, you know, meeting a person where they're at, so to speak.

  Destiny Winters LPC CRC: And, you know, I, we talk a lot on this podcast about, like, how broken the healthcare system is, and it is, but. There's still room for open ended questions in your 15 minute appointments. They're they're really that open ended question that you might ask a patient. Yes, they might ramble a little bit, but, like, you're listening skills.

  get better and better the more you [00:49:00] practice this. Mm-Hmm. . And you can, you don't have to be so frustrated with a client rambling. You can just take that rambling, paraphrase it real quick and get to the answer that you need to get to. Right. It's practice. But if you go into this field to help people well, you've committed, I would hope you're committing yourself to practices that help you help your patients better.

  So yeah, open ended questions. Yeah. 

  Jason Therrier DPT: I think you are the one who's. Told me first, uh, about the research on the efficacy of treatment being almost not entirely, but largely based off the relationship with the clinician and how important that is and above, above the treatment itself. What is the relationship?

  What is the dynamic? So, um, and, you know, paraphrasing a little and what you're describing sounds, you know, I think at a, at a very, at the very minimum, people just want to be heard. Okay. People want to be [00:50:00] seen, they want to be understood in their suffering, and that is so missing from our system. And in and of itself can have a healing effect, literally a healing effect on, on their health condition, not just their mental well being, although that's, you know, Supremely important, but literally their physical symptoms and health.

  So I think that's a great starting point. And then to go a little further, just asking these questions and sharing these reflections back to the person so that they know that they're being heard and they can hear themselves and what they're saying. So I think, yeah, that seems like a. A minimum mask. I don't think it's too much to ask there.

  Um, there's one other thing that wanted to share about passion.

  I forget. I'll come back to me. I'm sure. 

  Destiny Winters LPC CRC: No worries. I was curious to hear more because we got off topic, but. Coming homework. Yeah, like more specific [00:51:00] exercises that you like to give people or is that more of just a framework? Tell me more about how you explain coming homework to patients clients. 

  Jason Therrier DPT: Sure.

  Yeah It's it's one of my favorite things to do with people and it's kind of just an umbrella term for a few different types of Practices or different types of exercises you might say Um, that kind of have a central theme, and the central theme is the expression that we've all heard that home is where the heart is.

  And, um, I think that that phrase is, we all, we almost all always think of it as figuratively true, um, but I think it's also literally true. So figuratively, home is the place where we, home is where the heart is, would imply it's the place where we feel love, where we feel loved and loving, where we feel safe, where we feel connected, where we feel, um, peaceful or at ease.

  Literally, where is your [00:52:00] heart? It's in your body. So home is where the heart is, perhaps. Your body can also be home, or maybe it is your true home and has always been. It's the thing you enter the planet with and the thing you'll leave the planet with, if that's how you think about it. But the idea is coming home to your body in a variety of different ways.

  So in a real general sense, learning how to find that safety, peace, love, ease, In your own body, but the reason why it's called coming homework is because, well, if for many reasons, and we can get into them, we become disconnected from our bodies in a real general sense. I mean, it's a general commentary that most people would relate to is that we're very much up in our heads.

  A lot of the time thinking about the past, the future and fantasy fantasy land in between. Uh, we can be [00:53:00] very mentally preoccupied very often. And when we're not mentally preoccupied, one of the other components of our constructed experience to play with our friend Tyler's terminology is the external senses that we are, we can very much be Preoccupied with what's going on around us, what we're watching on the television, what's on our devices, a lot of device stuff, which then feeds back into thinking.

  But then there's this other thing that fills up our experience. And that is our sensations are bodily sensations. But that's where. It would seem that a large percentage of the people that I worked with with chronic pain and chronic illness have become more disconnected from is the physical sensations of their body.

  So, coming home work is about coming back to the body in a general sense in that way. But to go further, this is where the part stuff that I was mentioning before comes in. It's like, okay, well, why have you become disconnected from your body? Well, that's where you hurt. So why would you spend time [00:54:00] focusing on your body when that's the thing that hurts all the time?

  Or when you do focus on. In your body, it's only when the pain is elevated. So there's more resistance in those moments and mental reactivity. And I'm not going to put labels on that like many others would, but there's a part of you, I would say that's really scared and frustrated and upset about what's happening in your body and how it's affected you for, for a long time.

