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Chronic Illness Is Hard. Being Disbelieved Is Harder. · Fit As A Fiddle

• 0:00
  SPEAKER_02: Traditional CBT used to be a bit more like that's irrational, an irrational thought, let's replace it with a rational thought.
• 0:08
  SPEAKER_02: That doesn't work for PTSD or trauma.
• 0:12
  SPEAKER_02: Um, when you go through a traumatic event, it's not irrational to be worried about it happening again.
• 0:19
  SPEAKER_02: So they use language like this is a stuck point, and we can really validate the experience and the emotion.
• 0:28
  SPEAKER_02: And it's also true that you don't want to stay stuck there.
• 0:31
  SPEAKER_02: Like it's your suffering.
• 0:33
  SPEAKER_01: Hello, everyone.
• 0:34
  SPEAKER_01: I'm your host, Dr.
• 0:36
  SPEAKER_01: Sneha Ghazi, a physical therapist, course creator, and mom.
• 0:40
  SPEAKER_01: I own Sneha Physical Therapy, a private practice in New York City, and created the course Master Your Pelvic Floor to help you transform the way you think about and move your body.
• 0:51
  SPEAKER_01: Use discount code FIT20 for a special 20% discount exclusively for my listeners at the link in all show notes.
• 0:59
  SPEAKER_01: Each episode brings phenomenal guests in the health and wellness space who share inspiring tips and tangible advice.
• 1:06
  SPEAKER_01: All things health and wellness starts right here.
• 1:10
  SPEAKER_01: Hello everyone, and welcome to this week's episode on Fit as a Fiddle.
• 1:16
  SPEAKER_01: We have a round table discussion today with two lovely guests.
• 1:20
  SPEAKER_01: We have Ariel Katz and we have Kelsey Bates.
• 1:24
  SPEAKER_01: Both are licensed mental health counselors and they both live in New York City.
• 1:28
  SPEAKER_01: And uh they started an organization company called New York Women's CBT.
• 1:33
  SPEAKER_01: And the goal of their organization is to help women with chronic illnesses and so much more.
• 1:39
  SPEAKER_01: So today's conversation and topic is going to be on CBT, which is some acronym that they're gonna break down and really explain because it can get a little misunderstood in the therapy world.
• 1:51
  SPEAKER_01: So they're gonna talk about CBT, they're going to explain how it can help people with chronic illnesses.
• 1:57
  SPEAKER_01: We're gonna talk about things like medical trauma, which I'm really excited to hear about.
• 2:02
  SPEAKER_01: Um, I think there's probably a wonderful statistic that maybe you guys know of how many listeners could possibly have experienced that if they're, especially if they're women.
• 2:11
  SPEAKER_01: And just if you take a bunch of women just randomly, that it's not one or two, but a pretty significant proportion of women experience some level of medical trauma.
• 2:21
  SPEAKER_01: And what exactly does that mean?
• 2:22
  SPEAKER_01: So we're gonna cover all of that and so much more.
• 2:25
  SPEAKER_01: But before we get started, Ariel and Kelsey, could you guys please tell us a little bit more about yourselves, what brought you to this space, and more about the work that you do?
• 2:37
  SPEAKER_02: Um, so I started New York Women's CBT, uh, or the practice started in 2021.
• 2:43
  SPEAKER_02: So it's been um a build over the years.
• 2:47
  SPEAKER_02: Um, and because of the need for this, um I was like, you know what?
• 2:53
  SPEAKER_02: I think I'm ready to expand.
• 2:56
  SPEAKER_02: And the universe reconnected Ariel and I.
• 2:59
  SPEAKER_02: We had known each other briefly and got to just get connected again in real life at a networking event.
• 3:08
  SPEAKER_02: And it just felt very clear that like Ariel was the perfect fit to come in and and continue building.
• 3:16
  SPEAKER_02: Um, and I felt really passionate about leaning into this niche with my own health experience um and really seeing that it was hard for me to find a therapist that understood.
• 3:28
  SPEAKER_02: So um, even though I knew exactly who to look for and it would, if that was so challenging, this was a huge gap of care.
• 3:37
  SPEAKER_02: Um and really embraced like a third wave model, which we'll talk about more.
• 3:45
  SPEAKER_02: But um the third wave CBT is so trauma-informed, so it doesn't impact, you know, creating more dismissal around symptoms.
• 3:56
  SPEAKER_02: We're really like embracing that there is a reality of that medical trauma.
• 4:01
  SPEAKER_02: Um, but we incorporate dialectical behavior therapy and acceptance and commitment therapy.
• 4:06
  SPEAKER_02: Um, so it has been such a pleasure to, you know, stop doing this kind of solo and expand into this group and we'll we'll keep growing um over time.
• 4:20
  SPEAKER_02: Um, but just to be able to meet more women where they are and to give them the specialized mental health care that they really need.
• 4:29
  SPEAKER_00: Yeah, it was so funny because I tell Kelsey this all the time.
• 4:34
  SPEAKER_00: My grad school essay before knowing Kelsey was literally the practice that she had created.
