Singing Dragon Event #2 Audio Transcript
0:04
Hello, my name is Amy Wheeler and I am here with Matt Herb and Steve Haynes. Steve is from Geneva and Matt is from the United States. I'm from California, Southern California Madison Arizona. And we are just thrilled to be with Singing Dragon. so grateful that they are supporting the work of Steve and Matt and myself. And we're here tonight for the power of touch. And so far we have people from all over the world from the UK, United States, Australia, Canada, Ireland, Germany, Switzerland, Portugal, Belgium, Netherlands, Scotland, Spain, and more. So if you're just joining us, please feel free to write your name and where you're from. And if you are watching this, for the recording, we welcome you also, if you couldn't be here live, it's nice to be in connection with you through this webinar and
I also wanted to tell you that we are using closed captioning today in an attempt to be more inclusive. So if you're not familiar with the closed captioning, basically, at the very bottom toolbar, if you take your cursor down there, you should see something, a little box with cc on it that says live transcript. And if you press your cursor on that, you'll have the option to show your subtitle, or hide your subtitles. If they're a little bit distracting to you, some people like to turn them off. You can also click view full transcript, which will put the transcript in the chat. So especially if you have any kind of hearing hearing impairment, or the way that I speak doesn't actually work for your ear or it's not loud enough, sometimes it's helpful to have those extra supports through the closed captioning.
This event is being recorded, and a copy of it will be distributed to you in about two to three days. So if you have to leave early or you're missing a little bit or whatever comes up at your house, just know that you'll still have access to the recording.
We have a digital goodie bag for you that is really amazing. The first thing in the digital goodie bag that you get for registering is 25% off three different books. The first one is Matt's new book that's just come out from Singing Dragon called Integrative Rehabilitation Practice. And I've seen an early copy of it and you are going to want to get this book it is amazing. And then Steve also has several books. He has four books, some what we call graphic medicine, books, educational comic books, and the books that he's produced and Singing Dragon has helped to, to distribute are Touch Is Really Strange, Pain Is Really Strange, Trauma Is Really Strange, and Anxiety Is Really Strange. So those books have been given the highest award by the British Medical awards in 2016. And just so you know, all the links to those books are in the chat right now if you want to click on them or copy them into your Word doc. The other book that's 25% off is this wonderful book that just came out. And it's edited by Diane Finlayson and Laurie Hyland Robertson, and it's called Yoga Therapy, Foundational Tools and Practice. And I actually have chapter number three in this book called the foundations of yoga therapy that I wrote. And so that book also is 25% off through the the link that's being provided in the chat. In addition, in your digital goodie bag, you're going to have white papers from both Steve Haines and Matt Herb. And the extract or the chapter that I wrote for the book, Yoga Therapy, Foundational Tools and Practice. So there's a lot of great stuff. Don't Don't miss out on that. And so I think we should move into introducing our speakers this evening, depending on where you are, for some of you it's middle of the day. So I think I'll start with Matt. Matt Herb is a physical therapist and associate clinical director for the Centre for Mind Body medicine. He's also an instructor at the University of Arizona. Andrew Weil medical or Andrew Weil Centre for Integrative Medicine.
He's a guest lecturer for the Departments of psychiatry and family medicine. Matt also has a clinical practice with the Simon's physiotherapy in Tucson, Arizona. And he is the founder of Embody Your Mind which is focused on writing, teaching and counselling. And again, Matt's new book is called Integrative Rehabilitation Practice. Steve Haines is from Geneva. And he is a body worker, an author and trainer. He's studied in yoga, shiatsu, cranial sacral therapy, trauma release exercises, which are called TRE. And in the UK, he's registered as a chiropractor. As we stated earlier, he's the best selling author of four graphic medicine books, educational comic books, which have already won awards. So I would love to welcome Matt and Steve, and I'll just tell you a little bit about myself. Also, my name is Amy Wheeler. And I am the former president of the board for the International Association of Yoga Therapists. And I also am founder and director of a yoga therapy school that certifies yoga therapists at the 1000 hour plus
level. So my school is called Optimal State Yoga Therapy.
All right, so welcome to Steve and Matt. Thanks for being here.
6:34
We're happy to be here. Thank you. Great, so happy to have you.
6:41
All right. So we are having a discussion today of a really important discussion, one that has been kind of a hot topic in in the fields of physical therapy, bodywork yoga therapy for quite some time and that's the power of touch. And I think before we get done with this discussion, we'll we'll see that that power of touch can be used in an appropriate way and and in ways that support the
views appropriately and also cause harm and trauma. So one thing I want to kind of use to frame the discussion is that Steve is more in the body work world, although he has so many talents as we talked about Matt's in physiotherapy, I'm in yoga therapy, we all have maybe different language for the same concept. So we're going to do our best to limit the jargon. And and if we do use it, explain what how our field defines that, that language. So I think we'll just start off with a question. And I'll have Steve go first.
Steve, why are you so interested in this concept of touch as a healing modality? And specifically, you have said that we experience touch as a baby, and we experience sensation, long before we can even speak or articulate our words. So why is that important to our discussion today?
8:17
Thank you, I'm gonna start with a quote from Margaret Atwood actually. So touch comes before sight, before speech. It is the first language and the last and it always tells the truth. I really love that. So touch is one of the first things to develop. There's some evidence that we are responsive to touch after eight weeks in utero.
I think most of our early experiences are rooted in a world that touches us and we push against the world and it pushes back all our concepts of safety. What's too much too quick, too fast. Is
is embedded inside of us through the process of touch. We're shaped literally shaped by the world were moulded and formed by experiences. And all our early concepts of what is safe or what is too much, are actually formed by engaging with a world without words, words come much, much later, three years before we can have a timeline and a sense of a narrative that we can remember. But we've got a huge defining experiences pushing our way through a birth canal going from a warm, wet environment, to meeting gravity to being received by our caregivers, to feeding to finding the weight of our limbs even these things are are determinative about what's safe and learning. And I think this is always available to us there's a kind of a wordless knowing about being human and good touch can really lever that
wordless knowing these early experiences, and help us reconnect to safety, if that process was initially safe, and welcoming, and full of love and joy and ease and creativity, and also if our early experiences where, were a struggle, and maybe some trauma processes, some sense that it wasn't safe from where we're speeding up to survive or disappearing to survive, I really believe that safe touch in adults can help us rediscover something that was lost or didn't quite come into place. And we can refine the sense of safety, beyond contemplative words, as a deep felt sense, a deep world of sensation inside of us.
10:44
You know, when when you're saying that, it really helps me to understand as a yoga therapist,
why it is some people prefer to be adjusted or prefer not to be adjusted or why consent is so important, and giving people permission to say, No, thank you.
So, yeah, there might be some very, very old patterns behind that. So some people in the birth canal, their struggle, we did it all on our own, it felt like, you know, I came out fighting and the pattern of me and my autonomy involves independent action. And some of us got exactly the right help, maybe the way their mother contracted, or maybe a pair of hands, was came along at exactly the right moment. And that early priming, around support and touch goes very, very deep and sets up all sorts of habits and needs and ways of relating later on in life.
That's so beautiful. Thank you, Steve, for articulating that so beautifully, and I think it leads right into what I'd like to ask Matt to begin is, Matt, you're quoted as saying, sensation is the bedrock of our being, our the way we be in the world, and and specifically with reference to neuro development. So what did you mean by that sensation is the bedrock of our being?
12:16
Just getting myself unmuted here, essentially the same thing
that Steve has just said that
we sense the world first, before the development of the cognitive sort of capacity, the language realm even.
I once is, as I was listening to Steve talk, I was trying to remember where I read this, and I probably won't, but I was reading about heart rate variability, which has to do with the vagus nerve. And that respiratory sinus arrhythmia, which is where there's a really naturally synchronised speeding up and slowing down to the heart when we inhale and exhale, begins to disappear is a natural state somewhere between 5,6,7 years old, and that that parallels the onset of education, thinking realm, cognitive development, learning, and I don't remember who it was that wrote that and I and I want to be careful, I really like to stick to the, to the science, you know, to solid science. But I found that fascinating to contemplate,
how it is that when we transition to thinking our way through the world, as opposed to feeling our way, sensing our way through the world, and then oftentimes, in my own work, we're bringing that back into balance.
like helping people see where they're trying to rely on a purely cognitive strategy to navigate the world and have lost touch with this, this bedrock, this capacity to sense.
The other quote, I'll throw out real quick, and also gonna not remember this is from a yogi, I think it's been possibly in the book, The Science of Breath. So we'll have to look that up.
He says,
sensation is the connecting point between the mind and body where one can know what is right for the whole being.
And I the only thing I would add to that is that it's a connecting point between body, mind and environment, because each of us our body and mind is interacting with environments, and that carries profound influence on what we experience, including our sensory experience. And so it's really beginning to explore that.
14:30
You know, Matt, it's, it's reminded me of something that both you and I care deeply about, and that is indigenous cultures. And it seems to me that there is an embodied wisdom and and appreciation of that embodied wisdom with your environment with yourself with your loved ones. That's very different than just walking through the world as a talking head or thinking head and kind of feeling disconnected from from the neck down. Yet society is so much rewarding us for just thinking our way through, do you have anything you want to add to that?
