Ollie: Hello, Tim. Good morning. Welcome back to another chat between you and I. many of you know, in Health Coaching and Beyond, we alternate conversations between the two of us, chewing over hot topics, latest news and emerging ideas, but also bringing your conversations with thought leaders and people we admire in the field of health coaching and beyond. This week, it's Tim and I again, and we return to the topic of chronic pain management. A subject that's always been close to our hearts because it's where we got to know each other in the pain clinic. There are a number of new emerging techniques in the field, and Tim and I have been exploring these. We've been attending training,

Tim Williams: Morning Ollie, yes, it's good, it's good, it's good. It's always good to have a conversation, yeah.

Ollie: Yeah, so the kind of field of health coaching is evolving, isn't it? And you and I have always been interested in chronic pain management, where we met, wasn't it? Where we developed our passion for health coaching really, and saw how effective it could be. ⁓ And the field of chronic pain is evolving all the time. We've talked a fair bit about it on the podcast, haven't we? But we're going to revisit it again today, aren't we? hearing experiences of other practitioners and considering how they add value in each of our own practices. We know lots of health coaches and people who use health coaching skills are exploring and using many of these new techniques. We always remain curious about how new ideas fit in with the core principles of health coaching, keeping people in the driving seat themselves and ultimately empowering them with their own set of skills and ways of living life that works for them.

Tim Williams: Yeah, I suppose it's not surprising because like you say, that was kind of how we both found our way, I think, into health coaching was ⁓ realising that that was the approach that seemed to work well for people who were living with long-term pain. So, yes, maybe it's not surprising that we're returning to it, but again, we're returning to it for a specific reason, I suppose. And one of those is that we've both had, over the last 12 months, we've both had some training.

Ollie: What's most exciting and interesting to us is that with new techniques comes new hope and opportunity for recovery. At the same time, we're also old enough now to realize health and wellness is constantly evolving, as is the world around us. And we're all on a journey of discovery and learning. In our experience, it rarely pays off to think you have the complete answer. Our understanding will continue to deepen and we must remain ever curious and open to new discoveries.

Tim Williams: some new training in chronic pain management and some of that we've been sharing with people and we may have touched on it a little bit in the podcast previously but you've just finished your pain reprocessing therapy training with the, is the pain psychology center isn't it in the states?

Ollie: Yes. Yeah, the American one exactly. Yeah. So Alan Gordon and his team over there. Yeah, a really well-delivered course, great content. It's 22 hours in total. And, At the same time, it's important to critically reflect on how and why things are working for different people at different times. ⁓ you know, what's really interesting is there's a resurgent interest in pain reprocessing or perhaps you say pain techniques as a whole. ⁓ And, ⁓ as Especially in pain, we recognise the complex interaction of how the mind and physical body connect and influence each other and the range of social, psychological and biological factors amongst others that influence the ongoing experience of pain. We hope this conversation supports your ongoing exploration for what works for you and any people you support. who have had a real special interest in this. We're always curious, aren't we, about new things that are coming out. The Boulder back pain study was published in 2022 and that really shone a light on a fairly robust set of evidence that these sort of techniques can have real impact in people with longstanding chronic pain. Perhaps where other things haven't really had much impact or certainly nothing as significant as it demonstrated in the Boulder back pain study. So it piqued our interest. ⁓ Yeah, and I've been on a training course.

Tim Williams: Yeah, and I suppose what for me is it just feels a bit more hopeful. Do you what Like you say, lots of treatment modalities don't really work that well for people with long-term pain. it is, I suppose maybe we need to be a bit careful, don't we? Because we're going to be kind of jump on this thing that does seem to kind of offer a bit more hope. But I think, yeah, I think that feels like it's promising in terms of the results from the Boulder Back Pain Study. And it kind of, suppose maybe it also fits with the way that we're going to think about how pain kind of comes about and how it's maintained. So yeah, so I'd love to hear a little bit in terms of your experience of the training and also I'd love to get onto kind of how you've managed to kind of translate that into some of your practice. Because again, it's all very well to go on a really lovely training program, isn't it? But actually it's only when it translates into what you do in your practice where it counts.

Ollie: Yeah.

Tim Williams: Yes, say a little bit about what pain processing, reprocessing therapy is and a little bit about what you learned on the course, Wally.

