Welcome back to the Healing Pain Podcast with Shelly Prosko
We’re talking about the important topic of compassion and pain care. Our expert guest is my friend and colleague, Shelly Prosko. Shelly is a Canadian physiotherapist, yoga therapist, author, speaker and educator. She is someone who is empowering individuals to create and sustain meaningful change in their life by teaching and advocating for the integration of yoga into modern healthcare. You may know Shelly as the pioneer of PhysioYoga, which is a unique combination of physiotherapy and yoga. Shelly guest lectures at medical colleges, teaches at yoga therapy schools, provide yoga teacher trainings, speaks internationally at yoga therapy and medical conferences, contributes to yoga academic research and offers online and offline continuing education courses for both yoga and healthcare professionals on important topic such as chronic pain, pelvic pain, compassion and professional burnout.
Shelly has recently co-authored a book called Yoga and Science in Pain Care: Treating the Person in Pain. That’s available online. We’ll also discuss that book. You’ll learn all about the different components of compassion, why compassion and pain care is important for both people overcoming pain as well as the practitioners who treat them. What are some of the reasons why we don’t always provide compassionate pain care? We’ll discuss if compassion is something that can be trained and cultivated or is it something that you’re born with? Finally, how to differentiate between compassion, empathy, and compassion fatigue. To help celebrate the launch of her new book, Shelly is providing a free chapter written about Compassion and Pain Care from her book for you. To download that free chapter on Compassion and Pain Care, all you have to do is to text the word 155download to the number 44222 or if you’re on a computer or another device, open up a new browser and type in the URL, www.IntegrativePainScienceInstitute.com/155download.
Before we begin, I wanted to share a brand-new community with you that I started. I created a free Facebook community for those who follow the Healing Pain Podcast and the Integrative Pain Science Institute. Inside this group, you can access free tips, education resources, and connect with like-minded peers and friends. Anyone can join this group, but I would especially like to meet you if you are an integrated pain practitioner. This would include a physical therapist, a physiotherapist and occupational therapist, a physician, a health coach, a psychologist, a counselor, a social worker. No matter who you are, if you are a healthcare provider, I’m looking forward to personally meeting you and hearing all about the great things that you’re doing in the world of pain care. To join this group, all you have to do is go to www.Facebook.com/groups/ipsicommunity. If you can’t remember that long URL, you can simply send me an email at Joe@IntegrativePainScienceInstitute.com. Make sure to take the time to download our free gift. Make sure to take a moment to join that Facebook group. I can’t wait to meet you there. Let’s begin and let’s meet the wonderful and fabulous, Shelly Prosko.
Watch the episode here:
Insight Into Compassion: The Foundation Of Pain Care With Physiotherapist Shelly Prosko
You’re talking to us about compassion and pain care, an important topic. People know that you are a physiotherapist, you live in Canada, you do lots of teaching and traveling and workshops for practitioners, both licensed health practitioners as well as yoga and other fitness instructors and people. You are combining these incredible tools of physical therapy and PhysioYoga or yoga therapy. Tell me where compassion started to rise to the surface as an important part of the care for patients.
There’s no one answer. You know me by now. My answers aren’t always linear. This is what happened. It was a mix of things. I remember coming across Kristin Neff’s work and her work with Self-Compassion. I thought it was very interesting. At that time, I was prepping to teach a retreat course weekend for healthcare providers on how to use yoga and integrate yoga not just in their physio practice but in their own lives to help prevent practitioner burnout. Kristin Neff’s work, I came across my desk in preparing for this and that’s my first memory of getting into how there’s science around compassion and self-compassion.
Fast forward a little bit, I was interested in it and things started to make sense to me to what I was reading, as far as what I was seeing with the people that I was working with that were struggling with pain. I thought this is interesting. I myself took that Self-Compassion scale, the test that Kristin has. I’ve found myself struggling with self-compassion. I explored that a little bit. I also started to put two and two together on what some of my patients were saying and telling me. I didn’t have language for it though. Kristin brought the language to it in the research. That’s a little bit of my own experience, a little bit of me seeing maybe this can start to help some of the people that I’m working with. As the years went on, I started using some of that in my practicing with patients and listening more to people’s stories. Now with the work that I do, I’m so passionate about it now.
