Latest / Pelvic PT Rising / You're Not the Arbiter of Your Patient's When, Why or How

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You're Not the Arbiter of Your Patient's When, Why or How · Pelvic PT Rising

• 0:02
  Speaker 1: In the last 10 years, our field has gone from an unknown specialty to a household name.
• 0:09
  Speaker 1: This brings unprecedented opportunities, but we need to rise up to meet them and give our patients the care that they deserve.
• 0:17
  Speaker 1: In order to help others get better, we need to be better.
• 0:23
  Speaker 1: This podcast will help you to become more confident with your patients, more successful in your practice or business, and a leader in pelvic health.
• 0:33
  Speaker 1: We're going to have some fun along the way.
• 0:36
  Speaker 1: Join us as we rise together.
• 0:39
  Speaker 1: We're Jesse and Nicole Cozine, founders of Pelvic Sanity Physical Therapy and the creators of the Pelvic PT Huddle, and this is Pelvic PT Rising.
• 0:54
  Speaker 2: Hey guys, welcome back to another episode of the Pelvic PT Rising podcast with Jesse and Nicole Cozine.
• 0:58
  Speaker 2: Hello Well, we are continuing our conversation about you're not being the arbiter of your patients in this case when, why and how and I feel like a couple of you guys might have felt just a little bit hopefully lovingly called out by our last episode on not being the arbiter of your patients finances.
• 1:15
  Speaker 1: Yes, got a lot of conversations going on in the DMs about it, feeling that, oh my gosh, were you talking right to me?
• 1:23
  Speaker 1: It's like, yes, I was talking right to you, and it's something that I feel that sometimes, if you are acting as the arbiter of your patients finances, you don't realize it and it just becomes so much a part of what you're doing that sometimes it takes something like that podcast to sort of get you out of your rut and show you what you're doing and that you can then create change after that.
• 1:47
  Speaker 2: So we're going to dive on into that.
• 1:48
  Speaker 2: But if you guys have missed it, we are about a week away from tickets opening for Pelicon 2024 Ignite.
• 1:56
  Speaker 2: I am so excited.
• 1:57
  Speaker 2: Most of you guys I hope, listening to this are already on the wait list.
• 2:00
  Speaker 2: We've got more than 800 of you already there, but if you have not yet gotten on the wait list and you're interested, head on over to pelviconcom.
• 2:07
  Speaker 2: You'll see a list of all of the world-class speakers, you'll see a list of the dates and you'll be able to get on that wait list for priority access and the first chance to get tickets on Black Friday.
• 2:18
  Speaker 2: Nicole, for people who feel like now that we've done this for a couple of years, we feel like we've talked about this so much, but I think sometimes we still get questions on like wait, what is Pelvicon, what's the difference here and why is it so different than anything else that had come before?
• 2:32
  Speaker 2: What would you say?
• 2:34
  Speaker 2: What made Pelvicon so different when we did it for the first time in 2022?
• 2:39
  Speaker 1: One of the amazing quotes from Pelvicon 2022, when I was on stage, jessica was actually talking and one of the quotes that she said was all of this is designed for you and it really truly is.
• 2:55
  Speaker 1: There are so many things to consider when we're putting together a conference, but Jessica and I and, by extension, andrew and Jesse have really crafted an experience for you all.
• 3:06
  Speaker 1: It's so much different than just like a big organization, just throwing together some speakers and making a big vendor hall and calling it a conference, or just having a bunch of researchers come up and blather on about their research and while that can be helpful and good and we're not saying that that's like a terrible conference but it's certainly not an experience.
• 3:27
  Speaker 1: And so what you're getting when you come to Pelvicon is truly a curated experience for a pelvic rehab provider, a very specific person, pt, bot in the pelvic rehab space that loves what we do, that has a passion for helping our patients and the desire to challenge yourself, to continue to be better, to make bigger change together than we would be able to do individually, and everything that we do at Pelvicon from the speakers that we choose to the topics we have them speak on, to the happy hours to the prizes that are won.
• 4:07
  Speaker 1: All of that stuff is specifically designed to be like the best thing that a pelvic rehab provider could have ever come up with.
• 4:18
  Speaker 2: And you think about wanting community.