Ollie: Well, I certainly will, but I think you're absolutely right just to caution. I mean, we've learned this across our careers, haven't we? You you read a new book, you go on a course and suddenly everything seems to fit that paradigm, doesn't it? You know, that old phrase when you've got a hammer, everything looks like a nail. So you do something new, it's in the forefront of your mind and you start to look for ways, you know, it kind of creates a bias for you, doesn't it? That this is the answer to everything. I think we've learned across our career to be cautious about that, haven't we? and that there's no doubt, there's no one size fits all. And that you've got to work out how your growing toolbox and your growing kind of wisdom to be able to work out what's the right tool for the right person at the right time ⁓ fits in, as you say, into your regular practice. So that's been fascinating and hopefully can share bit around that. So yeah, so pain reprocessing therapy, ⁓ I guess it's built on the premise, which I think we share. that a significant amount of chronic pain ⁓ is neuroplastic in origin. And by that we mean that it's not related to significant tissue damage that's driving the pain. It's more complicated than that. And it's primarily driven by the neurological kind of web in our brain, the neurological sort of I ⁓ guess, patterns that build up over time. And that these are influenced by all sorts of things. So, you if you have tissue damage, you image, you you fall over, break your leg, you get kicked in the stomach, you know, there's some, there's some inflammation, tissue damage, bruising, trauma, that will cause sensations to rise up into your, into your brain. And very often it's interpreted as pain as ⁓ a sort of useful indicator that something's wrong and you need to just, you know, adjust your behavior whilst it heals and settles down. ⁓ So that's the sort of pain that really often used to. ⁓ Neuroplastic pain. is perhaps when that pain system that we're used to for that acute sudden pain gets persistently stimulated by other things, I guess really. So it could be ongoing signals from damage that causes long-term pain and in long-term conditions with long-term inflammation, long-term cancers, long-term rheumatoid arthritis, those sort of... ongoing kind of damage, you may well get a significant amount of signal from the tissues, but you're also getting inputs to the brain from all sorts of other things that influence your pain experience. So your emotions, your, um, your memories, your habits, your expectations, you know, when you've had pain for a while, you build up these kind of like, um, sort of learned pathways, a bit like sort of conditioning. You know, we, we all know that, um, Pavlov's dogs, you know, that classic conditioning experiment where, you know, they rang a bell when every time a dog get fed. got feathered and it was salivated when the food arrived and then after a while it would salivate just to the bell. So we sort of, get conditioned and we know that happens a lot in humans. So there's all sorts of complicated things that happen with pain. But if the pain is predominantly not driven by tissue damage, but by other mechanisms, then we have to think about other ways of trying to turn off that set of nerve patterns in our brain, I guess. So this I don't know if I've explained that very well. Does that come across alright?

Tim Williams: Yeah, yeah, I think that makes sense, Oli. I suppose some people may have had some tissue damage, of course, that started the process, but actually that tissue damage then heals up and people still end up with pain persisting long after that. So it's not that some of this, I mean, some pain can arise, the neuroplastic pain can arise without tissue damage at all, which is really interesting, but equally some of that neuroplastic pain persists after the

Ollie: Yeah. Yeah.

Tim Williams: that the tissue has healed in some cases as well.

Ollie: Yes, exactly. And I guess it comes back to this principle that pain is primarily a protective mechanism, isn't it? So ⁓ the brain is interpreting all sorts of indicators of of which, of course, tissue damage is one. ⁓ there are a lot of other things that influence that sort of threat ⁓ perception. So, you your social situation, your, let's say, memories of ⁓ common patterns that you found threatening in past. ⁓ And, you ⁓ just habits that build up. But particularly if you feel unsafe for some reason, doesn't feel safe to move, you just don't feel safe generally, you're very likely to make pain signals. So in this context of threat, I guess really, then the neuroplasticity, guess, that plastic means it can change, so that you get changes in the neural networks. in your brain primarily, but your spinal cord has a part to play as well, and to a small degree your peripheries. So the way that whole unit works, I guess gets locked into a pain experience, a pain sensation that's enduring, but nevertheless is not related to an underlying tissue problem that needs fixing, in perhaps in the traditional way that medicine would have focused on fixing tissue damage, ⁓ you know, through medicines, through therapies, through, you know, ⁓ surgery if necessary. ⁓ So we're looking at a different treatment paradigm, I guess, really. And it's in that context that pain reprocessing therapy sits.