• 4:41
  SPEAKER_00: Wow.
• 4:42
  SPEAKER_00: And it was just like so serendipitous that, like Kelsey said, the universe brought us together.
• 4:49
  SPEAKER_00: And in my own experiences with chronic illness, I would go to therapy.
• 4:54
  SPEAKER_00: And now I know the emotion I was experiencing afterwards was more shame.
• 4:58
  SPEAKER_00: That's not how you should feel when you're going to therapy at all.
• 5:01
  SPEAKER_00: And it took a while to like find that right therapist who was able to be like, oh, like what you're dealing with is medical trauma, and then kind of help me to find that meaning and purpose and change that relationship to that pain in order to realize, oh, there are a lot of people who are going through this.
• 5:18
  SPEAKER_00: I want to enter this space and be able to help women who are dealing with something that's similar and kind of break up that shame and make it so therapy is this place where you know you can be empowered and you can heal.
• 5:29
  SPEAKER_00: And I'm I'm so lucky that Kelsey formed this practice where I am able to do this really meaningful work.
• 5:35
  SPEAKER_01: That's amazing.
• 5:36
  SPEAKER_01: I think that most of the people who come onto the show, like the lovely, wonderful, like wonderful people like yourselves, you come with this experience of being either a patient or having some kind of a personal experience, whether it's a family member or something like that, that really drives your work.
• 5:53
  SPEAKER_01: And I think that it's it's it's not that everybody who like I always say, like just because you're a cardiologist doesn't mean you need to have had heart surgery.
• 6:01
  SPEAKER_01: Just because you're, you know, a prosthetic surgeon doesn't mean you need to have lost your limb.
• 6:06
  SPEAKER_01: But I think a lot of times in the therapeutic spaces, if you have just a little bit of understanding and empathy for what somebody is going through, again speak for like the physical therapy side of things in the same way.
• 6:18
  SPEAKER_01: Um, I think it just helps you show up as a better clinician, show up as somebody who's really going to provide patient-centered care and think about the patient's needs and why we're doing this and serve them much better, which um I think is wonderful.
• 6:35
  SPEAKER_01: Can we break down CBT?
• 6:37
  SPEAKER_01: Because um, I think personally, I have even heard an educated healthcare professional who is not a therapist, of course, be like, CBT is a big hoax.
• 6:48
  SPEAKER_01: It's nothing.
• 6:49
  SPEAKER_01: You know, I've heard these things before.
• 6:50
  SPEAKER_01: I know everyone has their opinions about all the things.
• 6:54
  SPEAKER_01: Um, but can we just help people understand what is that?
• 6:58
  SPEAKER_01: Break down the acronym, break down maybe adjacent, like the DBT.
• 7:01
  SPEAKER_01: What are what are these therapies and why uh why are there these different specialties or ways of providing therapeutic care?
• 7:11
  SPEAKER_02: Um I think the best way I can say it's so much alphabet soup, right?
• 7:17
  SPEAKER_02: Like uh when you start thinking of all these acronyms.
• 7:20
  SPEAKER_02: Um, so we will break them down.
• 7:22
  SPEAKER_02: I think what we do see in the research is like regardless of the therapeutic tool being used, the most impactful part of a client, a patient improving is the therapeutic relationship.
• 7:39
  SPEAKER_02: So I think that kind of goes back to like that empathy and personal experience.
• 7:47
  SPEAKER_02: So um I also think, at least when I was in grad school, like the thought of CBT as like, I am never using that.
• 7:54
  SPEAKER_02: It's so robotic.
• 7:55
  SPEAKER_02: Um, and as it has evolved in this third wave, I think that's what attracted me back to it.
• 8:03
  SPEAKER_02: Um and so cognitive behavior therapy is what CBT stands for.
• 8:09
  SPEAKER_02: Um, we incorporate tools from another alphabet soup, CPT, uh, cognitive processing therapy.
• 8:17
  SPEAKER_02: So that is a form of CBT that was actually developed by um clinicians at the BA.
• 8:24
  SPEAKER_02: So it was extremely trauma-informed.
• 8:27
  SPEAKER_02: And the language that they use, you know, in traditional CBT used to be a bit more like that's irrational, an irrational thought, let's replace it with a rational thought.
• 8:40
  SPEAKER_02: That doesn't work for PTSD or trauma.
• 8:43
  SPEAKER_02: Um, when you go through a traumatic event, it's not irrational to be worried about it happening again.
• 8:51
  SPEAKER_02: So they use language like this is a stuck point, and we can really validate the experience and the emotion.
• 8:59
  SPEAKER_02: And it's also true that you don't want to stay stuck there.
• 9:03
  SPEAKER_02: Like it's you're suffering in that stuckness.
• 9:07
  SPEAKER_02: So that is like kind of a much more trauma-informed version that I have also found just clinicians in other field, I think, are being more attracted to that because uh it's not robotic and because it's really informed and helpful.