As you’re sitting here now, if I were to take you back there and then as you’re starting to be introduced and you’re reading some of that work, did you feel like there were components of that that were already present in physical therapy and/or yoga? Was it like, “This is something completely new that I haven’t had any training on and this is opening new doors that I didn’t even know existed?”
It was all familiar especially with yoga. I remembered I took an online course with Kristin and Brené Brown. They did one together and I was getting excited because it was all very familiar to me. They bought the language to it, more tangible, accessible practices. They don’t mention the word yoga at all but all the components and everything, I was like, “Yes, I know this and this is familiar.” Yet I still learned a ton. It’s not that I know, even to this day, the depth that the researchers know. It was a combination of being familiar with it and then getting excited that this is something that I’m already doing and integrating. That’s why I became passionate about looking at ways that I can now integrate this knowledge and this work into what I already do and make it my own language and how I can help people and write about it.
You’re an excellent integrator which is a skill that many practitioners work on. A lot of practitioners have a bit of a challenge with that. We find practitioners that get involved in one certain aspect or one treatment technique and they stay with that for years and it takes them a while to be able to move on to something else. One of the things you do beautifully is integrating and implementing different types of techniques, which is a skill that many practitioners should work on a little bit more. Tell us what compassion is so we have a little bit of context as we move forward through this with you.
There’s no one agreed-upon definition. In the Oxford Handbook of Compassion Science, which is a huge compendium of anything and everything and that you need to know about compassion, the working definition they use in there is a definition that is basically recognizing the suffering and then with the motivation to alleviate the suffering. That could be the suffering or the struggling of others or even within yourself. Compassion includes self-compassion. It’s turning that recognition or acknowledgment of struggle or suffering on to yourself as well and then having the motivation to alleviate it. Compassion, sometimes it’s described as an emotion, sometimes as a behavior, sometimes as a motivation. It’s like language with anything. It can be semantics as well, talking about, “What is it really?” I go with what’s in that Oxford Handbook, which is it’s a combination of the recognition and the feeling and the emotion and then wanting to alleviate it and do something about it. There’s the behavior aspect.
The interesting distinction that I hear you’re making there is that there are many people when they talk, they may say, “I feel bad, I feel remorseful, I feel sad about that person or that situation or this is happening, what’s going on.” The motivation, that human drive to change your behavior and help to affect that or to change that is what sets compassion in motion.
Joan Halifax, I’m going to introduce that name here and you’ve had her before too, she has this inactive model of compassion. She has a little bit of a different definition and talks about compassion being more of a wisdom that emerges. You can have this desire and these feelings of maybe even empathizing with someone or feeling kindness towards someone. You have to go beyond that. There’s another aspect of doing something with behavior. With Joan’s model, she says there’s a little bit more to compassion than just motivation or behavior. She says that it’s an emergent process and it’s contextual. If you look at the therapeutic interaction, you’ve got the patient, you have the healthcare provider. What might be a compassionate response in this moment might be completely different later on that day or the next.
It’s not something that is linear where here’s what someone said and here’s what they’re feeling and here’s what would be the appropriate response. It doesn’t necessarily work that way because humans are dynamical systems. You’re an ecosystem, I’m an ecosystem. We have different experiences in this moment. When we come together, what emerges is this more of this compassionate wisdom. I love Joan Halifax’s model there. She goes beyond the definition that’s anywhere that I’ve seen.
I’ve had Joan Halifax talking about this. I’ve had Kristin Neff talking about it. You now have a whole chapter in a great book that everyone should check out and purchase, it’s called Yoga and Science in Pain Care, which Shelly wrote along with two other physical therapists and a lot of other great contributors to that book. In your book, you developed your own model of compassionate pain care which I want to make sure we share with people. Before we go on to those different models, why is this important for a healthcare professional? Lots of physical therapists read this, occupational therapists, mental health providers, physicians. A lot of people have a seat at the table when it comes to helping people with pain and a lot of them might be thinking, “I’m compassionate. I feel compassionate for my patients.” How does this take it a step further?
This topic is important and it’s near and dear to my heart because we don’t talk about it and we certainly don’t talk about it in school and we certainly don’t train for it. It’s assumed that we’re healthcare professionals, so of course we’re caring and we’re kind. “Don’t be a jerk. Be kind. It’s common sense.” This is my belief. To suggest that we need to be talking about this and we need to train to help us cultivate compassion, it might suggest that we’re not doing a good job or that we’re somehow deficient. That’s hard to admit.