Tim Williams: Yeah, and I suppose it's also, because I noticed you have put some things out on ⁓ LinkedIn recently, and I know you have had some comments back, and I've seen comments from other people as well saying, you know, that this, there's, you know, people with real pain, I'm thinking that where this, you know, this doesn't work for people with real pain, and I suppose it'd just be really worth saying at this, at the outset, that all pain is real, all right? It's not that some people are making it up because pain is generated in the brain. in all pain, it's all real. It's not some people are imagining it and some people's pain is somehow less valid than another person's pain. I don't know, what do you think?

Ollie: Yeah, no, I think that's really important, isn't it? Almost that like, you know, if you've not got tissue damage to have caused the pain, then your pain is not real. And I think that's what we've really got to get beyond, isn't it? You know, if you have a pain experience in your brain driven by tissue damage or not, it's real. And in fact, my own personal experience and what I've heard from lots of people is that the neuroplastic pain, pain that's, you know, not got ⁓ underlying ongoing tissue damage, it's probably worse than... ⁓ tissue damage pain, reckon. You know, it can amplify, it can get out of control and be a lot worse. The experience can be a lot worse than people that have got an injury. You know, sometimes when you, know what's going on, you know, you've, you've, I don't know. mean, you know, you've got a, you know, you've, you've had a broken limb even. I've had broken, broken bones, you know, and you sort of know what's going on. They're painful at the time when they happen, but they settle down quite quickly. I've had other. pains that have endured for months and months and months that probably fit into this neuroplastic category and they're really deep, gnawing, vicious, electrical, sort of like, you know, they just get under your skin and they're horrible, absolutely horrible. So yeah, all pain is real.

Tim Williams: really important because otherwise people can sometimes go away with impressions that sometimes people are making it up, they're just all in their head and all that kind of stuff. I think, you know, don't know how a tubular would say, you know, that is just one, it doesn't understand the modern pain signs. And also it's really just really unkind for people to kind of have that impression. So yes, glad we just got taken a moment just to kind of really underline that. ⁓

Ollie: Yeah, exactly. So if you've got pain, you're experiencing pain, it's always real, no matter whether it's caused by tissue damage or not. But I guess this is the key tenet to pain reprocessing therapy is that if you understand that you can have pain without tissue damage, in fact, it turns out the majority tends, the majority of the volume of pain we see out there is actually mostly not being driven by ongoing tissue damage. In the bolder back pain study, around 85 % of back pain was not related to underlying ongoing tissue damage. So, you know, if we understand that, then we can start to look at alternative ways of, you know, diffusing that of response that is enduring in the brain.

Tim Williams: Right, okay. So what did you take away from the course that you went on, Ollie? Tell us a bit about that.

Ollie: Yeah, so I think pain reproducing therapy is a set of techniques really. ⁓ And I guess the first thing is understanding the pain science, people getting their heads around that and knowing that. And then to some degree, finding credible evidence for them that their pain is likely not driven by tissue damage. Because if you're holding onto a kind of thought that it must be some tissue damage that needs fixing, it's then really hard for the brain to change its mind, if you like, and for the... the neuroplasticity that's set up to change. And a plastic means it can change. you're aiming to change the way the neural patterns are firing in your brain. So if you're not convinced that that's gonna be useful, then it's probably not gonna work. finding evidence and some of the things that indicate it is neuroplastic as opposed to tissue damage, it changes quite quickly. It might move around. I mean, I've had the experience. I'll have pain in one hip, really severe one day, and then it'll be in the other side, another day. Do know what mean? And that doesn't happen when you've got tissue damage. Other people describe that. Certain things like sometimes noise ⁓ or ⁓ horrible stress and pressure, ⁓ all those sort of things can aggravate the pain and it'll go up and down quite quickly. ⁓ So there's range of factors that can indicate that this is unlikely to be tissue damage, which would probably be more persistent and consistent, stay in one place. And usually there's an underlying reason why, you you'll know what you've done. So, you know, pain that comes on for no good reason or reignites for no good reason, but a pain that you had 10 years ago suddenly comes back, you know. So there's a lot of things we can do which perhaps indicate a positive diagnosis that this is neuroplastic. So a lot of PRT is building that evidence base together. you know, making people curious about things they could notice that would help them to, you know, feel confident, that's what's going on. ⁓ And then there's ⁓ a sort of a set of techniques, I guess, really, that help you then to defuse that sense of threat and the need for protection. I guess that's whole idea really. ⁓ And some of those techniques are, know, work really well for some people and not so well and others. So it's around finding the set of techniques that work best for the person you're working with really.