• 4:20
  Speaker 2: While we build that in by having breakfast together, by having happy hours afterwards all together, we build that in by not having you choose between different speakers.
• 4:28
  Speaker 2: I know, nicole, you're going to CSM and talking in February and people are going to have to choose between seeing you and Jessica and Michelle Lyons.
• 4:35
  Speaker 1: I mean right.
• 4:36
  Speaker 1: So it's like Jessica and I have specifically decided that we're not going to have breakout sessions.
• 4:42
  Speaker 1: We're going to have everyone go through the same content so that people don't have to choose.
• 4:46
  Speaker 1: Like you, just pet peeves of my experience at CSM and now I'm on the speaking end of it and feeling just as shitty about it, because I'm like shit, maybe I'll just blow off my talk and go and watch Michelle speak, like that's the kind of stuff that we don't have at Pelican.
• 5:03
  Speaker 1: And so, yeah, we're just like really proud of what we have created.
• 5:09
  Speaker 1: And you're picking up where we're putting down y'all because there's a ton of you guys on the waitlist.
• 5:13
  Speaker 1: Every year that it's been in existence, it sold out.
• 5:16
  Speaker 1: Last year we had over 625 people in the room in person and so many people came up to Jessica and I and we're saying things like this is the only time I've actually been in a room with other people.
• 5:30
  Speaker 1: I mean, we pulled the Pelviconners at this last conference and 50% of them, 50% of you guys that were there, were the only practitioner at your practice, the only Pelvic Health rehab provider at your practice, which means that 50% of you feel alone a lot of the time, and this is a place where you can just like, mingle, connect, learn and just nerd out with a bunch of people just like you.
• 5:58
  Speaker 2: And you know the actual one.
• 5:59
  Speaker 2: One anecdote that I think really probably informed a lot of how we decided to put together Pelvicon because every speaker is in pelvic rehab, every speaker is a clinician, every speaker is deliberately making what they're doing actionable so people can go home on Monday and start implementing.
• 6:15
  Speaker 2: I remember when you came back from I think it was the last CSM before the world shut down and you had gone to this course all about sleep, or this presentation all about sleep, and you were jazzed about it.
• 6:28
  Speaker 2: You had, you were fired up, all of your like nerdy brain was going and I was like cool, what are you going to do with that?
• 6:33
  Speaker 2: And then there was this big pause and it was like oh shit.
• 6:35
  Speaker 2: And you ended up spending like four days to take all of that research and information and all that stuff that they kind of bombarded you with to actually turn it into something practical that you could use for patients.
• 6:47
  Speaker 2: Yeah, absolutely, and it was like but no one else is doing that, people just get excited about it.
• 6:51
  Speaker 2: And then they come home and they've got these like research papers and it's like well, great, now, now what?
• 6:56
  Speaker 2: And so at Pelvicon, we don't want you having to be asking now what and like.
• 7:00
  Speaker 2: You've got to be excited to get back in the clinic, so it's going to be fun.
• 7:03
  Speaker 2: Get on the wait list.
• 7:04
  Speaker 2: You can find all the information at Pelviconcom.
• 7:07
  Speaker 2: So, nicole, let's talk about you're not the arbiter of your patients when, why or how.
• 7:13
  Speaker 2: I will say you are the arbiter of their where, like.
• 7:16
  Speaker 2: You get to choose, like where they see you.
• 7:18
  Speaker 2: You're a business owner, right, you can decide whether you see people in their homes or make them come in.
• 7:23
  Speaker 2: That's a whole other thing.
• 7:24
  Speaker 2: But when, why and how and I think this is interesting this is going to be another one that might be a little bit challenging.
• 7:30
  Speaker 2: But a lot of times, feeling some kind of way about this involves either your ego and or judgment.
• 7:38
  Speaker 2: And I feel like this is an interesting topic, nicole, because you are a self-proclaimed enneagram, one, a perfectionist and, frankly, the most judgmental person I have ever met.
• 7:52
  Speaker 1: It's one of my like wonderful traits.
• 7:55
  Speaker 2: Right in a very good way, right.
• 7:56
  Speaker 2: That's what they say about the.