  All this time and how it might continue to affect you and what kind of surgeries and procedures you might need or that vision of your retirement or your future is now not possible. It doesn't feel possible. So there's all these all this resistance, and I would say coming homework also means connecting with these parts of oneself.

  Through the physical sensations in their body, like I was mentioning before. So let's say that there's a part of you that's really anxious about the back pain. So if you stand for any longer, it's going to flare up and wake the bear. It's like, well, there's a part of you that's really scared that's showing up right now.

  And you might feel that maybe in your throat or your chest [00:55:00] or your belly. And then I would just ask the person to, to, to, Say those three things. Those three offerings. I see you. I'm sorry you're feeling this way and I'd like to get to know you more. I'm going to come back and check on you and just talk to that part of yourself that's really getting activated in that moment.

  And just doing that can go a very long way to reduce some of the nervousness in the nervous system. Help calm it down a little bit. And then do that same kind of thing for the body parts that hurt or have illness attached to them. 

  Destiny Winters LPC CRC: Right? Yeah. And again, just to reiterate, like, the goal is not to be calm.

  It's just to give a little bit of relief to this really overactive part that is trying to protect you in a moment where you may or may not need to be protecting that hard. 

  Jason Therrier DPT: Right. Yeah. But it's understandable why it would. And that's the thing that it just needs to hear. And the reason why I'm very careful about that, I know I've kind of said a couple of times, [00:56:00] we're not, you know, we're just trying to attend.

  And I know that you, you appreciate that. But just in case the listeners aren't, you know, understanding what I'm, what I mean by that, it's like, a lot of times the way these parts of ourselves operate are not necessarily, present moment oriented. Right. Yeah. Yeah. Yeah. And they're not thinking through things, logically, necessarily, and I'm not saying that's always true.

  Destiny Winters LPC CRC: And that's not an insult. It's like, literally, your emotion center is heightened and our emotions can be an amazing guide. 

  Jason Therrier DPT: Yes, 

  Destiny Winters LPC CRC: but we also don't attune to them either until they're in this heightened state and they're yelling. Correct. 

  Jason Therrier DPT: Correct. Exactly. So we just want to honor that. That part of you is scared.

  for a good reason, even if it's maybe not the most rational or reasonable or evidence based reason I mean, I'm not a big fan of trying to talk people into thinking thinking things differently. I invite them to I present my take or the [00:57:00] take that I've adopted from other smarter, wiser, people, or thinkers.

  And then I invite them to consider that and kind of evaluate it internally. Does it feel true? Does it make sense? I mean, we even say it, does it make sense? Well, why would we say make sense with something that is conceptual? And that's because there's a feeling it's like that feels right to me. Um, and then to also just look at their life experience or lived experience and see if, Hey, yeah, you know, I, I have noticed that when I'm more stressed, I hurt more.

  Or. Uh, when I start poking the bear, I start holding my breath. So there's some fear coming up, some anticipation. So I, I just try to help folks notice what they're up to first. And I like to say it that way because sometimes, well, I wouldn't say sometimes I would think most of the time, the parts that are involved in our reactivity and the feeling of vulnerability that comes with pain tend to be young parts.[00:58:00] 

  Now, that's maybe a very radical take on on this for some, uh, to me, it makes perfect sense. It aligns with a lot of the things that I've come to believe from the worlds of, uh, internal family systems, um, attachment theory, which informs that as well and this other newer, newer thing to me called interrelationship focusing.

  That's very often the case that these reactive, uh, parts that are highly resistant and scared, they don't think like a, an adult. They don't, they don't, you can't reason with them. They didn't get that care oftentimes when they were young to just experience their emotions in the state that they're in. And that's what you can provide to them now.

  So coming homework, just to kind of put that back in here. In many ways, it's like a reparenting process and reparenting the parts of you that show up in reaction to the health circumstance and the symptoms you're having. 

  Destiny Winters LPC CRC: Yeah, [00:59:00] that's exactly right. Yeah, there's a lot of reparenting stuff here. And, um, yeah, I'm also sometimes careful with like labeling processes that I use.