15:12
Just the validation and acknowledgement of indigenous wisdom.
There's a man in southern Ontario, he was a former judge, and I'm, I'm terrible with names, I really apologise, I should have these more ready at hand, but he wrote a book about his experience working in tribal communities in southern Ontario and the difference between indigenous mind and what he calls colonial mind. And that indigenous way of being so aware of the continuous interplay of our experience with nature, ecology, you know, one of my favourite phrases is ecosystem, ecosystems within ecosystems. And all of that really is the way that we can discover that is by coming into a deeper, more conscious relationship with our sensing capacity. And I and I, the work that I've been gifted to do, I'm calling calling in here from giving my own land acknowledgement. I think I saw someone acknowledge that in the in their introductions, but I'm on Tohono O'odham, and Pascua Yaqui land here in in, in Arizona, the ancestral lands of these people, it's important to acknowledge that, but all that I've learned in my work on the Pine Ridge Indian Reservation, is consistent with that what you've just expressed and what we're talking about here. And what none of this is new. Right.
16:45
Steve, did you want to add to that?
16:47
I love the idea that where a body is much more than a thing, a body is a process. And David Abraham who wrote The Spell of the Sensuous we are an open circuit that completes ourselves by engaging with the world. And if we just remove the external, if we remove the environment, we miss out on so much. And it's a real error. Because you don't stop at the flesh, you are always a process that's deeply contextual, and deeply shaped by what's around you. And yeah, always really good to know that, very hard to act out. I love the phrase, I'm a thinking head walking around. But we're a sensing body engaged in a world and we are only complete in the act of engaging with the world.
17:39
I could not agree more, Steve. And I think what's happened to a lot of us is that, through trauma, through life experience, we have kind of shut down that interoceptive awareness of, of feeling and being and sensing in the world. So Steve, how do you define interoception as a concept? And can you tie that to this idea of being able to self regulate internally, so that you can interact with your environment in a way that supports you and your nervous system.
18:15
I can try. So for many of us, we operate off a reduced sense of who we are. So feeling is hard. And it's a big mess of information streaming through us. And frequently there's pain or emotions that are churning, and we just limit our bandwidth because it's too much, quite often. So a kind of technical term for that is dissociation, we lose contact with who we are, it's a well known term term in trauma. So the idea that dissociation is an active, conscious withdrawal. But I'm going to offer that dissociation always involves an inability to relate to our body, an inability to feel the slow background tone of the body. So we have lots of ways of feeling and sensing our body, but there's a whole set of slow information. It's called the slow background tone of the body. Some of it coming from slow c fibres and fascia, lots of it coming from your organs, your blood vessels. It's the slow signals that seem to be really important in consciousness that form our homeostasis. This is your body right now. And when you have a constant stream of these interoceptive moments, you have a stream of coherence in your sense of consciousness, sense of who you are, it's coherent. I know what I feel, and I know who I am, is founded on this slow background tone of the body. That's very, very exciting science. But this stuff gets knocked out by traumatic experiences and by the act of protecting ourselves by making ourselves small and withdrawing. One of the we have lots of chemicals that mask signals that can be dangerous. And one of the things they mask particularly is those slow background tone of the body, the size, the shape, the weight, the flow, all those things fade into the background and become blank and, and hard and numb. So our first journey really in connecting is this journey of waking up the internal sense of our body. And when we feel safe inside of our body, when we have the ability to not be fragmented and disconnected from our body. And then I think selfhood is rooted in this ability to feel the slow background tone of our body. And when we're safe inside of us, we're safe to reach out and we start doing good things because we feel good inside of ourselves. And we're more open and available and we can relate to people. And then we stack spreads as a sort of spiritual act really, that I include more in my sense of how if I can pay attention to nature and spirit and mystery, I'm excited by difference because I feel safe inside of myself and I can explore from the safe home of my body. So interior section, the ability to feel this slow, safe sense of self really allows us to have a secure base to move out and explore the world and ultimately be more generous in our interactions and more able to see others viewpoints and have a larger framework.
21:30
And we've talked before, but it seems to me that you have even gone as far as to say that, when we don't have that interoception and that ability to self regulate internally, that it becomes very difficult to go out into the world and negotiate the world and the people in it.
21:52
Yeah, kind of reality, the whole business of knowing is really hard. If you don't know your body, what can you know, it's often just ideas floating around in a big old brain that can, you know, get really lost. We need the ground of the body and the ability to interact. I found a nice quote when I was writing touches really strange that the sense we rely on for reality most is touch. And there's the sort of we touch the world, the world touches us and it creates, reinforces our sense of reality. So yeah, this neutral becoming by feeling ourselves allows us to feel the world and the world touches us back and we feel more real and we get this virtuous circle, we just lose all of that if we disconnect from our body and don't get touched and disconnect from others.
22:43
You know, that's fascinating because the International Association of Yoga Therapists when I was President a couple of years ago, we looked at all the other health care fields like physiotherapy and body workers and and we saw that everyone had a touch policy and a way to guide people in how to get consent, how to touch appropriately what you can't do, and that yoga therapy was lacking that in our scope of practice. So, I would love to just share for a moment what IAYT came up with because I think it's important and we've I even asked my clients to sign this document right here, and I'll read it to you. But to up front when we are, you know, offering our whatever modality we're offering to allow people the opportunity to give consent or not, and to educate them a little bit about touch. So here's the consent form that I use, and the one that IAYT now recommends all of their CIAYTs create and have people sign. Touch is a powerful tool in teaching and in healing and transformation. It is integral to many approaches to yoga therapy as an effective and useful nonverbal way to assess, instruct, share information non-verbally and increase awareness. People's experience with touch, and feelings about touch, are varied and informed by their cultural and societal orientation. Yoga therapy principles, methods and practices, including language, movement, position, gesture, and touch, and when used respectfully and responsibly, are all essential attributes of the yoga therapy process. When you skillfully, with clear boundaries, sensitive application and good clinical judgement, touch has a legitimate and valuable role as a body-oriented mode of engagement and then we have them print their name and sign it. So I just wanted to share that because that that's a, you know, a big development in the field of yoga therapy, but I think it goes straight to the heart of of what Steve was talking about in terms of interoception and self regulation, if, if yoga therapy specifically is looking to help people learn how to self regulate, so they can negotiate the environment and the external world, it seems that that would be a big part of helping them learn that self regulation through the interoceptive experience. I also want to invite all of our attendees to write questions in the q&a. You can do it anonymously, or you can do it with your name on it. But I'm sure both Matt and Steve would really love to have some questions from the audience. So anytime, just pop them in there. And I will read them as we see them come up. So Matt, I want to, you know, talk to ask you a question now that is along the lines of what Steve was just talking about with interoception. Could you tell us how touch differs for different people like the same touch could be experienced differently, and maybe give us some examples of this intra-individual approach to touch?
26:26
Sure. Before I jump into that two important thoughts came to mind to emphasise from what Steve was sharing. And the first is, when I'm sometimes training people in interoceptive awareness, inadvertently, people get the message that somehow they're supposed to be tuned in to that 24/7. And so the message that that's not realistic, nor is it necessarily healthy or appropriate to be monitoring 100% of that information all the time. So what I'm saying is dissociation in stages and grades outside of what might be considered a problematic state, which can come with trauma states, mental health states, is actually normal on a spectrum for all of us. The question is, when do we tune in and act we, say drop anchor, which is the cue to check in with what is going on in the body right now. So I just wanted to emphasise that and then the other will speak to this question. And it's the idea of safety and what determines safety. What what does safety even mean, that's very different for each person. And the concept of safe enough, safe as relative, helps distinguish between things that may be unpleasant to us, new, unfamiliar, certain types of sensing, detecting sensations, as opposed to something that in the trauma world the concept of window of tolerance and zone of arousal, that up to a certain point, we can tolerate stimulation, activation. And then at a certain point, it may actually be outside of our window of tolerance or zone of arousal, where it actually becomes problematic, where it sets up more defensive behavioural responses, the fight flight freeze sort of responses. And so helping people understand that and know begin to identify and frame what what that zone is for them, and what is safe enough that there may not necessarily be 100% absolute sense of safety ever, as humans in a sense. Now, just adding one more thing to your question about what determines that I let the person tell me what determines that because I don't always know for sure what the balance of the interaction, the balance, the quality, whether the the touch, or the experience or the environment even is going to be experienced as friend or foe, pleasant or unpleasant, novel, which is like a healthy Ooh, what's that? Pay attention versus, you know, versus normal, where we're more apt to habituate, tune out that sensory input. And so I tried to set up a scenario where people are educating me through the provision of choice and then sometimes through trial and error. So that that what is it that determines that balance that determines safety? Is is made clear in process as I interact with clients with patients.