• 7:57
  Speaker 2: Instagram right, that's, you have a very clear idea in your mind of what the world should look like.
• 8:02
  Speaker 2: And if you don't, if you see something that's not there, I think that's why you have a drive to create courses, to do Pelvicon, to do all these amazing things that you've done in your career is because you have this vision of what the world should be and then you use that to motivate you.
• 8:16
  Speaker 2: If it's, if it's fall short of that, then you feel this sense of mission to bring it to the level that you want it to be.
• 8:23
  Speaker 2: So I think it's, it's an amazing thing in your career, but I don't think anybody who's met you would be like, oh wow, she's like the most laid back.
• 8:30
  Speaker 2: Do what you want to do.
• 8:31
  Speaker 2: Non-judgmental person.
• 8:35
  Speaker 1: I feel like I'm getting a little called out at this time.
• 8:38
  Speaker 1: I don't know if I like the word judgmental so much as as I like the should part of it.
• 8:43
  Speaker 1: I use the word should quite a bit.
• 8:45
  Speaker 1: And that is being and that is being judgmental, but the point being about Enneagrams is you also do it to yourself, so I am also doing this to myself, more than anybody could ever do it to me, which is why it works.
• 8:58
  Speaker 2: I love that you just judged my use of the word judgmental.
• 9:02
  Speaker 2: There guys, I hope you guys caught that wheels within wheels on this podcast, but I think it does.
• 9:08
  Speaker 2: It raises this really interesting question because I feel like you are as much as that's your tendency in every other aspect in clinical care you are the least judgmental person.
• 9:17
  Speaker 1: Yeah, it's actually a really interesting.
• 9:19
  Speaker 1: What's that word?
• 9:20
  Speaker 1: Juxtaposition?
• 9:22
  Speaker 1: Is that a good word?
• 9:22
  Speaker 1: Yeah, yeah, hey, sometimes I don't do words well, but right, so it's a very interesting juxtaposition because I feel like that.
• 9:31
  Speaker 1: Is true, I can be extremely like shitting all over everyone else, including myself, outside, but man, once we're in the walls of the clinic, I am extremely non-judgmental and man, especially in these areas of when, why and how patients are choosing to interact with us and choosing to work with us like I am very much check my ego at the door, check my judgment at the door and really try to enter into the patient's world and really understand where they're coming from in their lived experience.
• 10:12
  Speaker 2: Were you always that way, or was that something that was an evolution?
• 10:16
  Speaker 1: I think it was an evolution.
• 10:18
  Speaker 1: I think it's inevitable that when you're first learning and in pelvic health and you're learning all the things, it just like kind of when you're first a physical therapist, it's like, oh, everything should be this way, it's just what I was learned and just what I got taught, and so you have this very narrow worldview.
• 10:34
  Speaker 1: But I think that with the amount of patients that I've seen and the different amounts of people and personalities and all the different permutations of people's experiences and how that's manifested in their pelvic health journey, I feel like it's almost like no other way to be than extremely hands-offish, non-judgmental about where they're entering your world in.
• 11:02
  Speaker 2: I feel like that's really interesting and this is a total digression, but I feel like our whole fertility journey to having clay and all of that stuff also was like talk about lived experience and forming things.
• 11:14
  Speaker 2: I feel like before you had obviously a ton of respect for the new moms who were coming in to the clinic, but now, after having a child yourself, you're just like.
• 11:21
  Speaker 2: I think one of our people at the clinic was kind of complaining that one of the new moms on their schedule was often late and you're like it's a fucking miracle that she's here at all.
• 11:31
  Speaker 1: And that was a person that had twins.
• 11:32
  Speaker 1: Remember I was like, are you fucking kidding me?
• 11:34
  Speaker 1: You better shut up, because and that is something that I feel like I would have gotten irritated at like, oh, why can't they just get their childcare together?
• 11:42
  Speaker 1: And stuff like that but I just feel I feel like I have such a different experience, having treated especially people in the chronic pain world Like I have heard so many amazing, crazy, sad, like any other adjective, like word that you can describe, like stories of people of how they got to be where they are in their pelvic pain and also how they got out of it that I just feel like, when we really look at some of the things that we're saying about our patients, either in our head or to them, a lot of times we really are acting like the arbiter of our patients when, why and how and I really and I'm not perfect at it even still but, man, I really feel like I do a good job of this, and so I kind of put down some of these examples as we go through this podcast about what this might look like if you are being the arbiter of your patients when, why and how and how we might be able to take a step back and really choose if that's how we want to continue to be.