The important thing you’re saying is that compassion is a skill that can be cultivated. Even though you recognize in yourself that you have that seed inside of you that motivates you to help people with pain or help people with other types of mental health or physical conditions, that seed has to be cultivated like other skills, your hands-on, pain education, communication and your therapeutic exercise skills. People take courses on that year after year. Compassion may be the through-line that’s present in all of those, making them continually turn over day by day, year-after-year and help someone be a more effective practitioner.
If we can turn to the research so that people start listening to me and saying, “This is my opinion and my perspective.” I talk about this in the book chapter, I outline it. The research is telling us that as healthcare providers, there are benefits to providing compassionate care and there are some of the obvious benefits like the increased quality of care, improved patient outcomes, but even reduced medical errors and medical costs. Research is starting to show that increased compassionate care can help prevent practitioner burnout, which is interesting because some people may think that’s counterintuitive but we can talk about that later. It can even increase health outcomes, positive outcomes for the healthcare provider. Providing compassionate care, when we look at the self-compassion piece, they can also benefit the person in pain.
The research is showing that it can help increase the patient’s self-care. I outlined this study and I’ve talked about this in some of my presentations and it’s fascinating to me. Think about this for a moment. The people in pain, the patients we serve, we know that it helps if they can make different choices sometimes. We know that active self-care is important. As healthcare providers, we promote that. We try to guide our patients as best as we can. However, what the research shows is that not until people in pain and people who are suffering can be shown what it’s like to have to be cared for, loved, respected, seen, heard, validated, feeling whole, complete. These are some of that language in the research. Only then can they take these acts towards self-care. That’s fascinating.
Still on that point that you asked as to why this topic is so important, what the research is telling us is that self-compassion within the person in pain can provide a lot of benefits. This research is new. You had another person on, Karlyn Edwards, the first study. There have been a couple of other studies on self-compassion as a trait with people living with chronic pain, persistent pain, but also training self-compassion. It is preliminary, but it has shown some decreases in anxiety and depression, decreases in anger, in psychological distress, decreases in pain catastrophization, rumination, decreased in negative affect, even decrease in avoidance behaviors, fear-avoidance.
There’s an increase in pain acceptance, which we know the value that that can have, especially with on the ACT research we have, the acceptance and commitment therapy as you know very well, Joe. Even decreased pain severity in some of a couple of studies. There’s a value here which is why I wrote the chapter and I’m passionate about it because there’s something here. It’s not a panacea, but are we missing something? The very last thing I want to say on that point why this topic is so important is that we do have fears, blocks and resistances to providing compassion, not just as healthcare providers but as humans.
Paul Gilbert talks about this in his research and there are lots of papers about this. I don’t want to go too much on a tangent here, but when I read his work on the fears and the blocks and the resistances as to why we may want to provide compassion, and we think we should and we know we should, yet we don’t sometimes. Isn’t that fascinating? You can read about that and all the different reasons why. There you go. The research even tells us that we might be lacking sometimes in certain situations and the research tells us that it’s a good thing, that there are benefits and that we can train it.
Contemplative practices have known this for centuries, and it’s now starting to spill over into “the more mainstream.” There are some evidence-based research papers and articles that are coming out there that are supporting it. We have ab episode coming up on practitioner burnout in pain therapists or healthcare providers that specialize in pain. There is some information in there about how compassion can prevent or alleviate burnout. This is a statistic for all of our fellow practitioners. 25% to 60% of all healthcare workers and students experience distressing, disruptive and at times disabling symptoms of burnout. That’s healthcare workers in general. I’ve yet to find a study specifically on pain care, but I’m going to find it because I can bet you that those numbers are probably double when it comes to pain care. Some of it is high workload, some of it is a lost sense of control and autonomy that we experience in pain care, some of it is meaningless tasks that we are now provided as practitioners, such as increased paperwork that we have to deal with. There’s always work-life balance in there. This topic is so important and has tentacles that reach in so many different directions. How can we begin to train compassion as a practitioner?