29:42
I love what you're saying, Matt, because it it takes us all the way back to the neuro development and the ability as Steve was saying earlier to articulate what it is that feels pleasant to us, unpleasant to us, too hard, too soft, too fast, too slow, and and brings the the language together with the touch as an adult in a way that maybe we couldn't as a young child. So we have a wonderful question from one of our attendees. They say, I recently started an education in physiotherapy, my teacher and medical massage has the opinion that medical massage has to hurt in order to be effective. I think either of you could answer this, maybe we'll go to Steve first. But Steve, how would you respond to that?
30:37
Yeah, you don't need to give pain to change pain. So the stimulus needs to be safe and meaningful for that person. So some people like the notion of vigorous and intense sensation, because it makes sense in their history and their life story. It's not inherently good or bad for the tissues, it's a different type of stimulus. And if there's a contract and an agreement, and that type of touch is useful for the person who's receiving it because of their construct, then yes, it can be very useful to is a very particular type of stimulus, we have some receptors that only respond to deep vibrational, deep type of touch. But I very, I mean, I work in a soft touch way, I think you take far less risks when you do slow, gentle touch. And if you realise touch is about meeting a whole person, then I'd like you to think about a tickle. If we tickle someone every system in their chain system, every system in their body changes from this tiny, tiny stimulants, they'll have memories of early childhood experience, whether that was good or bad, but every muscle in their body will change, every system in their body will change from this tiny stimulus. So if you understand that, then you realise it's not about the pressure. It's a much larger game we're playing when we're touch.
32:06
And Steve, as I'm gonna stay with you for a minute, and then come back to Matt, you know that the trend in physiotherapy is now moving away from manual therapies to more passive therapies. I hope I got that right. And more towards a self empowered care. So what what would you say about that, that if we're withholding the passive therapies, because we feel it's not self empowered enough?
32:37
Passive therapy has come to mean in this context, as I understand it, things like the therapist, physical therapist, chiropractor, I trained as a chiropractor is doing something to the client, and the client lies on the table, receives, can ultimately fall asleep maybe. And that, in terms of changing pain, that model hasn't really stood the test of time, it doesn't do particularly well. So if my goal is externally to poke, prod, stretch, twist, to open your joint, unknot a muscle, whatever that means to align something. That doesn't really come out great in pain studies as a valid model. So there's been a huge move away in physiotherapy, to education around how pain works, bio psychosocial model, a much more complex experience that involves emotion, meaning, context, always. And then sort of more motivation about getting people moving and taking the fear around moving. So a lot of focus on exercise and how to help people to move safely in very creative ways. Not just not classic grunt and move in a gym, but kind of developing new safe movement patterns as a way out of pain. So in those gestures to educate and move, they've taken away this notion of touching as a primary tool. Diagnostic touch doesn't work particularly well, touch to change the tissues may, it's very hard to say that that's what's actually happening on a local level. I like a lot of that, but but but but but but I think there's a type of touch that's very different from the poking, prodding, stretching with the goal of just focusing on local dynamics. And I think you miss out on this notion of touch that meets a whole person, touch that can lever these early experiences of safety and help people reconnect to a sense of themself, that touches this tool that reinforces our sense of self. Touch is always emotional. It's always complex, but that's something to be celebrated and included. It's, you always touch whole people, never a part of a person. So I am worried that in the drive to focus on good things, education and movement, but strip away passive, I'm doing something to you type touch, we lose this other element of touch, what I call relational touch, sometimes called effective touch, touch that is always about complexity, but is always about inherently emotional and involves much earlier learning patterns, the when we tried to talk about earlier.
35:18
That is such a beautiful paradigm shift. Right. And, Matt, I know that that you have an article that you've pointed out by David Nichols in the Journal of Orthopaedic Sport, Physical and Orthopaedic Sport, Physical Therapy, JOSPT, that has something kind of interesting to say along these lines, do you want to fill us in on that?
35:45
Yeah, Dr. Nichols is in New Zealand. He's one of the founders of critical physical physiotherapy network, which is really looking to examine very deeply some of the historical underpinnings of the profession. And in this editorial, he pointed out that passive therapies have always been a part of human experience, and will likely always continue to be a part of human experience. And so this framework of sort of throwing out the idea of of passive therapies altogether really doesn't make a lot of sense and encourage people to take a look at the at the full, the full editorial if they can get access to it's very interesting framework, especially for my profession. And I agree with him that the I often frame the idea of core human needs of that safety, which we just talked about in the framework of contextual safety. And then nurturance and empowerment, which I like to see is the Yin and Yang, or the masculine and feminine and the sun and moon and yoga, of the nurturance principle, the feminine principle is very much supported by that passive type experience, passive therapies, passive touch. And I think it's vital to human human meeting human needs, in some cases in a safe setting that the person may not have ever experienced before when they encounter it. And then the empowerment piece comes in when that is balanced by keeping people very engaged, and finding a greater sense of empowerment or capacity or autonomy, agency, in how to respond. The concept of aggressive touch, I just wanted to add one thing about that or extreme massage. The the way that I work with that is help create the type of awareness that allows people to know whether the approach that's being used is putting them, it is dialling up the fight or flight, the sympathetic nervous system response. So I say if you if you're unable, if you're noticing that your body tension is going up instead of down, or if you are you're holding your breath, or you're gritting your teeth, or your face's tensing up, the risk for that to be counter-therapeutic is much greater. Now I agree with Steve, there are some people, some cases where that can be an effective, valuable approach and self selected and useful. But I wanted to point out that that's how I work with it. Because there was a question here about how, how do I in physiotherapy, and I'm just like, Steve, I work with lighter touch, you could call it. You know, some of these integrative or complimentary touch based therapies, I'm not so sure that the belief systems that people present them under necessarily can be fully validated, at least from the scientific model. But when it's looked at from the lens of what has happened, what am I communicating to the person? What's the balance of the relationship in which it's being delivered? So myofascial release, for example, or the cranial sacral therapy, I don't necessarily present that is that I am sustainably changing fascial structure in the body or that I'm necessarily changing cranial bone structure or CSF. That's not how I present it, because I think when it comes back to is sort of the sensory, dermal neuromodulation, it's changing the autonomic central nervous system patterning, and it's creating a new experience of the body that the person may have never had. And that's where I think the real juice comes from.
39:29
Yeah, love that. It takes us back to safety. So the idea of that, whatever your conceptual framework is, you're probably the change is happening for the mechanisms you articulated so clearly there, Matt. It's received as a safe stimulus. And then the body changes. The biggest predictor of stiffness, in sort of objective measures where you kind of measure how far people can bend, is that their sense of fear about the sensation is the thing that determines their ability to bend rather than the actual tissue capability. So sometimes you can trick people, and they'll bend really nicely because they're not thinking or experiencing or paying attention to the sensation. So when the fear is sort of tricked out somehow or factored out, people can bend this far. But when they're consciously paying attention to it, they're getting alarmed about the signal, that's the thing that determines the state of the body, the perceptual experience, hugely interesting stuff.
40:38
And that right there, Steve, is why I've never tried rolfing because I, I sense that I am scared of it. And I am not sure that it would be safe for me, right? So we have a question from Peter for I guess, either of you, but mainly for Steve, I think. He says, in my experience, the power of touch becomes truly potent when the client is guided to tune in and meet my touch as much as I meet them. Their presence is really facilitating the depth of the work. Do you feel this should be made explicit at the onset of the session? In my experience, if I don't include some dialogue to guide the client to understand the relational touch, they can become overwhelmed with the sensations that come up for them. And this person works as a massage therapist. So what do you think?
41:35
Yeah, no,
this often might come out in certain cranial sessions, is it okay to fall asleep in a cranial session? Yes, if you're exhausted, please do fall asleep, have a rest on the table, why you're paying me to touch you while you fall asleep? That's a different question. But I think for me, I really like my clients to stay awake. I really like my client to be consciously engaged in the process. And I think because the feeling business is so hard, it's my job to help make sure that what we're doing isn't too much for that person to sue. So very much, it's a sort of education that we can feel more, I'm hoping that my safe softball hands, my, my presence in that process is facilitating an increase in your ability to feel. But I realise that it's a tool. And if we've come from a dissociative place to be asked, What are you feeling? is often inherently scary and confusing, and just doesn't make sense. And it's very anxiety provoking. So it's a real skill to lever in a stimulus that isn't too much for that person at any given time. But I do think it's a worthwhile goal. And I explicitly over the course of sessions, I'm trying to prompt people to find words for feelings, and to try and be with the sensation, not to drift away not to fall asleep, those sometimes those things can be useful.
42:58
I love that. Thank you very much. We have so many great questions that we're not going to get to all of them today. I'd like to finish up with one from Matt. Matt, we we know that some people have zero tissue damage, and yet, touch is very painful to them. And we have other people who their their structural MRIs or X-rays look like it would be horrible, and yet there's not a sensation of pain. So there's kind of a big discussion about, is pain, a perception or a sensation? Is it made up in our heads? Or is it real? Could you could you finish us off today and just talk a little bit about that?