• 12:52
  Speaker 2: Yeah.
• 12:52
  Speaker 2: So a really good example that you have given Nicole from our staff.
• 12:57
  Speaker 2: Actually, as you train folks is being a little bit frustrated or getting in in feeling some kind of way about hey, I recommended that they do something and they say they're not going to or they're not ready to.
• 13:08
  Speaker 2: I've recommended mental health therapy.
• 13:11
  Speaker 2: I've recommended a medication, I've recommended a muscle relaxant suppository, I recommended a trigger point injection and they just keep saying no or not.
• 13:20
  Speaker 1: Yet or it's not even that the patients say, actually actively saying I won't do that, but they might even be saying I will do that and then not doing it, and so that the common phrase if you find yourself saying, well, I've recommended this and she just won't do, blank, she just won't do it, she won't go see a mental health therapist and she really needs to, and that kind of thing, and I just don't know how much else I'm gonna be able to help her until she does that type of an attitude.
• 13:54
  Speaker 1: We've all been there, we've all gotten frustrated, but I feel like that's one of the areas where we see it happen the most is if we really feel like someone needs to seek help from another place, a different doctor A lot of times it's mental health therapy and then we come back and we're suggesting it and we're basically being the arbiter of their when, like word saying, they should do this thing right now, and when they don't, instead of Having a little bit of compassionate empathy for why they might not be able to or have the capacity to do that now, we just come back and say, well, they won't do that, they won't take my advice, they won't change, they won't do their exercises they won't.
• 14:39
  Speaker 1: Blah, blah, blah.
• 14:39
  Speaker 1: And then you get really frustrated and then you're like, well, and I just don't know what else I'm gonna do.
• 14:44
  Speaker 1: Until they do that, then blank.
• 14:46
  Speaker 1: And I Really encourage if you've ever been in that place I really encourage you guys to ask yourself what if we changed that phrase they won't do this thing To what if they can't to do this thing?
• 15:03
  Speaker 1: What if they, like physically do not have the capacity to do the thing that you're asking them to do?
• 15:08
  Speaker 1: Because I will say this I Treated this one patient once who had an objectively extremely traumatic thing that had happened to her and her family and it became just abundantly clear that she needed help from a mental health therapist.
• 15:30
  Speaker 1: And I brought up the subject to her quite a lot.
• 15:33
  Speaker 1: We talked about it a ton in various different ways, trying to just get her to Believe that that was where her next phase of healing was going to come from.
• 15:45
  Speaker 1: And I didn't realize for a long time and this is when I was a little bit of a more greener Pt but I didn't realize that it's not that she wouldn't go Is that she physically couldn't go, she could not bring herself Back to that place of that traumatic thing happening to her and facing that.
• 16:08
  Speaker 1: She just couldn't at that time and and that's not for us to judge that we cannot be the arbiter of when somebody is ready to do something that's either very hard for them or something that would help make them face something that they don't want to face like.
• 16:27
  Speaker 1: We can't Be that arbiter of their when.
• 16:31
  Speaker 1: And that's One of the stories that changed some of the ways I was thinking about this when I changed my, my words to myself of like, instead of saying oh, she won't go to therapy, it was like she just can't right now.
• 16:44
  Speaker 1: It allowed me to open up enough time and that's truly the definition of like holding space for somebody holding space for her at pelvic pt While we were still working on her pedental neuralgia, symptoms in her nervous system and her posterior chain strength and her you know hip internal range of motion.
• 17:02
  Speaker 1: While we're doing all of that, what we're also doing is Is helping her build enough capacity to potentially be able Be able to and so that we could say she can now go instead of she won't go.
• 17:17
  Speaker 2: I love that mindset shift, nicole, from won't to camp like they.
• 17:20
  Speaker 2: There's something there that they just can't do that and I love that the part of that story.
• 17:24
  Speaker 2: You continued to work with her.