• 9:25
  SPEAKER_02: Um and I I Errol, maybe you can speak to the DVT and Act piece because I've also found chronic illness clients are wanting tangible tools as well.
• 9:39
  SPEAKER_02: So that's part of the benefit.
• 9:41
  SPEAKER_02: We have the empathy and rapport, but we have um, you know, tangible things that we send home with them uh that they can actually do during the week.
• 9:52
  SPEAKER_02: And it's not just us sitting here nodding of, yeah, that's hard.
• 9:56
  SPEAKER_02: We we want you to feel empowered.
• 9:59
  SPEAKER_00: Yeah, it's a really great balance of everything all together, where we're able to provide that like warm and empathetic and understanding space.
• 10:07
  SPEAKER_00: And that's so much of the healing from the trauma to have someone there that gets it and that can understand and also provides these really helpful tools with the DBT and acceptance and commitment therapy pieces.
• 10:22
  SPEAKER_00: That's where we really see, like Kelsey was saying, the tangible tools show up.
• 10:27
  SPEAKER_00: A lot of times with someone who is experiencing chronic illness and the trauma alongside it, the nervous system becomes really dysregulated and it's nobody's fault that that is happening.
• 10:37
  SPEAKER_00: It's the way in which the nervous system is trying to protect a person, but at times that can also cause a lot of distress.
• 10:44
  SPEAKER_00: So with the dialectical behavior therapy and the acceptance and commitment therapy pieces, we look at tools that we can implement to help to regulate the nervous system.
• 10:54
  SPEAKER_00: So someone may still be experiencing a lot of the physical and emotional symptoms, but that relationship to the symptoms starts to change through using these emotional regulation pieces and distress tolerance pieces, um, and also looking at ways in which we can identify values so someone can still live that meaningful life alongside that pain.
• 11:15
  SPEAKER_00: So they're not suffering as much as they're experiencing something that is really unimaginable to go through.
• 11:22
  SPEAKER_01: Yeah.
• 11:23
  SPEAKER_01: So now I know the answer to this question, but I'm sure listeners uh want to know why women?
• 11:30
  SPEAKER_01: Why, why do we focus on women here, especially when it comes to chronic illness?
• 11:36
  SPEAKER_01: And what is kind of the purpose of catering your services, particularly to this population?
• 11:44
  SPEAKER_02: It's a deep question.
• 11:45
  SPEAKER_02: Um, I think at least for for me, I I mean, women are vastly still under researched.
• 11:54
  SPEAKER_02: Um, Ariel and I went to alongside Dr.
• 11:57
  SPEAKER_02: Ghazi, uh, were at the public health conference a few weeks ago, and they gave a statistic that for every uh endometriosis patient, there's three dollars of um research we put behind that.
• 12:12
  SPEAKER_02: So um we are vastly underrepresented in medical research.
• 12:18
  SPEAKER_02: Uh, we are still not equal uh, period, in all facets.
• 12:24
  SPEAKER_02: So there are such barriers that women are facing every single day that add on like marginalized health care.
• 12:34
  SPEAKER_02: And then not to mention, you know, brown and black women, there's still the myth that they have higher pain tolerance.
• 12:41
  SPEAKER_02: And that's not true.
• 12:43
  SPEAKER_02: Um, I think it's just still, we're still so underserved.
• 12:48
  SPEAKER_02: Um and I do feel such hope whenever we go to these conferences that things are changing.
• 12:56
  SPEAKER_02: Uh, but I think they're they are changing because you know, people like yourself are really speaking out and um, you know, pushing the conversation forward and making this kind of care available.
• 13:11
  SPEAKER_01: Absolutely.
• 13:12
  SPEAKER_01: Um, on that topic, well, actually, quick side note.
• 13:16
  SPEAKER_01: I think was it, did they compare it to like the amount of research that goes into like male baldness or something like that?
• 13:22
  SPEAKER_01: Was that the comparison?
• 13:23
  SPEAKER_01: Yep.
• 13:24
  SPEAKER_01: And like that number per person was like exponentially higher for a male research that goes into a man's baldness versus women who have endometriosis, which for anyone who's listening who doesn't know what that is, it's a very complex multi-system diagnosis that can be severely debilitating and you lead to like seven to ten years delayed diagnosis, treatment, and care, um, and is extremely psych biopsychosocially impacting uh woman's life.
• 13:54
  SPEAKER_01: So um, and then male pattern baldness.
• 13:58
  SPEAKER_01: Just funny, isn't it?
• 14:00
  SPEAKER_01: Um so we want to step into the conversation about this concept of medical trauma.
• 14:07
  SPEAKER_01: We we want to understand what does what does that exactly mean, firstly, because I think people it's almost so much like a buzzfeed word to be like, oh, I'm traumatized, you know.
• 14:19
  SPEAKER_01: Sometimes people feel like it's been used so many times that it when it actually happens, it feels like it's not given the importance and the significance of the not only the psychological and the mental health implications, but also the physiological implications that we know through research that trauma creates.
• 14:39
  SPEAKER_01: So I would love to break down what medical trauma is.