  And because I recently learned about reparenting work from the world of Um, Al Anon, I don't know. I think I'm trying to remember. And so then it's actually the, like the coaching client I was working with was kind of educating me on this and I, I didn't understand, I didn't know where the origins came from.

  Um, so it's just funny how different things mean different, different things to different people. Um, but her, I guess her, her understanding of it felt very much like reparenting. She had this take of like. It's all my job now to re parent myself and I think that that is how it's presented in a lot of ways.

  Like, no one else is going to do it for you. You have to do it for yourself, which. Okay, [01:00:00] kind of yes, but we have to seek out models that we can learn from in that way. Right? Yeah. And so it's. It's hard. It's yeah, it's hard because you can't just teach yourself something. You don't you've never seen 

  Jason Therrier DPT: you never got.

  Yeah. Yeah now Just one, you know note here. I totally agree and I don't want to give anyone that impression I would just seems to be true and I mentioned this earlier is a lot of the people that I work with Particularly at the pain clinic. They just don't have the external support Uh, whether that be family, friends, community, church, some of that's there, but it's very superficial or some ways.

  It's actually part of the problem that they might be having. Um, so to me, the reparenting concept is. is intended for empowerment, but not to burden the person [01:01:00] with, Hey, you got to do it all yourself. And, and to be fair though, in the one, one area that I feel like, and I don't know, I use this often and I hope I'm not misstepping here.

  If I use the example, if there's a little kid that ran in the room right now, and that little kid was really scared and sad, maybe their parent left them there and they. They don't know how to get back home. They don't, they don't know their address. They don't know their phone number and not even sure if their parent left them there on purpose.

  I'm pretty sure, and I'll say this, I'll tell the patient or client I'm working with, pretty sure you're not going to send that kid out into the hallway and say, Hey, calm down. And then when you're done, you can come back in and we'll work on this. Like, that's not what happens. There's an immediate sense of compassion and sympathy for this child and a desire to want to protect and help.

  And then I just make the point, Okay, you've already got the format. You've already got it because I know you're not the kind of person would send the kid out and not help him [01:02:00] or her. And then the goal or part of the goal, part of the project maybe is to learn how to turn that inwardly, slowly at a little bit at a time, but you're right.

  And saying that. It's very unfamiliar turning it inward because they never got that that was or not always, but that's one of the unmet needs they perhaps perhaps add is someone who can lovingly attend to their feelings, uh, in emotion, emotional states without trying to tell them they should feel differently or invalidate their feelings in some way.

  Destiny Winters LPC CRC: Yeah, I think the slowly part is really important, too, because it's, it takes your brain, it takes my brain, and especially if you're having kids, my brain does not work quite the same way anymore, but, and I'm laughing, but it's actually very true, like my processing speed when somebody is talking to me, I have to pause what I'm doing, look them in the eye, you And sometimes ask [01:03:00] them to repeat themselves.

  I have heard what they said, but I really do need to slow down and do that whole process to fully understand what was just said to me. And if I'm stressed or tired or hungry, that takes longer. I have to slow down even more. So I think that's the other part of this is everyone is racing to some finish line.

  And right now there's all these pain programs, which love that for the people that it has helped. But I'm finding there's also just a lot of people who feel like, oh, great, I failed one more thing. Exactly. It's like, well, yeah, you were doing it alone through an app. Where you just saw other names, but no, there's no real community there and you are also racing to a finish line and I'm not even I'm saying that as like a you were doing this.

  It's not about it's not actually about blaming them. It's like, that's just how our society runs. And so you're [01:04:00] doing the same thing that you've been taught to do. And a lot of this is actually, yeah, slowing down. 

  Jason Therrier DPT: Yeah, in its own way, it is still kind of a find it, fix it kind of mentality instead of honoring the person and where they're at and maybe how they got to the place that they're at with compassion and acceptance.

  Um, so, yeah, I know you and I talked about this kind of Western mindset of, you know, trying to find and fix and in some of these more psychologically informed, neuroscience informed. Approaches to treating pain. It is still better than what we had before, which was nothing, but it's in some ways, I mean, One of the things I do say sometimes is that one of the worst things about these approaches, some of these more, um, race to the finish line approaches that you're describing with a program or a book or a combination of that, and maybe [01:05:00] some therapy is, uh, that it does work some of the time.