• 17:25
  Speaker 2: It wasn't that you just Dropped her like, oh well, you need a mental health therapist, so goodbye.
• 17:31
  Speaker 1: Right.
• 17:32
  Speaker 1: So until you do, when you make this it, until you do that that's what we have a tendency to do like when you decide that that's what you want to do, then come back to me and it's like no, why don't you stay with me right now?
• 17:44
  Speaker 1: I can help you to build that capacity for you to potentially be able to Do, go and face whatever it is that you need to face.
• 17:51
  Speaker 1: But I feel like also often we can recognize somebody's anxiety or nervous system up regulation or traumatic experience that needs our help outside of our expertise, and we think that that's like an all or nothing proposition either they go, they continue to see us and they go to that other person, or they don't go to the other person and then they also have to stop seeing us.
• 18:16
  Speaker 1: And those two things are are mutually exclusive.
• 18:19
  Speaker 2: So I think the other thing that kind of goes in that I love what you said about increasing their capacity Like that's one of the reasons they may be in your office is to in order to increase their capacity to do Whatever else it is, and trust a provider again, like all of that stuff, you are doing more than just improving their hip internal range of motion to help their posterior pelvic floor tension, like that's.
• 18:42
  Speaker 1: You're doing so much more than that, and so I really want you to think about are you, are you acting as the arbiter of your patients when?
• 18:51
  Speaker 2: and also Remember it for a lot of people it's a big deal to be in your office.
• 18:55
  Speaker 2: I feel like that it because that's the only people that we see, that you don't necessarily realize that there may have been an internal struggle to even come in to see you.
• 19:04
  Speaker 2: That might have been a big step for somebody, a big bridge, and we don't see that.
• 19:09
  Speaker 2: We just assume like hey, they're in our office, they're pumped pelvic PT.
• 19:11
  Speaker 2: I'm gonna show them all the things about the Pog floor.
• 19:14
  Speaker 1: If they're coming in for an evil, they must be ready to move on and do whatever I'm saying.
• 19:18
  Speaker 1: So that might be the end of their capacity is to actually just come in and be consistent every week.
• 19:23
  Speaker 1: They might not have the capacity to do all the other things.
• 19:26
  Speaker 1: So we can't get so excited and think that, oh perfect, Now they're ready to go.
• 19:33
  Speaker 1: That might be kind of.
• 19:35
  Speaker 1: Their max is actually just picking up the phone, calling, make an appointment, come in, be on time and that's it for right now.
• 19:42
  Speaker 1: And that's where you have to meet them is where they actually are.
• 19:46
  Speaker 2: And there was a line I heard you say in one of our training things at Public Sanity, nicole, that said why would you take it personally that they aren't healing on your timeline, like if you really boil it down, why would you take it personally that they aren't doing it on your timeline?
• 20:01
  Speaker 1: We're just going to like sit with that question.
• 20:03
  Speaker 1: It's going to be rhetorical for now.
• 20:06
  Speaker 2: Right.
• 20:06
  Speaker 2: So, moving on from the when, we're talking about the why, and this is something that's really interesting.
• 20:12
  Speaker 2: We actually had a conversation about this at Pelvicon last year.
• 20:15
  Speaker 2: But sometimes people get a little bit uncomfortable with certain types of motivating factors, one usually being aesthetics.
• 20:24
  Speaker 2: Like somebody wants to come to physical therapy so that they can look better, so they can have a flatter stomach, so they can get back to exercising, so they can lose weight.
• 20:33
  Speaker 2: And that's not always.
• 20:35
  Speaker 2: I feel like what you guys, as physical therapists, want to hear from your patients when they're like hey, can you make me look better?
• 20:42
  Speaker 1: Right.
• 20:42
  Speaker 1: So and I feel like this ends up being an interesting conversation, because I feel like you aren't the arbiter of their why.
• 20:48
  Speaker 1: You aren't the arbiter of why they're what their motivation is Right.
• 20:52
  Speaker 1: So if someone says that I don't want this shelf on top of my C-section scar because it looks bad, I think so often we jump to oh well, that's not really a, it's just aesthetics.
• 21:05
  Speaker 1: Then for you, like, and then we try to get them to care about something that they're just not going to care about.