• 14:43
  SPEAKER_01: And then very specifically, as we're talking about women and chronic illness, when a medical professional is entering um into a room, what are what do we know are, you know, pieces or pieces or facets of medical trauma that is so preventable from a healthcare professional, because all three of us are healthcare professionals.
• 15:05
  SPEAKER_01: What can we do and what can patients do to minimize that from happening?
• 15:10
  SPEAKER_01: First, listen to this podcast.
• 15:12
  SPEAKER_01: Other than that, please take it away.
• 15:14
  SPEAKER_02: Um, I think with you know, medical trauma.
• 15:18
  SPEAKER_02: So, not all medical trauma leads to PTSD.
• 15:22
  SPEAKER_02: Uh, you can still have a medically traumatic event without having the symptoms or diagnosis of PTSD.
• 15:29
  SPEAKER_02: Um, but medical trauma is, you know, threat to life or physical safety, repeated invasive procedures.
• 15:39
  SPEAKER_02: Um, and then of course, just living in a body that is in pain, is a repeated pain experience.
• 15:46
  SPEAKER_02: So, you know, if you have in the topic of endometriosis, if you have uh extreme pelvic pain, and every time you have to go to a gynecologist for your just yearly visit, I mean, even those pap smears, if they're not done with maybe, you know, care in the way that it should be done for patients with extreme pain and they maybe don't know exactly what is going on, that can be very traumatic.
• 16:17
  SPEAKER_02: Um so I I I like the way that you know we can validate that just because you know, it might not look like trauma to someone else for for you, this was medically traumatic.
• 16:32
  SPEAKER_02: Um, but I and really the person going through it is the the one who can say this was medically traumatic or not, because they are able to say this was a felt like a threat of safety.
• 16:47
  SPEAKER_02: Um uh sometimes the word like violating, you know, comes up.
• 16:51
  SPEAKER_02: Um so in a nutshell, I think that's kind of a uh definition of medical trauma.
• 17:00
  SPEAKER_01: That's great.
• 17:01
  SPEAKER_01: And then could we maybe add on now?
• 17:04
  SPEAKER_01: If a healthcare professional of any kind, so it could be anything from, like we said before, an example of a cardiologist to physical therapist to uh any anybody else, um, when you're walking into that therapeutic space and you're beginning that patient-client um, sorry, that uh healthcare professional provider-client relationship, what are things that a healthcare provider should be watching out for?
• 17:30
  SPEAKER_01: What should we be thinking about conscientiously to reduce this from happening to patients?
• 17:37
  SPEAKER_00: I think a big piece of it is listening to the patient and validating the pain.
• 17:44
  SPEAKER_00: There's this kind of concept on top of the medical trauma of something called a moral injury.
• 17:49
  SPEAKER_00: And this can happen when people are going to see healthcare professionals and the person is in so much pain and is asking for help and is being told your pain is not real or you're overreacting.
• 18:03
  SPEAKER_00: I've heard people say that they've been called crazy, which is so, so not okay.
• 18:08
  SPEAKER_00: So there's so much power in listening and also just making sure that you're reflecting back the pain that the person is experiencing and that the healthcare professional is understanding what the patient is saying.
• 18:23
  SPEAKER_00: Really letting that patient know that they understand that the pain is real and they're going to do what they can to help.
• 18:30
  SPEAKER_00: What's really challenging, and I hear this a lot with pelvic pain, and at the conference we went to as well, they described it as this emerging field in medicine.
• 18:39
  SPEAKER_00: So sometimes someone may go to see a doctor and they think it's the right doctor, but the doctor isn't properly educated in the condition because it is an emerging field.
• 18:48
  SPEAKER_00: So something that's so helpful too is that a healthcare professional can acknowledge, I want to help you, but I can't.
• 18:54
  SPEAKER_00: So let me help you find someone else or encourage the patient to find that other care as well.
• 19:01
  SPEAKER_00: But there's so much power in preventing more of that moral injury and more of that trauma simply by listening and validating.
• 19:09
  SPEAKER_01: Yeah, I like, I like that concept.
• 19:11
  SPEAKER_01: So the act of listening, of course, at least gives the patient an opportunity to explain themselves.
• 19:16
  SPEAKER_01: And I know that there's some statin PT uh world where uh, you know, like the number of seconds that it takes before the PT interrupts the patient during an evaluation when they're taking a subjective history, which is like not supposed to happen.
• 19:29
  SPEAKER_01: You're supposed to allow them to speak and explain their condition.
• 19:34
  SPEAKER_01: I know that there's always a little bit of like, well, you can't spend an hour because sometimes people come in with a really long history and they do take it does take an hour to explain their symptoms.
• 19:45
  SPEAKER_01: And there's a whole insurance concept of like they can't like if we don't have an evaluation, if we don't have something tangible to report, their visits don't get covered.
• 19:53
  SPEAKER_01: So there's a lot of like, I guess, systemic and you know, I guess just social factors that contribute to some of the interruption and the lack of active listening.