  I think that we, as clinicians, can be blinded by our biases, and seeing that when it works for some, that the reason why it's not working for others is that it's, it's their problem, that they're not getting it, they're not accepting it, they're not doing their homework enough, and I think perhaps it might be missing that there's something else that might be missing.

  Getting them the results that are looking that they believe are coming from the approach. Um, so I'm trying to be careful not to step on toes of some specific ones that you and I have talked about. But, um, 1 other thing, though, and this goes back to the, I mean, I was going to say earlier is about goals. 1 of my favorite concepts from the mindfulness world, you could say, is the path is the goal.

  And that idea, I think, is very true. And you talked about the race to the finish line is [01:06:00] totally understandable and desirable, but it's, it's each step. The goal is each step and that can be really frustrating and really unpleasant to hear, but it's also the path that leads to the lasting changes that most people desire, um, at least from my experience.

  Destiny Winters LPC CRC: Yeah, I agree with all that. 

  Jason Therrier DPT: Um, Yeah,

  Destiny Winters LPC CRC: it turns into a little bit of a spiritual conversation, which I would be careful about, but I don't know. I mean, yeah, I guess when you live with chronic pain enough, or when you. You know, work in this, it's not just chronic pain, but, like, when you work in this field, or when you see this, when you see problems that can't be fixed, I think all you have left to do is think about something that's bigger than you.

  The universe.

  Whatever your spirituality looks like for you. [01:07:00] Um, yeah, I just think because where else are you going to, how else are you going to cope? That's my take on it. 

  Jason Therrier DPT: Yeah, the spiritual dimension to this is extremely important, but also highly delicate because there's so many different perspectives and opinions.

  Um, so I, I think the things that I'm talking about. Don't have to be spiritual. They don't have to have a religion or mysticism to them. But I do think that there is something was I spiritual about learning how to become more aware of what your inner experience is like and Be guided by your own instincts and intuitions, which you might say are God given, you know, these are, these are things that you're equipped with to help.

  You know, I make the joke a lot of times that there's a, there's a lot of books that I [01:08:00] would like to write whether that anyone reads them is a, another story but the one book that if, if I wrote one book just one, the book would be called The Body Brings You Home and that's how I, how I view so much of what I do And for some that might be a confusing title and for some that might even be a little off putting, but the idea is, um, that some of the pain that a person, maybe going back to that, some of the pain that they're experiencing, um, might have something to do with a part of themself that's been trying to get their attention for a very long time.

  And that it needs attending and care, but for very understandable reasons. largely to do with how a person's raised and the culture in which they grow up and the way they've been treated over their life. Um, they've learned to [01:09:00] unconsciously mostly ignore or avoid. Um, so when they start to realize these inner dynamics at play, Again, it is a step in a long journey, but they start to realize that the, the path towards coming home to themselves and to their body is to learn to make these, to, to, to have these realizations about what's happening inside of themselves.

  And I, I don't think that I don't think of that as spiritual necessarily, but I do think it has. A really powerful effect to it. 

  Destiny Winters LPC CRC: I think you're right. I don't think it is inherently spiritual, but for some reason, every time I have this conversation, there is something inside of me that goes. This is spiritual.

  Like, I think we can, I think neuroscience explains it all. I think our Western techniques explain it all. But, and yes, this is just my own. This is like my own thing. Now, this is not something I'm I [01:10:00] think everyone should should think. But that's what happens for me. Every time we have this conversation is like, and then I didn't grow up.

  I didn't grow up spiritual like it, you know, I grew up as, as secular as anyone else in this country. Um, who's not religious and to me, you know, maybe that's part of it. Maybe that's I don't know, but it always feels like when we start, maybe it's just this sense of awe and wonder. That happens for me when we have this conversation, like my brain just starts going and going and thinking about how many different moving parts.

  There are billions, right? If you think about all the, the neuro activity that has happening in our bodies and and yeah, I just start seeing like, I don't know, like galaxies in front of me and it just feels super spiritual. So 

  Jason Therrier DPT: that's cool. I like that. I like that experience. Um, yeah, I think. One word, there's two words that come up very [01:11:00] often that have a very religious connection, but I think don't have to be, and one is grace.