There are programs out there, quite a few. I’m going to suggest a resource for your readers if people are interested. I’ll go through one of my favorite models very briefly that might give some people some accessible tangible points. The resource is an eBook and I believe it’s now open access, which is cool. It is Compassion: Bridging Practice and Science. I believe it’s a Tania Singer is one of the researchers and it’s with the Max Planck Institute. It’s an amazing collaboration of the leading compassion researchers. In there, they outline probably about six or eight different compassion-focused trainings out there. The one that I would like to briefly mention is Joan Halifax’s that I already mentioned, and that’s her inactive model of compassion.
One of the reasons that I like it is I love her whole idea that she believes compassion cannot be trained directly, but you can train these six elements that are non-compassionate inherently. You can train these six elements that then lead to this compassionate response that then emerges. This is in my book chapter. I go through her model and each of these six elements. I parallel them to different yoga practices. That’s cool for people who are interested in different yoga practices and teachings. Briefly, I won’t spend too much time here, but I do want to list the six. The first component is attention. You’ve talked a lot about this and that’s being mindful, fully present, and focusing and cultivating your focus and your concentration and your attention. There are lots of different ways to do that.
The second one is effective. The effective domain is similar to the attentive and that we want to be fully present and aware of our emotions. If we can be fully present and aware of our state right now, particularly our emotions, we do have research that shows that can help us not only be more attuned with our own emotions and then able to regulate them because if we’re not regulating ourselves, that’s going to influence how well we can be present for the person in front of us. We have research that shows if we can be in tune with our emotions, that can even help us be more in tune with another person’s emotions and their state. Therefore, gaining deeper insight and understanding into their situation and therefore being able to provide a more appropriate response, a more compassionate response that suits their needs.
The third component is intention. That’s setting an intention. It sounds pretty straight forward and it is. There’s some research behind it. Where our thoughts go, where our energy flows is something we say a lot in yoga teaching. An intention could be something like reminding yourself that you want to be present for yourself first and care for yourself first. Second, you want to be fully present and care for the person in front of you that you’re trying to serve and the person in pain. Thirdly, it’s setting an actual intention that you repeat to yourself, reminding yourself something like maybe, “I am here to serve.” Those intentions can inform our language and they can inform our ultimate action.
The fourth one is insight. If we follow these elements in these components that I’ve mentioned, this can lead to deeper insight and something called therapeutic humility that Joan talks about, which I love. It’s this idea that we’re not the fixers. We are facilitators of recovery. There was something that you said, Joe, when you were talking about burnout. You were talking about some of the different reasons why in pain care, it might be even higher. To add to what you said, I would even say that this is true for a lot of healthcare providers. In pain care, we want to so badly try to fix the pain. In pain care, that can lead to burnout because sometimes there’s no one bullet solution and there is no fix. There are two paths. Pain can change but sometimes it’s about living with the pain and changing your relationship to the pain. In pain care, that burnout is even higher because we want to be the fixer. When that doesn’t happen, can you imagine that many of us can, day in day out, you’re not fixing. This is that insight part of the compassion piece. You’re gaining this deeper insight into the whole context.
The last two we’ve got embodied. That’s the fifth component. This is the embodied stage, which is what is your experience, your fully embodied experience in that moment and staying fully present. It’s similar to what I’ve said but the embodied is a bit different because you are paying attention to yourself, your physical self, your physiological, your emotions, what’s happening inside you, is your heart beating. You feel some tension in your thoughts when you’re listening to the person’s story, some tension in the body. It’s being fully embodied but at the same time, you’re dividing your attention because you have to be fully present and listen to the person in front of you. This is a skill that we can cultivate. How can we divide our attention so we know what’s going on with ourselves, but at the same time be present with the person in front of us?
The last one is engaged. The engaged domain, that’s the active part of compassion. What Joan talks about here, this engagement is now compassion in action where we can truly provide a response that is mutually a value for both the healthcare provider and the person we’re working with. It’s something that’s been agreed upon and it encompasses all the five elements that I talked about. That response can be not always something that you do, but sometimes it can also be something that you don’t do. It could be just doing nothing and providing space, listening, being still, validating. In this engaged part, we can look at these ideas and these questions like what does the person need to succeed here? It’s getting your newer stuff out of the way and also having this humility of what can I learn in this moment and how can I serve?