• 20:04
  SPEAKER_01: But I think, Ariel, to your point, I think what's important is that we at least allow them to get some of their story out and validate what we can get out.
• 20:15
  SPEAKER_01: And I think that there's a very um nice way to redirect a conversation, to explain to them that we are going to finish this topic that you are sharing and adjacently, which is of course very related.
• 20:30
  SPEAKER_01: Um, let's get to a few things.
• 20:32
  SPEAKER_01: And then as while I'm working on you, I want to hear more of the story.
• 20:35
  SPEAKER_01: That's something that I have done before when we really just did need to get the insurance coverage and we needed to do some tests and measures, meaning I needed to put my hands on the patient to understand what was going on.
• 20:49
  SPEAKER_01: Um, but I do think that there's a way to do that that provides empathy, still actively listening, validates and provides compassion.
• 20:59
  SPEAKER_01: I think this also goes back to the point I think, Kelsey, that you made, maybe maybe Ariel or Kelsey, one of you, both of you made, um, about the that like kind of therapeutic alliance, because that I think exists, it should exist in every profession.
• 21:14
  SPEAKER_01: Because if we think about it that way, it doesn't actually just have to be with mental health.
• 21:20
  SPEAKER_01: I think if we thought about all healthcare providers, like even the tech or aid that came to take your blood pressure to the person that's performing the surgery and or the person who's telling you and your family that unfortunately you have a diagnosis of this severe condition.
• 21:36
  SPEAKER_01: I think if we all thought of that in the form of therapeutic alliance, I think that that would actually solve so much of the problem.
• 21:43
  SPEAKER_01: Because I do think that there's this disconnect.
• 21:45
  SPEAKER_01: It's not it, I feel like sometimes it doesn't feel like it's an alliance.
• 21:48
  SPEAKER_01: Like the patient and the provider are on the same team working together.
• 21:52
  SPEAKER_01: I think that when that disconnect happens, you have to drop the ego as a provider to be like, this is not the right fit.
• 22:00
  SPEAKER_01: For me.
• 22:01
  SPEAKER_01: And that's okay.
• 22:02
  SPEAKER_01: I'm I'm not sure.
• 22:04
  SPEAKER_01: I'm pretty sure that this is the same in most states, I've been told, right?
• 22:07
  SPEAKER_01: Is that after the first session of um like your mental health therapy evaluation, um, that the therapist asks you, do you think we are a right fit?
• 22:16
  SPEAKER_01: Is that correct?
• 22:17
  SPEAKER_01: Do they do they do that across states?
• 22:20
  SPEAKER_02: It's uh I think it's I don't know if there's a hard and fast rule of like when you have to ask that, but we make it very clear, like if after the initial first few sessions it it becomes clear that maybe a higher level of care is needed, um, you know, we'll we'll talk about that and give you the proper referral.
• 22:37
  SPEAKER_02: So we do make that clear, you know, that we're we're trying to get you to the right care because that's the most important thing.
• 22:44
  SPEAKER_02: And I do feel for any, you know, person in a helping profession, um, like Ariel and I know what we're very good at treating.
• 22:54
  SPEAKER_02: And we also know where our limitations are.
• 22:56
  SPEAKER_02: And it doesn't serve the client to, you know, work with someone that we're not trained and skilled in.
• 23:04
  SPEAKER_02: Um, we're very good at pelvic pain and and chronic illness.
• 23:09
  SPEAKER_02: And there are a lot of clinicians that that's such a relief because that's not something they have expertise in.
• 23:14
  SPEAKER_02: I don't do couples.
• 23:16
  SPEAKER_02: Like that's such a relief when I know I have an amazing couples referral, right?
• 23:20
  SPEAKER_02: So um knowing what you're good at, that's good for the patients as well.
• 23:26
  SPEAKER_02: Um, and I think too, I uh as a patient myself, I think it's so refreshing when a doctor is like, you know what, I'm not sure about that, but I'm gonna look into it and I'll ask some colleagues.
• 23:38
  SPEAKER_02: Like that to me, that doesn't say you don't know what you're talking about.
• 23:42
  SPEAKER_02: That says you're a lifelong learner, you're curious.
• 23:45
  SPEAKER_02: And um, that's such a a beautiful vulnerability.
• 23:50
  SPEAKER_02: Um, and uh I I think I don't know, I I hope more medical professionals would lean into that as not a um not a negative, but such a sign of desire to help and learn.
• 24:05
  SPEAKER_02: Absolutely.
• 24:06
  SPEAKER_01: I think it's a form of actual, like I think it makes someone feel more powerful when they have that vulnerability.
• 24:13
  SPEAKER_01: Um, and it I think it communicates to patients that there is trust.
• 24:18
  SPEAKER_01: Because if you just sit there and you say, I know everything, it's just not possible, right?
• 24:22
  SPEAKER_01: Like you can't, and also the medical field, especially when it comes to pelvic pain and it comes to women, because of what we discussed before of it being so under-researched, it's evolving, continuously evolving.