43:50
Well, it's a rabbit hole. And I'll start with the title of Steve's book Touch is Really, or Pain is Really Strange. There are several professionals. One is a rheumatologist John Quintner, and I'm not thinking that the other person's name, but they talk about pain is an aporia which means it's a mystery. There's apouria a p o r i a. It's an interesting framework. The way that I work with it and acknowledging my own humility, and that there's a lot that we have yet to be discovered. But pain is first and foremost a sensation. It is something that is felt in the body. And so even though in cases where this, this idea that I shouldn't address the part of the body, you know, this hands off, shouldn't address the part of the body where the pain is felt, under the assumption that there's nothing happening there, could potentially be flawed. For example, there's research into micro inflammation that may be impacting nociceptive signals, nociceptive input from the body into the brain. I tend to take a very validating approach that pain is first and foremost a sensation. I do think once it arises into consciousness, there are perceptual influences. It's kind of like that friend or foe, pleasant or unpleasant, novel or normal, I like this, I don't like this, that that balance can be explored consciously. And we can interact with it. I don't know how much of that determination of that categorization and that emotional piece that we've been talking about the Somato Emotional piece, that all sensory input is an informant to what we call feelings and emotions. And so it's rising up into our consciousness somewhere along the way. You can hear from my language, the the rabbit hole piece, because there's such a big topic here, and it can go in many different directions. But that's how I would start with it. I don't know if Steve has something he would add to that.
46:00
Yeah, I kind of it's always complex. And yeah, and a rabbit hole, absolutely. But it's always real. So if someone tells you they're in pain, they're in pain. My pain is different from your pain, I can never truly understand your pain. So the particularly as clinicians, you know, there's old insurance industries that are trying to find out whether it's real pain or not, if people are faking their back pain, but for insurance purposes, but that's a very, very minor facet of the pain experience, if you're a clinician or if you're a human being, and someone says they're in pain, they're in pain. And that might be many things, might have all sorts of advantages. Sometimes it has all sorts of meanings in their life. But start with this incredible validation that something suffering here and someone's hurting. When I hear the word pain, I like I directly equate it to the word suffering, differentiating the two out is actually very hard. Suffering may be a larger existential category of meaning. But really, if you start from the idea that minds and bodies are unified in the process of engaging with the world, then if you say that pain is about bodies, and suffering is about mind, you're sort of in reinforcing that split. So yeah, it's it's tricky, really tricky. You get into quirky philosophy. For most of my clients, validate the experience, and say, it's never just about the tissues, it's always more complex. You know, if you're getting divorced, and you and your boss is giving you a hard time, you're more likely to be sensitive, and it's more likely to hurt. Let's look at all the other things that might be making you sensitive and that's all in the pot, probably contributing to your stress response and sense of not being able to cope with this horrible signal.
47:54
I completely agree. And I see Matt shaking his head. You know, in yoga therapy, we say that the client's reality is the reality that we meet them in that place where they are. And again, we can't separate out that divorce or that stress at work from the torn ACL or whatever it is that's going on in the tissues. It's it's all one. So we're going to have some time for a few more questions, and I see that they have come in but before we get into about 10 minutes of questions, I just wanted to announce the next Singing Dragon event like this, which is going to be on September 30. And the title is Showing Up Safe, what we've been talking about today, cross disciplinary conversations on emotional and ancestral trauma, and healing from within and that those talks will be featuring Gail Parker, Lorie Dechar and Kevin Durjan. So there is a link in the chat if you'd like to book at an early bird rate to join us again on September 30. All right, well, we have just a couple more questions here. I love this one and whoever wants to answer it can take it. What if someone is in a dissociative state? Will they even notice light touch? Or do you need to put more firm pressure for them to actually sense and feel? Anyone want to? How about you Matt? What do you think?
49:36
Well, the again naming that dissociation comes in many forms, stages and grades. I can give an example of my own years ago working actually have the same patio that this little frog picture you see up there in the wall, I took that in Minnesota, I suddenly saw blood everywhere. And I was like, What? And then suddenly I discovered I'd gashed my arm open, I had no conscious awareness that it had happened. But after I saw it, it hurt like heck, I didn't notice that I had actually cut my arm open. And so the attentional modulation might interact with various forms and stages of dissociation and where attention is focused to sort of gateway out of attention various forms of touch. So that I'll let Steve pick up from there to see what he would add.
50:37
Um, yeah, I think the first step is, is don't make it a bad thing. So it's actually quite normal for most of us, I believe most of us, to dissociate most of the time. And that's okay. So, I've had lots of conversations with people. I remember a woman she had a PhD, she was a dancer, Pilates teacher, amazing. And, you know, it was a struggle, the interview and struggled with the early sessions, and I asked this question, Where are you right now? And she kind of looked at me and says, I'm on the outside looking in, says, Well, how far are you away? So I didn't say, Oh, that's bad. I said, How far are you away? She says, I'm on the building opposite outside looking in, Oh, gosh, you don't feel very safe here do you? No I hate being touched. And, you know, became the start of a long conversation and a long therapeutic process that hopefully, well, she reported some real benefits in knees and pains and back. But the sense was we normalise to experience of being outside of it became a negotiation. You notice when you do that? How far away do you go? Are you upside, or you know, above looking in or in front looking in front of yourself looking in. So playing with the construct is a very nice thing and sort of making it normal and we can negotiate. So another way is, if people can't find an anchor into their body right now, then can they remember that? So was there a time maybe walking in the woods last weekend? Or or a favourite holiday lying on a beach? And if they can't remember feeling connected to their body, can they you might be asked, Can you have a fantasy or a dream or an ideal state what that might be like? So hopefully, in that conversation, you can find some threads of connection. What's it like when you do your favourite thing playing a guitar playing the guitar, baking cakes? What's it like when you're breathing or your muscle tone, maybe you collect some peak experiences, and you start weaving these in is there's a thread you there's something that you can remember about being in bodies that's not about pain, but has a sense of celebration. So yeah, lots of ways to negotiate that you do have to be creative sometimes. But I do think it's a really worthwhile journey. And the payoff is enormous as people slowly make friends with their body and go beyond the painful, difficult, tough things. There's a real sense of I don't know finding joy, and this sense of the body just kicks into gear and starts healing and reorganising things because the consciousness is rooted in the body.
53:16
I think you just answered one of the other questions, which was what are some approaches or some advice for therapeutic work and how we can make people more aware and comfortable of connecting with their own sensations? And I think you just kind of answered that one. So let's take our last question of the day. And I'll I'll start with Matt and then go back to Steve. It says, I'm curious to know what you might speak to when light touch is actually more dysregulated or disorienting than a more grounded, firm, kind of Earth touch. What do you think of that, Matt?
53:55
Yeah, I think it comes back to setting up a forum of choice and feedback, feedback informed care. To determine that the Occupational Therapist Peggy Ninow who is certified Somatic Experiencing Practitioner SEP, Peter Levine's work, who contributed the sensation exploring sensation chapter in our textbook, did talk about that, and how important it is to be aware of that as a potential and to work with people to determine what the right amount of pressure or force is for their comfort level. And I think feedback is where the that's at. And your attunement, too, we can't always rely on accurate feedback, because sometimes people will be experiencing something and that safe enough scenario isn't set up. So it's hard for them to give you feedback. So you have to use your own capacity to sense what's going on with that person.
54:55
And very nicely put, I think some people heal in space, some people healing containment, and some people heal in different ways on different days. So it's a constant dance and the constant negotiation as Matt described.
55:12
Beautiful.
But I think that is a fantastic note for us to end on. And I just want to say thank you to both Steve and Matt, and highly recommend both of their their books. Steve has four books, Touch is Really Strange, Pain is Really Strange, Trauma is Really Strange, and Anxiety is Really Strange. And again, these are graphic medicine, kind of educational comic books. And then Matt has just come out with the Integrative Rehabilitation Practice. And I want to thank both of you for your time contributing to the field, the fields that you're in, and that we're all in together. And also just note that Matt, people would love to see the reference for that article from, let me find the
56:08
David Nichols.
56:10
Yeah, the David Nichols article, so maybe we can put that out with the email with the recording if that's okay.
56:20
Yes, I saw that they already acknowledged that it'll be sent but I just posted the DLI in there too. So if people want to try to look for it sooner.
56:28
Perfect, thank you.
56:29
I did also want to acknowledge our book. It's co edited. I had a co editor Arlene Schmid, who's a professor of OT, who studies yoga therapy at Colorado State and we did have multiple contributors, yoga therapists, PTs, OTs, art therapists, music therapists, so broad range of professions contributed to our book I want to acknowledge them all.
56:50
It's a fantastic book I got a pre copy as huge a huge amount of work must have gone into that, Matt. I've huge respect I've I've dipped in a few times and found a bunch of stuff that was interesting. Great stuff.
57:02
And Steve, could you just show us a one of your your books? You held it up before and I thought it looked so amazing.
57:10
So there you go. There's Matt. This really big old beautiful beast, please look at it. I go a bit quicker and with pictures because I'm very simple, but there you go. Touch is Really Strange.
57:25
Love it. Love it. Love it. And thank you to Singing Dragon, I'm sure from Matt and Steve, and myself. We're so appreciative of you putting on this webinar for us. And we hope to see you again soon. Have a great day.
57:42
Thank you, Amy.
57:43
Thank you.
57:44
Thanks, everyone. Bye bye.