• 21:12
  Speaker 1: No one's going to care about their transversus abdominis or their pressure management.
• 21:16
  Speaker 1: If someone's coming into like have a flatter stomach, than like that's fine.
• 21:21
  Speaker 1: Now we might have to have a clinical conversation as to what type of deliverables we can have on that, and is that ethical to promise something like that and all of the things I mean?
• 21:31
  Speaker 1: That's a whole different clinical discussion, but the fact remains that your person came in because they want to look better and their C-section scar or their whatever is impeding their ability to get a flat stomach, in their opinion, and you are the diastasis recti and or the C-section scar queen, and so they are coming to you for that reason.
• 21:55
  Speaker 1: That's their motivating factor.
• 21:56
  Speaker 1: It's not bad, then to use that in their recovery.
• 22:01
  Speaker 1: I mean, this is what we talk about, like patient centered goals, like I don't know why, all of a sudden, we decide that we like put an arbitrary like line on when a patient centered goal is okay and isn't okay.
• 22:13
  Speaker 1: Like, if they want to look a five of flatter stomach, then that's cool.
• 22:16
  Speaker 1: Now again, we have to have a conversation about, like, how we're able to do that and what processes we're going to go through in order to help them towards that goal, but we cannot be the arbiter of their why.
• 22:31
  Speaker 2: Well, especially I think this is as a patient myself.
• 22:33
  Speaker 2: I think this is a little bit funny.
• 22:34
  Speaker 2: But do you guys realize that when somebody wants to get back to working out, there's usually at least some, if not an entirety, of an aesthetic purpose in that too?
• 22:42
  Speaker 2: Like I've gone to physical therapy because my ankle wasn't feeling good so I couldn't play tennis.
• 22:47
  Speaker 2: If you really got down to the bottom why it's like, well, I'd probably like to lose that weight that I've gained since not playing tennis.
• 22:54
  Speaker 2: Right, I mean, like I'd like to look better, like that.
• 22:57
  Speaker 2: There's a component of that and everything.
• 22:59
  Speaker 2: And then you kind of start to penalize folks who are just a little bit more honest or direct about that.
• 23:03
  Speaker 2: But we're totally fine if their goal is to get back to working out, even if the reason they want to work out is a flat stomach.
• 23:09
  Speaker 1: Totally so.
• 23:10
  Speaker 1: I just feel like there's again, if we start to insert our own judgments on a patient's why, that's where we get ourselves into trouble.
• 23:18
  Speaker 1: I was taught this and I'll be forever grateful to this one patient when I was just a young little whipper snapper out of PT school I was thinking my shit didn't smell.
• 23:28
  Speaker 1: I was like so high on the hog there at Hogue Hospital and I was doing the program and I was 26 years old and I had built this thing up and it was blowing up and everybody was like, oh my gosh, nicole started the program and thinking I'm just great.
• 23:45
  Speaker 1: And this one patient she was probably like early sixties, maybe late fifties, and she was coming with pelvic pain and urinary issues and a bunch of stuff.
• 23:59
  Speaker 1: And on her intake form she'd also mentioned that she had had some painful intercourse.
• 24:04
  Speaker 1: And so in my 26 year old brain I was like, holy crap, the painful intercourse thing is something that we are going to totally work on.
• 24:13
  Speaker 1: And I was like, well, let's get that fixed first.
• 24:17
  Speaker 1: And so we did a bunch of treatments, all based on that insertional pain that she was having and all kinds of stuff.
• 24:24
  Speaker 1: And I kept asking her when she came back in like, oh, how you know, were you able to, to have an intercourse and see if that hurt and stuff?
• 24:32
  Speaker 1: And she sat me down one day and she was like you know, nicole, don't take this personally.
• 24:36
  Speaker 1: She goes and I love you and your enthusiasm for pelvic floor health, she said, but I just have to tell you that I don't care whether or not I have sex ever again.
• 24:47
  Speaker 1: My husband and I have a wonderful marriage.
• 24:49
  Speaker 1: It's super awesome and that's just not a priority for us.
• 24:53
  Speaker 1: But what I really want to focus on is this incontinence that keeps bothering me.