  I think graciousness and having grace for oneself. Um, one of my many little sayings, I call them my dumb jasonisms, is, uh, you know, shame leads to more of the same, but grace leads to growth. Yeah, I think that's so true because we, we put so much should and ought on ourselves to do different or better. And that tends to lead to more of the same because either the change isn't lasting or we, again, we get more stressed as a result of all that pressure, but the grace.

  That's it. 

  Destiny Winters LPC CRC: The stress makes it harder to achieve. Absolutely. Yeah. 

  Jason Therrier DPT: But if we can have grace, which I think of as a, an understanding that's kind, clear, compassionate, um, benevolent, maybe, uh, I think that will lead to longer [01:12:00] term changes. Uh, it's a more fertile soil for those for that growth to occur. And in the other word, to go back to what you're saying is, is faith and faith, not in a higher power per se, although that is super important for many, um, in that or faith in some kind of specific belief.

  But more of a, it's kind of like a trusting without the knowledge. So it's kind of like going back to that walking the path that there's, you don't know exactly where the path will go. And as much as you try to control, you can't know what will come next. You can have faith in yourself, not in yourself, Like alone, but that you have wisdom inside.

  You have insight. You have the ability to get to know yourself and to make healthier and healthier choices for how you, um, healthy, wholesome choices and skillful [01:13:00] choices for how to walk that path. And that's where I think some degree of faith comes in. You can't know it all, and you can't necessarily be in front of everything.

  And in doing so, it just creates more fear and stress and resistance anyways. 

  Destiny Winters LPC CRC: Yeah. Yeah. You know, there was a time where I was really getting into a lot of the neuroscience and reading everything I could about how the brain works, how the nervous system works, how the body works. And the more I knew Yes, there was a lot of insight that came along with that.

  Like, oh, wow, this makes sense. And that makes sense. And I love learning. I still occasionally, but now when I open up a book like that, I intentionally label it as this is for entertainment, not for learning. And that's because. As soon as I start to try to absorb it all, remember it all, it just feels like, and you'll, you'll, the more you read too, you start to read [01:14:00] opposing ideas that have just as much like research behind it, or just as much wisdom behind it too.

  And then you're like, wait, so which one's right? Because they're opposing ideas. And you're like, that's again, where it starts to get spiritual for me. I'm like. I'm like, This is to, again, and I'm not even not religious. I didn't grow up religious, but, um, it's just the, you know, in the, in the Christian faith, it's like, the Bible says that you cannot, you won't like, know everything until you get to heaven.

  And so, again, even though that's not my religion, I just that concept really sits with me. I'm like, okay, you, we think we know so much, but, like, we really don't. 

  Jason Therrier DPT: Yeah. 

  Destiny Winters LPC CRC: And so there has to be some, some trust in what. I like how you said it earlier. I can't remember exactly, but it was big. I think that was the key piece is like.

  Without the knowledge, all you have to, all you have is trust or [01:15:00] don't trust because the knowledge is what helps you, like, know something, and if the knowledge isn't there, or if there's all this knowledge out there, but none of it, like, it doesn't all agree with each other, then you don't actually know.

  That uncertainty piece is really hard, but 

  Jason Therrier DPT: Oh, yeah. Yeah, it makes you think of, uh, Alan Watts book, The Wisdom of Uncertainty. I'm sorry, uh, insecurity, the wisdom of insecurity, which has a lot to do with that same idea, which I will try to paraphrase him. He's, he was a brilliant man. But anyways, I, I totally resonate with what you're saying.

  You know, there's a reason a very intentional reason why I named my business insight and coaching. Insight can have lots of meaning to it. A very, I'm going to paraphrase the, like, standard textbook definition as something like a, a deep understanding of a thing or a, uh, of a [01:16:00] person or a thing or something like that.

  Uh, insight has also a lot of other meanings that I would relate to it. So yes, so on that note, you know, understanding can be knowledge. It can be, you know, knowing, uh, something about your pain that you didn't know before that can be really useful, that tension makes it worse. So relaxing might make it better or that your pain has been attributed largely to some age related changes in that structure, in that body part.

  A lot of people have that same situation in their joints. And don't hurt. It doesn't mean that your MRI is irrelevant. It's just not the whole picture. So knowledge can go a long way. It can open doors. It's kind of like these little, you know, pointers like, hey, look over here, or maybe don't look over there so much or something like that.