Tim Williams: So that is the, I suppose that's where the coaching comes in, isn't it? Is that very personalized approach. It's not kind of like, here's the treatment, this is what you need. You're gonna tailor that depending on how people respond, I suppose, in the moment to the different tools that you might use.

Ollie: Absolutely. And I think this is exactly why health coaching is so relevant. I guess why we found it so relevant in the chronic pain clinic, wasn't it? We found, didn't we, that when people started to regain their sense of control and that they were in the driving seat and there were things they could do, whether that's pacing their activities, whether it was using medication in a slightly different way rather than relying on it all the time, it was that sense of confidence, I think, that we noticed. And I think that's quite core to pain reprocessing therapy because if you start to believe, actually there is hope at, know, light at the end of the tunnel, there is hope here. And there are some techniques that I can do rather than relying on somebody else. And you you start to see some success that really helps as well. So one of the key things around PRT is something they call somatic tracking, which is starting to sort of, ⁓ I guess, become curious about the actual sensations you're experiencing and trying to look at them with a sort of slightly impassionate approach. I think when we have persistent pain, we tend to get really hyper-focused on it. We tend to sort of really get absorbed by it. It grabs our attention, it's supposed to. And I guess that reinforces these conditioning responses. So if we can start to take a slightly different view of it by becoming aware of its... qualities, its color, its distribution, its intensity. But look at that with a sort of, they talk about a lens of safety, but look at it almost a little bit impassionately. Some of the times I've heard it described as looking at fish in a fishbowl. So you're sort of trying to observe your pain experience without all the emotions and worry and fear that goes with it. And I guess they're all just ways of reconditioning the way the brain responds to the pain. and you're trying to sort of defuse it, deregulate that kind of threatened worry and anxiety that not surprisingly goes with it. Yeah, so that experience of somatic tracking, you become, I guess, mindfully aware of what's going on with it, what the experience is like. You try and look at it through a sort of lens of safety, safety, what they call safety reappraisal. And then the last bit of somatic tracking, which I think is really crucial actually, and I think is... good for life in general, ⁓ is trying to be little bit less intense about it. Like I say, try, you know, and that can be very different for everybody and finding how to do that I think is again, quite ⁓ tricky. ⁓ Tricky as therapist, as a patient. But it's something about sort of having a less of a kind of tight grip on your awareness of the pain. Like you're, you know, you're grabbing a steering wheel really tight in your hands. You're really aware of everything. every movement, every sort of, you know, threat that might come to that part of your body that's painful and just trying to loosen your grip a bit. Which even when I'm talking about it now, it sounds a little bit vague, doesn't And I think the skill of this seems to be exactly as said, there's no one size fits all, but it's working with somebody to help them to be to invite them to... Be brave to some degree and try some different sort of techniques, but find the one that works for you.

Tim Williams: And as I'm listening to you and I'm noticing is that this is quite a journey that, well, you've been on, but also you need to take people on and you can't force people into doing this kind of work. It has to be led by them. And I suppose there has to be a good level of trust and rapport that you build up with the person you're supporting if you're gonna do this type of work.

Ollie: I think so, yeah. And I think, you know, that actually having been on the course and then trying to practice it and put it into action, it's actually challenging. It's really quite challenging because, you know, there is no single formula for everybody. There's some themes I've talked about that you go through, you know, and there's some sort of like, there's some contradictions almost here, you know, sort of pain is supposed to make you feel on edge, ⁓ you know, sort of hyper alert. In fact, you know, part of the driving of neuroplasticity is your sort of natural flight and fight system, your sympathetic nervous system is highly activated because pain highly activates that, which then feeds into the way you hold yourself and the way you think. ⁓ So ⁓ you're trying to sort of like defuse that, but it doesn't feel like it's the intuitive, the right to you know, trying to bring in humor and lightheartedness ⁓ when you're thinking about pain. seems contradictory, you know, it's not a light-hearted, humorous thing, it's horrible, it's miserable. But nevertheless, if you can reprocess the way your brain reacts to it, so there is a bit of light-heartedness and humor, it seems to be really effective. But how do you do that with someone? How do you do that without them feeling like you're patronizing them or you're not taking them seriously? So it's a real skill about how you can invite people into a slightly different way of thinking about it in a way that doesn't feel... belittling or patronising or undervalues their experience.