Shelly is extremely humble because she’s sharing other people’s frameworks about compassion and pain care. I want to make sure that you all hear her framework from her book that she wrote called Yoga and Science in Pain Care. At the end of the chapter that she wrote on this topic about compassion in pain care, she has a five-step model to compassion in pain care. The first part is the healthcare provider cultivates compassionate care for the person in pain. The second part is the healthcare provider and the person in pain cultivates self-compassion together. The third part is family and friends cultivating passion toward themselves, toward others and the person with pain. The fourth is the healthcare organization is committed to compassion in care and includes it in their policies and procedures with regard to pain care.
The fifth, which is one of the ones I think is most profound, is the public and the community is committed to the increased awareness of compassion in pain care. It’s a beautiful model for pain care in general. That speaks to the social model of the biopsychosocial aspect, which is so important. One of the hardest places is to get any movement interaction is that social part. Number five, having public and community increase awareness toward compassion in pain care can take us decades into the future.
I believe that is a model we can look at and I don’t have any task forces or any bullet points on those last few, but this is my life’s work. Looking at that model and believing it, I know my work or the rest of my life is going to continue along that. That last one, the social piece, this is what it’s all about. It’s the connection and how we relate to the world.
Also in your chapter, you have an exercise called The Resurrection Breath. Can you tell us about that? It sounds cool. As I’m going through your chapter, I was like, “What is that?”
This is inspired by somebody named Lisa Pearson. I’d like to give a shout out to Lisa Pearson for teaching this breath practice to me. It’s a beautiful breath that helps you come back to the present. It’s a breath practice that’s from the yoga tradition. Be present. It’s quite simple and we’ll do it, it takes a couple of moments. Turn your head one way and take two quick breaths to the left. That is this idea of blowing away the past, all the things we’ve been thinking about or ruminating on or even other thoughts and beliefs we have about the story that the person is telling us, let that go. It’s then inhaling, exhaling the other way with the first lip and blowing away the future. It helps us not catastrophize or start to make up stories or worry. The last exhale is bowing the chin in a nice exhale to the heart center to become fully present. Do you want to try it with me? I’ll take you through it.
Let’s do it. I love experiential exercise.
To remind you, the first one will be two exhales through the mouth. The second one will be looking over the right shoulder and it will be one long exhale to your pursed lips. The third one will be directly to the center, a nice exhale. Your hands can even come to your heart center if you want on that last one. Come to a comfortable position. Your hands can be wherever you like, eyes opened or closed, whatever you want. Let’s all bring our breath out in a nice inhale, it doesn’t have to be deep. As you exhale, turn your head left, inhale, head back to the center. Exhale, turn your head right, take one long breath. Inhale back to center. Exhale, bowing the chin, hands to heart center. Maybe setting an intention, “I am fully present.” The beauty of that is we get to begin again. I want to also mention Sharon Salzberg. She was on the show and one thing I’ve learned is this beauty of you get to begin again no matter what. This is what I love about the compassion piece and the self-compassion piece both for us as healthcare providers and the person in pain and the people we serve. This breath is so beautiful. A lot of people do enjoy it. No matter what, we get to begin again in this moment.
I have a friend, Jennifer, who is a Pilates instructor and physical therapist. She has a busy day and she’s seeing client after client. She takes a moment in between each session to ground herself and to come back to that present moment and to stabilize herself. She can have a moment of being in that present moment before she moves on with the next person or so that she doesn’t stay wrapped up in the last person she had. She’s a Yogi also. She’s a big Yogi. She has all these skills and techniques and rituals, if you will. We don’t have that in healthcare. It’s almost not acceptable if you left the room with one patient and did a breathing exercise for 30 seconds and moved on. Would you agree with that? In the average traditional healthcare setting, in the average hospital, I would say you don’t see too many practitioners doing that.
I don’t know if they’re not acceptable. People who do this would have certain judgments if they were to see you do that. In some organizations, maybe there is an acceptance issue where they wouldn’t want you doing that. I would say it’s not something that our culture in healthcare feels comfortable with. We look at it as that person is odd when they’re doing their little spiritual thing, which is interesting. That’s something that I do in between each patient during handwashing. I don’t work in a busy clinic like I used to. Back when I did and had patients one after another, during hand washing, so you don’t have to necessarily step out and chant something or do something or people even know what you’re doing, although that’s fine too. Even washing your hands, you can say a little intention for yourself. You’re washing the experience and letting go. In the yoga tradition, we talk about non-attachment. You do your best and you give all that she can give and then you detach with them because it’s out of your control after that. Washing the hands is the symbolism of letting go and detaching so that now you can start with a fresh perspective with the next person. It’s very energizing and it fuels you.