  So knowledge, I think, is important. Insight also, though, means awareness. I think that's a different kind of [01:17:00] understanding, the awareness of yourself, of your inner nature, of what's going on, the different layers and dimensions to your experience. So that kind of knowing or, uh, or understanding and insights also associated with wisdom.

  And wisdom and knowledge are very different. In my opinion, wisdom is, uh, something that isn't acquired with, you know, more intellectual concepts or understanding. It's more of the truth of things. What feels wholesome? What is aligned with my values? Is this serving me? Is it not serving me? What am I, um, what is my next best step here?

  You know, learning how to listen to those, that inner wisdom or those instincts, I think all that goes back to insight. So again, back to just your point about, you know, knowledge can be go a long way. It's just, it's. It's never enough. There's no knowledge in the world that you can acquire that will make you feel safe and help create [01:18:00] the resolution you desire, I don't think.

  Destiny Winters LPC CRC: No, I love that. I love that so much. I love the word insight and I love all the meaning that you, you put into it for yourself and naming your practice that. Yeah, it's. I love that. Yeah, it's true. It's, it really is about, it's the journey of figuring yourself out what lights you up, what darkens you and you're right.

  Like, yeah, you explained that perfectly because usually a lot of these pain science podcasts, they'll bring up the bulging discs. Um, and how, you know, you have to MRIs. One shows bulging, both show bulging discs, one person has pain, one person doesn't. Another MRI, no bulging discs, one person has pain, one person doesn't.

  And so they're basically saying like the bulging disc doesn't cause the pain. It's your brain that causes the pain, blah, blah, blah. I get that. There's, there's legitimacy to that. But again, it's [01:19:00] not that your MRI doesn't matter or that you're like, Oh, see, like. You're fine, or, or it's, it's your fault for feeling pain when you have a bulging disc, but this person over here with a bulging disc doesn't have pain.

  No, it's, there's so much more to the, the puzzle, um, and some of it might be within our control, like our stress management, but even within stress management, there's a lot that isn't within our control. 

  Jason Therrier DPT: Oh, that's very true. 

  Destiny Winters LPC CRC: Like, you can't control what your industry standard is for pay rate. Like if you have a certain skill and a certain job, and that's.

  All you can do, mostly what you can do, then you can't control what you get paid. Yeah. Um, entrepreneurs will tell you differently. I'm an entrepreneur. I love the pursuit of excellence and doing more. And, but I'm very aware that that is a privilege that I have. That's not a choice that I made some rags to riches story that I, you know, did all on my own.

  Like, no, there's a lot of privilege that comes with that. So 

  Jason Therrier DPT: I [01:20:00] agree. Yeah. Yeah. I'm glad you made that point about the, uh, The pain science. Approach, which I don't want to label it so broadly because so much of what I do and what I believe and what I know and what's been helpful is, is pain science and and I've, I still teach people about how pain works and I use other metaphors like the alarm metaphor and I can explain that if you're interested, but the, the, the point is.

  You can tell people and try to explain things in all, in the best ways. And, and, and maybe to be fair, maybe I hadn't, I haven't tried hard enough, or I haven't, uh, tested the learning of my patients over time to see if they were really hearing and understanding the, the science I was sharing with them about their bulging discs or about the role of the nervous system.

  Um, Or [01:21:00] how sleep affects things or inflammation or whatever, maybe, maybe I just didn't do a good enough job at teaching in that way, but I don't think that's the case. I think that there, until the experiential awareness or learning occurs, it's just, it's not just it again, it can help a lot of people, but when it doesn't help, it doesn't mean that.

  Either A, the person is unwilling to be open to the perspective, or B, that you just need to keep hammering it in. Maybe there's something deeper experientially that will help them know that there's a truth there. Explaining it. So, for example, if someone comes in and they tell me that their back is hurting and because of everything they've been told by everyone else, except for me was like, what was this guy?

  No, it's like, everyone else told me it's a disk problem or it's, uh, uh, arthritis issue. And then I have them go through maybe a [01:22:00] breathing exercise or a loosening practice where I teach them how to relax their body and their symptom experience. First person changes. If it gets better or changes at all, what didn't change was their desk.