Transcribed by https://otter.ai
Hello, my name is Amy Wheeler and I am here with Matt Herb and Steve Haynes. Steve is from Geneva and Matt is from the United States. I'm from California, Southern California Madison Arizona. And we are just thrilled to be with Singing Dragon. so grateful that they are supporting the work of Steve and Matt and myself. And we're here tonight for the power of touch. And so far we have people from all over the world from the UK, United States, Australia, Canada, Ireland, Germany, Switzerland, Portugal, Belgium, Netherlands, Scotland, Spain, and more. So if you're just joining us, please feel free to write your name and where you're from. And if you are watching this, for the recording, we welcome you also, if you couldn't be here live, it's nice to be in connection with you through this webinar and
I also wanted to tell you that we are using closed captioning today in an attempt to be more inclusive. So if you're not familiar with the closed captioning, basically, at the very bottom toolbar, if you take your cursor down there, you should see something, a little box with cc on it that says live transcript. And if you press your cursor on that, you'll have the option to show your subtitle, or hide your subtitles. If they're a little bit distracting to you, some people like to turn them off. You can also click view full transcript, which will put the transcript in the chat. So especially if you have any kind of hearing hearing impairment, or the way that I speak doesn't actually work for your ear or it's not loud enough, sometimes it's helpful to have those extra supports through the closed captioning.
This event is being recorded, and a copy of it will be distributed to you in about two to three days. So if you have to leave early or you're missing a little bit or whatever comes up at your house, just know that you'll still have access to the recording.
We have a digital goodie bag for you that is really amazing. The first thing in the digital goodie bag that you get for registering is 25% off three different books. The first one is Matt's new book that's just come out from Singing Dragon called Integrative Rehabilitation Practice. And I've seen an early copy of it and you are going to want to get this book it is amazing. And then Steve also has several books. He has four books, some what we call graphic medicine, books, educational comic books, and the books that he's produced and Singing Dragon has helped to, to distribute are Touch Is Really Strange, Pain Is Really Strange, Trauma Is Really Strange, and Anxiety Is Really Strange. So those books have been given the highest award by the British Medical awards in 2016. And just so you know, all the links to those books are in the chat right now if you want to click on them or copy them into your Word doc. The other book that's 25% off is this wonderful book that just came out. And it's edited by Diane Finlayson and Laurie Hyland Robertson, and it's called Yoga Therapy, Foundational Tools and Practice. And I actually have chapter number three in this book called the foundations of yoga therapy that I wrote. And so that book also is 25% off through the the link that's being provided in the chat. In addition, in your digital goodie bag, you're going to have white papers from both Steve Haines and Matt Herb. And the extract or the chapter that I wrote for the book, Yoga Therapy, Foundational Tools and Practice. So there's a lot of great stuff. Don't Don't miss out on that. And so I think we should move into introducing our speakers this evening, depending on where you are, for some of you it's middle of the day. So I think I'll start with Matt. Matt Herb is a physical therapist and associate clinical director for the Centre for Mind Body medicine. He's also an instructor at the University of Arizona. Andrew Weil medical or Andrew Weil Centre for Integrative Medicine.
He's a guest lecturer for the Departments of psychiatry and family medicine. Matt also has a clinical practice with the Simon's physiotherapy in Tucson, Arizona. And he is the founder of Embody Your Mind which is focused on writing, teaching and counselling. And again, Matt's new book is called Integrative Rehabilitation Practice. Steve Haines is from Geneva. And he is a body worker, an author and trainer. He's studied in yoga, shiatsu, cranial sacral therapy, trauma release exercises, which are called TRE. And in the UK, he's registered as a chiropractor. As we stated earlier, he's the best selling author of four graphic medicine books, educational comic books, which have already won awards. So I would love to welcome Matt and Steve, and I'll just tell you a little bit about myself. Also, my name is Amy Wheeler. And I am the former president of the board for the International Association of Yoga Therapists. And I also am founder and director of a yoga therapy school that certifies yoga therapists at the 1000 hour plus
level. So my school is called Optimal State Yoga Therapy.
All right, so welcome to Steve and Matt. Thanks for being here.
6:34
We're happy to be here. Thank you. Great, so happy to have you.
6:41
All right. So we are having a discussion today of a really important discussion, one that has been kind of a hot topic in in the fields of physical therapy, bodywork yoga therapy for quite some time and that's the power of touch. And I think before we get done with this discussion, we'll we'll see that that power of touch can be used in an appropriate way and and in ways that support the
views appropriately and also cause harm and trauma. So one thing I want to kind of use to frame the discussion is that Steve is more in the body work world, although he has so many talents as we talked about Matt's in physiotherapy, I'm in yoga therapy, we all have maybe different language for the same concept. So we're going to do our best to limit the jargon. And and if we do use it, explain what how our field defines that, that language. So I think we'll just start off with a question. And I'll have Steve go first.
Steve, why are you so interested in this concept of touch as a healing modality? And specifically, you have said that we experience touch as a baby, and we experience sensation, long before we can even speak or articulate our words. So why is that important to our discussion today?
8:17
Thank you, I'm gonna start with a quote from Margaret Atwood actually. So touch comes before sight, before speech. It is the first language and the last and it always tells the truth. I really love that. So touch is one of the first things to develop. There's some evidence that we are responsive to touch after eight weeks in utero.
I think most of our early experiences are rooted in a world that touches us and we push against the world and it pushes back all our concepts of safety. What's too much too quick, too fast. Is
is embedded inside of us through the process of touch. We're shaped literally shaped by the world were moulded and formed by experiences. And all our early concepts of what is safe or what is too much, are actually formed by engaging with a world without words, words come much, much later, three years before we can have a timeline and a sense of a narrative that we can remember. But we've got a huge defining experiences pushing our way through a birth canal going from a warm, wet environment, to meeting gravity to being received by our caregivers, to feeding to finding the weight of our limbs even these things are are determinative about what's safe and learning. And I think this is always available to us there's a kind of a wordless knowing about being human and good touch can really lever that
wordless knowing these early experiences, and help us reconnect to safety, if that process was initially safe, and welcoming, and full of love and joy and ease and creativity, and also if our early experiences where, were a struggle, and maybe some trauma processes, some sense that it wasn't safe from where we're speeding up to survive or disappearing to survive, I really believe that safe touch in adults can help us rediscover something that was lost or didn't quite come into place. And we can refine the sense of safety, beyond contemplative words, as a deep felt sense, a deep world of sensation inside of us.
10:44
You know, when when you're saying that, it really helps me to understand as a yoga therapist,
why it is some people prefer to be adjusted or prefer not to be adjusted or why consent is so important, and giving people permission to say, No, thank you.
So, yeah, there might be some very, very old patterns behind that. So some people in the birth canal, their struggle, we did it all on our own, it felt like, you know, I came out fighting and the pattern of me and my autonomy involves independent action. And some of us got exactly the right help, maybe the way their mother contracted, or maybe a pair of hands, was came along at exactly the right moment. And that early priming, around support and touch goes very, very deep and sets up all sorts of habits and needs and ways of relating later on in life.
That's so beautiful. Thank you, Steve, for articulating that so beautifully, and I think it leads right into what I'd like to ask Matt to begin is, Matt, you're quoted as saying, sensation is the bedrock of our being, our the way we be in the world, and and specifically with reference to neuro development. So what did you mean by that sensation is the bedrock of our being?
12:16
Just getting myself unmuted here, essentially the same thing
that Steve has just said that
we sense the world first, before the development of the cognitive sort of capacity, the language realm even.
I once is, as I was listening to Steve talk, I was trying to remember where I read this, and I probably won't, but I was reading about heart rate variability, which has to do with the vagus nerve. And that respiratory sinus arrhythmia, which is where there's a really naturally synchronised speeding up and slowing down to the heart when we inhale and exhale, begins to disappear is a natural state somewhere between 5,6,7 years old, and that that parallels the onset of education, thinking realm, cognitive development, learning, and I don't remember who it was that wrote that and I and I want to be careful, I really like to stick to the, to the science, you know, to solid science. But I found that fascinating to contemplate,
how it is that when we transition to thinking our way through the world, as opposed to feeling our way, sensing our way through the world, and then oftentimes, in my own work, we're bringing that back into balance.
like helping people see where they're trying to rely on a purely cognitive strategy to navigate the world and have lost touch with this, this bedrock, this capacity to sense.
The other quote, I'll throw out real quick, and also gonna not remember this is from a yogi, I think it's been possibly in the book, The Science of Breath. So we'll have to look that up.
He says,
sensation is the connecting point between the mind and body where one can know what is right for the whole being.
And I the only thing I would add to that is that it's a connecting point between body, mind and environment, because each of us our body and mind is interacting with environments, and that carries profound influence on what we experience, including our sensory experience. And so it's really beginning to explore that.
14:30
You know, Matt, it's, it's reminded me of something that both you and I care deeply about, and that is indigenous cultures. And it seems to me that there is an embodied wisdom and and appreciation of that embodied wisdom with your environment with yourself with your loved ones. That's very different than just walking through the world as a talking head or thinking head and kind of feeling disconnected from from the neck down. Yet society is so much rewarding us for just thinking our way through, do you have anything you want to add to that?