I’m always grateful to be chatting with you. Every time I’m with Shelly, I’m like, “We’re going to hang out for three hours and talk about everything between physical therapy or physiotherapy and yoga. I love that you’re folding the compassion care into what you’re doing now. I wish you tremendous success with the book. Please tell everyone what the name of the book is and your co-authors. Tell us about them and tell everyone how they can learn more about you.
It is called Yoga and Science In Pain Care: Treating The Person In Pain. I’ve co-edited and co-authored it with Neil Pearson and Marlysa Sullivan and the contributors, Joletta Belton, Steffany Moonaz, Matthew Taylor, Matt Erb, Lori Rubenstein Fazzio, Michael Lee, Tracey Sondik, Antonio Sausys. They’re all experts in their different fields. What we wanted to do here was to have a wide perspective so that it’s not all physical therapists. We’ve got psychologists and people who have been steeped in psychology and yoga. A lot of time in professors, researchers, all kinds. It’s a beautiful collaborative effort and we want to help increase pain literacy across all sectors and help improve pain care with this beautiful book that integrates science and what we know about pain and our understanding of pain, the person’s lived and experienced of pain and yoga and all the teachings and the practices.
You can reach out and find more information about Shelly Prosko at www.PhysioYoga.ca. The information about her book is there as well as about the different types of courses, seminars and trainings that she provides. I want to thank Shelly for being with us. There will be more. You’ll be back. I guarantee it because you’ll have something new brewing that’s free to share with the world. I know you value this. I know you value helping both practitioners as well as people with pain. I ask you to share this with your friends and family. Make sure you take this, share it out on Facebook, LinkedIn, Twitter, Instagram, in a Facebook group where there are lots of physios and pain science geeks and yoga science geeks. They’re going to enjoy this and of course they’ll enjoy Shelly.
- Shelly Prosko
- Yoga and Science in Pain Care: Treating the Person in Pain
- Oxford Handbook of Compassion Science
- Joan Halifax – previous episode
- Kristin Neff – previous episode
- Karlyn Edwards – previous episode
- Compassion: Bridging Practice and Science
- Sharon Salzberg – previous episode
About Shelly Prosko
Shelly Prosko, PT, C-IAYT, CPI, is a Canadian physiotherapist, yoga therapist, author, speaker and educator dedicated to empowering individuals to create and sustain meaningful lives by teaching and advocating for the integration of yoga into modern healthcare. She is a respected pioneer of PhysioYoga, a combination of physiotherapy and yoga.
Shelly guest lectures at medical colleges, teaches at yoga therapy schools and yoga teacher trainings, speaks internationally at yoga therapy and medical conferences, contributes to yoga academic research and offers onsite and online continuing education courses for yoga and healthcare professionals on topics surrounding chronic pain, pelvic health, compassion and professional burnout.
Her courses and retreats are highly sought after and have been well received by many physiotherapists, yoga professionals and other healthcare providers. She is a Pain Care Yoga Trainer and has authored book chapters and is co-editor and co-author of the textbook Yoga and Science in Pain Care: Treating the Person in Pain by Singing Dragon Publishers.
She is also known for her TEDx talk: Pushing Boundaries in Physiotherapy. Shelly is a University of Saskatchewan graduate and has extensive training in numerous specialty areas with over 20 years of experience integrating yoga therapy into rehabilitation and wellness care.
She emphasizes the immense value gained from clinical experience and learning from her patients, the professionals she teaches and the colleagues with which she collaborates. She considers herself a lifelong student, truth seeker and change maker. She maintains a clinical practice in Sylvan Lake, Canada and mentors professionals who are interested in pursuing this integrative path.
In addition to her many skills as a healthcare practitioner, Shelly is also an accomplished figure skater and has traveled the world with many professional ice shows. She is passionate about music, dance and spending quality time with family and friends. Shelly believes that meaningful connections, spending time in nature and sharing joy can be powerful contributors to healing and well-being.
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