  What didn't change is that became less arthritic. You know, there's something that just happened and had nothing to do with those structural explanations. So it's more about just opening their, um. Awareness to the multitude of contributing factors and also helping them focus in on the areas where they do have the most agency.

  And then we got into some of the, I call it the cart issues, putting the cart before the horse, like these heavier issues about relation, your relationship to your body and stress and emotions and attachment and trauma, all that matters. Deeply, but it's not always the best place to start. So, I mean, sometimes it's just a simple breathing technique to help them see a, I hold my breath all the time [01:23:00] and I tend to do it when I'm hurting or I anticipate hurting more or when I'm more tense and guarded, I'm hurt, hurt more or when I'm more relaxed.

  I hurt less where I sleep better. Just those. Recognitions. That's that's way more valuable than teaching them about pain or having them read a book about it. So I totally resonate with you on that. Um, and then if they can apply that, I think that's where the wisdom part comes in when they can apply that awareness and learning for going forward.

  Well, you know, one of the other. Cheesy Jason isms that I like to share is I want to teach people how to fire me. I want to teach people how to not need me anymore. It's like, once they start realizing that they have more, uh, potential for impacting their experience than they were ever old. Um, yeah, then, you know, the goal would be for them to not need me as much of a time.

  Destiny Winters LPC CRC: Yeah, exactly. And, you know, same here. Um, [01:24:00] but I will say my percept, my conceptualization of that. Is so much different now than it used to be. I used to feel like, okay, I'm doing a good job as a therapist of like, we've reached these goals and you don't need me anymore. But I've, the more and more I do relational work and attachment work, it's actually like, okay, we might not need weekly anymore.

  And my goal is to go from weekly to bi weekly to monthly to quarterly. And it's not linear like that. Um, and then some people will be with me weekly for a year. Some people will be with me weekly for six weeks, and it just depends on, like, what you need support wise. And if you're getting that in your life elsewhere, then you don't need to come see me if you're not getting that.

  That's okay. If I am the person providing you with that and you're getting other things outside of here, um, that's fair. Yeah, yeah, 

  Jason Therrier DPT: yeah. I think that's a good point. I don't want to [01:25:00] mislead and too much there, because I think you're 100 percent right. There are some patients who I've been working with for many years, um, but yeah, it's, it's more to illustrate the point that, you know, you don't need to come in.

  I'm, I'm, I know anyone else can fix you because you don't need fixing, first of all, but second of all, the, the healing comes from within, not from the outside. Right. So you perhaps won't need me as much over time. That's definitely true. And I do like to see folks maybe more often at the beginning and then less often over time, maybe once a month or even less than that.

  So that can have that place to turn to to. You know, they have any new challenges or want to progress or explore something new. 

  Destiny Winters LPC CRC: Because, yeah, new challenges will come up, right? And you might have done a phenomenal job when they were working with you consistently, um, but you might be also the only one in their life who, like, talks about things in this way.

  And so they just [01:26:00] might need a little refresher and that is very human and, and necessary. So, yeah, I want to, I always want to make that really clear too. That's true. 

  Jason Therrier DPT: Yeah, I'm glad you said that and it was a good recognition for me to hear that. So thanks. 

  Destiny Winters LPC CRC: Yeah, of course. What else comes to mind? This feels like a good ending spot, but I'm wondering if there's anything that you want to leave people with or that we didn't touch on that you would like to touch on.

  Jason Therrier DPT: Yeah. Um, I feel like our conversation meandered in, in kind of some fun and interesting ways and unexpected ways. And I, I enjoyed that. Um, Yeah, I think if there were just maybe a couple things that I hope folks will either take from this or will be interested in exploring more is that, uh, pain is complicated.

  If we're just going to stay with that one, that's like my, you know, main topic anyways. [01:27:00] Pain is very complicated. Uh, there are a lot of things that contribute to it. It's never just one thing. I like to use the silly example, if you stub your toe, and your dog died, and your truck broke down, and all the bad things that happen in a country music song, that toe pain is going to feel one way, and the healing will even be affected by those other factors.

  But if you stubbed the same toe, and you never had before, it's the same exact injury, and you just won the lottery, and you had a wonderful evening with your wife the night before, or your, or your husband, um, and everything's going well, it's going to be a different experience. Anyways, that's just a, that's just a silly way of saying that your experience is going to be, uh, affected by lots of things, sleep, diet.