15:12
Just the validation and acknowledgement of indigenous wisdom.
There's a man in southern Ontario, he was a former judge, and I'm, I'm terrible with names, I really apologise, I should have these more ready at hand, but he wrote a book about his experience working in tribal communities in southern Ontario and the difference between indigenous mind and what he calls colonial mind. And that indigenous way of being so aware of the continuous interplay of our experience with nature, ecology, you know, one of my favourite phrases is ecosystem, ecosystems within ecosystems. And all of that really is the way that we can discover that is by coming into a deeper, more conscious relationship with our sensing capacity. And I and I, the work that I've been gifted to do, I'm calling calling in here from giving my own land acknowledgement. I think I saw someone acknowledge that in the in their introductions, but I'm on Tohono O'odham, and Pascua Yaqui land here in in, in Arizona, the ancestral lands of these people, it's important to acknowledge that, but all that I've learned in my work on the Pine Ridge Indian Reservation, is consistent with that what you've just expressed and what we're talking about here. And what none of this is new. Right.
16:45
Steve, did you want to add to that?
16:47
I love the idea that where a body is much more than a thing, a body is a process. And David Abraham who wrote The Spell of the Sensuous we are an open circuit that completes ourselves by engaging with the world. And if we just remove the external, if we remove the environment, we miss out on so much. And it's a real error. Because you don't stop at the flesh, you are always a process that's deeply contextual, and deeply shaped by what's around you. And yeah, always really good to know that, very hard to act out. I love the phrase, I'm a thinking head walking around. But we're a sensing body engaged in a world and we are only complete in the act of engaging with the world.
17:39
I could not agree more, Steve. And I think what's happened to a lot of us is that, through trauma, through life experience, we have kind of shut down that interoceptive awareness of, of feeling and being and sensing in the world. So Steve, how do you define interoception as a concept? And can you tie that to this idea of being able to self regulate internally, so that you can interact with your environment in a way that supports you and your nervous system.
18:15
I can try. So for many of us, we operate off a reduced sense of who we are. So feeling is hard. And it's a big mess of information streaming through us. And frequently there's pain or emotions that are churning, and we just limit our bandwidth because it's too much, quite often. So a kind of technical term for that is dissociation, we lose contact with who we are, it's a well known term term in trauma. So the idea that dissociation is an active, conscious withdrawal. But I'm going to offer that dissociation always involves an inability to relate to our body, an inability to feel the slow background tone of the body. So we have lots of ways of feeling and sensing our body, but there's a whole set of slow information. It's called the slow background tone of the body. Some of it coming from slow c fibres and fascia, lots of it coming from your organs, your blood vessels. It's the slow signals that seem to be really important in consciousness that form our homeostasis. This is your body right now. And when you have a constant stream of these interoceptive moments, you have a stream of coherence in your sense of consciousness, sense of who you are, it's coherent. I know what I feel, and I know who I am, is founded on this slow background tone of the body. That's very, very exciting science. But this stuff gets knocked out by traumatic experiences and by the act of protecting ourselves by making ourselves small and withdrawing. One of the we have lots of chemicals that mask signals that can be dangerous. And one of the things they mask particularly is those slow background tone of the body, the size, the shape, the weight, the flow, all those things fade into the background and become blank and, and hard and numb. So our first journey really in connecting is this journey of waking up the internal sense of our body. And when we feel safe inside of our body, when we have the ability to not be fragmented and disconnected from our body. And then I think selfhood is rooted in this ability to feel the slow background tone of our body. And when we're safe inside of us, we're safe to reach out and we start doing good things because we feel good inside of ourselves. And we're more open and available and we can relate to people. And then we stack spreads as a sort of spiritual act really, that I include more in my sense of how if I can pay attention to nature and spirit and mystery, I'm excited by difference because I feel safe inside of myself and I can explore from the safe home of my body. So interior section, the ability to feel this slow, safe sense of self really allows us to have a secure base to move out and explore the world and ultimately be more generous in our interactions and more able to see others viewpoints and have a larger framework.
21:30
And we've talked before, but it seems to me that you have even gone as far as to say that, when we don't have that interoception and that ability to self regulate internally, that it becomes very difficult to go out into the world and negotiate the world and the people in it.
21:52
Yeah, kind of reality, the whole business of knowing is really hard. If you don't know your body, what can you know, it's often just ideas floating around in a big old brain that can, you know, get really lost. We need the ground of the body and the ability to interact. I found a nice quote when I was writing touches really strange that the sense we rely on for reality most is touch. And there's the sort of we touch the world, the world touches us and it creates, reinforces our sense of reality. So yeah, this neutral becoming by feeling ourselves allows us to feel the world and the world touches us back and we feel more real and we get this virtuous circle, we just lose all of that if we disconnect from our body and don't get touched and disconnect from others.
22:43
You know, that's fascinating because the International Association of Yoga Therapists when I was President a couple of years ago, we looked at all the other health care fields like physiotherapy and body workers and and we saw that everyone had a touch policy and a way to guide people in how to get consent, how to touch appropriately what you can't do, and that yoga therapy was lacking that in our scope of practice. So, I would love to just share for a moment what IAYT came up with because I think it's important and we've I even asked my clients to sign this document right here, and I'll read it to you. But to up front when we are, you know, offering our whatever modality we're offering to allow people the opportunity to give consent or not, and to educate them a little bit about touch. So here's the consent form that I use, and the one that IAYT now recommends all of their CIAYTs create and have people sign. Touch is a powerful tool in teaching and in healing and transformation. It is integral to many approaches to yoga therapy as an effective and useful nonverbal way to assess, instruct, share information non-verbally and increase awareness. People's experience with touch, and feelings about touch, are varied and informed by their cultural and societal orientation. Yoga therapy principles, methods and practices, including language, movement, position, gesture, and touch, and when used respectfully and responsibly, are all essential attributes of the yoga therapy process. When you skillfully, with clear boundaries, sensitive application and good clinical judgement, touch has a legitimate and valuable role as a body-oriented mode of engagement and then we have them print their name and sign it. So I just wanted to share that because that that's a, you know, a big development in the field of yoga therapy, but I think it goes straight to the heart of of what Steve was talking about in terms of interoception and self regulation, if, if yoga therapy specifically is looking to help people learn how to self regulate, so they can negotiate the environment and the external world, it seems that that would be a big part of helping them learn that self regulation through the interoceptive experience. I also want to invite all of our attendees to write questions in the q&a. You can do it anonymously, or you can do it with your name on it. But I'm sure both Matt and Steve would really love to have some questions from the audience. So anytime, just pop them in there. And I will read them as we see them come up. So Matt, I want to, you know, talk to ask you a question now that is along the lines of what Steve was just talking about with interoception. Could you tell us how touch differs for different people like the same touch could be experienced differently, and maybe give us some examples of this intra-individual approach to touch?
26:26
Sure. Before I jump into that two important thoughts came to mind to emphasise from what Steve was sharing. And the first is, when I'm sometimes training people in interoceptive awareness, inadvertently, people get the message that somehow they're supposed to be tuned in to that 24/7. And so the message that that's not realistic, nor is it necessarily healthy or appropriate to be monitoring 100% of that information all the time. So what I'm saying is dissociation in stages and grades outside of what might be considered a problematic state, which can come with trauma states, mental health states, is actually normal on a spectrum for all of us. The question is, when do we tune in and act we, say drop anchor, which is the cue to check in with what is going on in the body right now. So I just wanted to emphasise that and then the other will speak to this question. And it's the idea of safety and what determines safety. What what does safety even mean, that's very different for each person. And the concept of safe enough, safe as relative, helps distinguish between things that may be unpleasant to us, new, unfamiliar, certain types of sensing, detecting sensations, as opposed to something that in the trauma world the concept of window of tolerance and zone of arousal, that up to a certain point, we can tolerate stimulation, activation. And then at a certain point, it may actually be outside of our window of tolerance or zone of arousal, where it actually becomes problematic, where it sets up more defensive behavioural responses, the fight flight freeze sort of responses. And so helping people understand that and know begin to identify and frame what what that zone is for them, and what is safe enough that there may not necessarily be 100% absolute sense of safety ever, as humans in a sense. Now, just adding one more thing to your question about what determines that I let the person tell me what determines that because I don't always know for sure what the balance of the interaction, the balance, the quality, whether the the touch, or the experience or the environment even is going to be experienced as friend or foe, pleasant or unpleasant, novel, which is like a healthy Ooh, what's that? Pay attention versus, you know, versus normal, where we're more apt to habituate, tune out that sensory input. And so I tried to set up a scenario where people are educating me through the provision of choice and then sometimes through trial and error. So that that what is it that determines that balance that determines safety? Is is made clear in process as I interact with clients with patients.
29:42
I love what you're saying, Matt, because it it takes us all the way back to the neuro development and the ability as Steve was saying earlier to articulate what it is that feels pleasant to us, unpleasant to us, too hard, too soft, too fast, too slow, and and brings the the language together with the touch as an adult in a way that maybe we couldn't as a young child. So we have a wonderful question from one of our attendees. They say, I recently started an education in physiotherapy, my teacher and medical massage has the opinion that medical massage has to hurt in order to be effective. I think either of you could answer this, maybe we'll go to Steve first. But Steve, how would you respond to that?