Tim Williams: Yeah. So tell me, Ollie, I mean, you have been putting into practice a bit, so tell me a little bit, but what has your experience been? Again, maybe not obviously the details of people you work with, but what's been your experience?

Ollie: Yeah, yeah, yeah. Well, again, very varied, I'd say. So the somatic tracking, for instance, it relies on people sort of visualising and conceptualising things, almost using your imagination. So you might sort of say, well, tell me where your pain is, or let's say in this part of the body. You might say, well, what's it like? Has it got a really clear margin or has it got sort of like a fuzzy, tell me a bit about it. And you might go into the nature of it or the colour of it or the sound of it. And some people are really good at that, you know, they'll go, oh yes, it's kind of, it's pink and it's got fluffy edges and oh, it's a bit spiky and it's kind of, it's, it's pulsing and oh, it's actually got a bit of a sound to it. You know, they can really get into it and you can then work with that to sort of like try and maybe shift it a bit or make it feel a little bit less threatening. You know, maybe they can use their imagination to do things with it or primarily just observe it and just become curious about it. But for other people, that's really difficult. People don't find that easy at all. They'll say, well, it's just pain. It's just pain. And so I think it's really interesting what works for different people. And so sometimes people actually find ⁓ movement, patterns of movement associated with it is a great way of ⁓ reducing the threat. And maybe sometimes even a mantra of it's just reminding yourself, I'm safe. Although I'm feeling pain, there's no threat here, it's not dangerous to me. You know, kind of replaying some of these positive, reinforcing thoughts whilst they are paying attention to the pain can be useful. So there's lots of different tactics, I think. And this is me at my early stage of learning this. you know, I think it's not just super simple and easy, but it's... When you find something that people get hold of and start to work with in a different way, they start to see some change and that is a positive reinforcement in itself.

Tim Williams: Yeah, and I suppose the other thing I'm noticing is that they need to go at quite, you will go at the pace of the person, but probably slower than you think. Because actually, I can imagine you'll get some people and you'll be talking about kind of what does it look like and people will be really looking at it for this lens of intensity and trying to change it and trying to get rid of it by the end of the session almost. It's that kind of, and if it's still the same, actually somehow it's not worked. But actually, if we want to kind of, dial down the intensity and just observe it, then we're going to expect that we're just going to observe it. We're not going to try and change it or manipulate it in any way. We're just going to notice it, I suppose. Is that kind of where you need to get the...

Ollie: Yeah, absolutely. And again, that's one of the other sort of like ⁓ dilemmas about this really is that like sort of, you some people go, right, I've heard of it's pain repositing therapy. I'm going to get really good at this. You know, I'm going to resolve my pain quickly than anybody else has done, which creates an intensity in itself that is counterproductive to the process. So, you know, there's this phrase I've heard Alan Gordon use is one of the main proponents of ⁓ PRT, you know, that you have to trust the process. There's a sort of set of ways of rethinking about things that seem quite unnatural, quite counterintuitive. But if you trust, you know, regularly practicing these, you are likely to change the way your brain is the pain. over time, that's likely to loosen the grip on it and to down regulate it and to let it dissipate away, ⁓ which is what we're aiming for. So you can't do this with intensity. It's more around, you know, in the same ways you get conditioned to anything, it's kind of like just learning a new pattern that you trust and you become familiar with ⁓ that is less threatening than previous.

Tim Williams: Right. I mean.

Ollie: Yeah, I've done lot. So Tim, I've done a lot of talking anyway, and I don't know, you know, this is a point in time. It's a sort of journey. And I know a lot of other people are on this journey as well. There are a lot of other people who are far more expert on this. But equally, you've done a bit of learning recently, haven't you? So you went on Howe Chubiner's course, thinking about sort of emotional expression and awareness therapy, if I got that right. Almost.