• 24:59
  Speaker 1: I was just shocked and I will never forget that that I was being the arbiter of her, why I was like well, you should care about this thing more than the other thing, and I will never forget that person for actually being just so direct with me, sitting me down and being like you know, can you stop talking about the sex thing?
• 25:22
  Speaker 2: That's actually really funny.
• 25:23
  Speaker 1: Yeah.
• 25:24
  Speaker 2: So are you being an arbiter of your patients?
• 25:28
  Speaker 2: Why are you having any judgment or ego around that?
• 25:31
  Speaker 2: And the final part is are you trying to be the arbiter of your patients?
• 25:34
  Speaker 2: How and I feel like we hear this a fair bit of, even just seeing some of the questions in the huddle Like, oh, it bothers you when your patient's not following your plan of care.
• 25:46
  Speaker 2: Like, oh, I put together this great plan and I'm going to do this, and I told them to do these three things and they came back and now you're some level of frustrated and they're like nope, didn't do it.
• 25:56
  Speaker 1: Yeah, won't do it, Like not going to, just that's it Like no, I didn't do it.
• 26:00
  Speaker 2: I don't feel bad about doing it, yeah.
• 26:01
  Speaker 1: I don't feel bad.
• 26:02
  Speaker 1: And then we're like what do we even do with that?
• 26:05
  Speaker 1: Right?
• 26:05
  Speaker 1: So we give them tools to help themselves and do all the coaching things that we know how to do, and I'm not your fixer and you've got to take responsibility and all that stuff.
• 26:17
  Speaker 1: But at the end of the day, sometimes that can and if that goes too far, that can manifest as being the arbiter of the patient's how.
• 26:27
  Speaker 1: It's one thing to give your clinical recommendation on what the biggest bang for their buck is, in their home program, for instance, and when they come back and they don't do it for whatever reason, I feel like a lot of times we get too well, they're not committed.
• 26:39
  Speaker 1: Well, they just won't do that thing.
• 26:42
  Speaker 1: You're judging how they are showing up and wanting to get better.
• 26:48
  Speaker 1: You're equating them not doing the thing that you told them to do with.
• 26:52
  Speaker 1: Oh well, they're just not motivated right now.
• 26:55
  Speaker 1: And that could be further from the truth.
• 26:58
  Speaker 1: We talked a little bit about sometimes that the max capacity is just coming in and showing up to your sessions and maybe they don't actually have the capacity yet to go home and implement something outside of the session that they have with you, and that's fine.
• 27:13
  Speaker 2: Or maybe you did a pretty poor job of explaining why it was important Totally.
• 27:17
  Speaker 1: And on that end.
• 27:18
  Speaker 2: As a patient where it's like you told me to do something, I have no idea why.
• 27:22
  Speaker 1: Right.
• 27:22
  Speaker 1: So it becomes our job to not just judge how they're doing or not doing their stuff, but to change it then to help them to implement it in a way that fits their life right now.
• 27:40
  Speaker 1: And sometimes that might just be like, okay, well, we're going to see you once a week or twice a week, and that may be all that you do, but we don't actually give you any home program.
• 27:48
  Speaker 1: That we don't do that because how they're implementing their plan of care right now is just at their max capacity.
• 27:55
  Speaker 1: They can't do anything outside of the sessions, and it's still valuable then for you to continue to see them.
• 28:03
  Speaker 1: That's the huge piece.
• 28:05
  Speaker 1: The other thing that we can't be the arbiter of in terms of their how is how they live their life, is how they view the world.
• 28:12
  Speaker 1: There's so often times that I'll hear, even in comments, in the huddle, or people that are getting frustrated, of people that I'm mentoring clinically, and they'll just be like, well, they're just so pessimistic, they're just so pessimistic if they would just be a little bit more optimistic about things and that their whole life would be better.
• 28:34
  Speaker 1: And while that statement is probably objectively true, you are not the arbiter of how they've chosen to live their life.
• 28:42
  Speaker 1: You're not the arbiter of their lived experience and the things that have happened in their life that have created this pessimism.
• 28:51
  Speaker 1: You can't be that arbiter, that's just like not.
• 28:55
  Speaker 1: You can't change somebody's.