  Diet, stress, uh, patterns of tension, connection with your body and, and stress is kind of just stuck it in there. Like it was on this equal footing. I mean, hopefully at this point, it's no, [01:28:00] uh, mystery that that is the single greatest picture. Part of this picture is the impact of stress and emotions, in my opinion, but it's not the only thing, 

  Destiny Winters LPC CRC: just as long as we always have that caveat that stress is not you're always, you're always It's not always within your control.

  Jason Therrier DPT: Oh, no. 

  Destiny Winters LPC CRC: Yeah, 

  Jason Therrier DPT: totally. Yeah. It's not to say that it is a target for, uh, change, but it is a target for understanding. Like, there's, there's this piece here and it's, let's get curious about this and let's get to know it, uh, what, what's going on here that and how it's, it's affecting things with some desire. I think that there are some steps in place to reduce, but to more understand, and I think that can go a long way just in and of itself, that when you see pain in a gray lens and not a black or white lens, I think for most people that can be very empowering and help them see that there's more that they can do about their circumstance than they had previously been [01:29:00] told.

  So that's one of the main things. I do think. Your relationship to your experience is supremely important, and that's weird language for many, particularly if they have no experience with something like meditation or mindfulness, but it isn't too hard to acquire anyways or otherwise. I'll, I'll take people through practices with no experience with meditation and they'll see fairly quickly that there is a, there's a difference between the sensation that they're having and the relationship to the sensation or the experience.

  And once they start seeing that relationship, that's, I think, a very important starting point to ultimately, I mean, if you were to put a goal up there on the, on the horizon, it's, can we have a, uh, more of a partnership with our bodies? And have a relationship that is more supportive and respectful and, and treat the body with compassion and dignity and [01:30:00] all the things that you would, you know, again, can you come home?

  Can you, can we move in a direction where you feel more at home, at peace, safety, ease in your body again? Okay, that's the target now, like any relationship in life, you can try to start fresh, you can start with, try to start with a blank slate, but that ain't going to work. Okay. You have to kind of know where, where is this relationship now?

  What are the level? What are the layers and dynamics that are already here? And that just getting curious about those things, I think, can lead people in a really fruitful direction for long term, positive change. 

  Destiny Winters LPC CRC: I love that. Yeah, thank you so much for sharing all that. And your people can find you through your website.

  insightpowers. com and they can work with you one on one virtually and then you also have a YouTube channel. Yeah. 

  Jason Therrier DPT: Yeah, I do. Yeah. So feel free, uh, to check out [01:31:00] the website, insight and powers. com. Um, there are links to some videos I've made, educational videos, um, breathing exercises, meditation, and if a person's, you know, interested in working with me, they can They can reach out to me through the website, or they can just email me at Jason at insight and powers dot com.

  Um, and if we just need to start with a short consultation to describe to explain what that working relationship might look like, I'd be happy to provide that for free and then. We'll go from there. I also have a class that if folks are interested in it, it meets every Friday at lunch at 12 Eastern time.

  And it's called, uh, the caring for pain class. And it incorporates, um, there's three main components to it. One is a, a practice of some kind. Usually it's a breathing based. Well, [01:32:00] there's, there's a little bit of breathing and, and a little bit of mindful awareness of the body. And I might throw a few. Layers of this coming home work in just getting to know the pain and the relationship to it and that sort of thing.

  But just, you know, just to perk. Someone's curiosity. Uh, then there's the group discussion part, which I think is really important and interesting for people to be able to share. What their experience is and, and, and kind of hear from each other and feel supported and seen, uh, with other people who experience something similar.

  And then there's the education piece, which I tend to wrap the session up with some kind of takeaway or insight that people can apply in their lives. And, and, yeah, you don't, it's not a, it's a drop in style class where you can just show up anytime. So those are just a few things for folks to explore if they're interested.

  Destiny Winters LPC CRC: I'd love that. And that's all on your website. So I'll link that in the show notes. Um, [01:33:00] thank you so much for this conversation. It was so, it was exactly what I expected. I know we're on the same page with a lot. So thank you. 

  Jason Therrier DPT: Absolutely. Thank you.

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