Tim Williams: Almost you almost got that right. Well, I I did do yes is Howard Schubiner's freedom from chronic pain course and again It was a similar thing I went on the there was a recorded program and then you were encouraged to buddy up with someone ⁓ and I I butted up with Someone from Ireland actually and we we met a number of times in between the sessions to kind of practice the techniques And things so yes, we did definitely did the pain-reprocessing therapy, but there were other things as that they touched on ⁓ a bit internal family systems, they touched on that. And they also touched on emotional awareness and expression therapy, ⁓ EAET, which I hadn't come across before. So it was really, it was interesting. ⁓ And I suppose what they were comparing it to were things like ACT and CBT. And I suppose those other ones, in terms of studies, they kind of show that they do benefit, but it's very marginal benefit, whereas

Ollie: Mm-hmm.

Tim Williams: They felt strongly that EAET, emotional awareness and expression therapy, had ⁓ a more positive impact ⁓ on people with chronic pain. exciting. And again, I suppose what I like about it is that it's not just one technique. It's not like PRT or EAET. It's kind of a combination. And I suppose a skilled practitioner would move between these different tools and techniques as you were describing, rather than, ⁓ this is the program. Does that make sense?

Ollie: It does, does. So emotional ⁓ expression and awareness. I can't get it right, can I? Yes. Right, okay.

Tim Williams: or close, Olly, emotional awareness and expression therapy. So being aware of the emotion and then encouraging people to express it. So.

Ollie: And how does that help then? So expressing your emotions, what's the theory behind that?

Tim Williams: Well, I suppose the theory is that a lot of pain, because it's a kind of, it's an alarm signal, isn't it, from the threat system being activated, can be driven by unexpressed emotions. And therefore, getting people

Ollie: Hmm.

Tim Williams: to identify what those emotions might be and giving them opportunity to express them as fully as they can is, yeah. releases that and that's that therefore the threat system then just kind of calms down because they've been not now holding on to this thing which is driving it which I suppose anger would be one of the ones that they would identify and that was interesting I suppose for me because I do think that anger is one of those emotions which is you know I think people find it really difficult to express and probably feel that they shouldn't express do you mean there's a lot of guilt

Ollie: Mm.

Tim Williams: and shame that comes around, people expressing anger ⁓ as well, and they feel like they shouldn't do it. So I suppose that's the emotion that it mainly centers around because people don't express it. that make sense?

Ollie: Yeah, so you're encouraging people to express anger where they've perhaps not expressed it before or hidden it or bottled it up or maybe it's not been safe to do that. I mean, that's a common pattern we see in people that have trauma experiences, isn't it? Is that they're exposed to trauma, particularly as children, where they're extremely vulnerable and it's just not safe for them to express what they might naturally express and that that can be the route of building up, you know, persistent... persistent pain, I guess in this context, but all sorts of sort of unhelpful persistent patterns. Have I got, is that right?

Tim Williams: Yeah. So, yeah, exactly, exactly right. So, again, it is something that I think takes quite a lot of practice and quite a lot of confidence to do because people won't naturally, it'll feel quite strange to them to kind of be in maybe a room with you as a practitioner and you're getting them to go back to a time when, you know, maybe a kind of an experience where someone hurt them or kind of a hurtful experience that they had and for them to in some way express it was what they wanted to say and how angry that them at the time and actually express it in that moment with you in the room to express what that felt like. There's other ways you can do it. People can write stuff, you know, they talk about kind of you have that unsent letter generally you can write to someone who hurt you in the past you can express everything about it ⁓ but you don't send the letter you just kind of But because the work is just getting it out. That's the work. So you go back to a kind of maybe a hurtful experience. You would encourage people to really go, really go for it. I mean, not just kind of gently just explain how hurtful it was and how angry they were, but really express it. mean, shake your fists, clench your fists and really rage about it. And yeah, Howard Schumer was saying, do you know what I mean?

Ollie: Yeah, Hmm.