• 24:33
  SPEAKER_01: So we have more information all the time.
• 24:35
  SPEAKER_01: Like, even what I learned 10 years ago, like, for example, in the healing or treatment of diastys recti is very different from the conversation that we have right now in how to treat that and why we're treating that and what does that even mean?
• 24:49
  SPEAKER_01: And so I think it's important as providers to, like you said, stay curious and keep evolving and keep learning and let your patients know, like, if this is not the right fit, it's okay.
• 25:00
  SPEAKER_01: We can find you somebody that would work better, right?
• 25:04
  SPEAKER_01: There's anything else to add to that point.
• 25:08
  SPEAKER_02: I I I think uh just to build on that, is like when you know what you're good at, you also like you feel more confident in the treatment, you're able to help your clients make that multidisciplinary team.
• 25:21
  SPEAKER_02: So that's something that's really important to us is we are just one piece of the puzzle.
• 25:27
  SPEAKER_02: Um, we cannot cure your pain.
• 25:30
  SPEAKER_02: Uh, we can help you thrive and live with joy in the midst of a diagnosis.
• 25:37
  SPEAKER_02: Um, but we need surgeons, we need PTs, we need acupuncturists, we need lymphatic massage, we need all of these people um to help provide the care so that you can find stability.
• 25:52
  SPEAKER_02: So you also know like what obviously is in your wheelhouse and your limitations.
• 25:58
  SPEAKER_01: Absolutely.
• 26:00
  SPEAKER_01: Um, I want to touch on this, the patient side, because we kind of talked about what providers can do.
• 26:05
  SPEAKER_01: I think Ariel, you spoke really nicely about especially the act of listening, um, which I think is really important in validation.
• 26:12
  SPEAKER_01: What because a lot of our listeners are also just patients who are trying to learn.
• 26:16
  SPEAKER_01: Possibly somebody who's listening right now is experiencing chronic illness.
• 26:21
  SPEAKER_01: And possibly, especially if you're a woman, you might have experienced some kind of maybe medical trauma or some kind of disregard in any situation to your pain or to the experience that you're having.
• 26:34
  SPEAKER_01: What can patients do when they enter that waiting room or enter that space to help mitigate this that happen this thing that happens so unfortunately often?
• 26:47
  SPEAKER_00: Yeah, it's a challenging one because there's sometimes those situations where it's just out of the patient's control.
• 26:54
  SPEAKER_00: But when the patient is entering that waiting room, finding a way to relax as much as possible is so incredibly helpful because it helps with downregulating the nervous system and just accessing some safety in a situation that they're unsure if it's going to be safe or not.
• 27:11
  SPEAKER_00: So doing some grounding, bringing in some like comforting music to listen to, comforting pictures to look at, um even doing some like gentle self-tapping in the waiting room or breathing exercises as well.
• 27:25
  SPEAKER_00: Sometimes those appointments can also feel really, really overwhelming.
• 27:28
  SPEAKER_00: Just going through the medical history in and of itself is so overwhelming and can be so emotional.
• 27:34
  SPEAKER_00: So having a list ready of what they want to bring up, the pieces of the history that they want to talk about as well, can be so helpful because in those moments of feeling so much of that anxiety in the room, just having something tangible to use can be really, really helpful.
• 27:52
  SPEAKER_00: And then it's kind of so it's hard to give an answer to this because it's so patient specific.
• 27:58
  SPEAKER_00: But some patients may be like, you know, what I want to advocate to be heard.
• 28:02
  SPEAKER_00: And kind of having a way of doing that, having an approach, practicing that even before the appointment.
• 28:07
  SPEAKER_00: Some patients may decide, you know, what if this practitioner isn't able to hear me, they're just not the practitioner for me.
• 28:13
  SPEAKER_00: And then validating with that self-compassion after the appointment that the pain is real and that they're allowed to go and find other practitioners as well.
• 28:22
  SPEAKER_00: Um, on the other side of it too, and this is kind of both patient and practitioner, but it can be helpful to kind of understand what the appointment is going to look like to protect from some of that trauma.
• 28:34
  SPEAKER_00: So, Dr.
• 28:34
  SPEAKER_00: Gazi, like you were saying, how when you go through your appointments, you tell the patient what they can expect.
• 28:40
  SPEAKER_00: And you tell them, like, oh, we're going to go through more of the history at this point in time.
• 28:44
  SPEAKER_00: For the practitioners to explain that can be really helpful for the patients.
• 28:49
  SPEAKER_00: And if they're not explaining that, the patient to ask, like, how can I expect this appointment to go so that they can feel more prepared and also more prepared in how they want to be sharing the information.
• 29:00
  SPEAKER_01: Yes, I do really love that.
• 29:02
  SPEAKER_01: I think that I think it's not easy to do all the things that you said.
• 29:05
  SPEAKER_01: So I want to acknowledge that it's very difficult and challenging to anybody who's listening who's like, oh my God, that sounds scary.
• 29:13
  SPEAKER_01: Uh, it is.
• 29:14
  SPEAKER_01: It's very scary.