30:37
Yeah, you don't need to give pain to change pain. So the stimulus needs to be safe and meaningful for that person. So some people like the notion of vigorous and intense sensation, because it makes sense in their history and their life story. It's not inherently good or bad for the tissues, it's a different type of stimulus. And if there's a contract and an agreement, and that type of touch is useful for the person who's receiving it because of their construct, then yes, it can be very useful to is a very particular type of stimulus, we have some receptors that only respond to deep vibrational, deep type of touch. But I very, I mean, I work in a soft touch way, I think you take far less risks when you do slow, gentle touch. And if you realise touch is about meeting a whole person, then I'd like you to think about a tickle. If we tickle someone every system in their chain system, every system in their body changes from this tiny, tiny stimulants, they'll have memories of early childhood experience, whether that was good or bad, but every muscle in their body will change, every system in their body will change from this tiny stimulus. So if you understand that, then you realise it's not about the pressure. It's a much larger game we're playing when we're touch.
32:06
And Steve, as I'm gonna stay with you for a minute, and then come back to Matt, you know that the trend in physiotherapy is now moving away from manual therapies to more passive therapies. I hope I got that right. And more towards a self empowered care. So what what would you say about that, that if we're withholding the passive therapies, because we feel it's not self empowered enough?
32:37
Passive therapy has come to mean in this context, as I understand it, things like the therapist, physical therapist, chiropractor, I trained as a chiropractor is doing something to the client, and the client lies on the table, receives, can ultimately fall asleep maybe. And that, in terms of changing pain, that model hasn't really stood the test of time, it doesn't do particularly well. So if my goal is externally to poke, prod, stretch, twist, to open your joint, unknot a muscle, whatever that means to align something. That doesn't really come out great in pain studies as a valid model. So there's been a huge move away in physiotherapy, to education around how pain works, bio psychosocial model, a much more complex experience that involves emotion, meaning, context, always. And then sort of more motivation about getting people moving and taking the fear around moving. So a lot of focus on exercise and how to help people to move safely in very creative ways. Not just not classic grunt and move in a gym, but kind of developing new safe movement patterns as a way out of pain. So in those gestures to educate and move, they've taken away this notion of touching as a primary tool. Diagnostic touch doesn't work particularly well, touch to change the tissues may, it's very hard to say that that's what's actually happening on a local level. I like a lot of that, but but but but but but I think there's a type of touch that's very different from the poking, prodding, stretching with the goal of just focusing on local dynamics. And I think you miss out on this notion of touch that meets a whole person, touch that can lever these early experiences of safety and help people reconnect to a sense of themself, that touches this tool that reinforces our sense of self. Touch is always emotional. It's always complex, but that's something to be celebrated and included. It's, you always touch whole people, never a part of a person. So I am worried that in the drive to focus on good things, education and movement, but strip away passive, I'm doing something to you type touch, we lose this other element of touch, what I call relational touch, sometimes called effective touch, touch that is always about complexity, but is always about inherently emotional and involves much earlier learning patterns, the when we tried to talk about earlier.
35:18
That is such a beautiful paradigm shift. Right. And, Matt, I know that that you have an article that you've pointed out by David Nichols in the Journal of Orthopaedic Sport, Physical and Orthopaedic Sport, Physical Therapy, JOSPT, that has something kind of interesting to say along these lines, do you want to fill us in on that?
35:45
Yeah, Dr. Nichols is in New Zealand. He's one of the founders of critical physical physiotherapy network, which is really looking to examine very deeply some of the historical underpinnings of the profession. And in this editorial, he pointed out that passive therapies have always been a part of human experience, and will likely always continue to be a part of human experience. And so this framework of sort of throwing out the idea of of passive therapies altogether really doesn't make a lot of sense and encourage people to take a look at the at the full, the full editorial if they can get access to it's very interesting framework, especially for my profession. And I agree with him that the I often frame the idea of core human needs of that safety, which we just talked about in the framework of contextual safety. And then nurturance and empowerment, which I like to see is the Yin and Yang, or the masculine and feminine and the sun and moon and yoga, of the nurturance principle, the feminine principle is very much supported by that passive type experience, passive therapies, passive touch. And I think it's vital to human human meeting human needs, in some cases in a safe setting that the person may not have ever experienced before when they encounter it. And then the empowerment piece comes in when that is balanced by keeping people very engaged, and finding a greater sense of empowerment or capacity or autonomy, agency, in how to respond. The concept of aggressive touch, I just wanted to add one thing about that or extreme massage. The the way that I work with that is help create the type of awareness that allows people to know whether the approach that's being used is putting them, it is dialling up the fight or flight, the sympathetic nervous system response. So I say if you if you're unable, if you're noticing that your body tension is going up instead of down, or if you are you're holding your breath, or you're gritting your teeth, or your face's tensing up, the risk for that to be counter-therapeutic is much greater. Now I agree with Steve, there are some people, some cases where that can be an effective, valuable approach and self selected and useful. But I wanted to point out that that's how I work with it. Because there was a question here about how, how do I in physiotherapy, and I'm just like, Steve, I work with lighter touch, you could call it. You know, some of these integrative or complimentary touch based therapies, I'm not so sure that the belief systems that people present them under necessarily can be fully validated, at least from the scientific model. But when it's looked at from the lens of what has happened, what am I communicating to the person? What's the balance of the relationship in which it's being delivered? So myofascial release, for example, or the cranial sacral therapy, I don't necessarily present that is that I am sustainably changing fascial structure in the body or that I'm necessarily changing cranial bone structure or CSF. That's not how I present it, because I think when it comes back to is sort of the sensory, dermal neuromodulation, it's changing the autonomic central nervous system patterning, and it's creating a new experience of the body that the person may have never had. And that's where I think the real juice comes from.
39:29
Yeah, love that. It takes us back to safety. So the idea of that, whatever your conceptual framework is, you're probably the change is happening for the mechanisms you articulated so clearly there, Matt. It's received as a safe stimulus. And then the body changes. The biggest predictor of stiffness, in sort of objective measures where you kind of measure how far people can bend, is that their sense of fear about the sensation is the thing that determines their ability to bend rather than the actual tissue capability. So sometimes you can trick people, and they'll bend really nicely because they're not thinking or experiencing or paying attention to the sensation. So when the fear is sort of tricked out somehow or factored out, people can bend this far. But when they're consciously paying attention to it, they're getting alarmed about the signal, that's the thing that determines the state of the body, the perceptual experience, hugely interesting stuff.
40:38
And that right there, Steve, is why I've never tried rolfing because I, I sense that I am scared of it. And I am not sure that it would be safe for me, right? So we have a question from Peter for I guess, either of you, but mainly for Steve, I think. He says, in my experience, the power of touch becomes truly potent when the client is guided to tune in and meet my touch as much as I meet them. Their presence is really facilitating the depth of the work. Do you feel this should be made explicit at the onset of the session? In my experience, if I don't include some dialogue to guide the client to understand the relational touch, they can become overwhelmed with the sensations that come up for them. And this person works as a massage therapist. So what do you think?
41:35
Yeah, no,
this often might come out in certain cranial sessions, is it okay to fall asleep in a cranial session? Yes, if you're exhausted, please do fall asleep, have a rest on the table, why you're paying me to touch you while you fall asleep? That's a different question. But I think for me, I really like my clients to stay awake. I really like my client to be consciously engaged in the process. And I think because the feeling business is so hard, it's my job to help make sure that what we're doing isn't too much for that person to sue. So very much, it's a sort of education that we can feel more, I'm hoping that my safe softball hands, my, my presence in that process is facilitating an increase in your ability to feel. But I realise that it's a tool. And if we've come from a dissociative place to be asked, What are you feeling? is often inherently scary and confusing, and just doesn't make sense. And it's very anxiety provoking. So it's a real skill to lever in a stimulus that isn't too much for that person at any given time. But I do think it's a worthwhile goal. And I explicitly over the course of sessions, I'm trying to prompt people to find words for feelings, and to try and be with the sensation, not to drift away not to fall asleep, those sometimes those things can be useful.
42:58
I love that. Thank you very much. We have so many great questions that we're not going to get to all of them today. I'd like to finish up with one from Matt. Matt, we we know that some people have zero tissue damage, and yet, touch is very painful to them. And we have other people who their their structural MRIs or X-rays look like it would be horrible, and yet there's not a sensation of pain. So there's kind of a big discussion about, is pain, a perception or a sensation? Is it made up in our heads? Or is it real? Could you could you finish us off today and just talk a little bit about that?