Tim Williams: sometimes people, it got quite graphic, you know, so you're gonna need to be up for that because it gets quite graphic because people are really expressing, sometimes a quite violent kind of thoughts. But what he would say is that that's an important thing to do. It's not that people will go and be violent, you know, they are expressing it in that session. And that's, suppose, it's kind of feels like a safe space for people to do it, but important for people to express it fully and

Ollie: Mmm.

Tim Williams: And then I suppose it's not that's it. That's not the end point. The end point then, okay, so having expressed it, are you then able to in some way let go of that and give some compassion to yourself? Maybe, maybe you can find some compassion for the person that was hurtful towards you, not definite, but the most important thing is to be compassionate to yourself that actually that anger is justified. Therefore you don't need to feel guilty about it.

Ollie: Yeah, yeah, yeah.

Tim Williams: ⁓ And yes, you might feel sad and you might even feel depressed about it. But again, it's just, again, just ⁓ giving those emotions a bit of space as well.

Ollie: Yeah, yeah. And it's interesting that ⁓ we doctors are starting to sort of consider these treatments. It's interesting that think that a lot of the health coaches we see around the country, some we're working directly with, others we're reading about, are starting to pick up these techniques. And I mean, there's some ⁓ critiques. I of feel it myself as well. Some of this perhaps is just superficial techniques on top of really deep seated, you know, emotional traumas. And that perhaps, you know, psychotherapists would say, look, you're messing in our territory. You know, you're kind of like playing with some of these techniques and, you know, you're not quite sure what you're doing, if you like, really. And, you know, it's interesting, isn't it? Nevertheless, a lot of these techniques seem to be incredibly powerful, incredibly effective for people where other things really haven't worked before. And, you know, very doable in a more... perhaps superficial way, you're not having to go down and completely unpack everything from a sort of deep rooted psychotherapy point of view. I don't know, do you have any thoughts on that, Tim? Because it's, know, where are we going with this?

Tim Williams: Yeah, I think it is really important that we kind of, remain, people remain within their scope of practice and their training and definitely not just go off and try these things. And definitely, you know, people need to have the training in order to do it. But what I'd say is, for me, the most important thing is that the person that you are working with, they absolutely stay in the driving seat. You know, it's not pushing, it's not us pushing people down a particular path. It's inviting people.

Ollie: Hmm.

Tim Williams: if they want to try some of these techniques but again hold them lightly as in you know at any point you find this you know you're feeling ⁓ dysregulated or you're not feeling like you're in control then it's okay just come back out I think that's absolutely fine ⁓ but yes as long as we're not in the driving seat I suppose forcing people to go beyond what's comfortable for them does that make sense?

Ollie: It does, it does, yeah. And if I was going to critique PRT to some degree, I think sometimes it can be come across as quite directive in that you're sort of, you're slightly trying to convince people that they've got it wrong in the past and the way they've conceptualized pain is wrong. And this is the, this is, you know, this awareness of neuroplasticity and this awareness of rethinking things is, is the total solution and I think what you've said there is really important about having these techniques up your sleeve, being able to invite people to explore them and find out what works for them. ⁓ you know, ⁓ we've seen, we, ⁓ before PRT came in, you know, we saw a lot of success in the pain clinic with people ⁓ starting to sort of pace their movement and starting to feel confident that could start, you know, ⁓ re-establishing some movement patterns ⁓ and that was incredible. incredibly effective for some people without even any of this PRT or without any sort of, you know, emotional awareness, expression therapy. So it's, yeah, we're built, it feels like we're building up a range of new insights and a range of new potential tools. But what we mustn't do is feel like we've got the, you know, we've got the answer for people and we're, you know, that dynamic again of doing things to people and telling people what they should think or do. is counterproductive, isn't it? I think that's where the health coaching mindset is so important to hold.

Tim Williams: Yeah, and therefore where health coaches might be in a good position with additional training, by the way, not just to kind of give it a go, but with additional training, I think they are because they have got that mindset. They have got that mindset and they don't just use one particular approach. Health coaches that are experienced draw on lots of different techniques and lots of different approaches, lots of different models ⁓ and tailor it to the person in front of them. Yeah, and again, mean, you these techniques aren't, I mean, don't know, Ollie, I you learn them. So I'm guessing they're not difficult. I mean, so we can all learn them. We can all learn them with, you know, have appropriate training. could all learn them. But yeah, but the skill is, the skill is, is knowing when to bring them in, I suppose.