• 29:15
  SPEAKER_01: It can be very scary, but it doesn't have to, and you can get the support and the tools by working with specialists who real literally can give you the tangible practical application of how to even do the simplest, seemingly simplest thing like going to a doctor's appointment, right?
• 29:33
  SPEAKER_01: It seems like it should be so straightforward, but it can be so complex, especially for people who have experienced some kind of medical trauma or some kind of dismissal or, you know, pushed off to the side or told them to, you know, told to drink a glass of wine or everything is in your head, or that it's absolutely crazy that you feel that way.
• 29:51
  SPEAKER_01: Um, I've heard this from my patients so many times, you know.
• 29:56
  SPEAKER_01: Um, and I think it's extremely important to know that there are tools, that you do have tangible tips that you can use.
• 30:04
  SPEAKER_01: And it doesn't have to work out with that provider.
• 30:07
  SPEAKER_01: And that's okay.
• 30:08
  SPEAKER_01: It's not a failure on you, and there's nothing wrong with you.
• 30:12
  SPEAKER_01: It's just the way that it is, that it's okay if that happens, right?
• 30:15
  SPEAKER_02: Yeah.
• 30:16
  SPEAKER_02: And I love Ariel, those are amazing tips.
• 30:19
  SPEAKER_02: I I think the only other thing I can uh think of to add is like having a um narrative written that sometimes just filling out the forms is also very overwhelming.
• 30:32
  SPEAKER_02: So if you can have something on your computer, you know, because we tend to know what the forms are going to be like.
• 30:38
  SPEAKER_02: Like, what's your surgical history?
• 30:40
  SPEAKER_02: You know, what medications are you on?
• 30:41
  SPEAKER_02: That's also for folks with chronic illness, like such a mental load and brain fog and that all of that can be very challenging to just remember and then it's upsetting to like spend extra time.
• 30:55
  SPEAKER_02: So can you just like copy and paste, like have this in your computer and then print it out?
• 31:01
  SPEAKER_02: And if there's something you want to really make sure the doctor sees, like highlight it and just say front desk, hey, can you scan this and then give give the actual paper like to the doctor?
• 31:12
  SPEAKER_02: Um, and keep it like maybe like a one-page or bullet points, like very simple.
• 31:17
  SPEAKER_02: But again, like how Ariel was saying, having your questions written down, there might also be pieces in your history that you maybe, you know, don't always think about or forget about that might be really helpful for that provider to know.
• 31:31
  SPEAKER_02: Um, so just cutting down on that mental load can also help turn down the volume on that anxiety too.
• 31:37
  SPEAKER_02: So it's like it, it's so many proactive things uh as well that can be helpful.
• 31:44
  SPEAKER_01: I love that.
• 31:45
  SPEAKER_01: I actually once had a 92-year-old man that I treated.
• 31:48
  SPEAKER_01: He like flattened World War II and he was so great.
• 31:52
  SPEAKER_01: He brought me a handbook of his history because he needed a he needed a handbook to explain all the surgeries that he'd gone through, all the medication that he had been on, had been on historically and present.
• 32:04
  SPEAKER_01: And it was just, he was like one of the sweetest, sweetest.
• 32:08
  SPEAKER_01: Unfortunately, he was one of two people that passed away during care um that I've ever ever experienced.
• 32:12
  SPEAKER_01: But he was just such a lovely man.
• 32:14
  SPEAKER_01: And he he did the same thing.
• 32:16
  SPEAKER_01: He said, I I can't explain everything to you.
• 32:18
  SPEAKER_01: I know what we have to do.
• 32:19
  SPEAKER_01: I've been to physical therapy before.
• 32:21
  SPEAKER_01: And he said, Here's the handbook, I'm sure you'll figure it out and like write it down in your chart later.
• 32:27
  SPEAKER_01: But here's what I need right now.
• 32:28
  SPEAKER_01: I was like, you you amazing human.
• 32:31
  SPEAKER_01: I love you.
• 32:32
  SPEAKER_02: I love that.
• 32:34
  SPEAKER_02: Oh, that's so and it and the information really is important, like for and for us too.
• 32:41
  SPEAKER_02: The I thinking of medical trauma and just thinking about how we also try to mitigate that of it's important that we have your history.
• 32:50
  SPEAKER_02: Uh, but sometimes people come in of like, I've been in therapy for my childhood, like I don't want to get into it again.
• 32:57
  SPEAKER_02: And I'm like, that is so fine.
• 32:59
  SPEAKER_02: You you've done the work.
• 33:00
  SPEAKER_02: Can you just give me the highlights of what you want me to know?
• 33:04
  SPEAKER_02: And um, we don't need to re-traumatize, right?
• 33:08
  SPEAKER_02: So that again, kind of full circle, like thinking of cognitive processing therapy, understanding what a step point is, I don't need to know the details of what traumatic event you know happened or what that looked like, but how are you, how is it impacting you right now?
• 33:24
  SPEAKER_02: Um, and it's really amazing.