• 28:57
  Speaker 2: The core, fundamental personality.
• 28:59
  Speaker 2: Yeah, there's their viewpoint.
• 29:00
  Speaker 2: We need viewers in this world, guys.
• 29:01
  Speaker 1: Yeah, I mean, you can't change their worldview.
• 29:05
  Speaker 1: That's not your job.
• 29:07
  Speaker 1: Your job is to potentially, despite their worldview, show them something or motivate them in a certain way, but you can't be the arbiter of how they are living their life, viewing the world and or utilizing the tools that they're giving you.
• 29:23
  Speaker 1: It just needs to come from such a place of whatever y'all want to do, whatever you want to think, that's great.
• 29:29
  Speaker 1: But here's what my clinical recommendation is If you're not going to do that, then let's figure out a different way to work with each other period.
• 29:39
  Speaker 1: And it's not.
• 29:40
  Speaker 1: I feel like each one of these things, when you get frustrated and when you let your ego or your judgment of a situation get too far down the line, it ultimately leads to well, they're just not ready for therapy right now.
• 29:55
  Speaker 1: They're just not.
• 29:55
  Speaker 1: This just isn't the right time for them to heal, and it's like but what if it is?
• 30:01
  Speaker 1: What if it is the right time for them to heal?
• 30:03
  Speaker 1: And you're just the one that is trying to be the arbiter of their when, why and how?
• 30:08
  Speaker 1: And maybe, if we think about it that way, the only thing that we can change is your own actions.
• 30:14
  Speaker 1: Then, potentially, we can change how we're viewing where they are and that's what we can bring to the table in their sessions.
• 30:24
  Speaker 2: I love that.
• 30:25
  Speaker 2: If that's the only thing you can change is the way that you're feeling about it and the way that you're interacting with that.
• 30:30
  Speaker 2: You can change that.
• 30:31
  Speaker 2: I think that's a hugely valuable way to be thinking about that, instead of getting frustrated because, at the end of the day, these people are in your office.
• 30:39
  Speaker 1: They're there, they're right there.
• 30:41
  Speaker 1: They're like asking you for help, and if just because they're not taking it in the way that you feel like they should, does that mean that they're not worthy of you continuing on to help them?
• 30:52
  Speaker 2: And, in fact, if everything that they were doing was perfect, they probably wouldn't be in your office.
• 30:56
  Speaker 1: Totally.
• 30:57
  Speaker 2: And this when I was just as a side is when I was working as a business consultant, I started getting frustrated that all of my clients were like terrible at business.
• 31:06
  Speaker 2: And I was like, yeah, that's why they're here, right, you can't get mad that they can't read their P and L, that's why they're calling you.
• 31:15
  Speaker 2: If they had a perfect financial situation, you wouldn't be getting paid to help them.
• 31:19
  Speaker 1: Right.
• 31:20
  Speaker 1: If everybody was just like super great with their own stress management and self-care tools, like they literally would not have a pelvic floor problem.
• 31:27
  Speaker 1: So be careful.
• 31:28
  Speaker 1: What you wish for too, I don't know.
• 31:30
  Speaker 1: I just feel like the more that I've treated and the longer I've been in this field, the less judgmental and the less egotistical I've had to become, because we really can't control what other people do or say, and the only thing that we can control is how we show up to their sessions and how we show up for them.
• 31:53
  Speaker 1: And I know as like an Enneagram one that sounds so counter to what an Enneagram one is, but I guess in the most meta form it's like we shouldn't be judgmental about our patients, and so that's what we're talking about today.
• 32:09
  Speaker 2: Guys, I hope this has been really helpful for you and maybe has helped you identify somewhere where this has kind of trickled into some of your clinical philosophy.
• 32:17
  Speaker 2: I would always love to hear from you guys, hear your stories.
• 32:20
  Speaker 2: Is there a time where you learned some of those same lessons that Nicole did about kind of checking your ego or judgment at the door?
• 32:27
  Speaker 2: We'd love to hear them.
• 32:28
  Speaker 2: And so, as always, please reach out.
• 32:30
  Speaker 2: We want to keep this conversation going.
• 32:33
  Speaker 1: And let's continue to rise.