Ollie: Yeah, exactly. Yeah, I can learn them. Anyone can learn them. Yeah. Yeah, well, learning the techniques is just a very small part of it, isn't it? Because applying the techniques or working together with an individual who comes with a whole load of unique sets of contexts and previous experiences and just, that's the tough bit, isn't it? They're sort of like, you've got this bolt-on set of techniques. When we were doctors, you Primarily in the pain clinic, were giving epidurals to people, we? We were prescribing strong opiate medication. was when we working as medics in that situation, and those are the tools we drew on. And for some people, they were effective. Not all the time, but some of the time. And sometimes I'm, I know every patient I work with will use a pain relieving medication to, you could say, break the cycle of pain experience for a bit. It helps. you makes you feel more in control, gives you a bit of confidence. But of course we found that if you become over dependent on medication, you're using them all the time, they stop becoming so effective, you start to feel less control, you get side effects. So, you know, there's nothing that sort of like is absolutely off limits, I would say, but there's also nothing that is entirely always going to be the solution for someone. So it is complicated. And I think as we journey this together as a group of interested let's say helpers for want of a better word, we all bring different techniques, all bring different styles, but I think at the core of it, why I really believe in health coaching, the core of it is that you wanna try and keep the person you're working with in the driving seat. Whatever you do, however you teach people to adopt new ways of working or thinking, if the ultimate outcome is that they know how to manage their own body and their own situation, then that's the sustainable endpoint that we're aiming for, I think really. So however we use these techniques, we have to end up with them feeling more confident and capable about how they go on to live their lives, I think.

Tim Williams: Yeah, yeah. So, so yes, exactly. rather than rather than you have to go and see this person to have this thing done to you, it's something that you can do yourself, maybe, you know, with support. And I know there's a curable app which, you know, goes along these lines, which people can do some stuff for themselves. And I'm sure there are other resources out there as well. ⁓ It's always helpful to have someone accompany you, which is why. building communities and pain cafes and things where you get people that peer support. think that can be really helpful. other people to kind of help guide. But ultimately people need to be in control and in the driving system. I'm glad we've ended there, ⁓ Ollie, because I kind of think that is all we have to take a message. ⁓

Ollie: Yeah, I think so. And I think, you know, that's where all these things, you we all need a bit of, we all need to be helped, don't we? Sometimes we all need some external sort of confidence boosting and it can come in all sorts of forms. You know, it can be a massage, it can be having some acupuncture, it can be having, you know, joint manipulation. They all have some degree of, they do something for us, don't they? They change some. patterns of the way our nerves are working, they change our confidence level, we feel like we've been supported and helped, which can boost us, but it should all be building blocks for how we're building our internal capabilities, I think. And at the end of the day, the more we rely on external stuff, the less we are really building our internal capabilities. But nevertheless, sometimes we all need some external help just to help that internal bit build. So I think it's getting that balance right. And I think that's where we're wanting to support health coaches, aren't we? To find techniques that you can support people with. But there's a lovely phrase which I keep in mind, and call Matt Russell, who someone I've always admired, with his asset-based community development. He talked about leading walking backwards. So even in community development, you're sort of like, you're trying to help communities to be independent on their own. So you're doing it by walking backwards, you're gradually walking away. And I think that's what... health coaching is all about really is bringing in, making people aware of new things they weren't aware of, helping them to put them, make sense of them and put them into their, you know, right context. But nevertheless, you're trying to walk backwards because you're actually encouraging them to take the lead over time.

Tim Williams: Great. That's ⁓ probably a really good place to leave this conversation. We could talk quite a bit longer, I'm sure. And again, maybe in a few episodes, we'll bring in an update because you're putting ⁓ these new techniques into practice. So it'd be good to kind of hear how that is going down the line. That would be really good. for now, I think we will draw our conversation to a close. But it's been really good to hear about your experience and see how it's working for you, Ollie.

Ollie: Well, likewise, Tim, we're both on a learning journey, aren't we? And I think you continue to do a lot of coaching yourself and put these things into practice as well. So let's enjoy sharing the journey with other colleagues. And yeah, we're all on the learning path, aren't we?

Tim Williams: Great, nice to talk to you, Ollie.

Ollie: Cheers, Tim.