• 33:26
  SPEAKER_02: We see if especially dealing with more complex PTSD, right?
• 33:30
  SPEAKER_02: These repeated traumatic events, which is can be medical trauma, can be other things.
• 33:35
  SPEAKER_02: You start, you see the same stock points from the first traumatic event to the present.
• 33:41
  SPEAKER_02: That those narratives tend to remain the same.
• 33:45
  SPEAKER_02: It's fascinating.
• 33:46
  SPEAKER_02: So you can really stay in the present moment.
• 33:49
  SPEAKER_02: So the amygdala is not getting so hyperactive and stay in the present moment, but you're actually addressing the trauma that happened at five years old, too.
• 33:59
  SPEAKER_02: Um, so that that's what amazes me about CPT.
• 34:03
  SPEAKER_02: It's just, it's remarkable.
• 34:05
  SPEAKER_01: It's wonderful.
• 34:06
  SPEAKER_01: Do you guys have anything else to add to this conversation?
• 34:09
  SPEAKER_01: I know we can go on for a million years, and I want to.
• 34:13
  SPEAKER_01: Um, but is there are there any salient points that you want our listeners to take away from either the work that you do, the importance of the work, of course, or anything else that would help them in their journeys?
• 34:25
  SPEAKER_02: I I think for me, the bottom line is always like we we believe you and um the pain that is not in your head.
• 34:35
  SPEAKER_02: Pain, you know, we understand we can go into the, you know, what the amygdala is doing and that we can turn the volume down, right?
• 34:44
  SPEAKER_02: I I can't help turn the switch on and off.
• 34:47
  SPEAKER_02: Um, yes, we can, you know, help manage the symptoms, but it is, it's real.
• 34:53
  SPEAKER_02: And uh, you know, psychosomatic, in my clinical opinion, uh pain is the exception, not the rule.
• 35:01
  SPEAKER_02: So if we can approach care with that, um, it goes so far.
• 35:05
  SPEAKER_02: And there, I think I I think Ariel will echo this, but like there is a possible path for stability and joy, even living with invisible disability and pain.
• 35:17
  SPEAKER_00: And just having that compassion from providers and providers that will work together as well to help in the care makes such a big difference in healing from the medical trauma and living with chronic illness.
• 35:32
  SPEAKER_00: And I think a point that we really touched on as well is how important it is for the person who's dealing with chronic illness to have access to that self-compassion through this, to know that their pain is real and they are deserving of care and that they can find that care and hold that compass and how they want to proceed with their care as well.
• 35:52
  SPEAKER_01: That's amazing.
• 35:53
  SPEAKER_01: I'm sure that if you are a provider listening right now and you serve patients who have chronic illnesses, and especially if you live in the New York City area, Ariel and Kelsey would love to connect with you.
• 36:06
  SPEAKER_01: And if you are a patient who's suffering and struggling, you don't have to.
• 36:11
  SPEAKER_01: Um, there are tools that you can use and you can reach out to these wonderful women and their organization.
• 36:16
  SPEAKER_01: They have plenty of help that they can provide for you.
• 36:19
  SPEAKER_01: Um, Ariel would like to just let us know what's the best way to reach you guys, maybe your website or handles or anything like that.
• 36:28
  SPEAKER_02: Yeah, so um our emails are Kelsey at women's cbt, women's with an S, or Ariel at women's CBT with an S.
• 36:38
  SPEAKER_02: Uh and or the website is women's CBT.com, very easy.
• 36:42
  SPEAKER_02: And uh Instagram, trying to be a bit more active on is at women's cbt.
• 36:48
  SPEAKER_01: Amazing.
• 36:49
  SPEAKER_01: I'm gonna drop all of that in the show notes so people um can click on it directly or copy and paste that and um find you guys.
• 36:57
  SPEAKER_01: I think the work is really important.
• 36:59
  SPEAKER_01: I am so glad that we are having more practitioners focused in this field.
• 37:04
  SPEAKER_01: And, you know, it works very closely with the work that I do with public health as well.
• 37:09
  SPEAKER_01: And so I would love to continue the collaboration.
• 37:12
  SPEAKER_01: I'm so excited to see where you guys take this organization and the impact that you're gonna make for people far and wide.
• 37:19
  SPEAKER_01: So thank you so much for being on the show, for explaining what you do, and we hope to have you guys again at some point in another season.
• 37:27
  SPEAKER_02: Thank you.
• 37:28
  SPEAKER_01: Thank you for having us, and thank you for the work that you do as well.
• 37:33
  SPEAKER_01: Thank you all for tuning in and investing in yourself and your well-being.
• 37:37
  SPEAKER_01: If you listened to the show today and gained anything out of it, share it far and wide.
• 37:42
  SPEAKER_01: It means a world when you rate and review the show.
• 37:46
  SPEAKER_01: Don't forget to use your exclusive 20% discount code FIT20 when you sign up for our signature course Master Your Public Floor, linked in the show notes.
• 37:56
  SPEAKER_01: See you again next week with an exciting new guest and topic.