43:50
Well, it's a rabbit hole. And I'll start with the title of Steve's book Touch is Really, or Pain is Really Strange. There are several professionals. One is a rheumatologist John Quintner, and I'm not thinking that the other person's name, but they talk about pain is an aporia which means it's a mystery. There's apouria a p o r i a. It's an interesting framework. The way that I work with it and acknowledging my own humility, and that there's a lot that we have yet to be discovered. But pain is first and foremost a sensation. It is something that is felt in the body. And so even though in cases where this, this idea that I shouldn't address the part of the body, you know, this hands off, shouldn't address the part of the body where the pain is felt, under the assumption that there's nothing happening there, could potentially be flawed. For example, there's research into micro inflammation that may be impacting nociceptive signals, nociceptive input from the body into the brain. I tend to take a very validating approach that pain is first and foremost a sensation. I do think once it arises into consciousness, there are perceptual influences. It's kind of like that friend or foe, pleasant or unpleasant, novel or normal, I like this, I don't like this, that that balance can be explored consciously. And we can interact with it. I don't know how much of that determination of that categorization and that emotional piece that we've been talking about the Somato Emotional piece, that all sensory input is an informant to what we call feelings and emotions. And so it's rising up into our consciousness somewhere along the way. You can hear from my language, the the rabbit hole piece, because there's such a big topic here, and it can go in many different directions. But that's how I would start with it. I don't know if Steve has something he would add to that.
46:00
Yeah, I kind of it's always complex. And yeah, and a rabbit hole, absolutely. But it's always real. So if someone tells you they're in pain, they're in pain. My pain is different from your pain, I can never truly understand your pain. So the particularly as clinicians, you know, there's old insurance industries that are trying to find out whether it's real pain or not, if people are faking their back pain, but for insurance purposes, but that's a very, very minor facet of the pain experience, if you're a clinician or if you're a human being, and someone says they're in pain, they're in pain. And that might be many things, might have all sorts of advantages. Sometimes it has all sorts of meanings in their life. But start with this incredible validation that something suffering here and someone's hurting. When I hear the word pain, I like I directly equate it to the word suffering, differentiating the two out is actually very hard. Suffering may be a larger existential category of meaning. But really, if you start from the idea that minds and bodies are unified in the process of engaging with the world, then if you say that pain is about bodies, and suffering is about mind, you're sort of in reinforcing that split. So yeah, it's it's tricky, really tricky. You get into quirky philosophy. For most of my clients, validate the experience, and say, it's never just about the tissues, it's always more complex. You know, if you're getting divorced, and you and your boss is giving you a hard time, you're more likely to be sensitive, and it's more likely to hurt. Let's look at all the other things that might be making you sensitive and that's all in the pot, probably contributing to your stress response and sense of not being able to cope with this horrible signal.
47:54
I completely agree. And I see Matt shaking his head. You know, in yoga therapy, we say that the client's reality is the reality that we meet them in that place where they are. And again, we can't separate out that divorce or that stress at work from the torn ACL or whatever it is that's going on in the tissues. It's it's all one. So we're going to have some time for a few more questions, and I see that they have come in but before we get into about 10 minutes of questions, I just wanted to announce the next Singing Dragon event like this, which is going to be on September 30. And the title is Showing Up Safe, what we've been talking about today, cross disciplinary conversations on emotional and ancestral trauma, and healing from within and that those talks will be featuring Gail Parker, Lorie Dechar and Kevin Durjan. So there is a link in the chat if you'd like to book at an early bird rate to join us again on September 30. All right, well, we have just a couple more questions here. I love this one and whoever wants to answer it can take it. What if someone is in a dissociative state? Will they even notice light touch? Or do you need to put more firm pressure for them to actually sense and feel? Anyone want to? How about you Matt? What do you think?
49:36
Well, the again naming that dissociation comes in many forms, stages and grades. I can give an example of my own years ago working actually have the same patio that this little frog picture you see up there in the wall, I took that in Minnesota, I suddenly saw blood everywhere. And I was like, What? And then suddenly I discovered I'd gashed my arm open, I had no conscious awareness that it had happened. But after I saw it, it hurt like heck, I didn't notice that I had actually cut my arm open. And so the attentional modulation might interact with various forms and stages of dissociation and where attention is focused to sort of gateway out of attention various forms of touch. So that I'll let Steve pick up from there to see what he would add.
50:37
Um, yeah, I think the first step is, is don't make it a bad thing. So it's actually quite normal for most of us, I believe most of us, to dissociate most of the time. And that's okay. So, I've had lots of conversations with people. I remember a woman she had a PhD, she was a dancer, Pilates teacher, amazing. And, you know, it was a struggle, the interview and struggled with the early sessions, and I asked this question, Where are you right now? And she kind of looked at me and says, I'm on the outside looking in, says, Well, how far are you away? So I didn't say, Oh, that's bad. I said, How far are you away? She says, I'm on the building opposite outside looking in, Oh, gosh, you don't feel very safe here do you? No I hate being touched. And, you know, became the start of a long conversation and a long therapeutic process that hopefully, well, she reported some real benefits in knees and pains and back. But the sense was we normalise to experience of being outside of it became a negotiation. You notice when you do that? How far away do you go? Are you upside, or you know, above looking in or in front looking in front of yourself looking in. So playing with the construct is a very nice thing and sort of making it normal and we can negotiate. So another way is, if people can't find an anchor into their body right now, then can they remember that? So was there a time maybe walking in the woods last weekend? Or or a favourite holiday lying on a beach? And if they can't remember feeling connected to their body, can they you might be asked, Can you have a fantasy or a dream or an ideal state what that might be like? So hopefully, in that conversation, you can find some threads of connection. What's it like when you do your favourite thing playing a guitar playing the guitar, baking cakes? What's it like when you're breathing or your muscle tone, maybe you collect some peak experiences, and you start weaving these in is there's a thread you there's something that you can remember about being in bodies that's not about pain, but has a sense of celebration. So yeah, lots of ways to negotiate that you do have to be creative sometimes. But I do think it's a really worthwhile journey. And the payoff is enormous as people slowly make friends with their body and go beyond the painful, difficult, tough things. There's a real sense of I don't know finding joy, and this sense of the body just kicks into gear and starts healing and reorganising things because the consciousness is rooted in the body.
53:16
I think you just answered one of the other questions, which was what are some approaches or some advice for therapeutic work and how we can make people more aware and comfortable of connecting with their own sensations? And I think you just kind of answered that one. So let's take our last question of the day. And I'll I'll start with Matt and then go back to Steve. It says, I'm curious to know what you might speak to when light touch is actually more dysregulated or disorienting than a more grounded, firm, kind of Earth touch. What do you think of that, Matt?
53:55
Yeah, I think it comes back to setting up a forum of choice and feedback, feedback informed care. To determine that the Occupational Therapist Peggy Ninow who is certified Somatic Experiencing Practitioner SEP, Peter Levine's work, who contributed the sensation exploring sensation chapter in our textbook, did talk about that, and how important it is to be aware of that as a potential and to work with people to determine what the right amount of pressure or force is for their comfort level. And I think feedback is where the that's at. And your attunement, too, we can't always rely on accurate feedback, because sometimes people will be experiencing something and that safe enough scenario isn't set up. So it's hard for them to give you feedback. So you have to use your own capacity to sense what's going on with that person.
54:55
And very nicely put, I think some people heal in space, some people healing containment, and some people heal in different ways on different days. So it's a constant dance and the constant negotiation as Matt described.
55:12
Beautiful.
But I think that is a fantastic note for us to end on. And I just want to say thank you to both Steve and Matt, and highly recommend both of their their books. Steve has four books, Touch is Really Strange, Pain is Really Strange, Trauma is Really Strange, and Anxiety is Really Strange. And again, these are graphic medicine, kind of educational comic books. And then Matt has just come out with the Integrative Rehabilitation Practice. And I want to thank both of you for your time contributing to the field, the fields that you're in, and that we're all in together. And also just note that Matt, people would love to see the reference for that article from, let me find the
56:08
David Nichols.
56:10
Yeah, the David Nichols article, so maybe we can put that out with the email with the recording if that's okay.
56:20
Yes, I saw that they already acknowledged that it'll be sent but I just posted the DLI in there too. So if people want to try to look for it sooner.
56:28
Perfect, thank you.
56:29
I did also want to acknowledge our book. It's co edited. I had a co editor Arlene Schmid, who's a professor of OT, who studies yoga therapy at Colorado State and we did have multiple contributors, yoga therapists, PTs, OTs, art therapists, music therapists, so broad range of professions contributed to our book I want to acknowledge them all.
56:50
It's a fantastic book I got a pre copy as huge a huge amount of work must have gone into that, Matt. I've huge respect I've I've dipped in a few times and found a bunch of stuff that was interesting. Great stuff.
57:02
And Steve, could you just show us a one of your your books? You held it up before and I thought it looked so amazing.
57:10
So there you go. There's Matt. This really big old beautiful beast, please look at it. I go a bit quicker and with pictures because I'm very simple, but there you go. Touch is Really Strange.
57:25
Love it. Love it. Love it. And thank you to Singing Dragon, I'm sure from Matt and Steve, and myself. We're so appreciative of you putting on this webinar for us. And we hope to see you again soon. Have a great day.
57:42
Thank you, Amy.
57:43
Thank you.
57:44
Thanks, everyone. Bye bye.
Transcribed by https://otter.ai