"That's a Good Looking Nervous System"

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Transcript

Lindsey Vestal: Co-regulation is a really key concept in building our therapeutic rapport in any therapeutic setting. But specifically today, we're going to be focusing on its importance in pelvic health. Co-regulation really supports safety in connection and creates trusting relationships. And when you're talking about something as intimate as how pelvic floor habits affect someone's quality of life, you better believe that co-regulation is a way that we can nourish and regulate with our client in the process.

The more that we each can stay centered and grounded in our experience during our work with clients, the more co-regulation and safety your clients will find during your sessions. And this is imperative because clients, during the course of working with us, are often discovering things about their own life, about their habits, about experiences that maybe bring them back to potty training when they were just a toddler, their first intimate experience, or even their first pap smear at a gynecological office. Regardless of memories or experiences that perhaps they're really pausing to reflect on or even to explore and find out their meaning on some of the issues they're experiencing, it is a very intimate experience.

Polyvagal theory really sees co-regulation as absolutely essential in a person's ability to feel comfortable and enables them to move into safe relationships and meaningful connections. And then a very important aspect of being a pelvic health practitioner really involves tracking both your own and your client's autonomic nervous system. This concept is actually called dual awareness and can really help with burnout and some of the compassion fatigue that we often experience as rehab professionals.

An important aspect of dual awareness that I love talking about is this idea of "one eye in and one eye out" as you kind of track your nervous system state when you're working with a client. One eye in means keeping a portion of attention on yourself by kind of checking in with your own experiences, kind of your somatic responses. A question you might ask yourself when you're doing this is kind of like, "What am I noticing in my body? Am I starting to feel activated?" One eye out means keeping a portion of your attention on your client by tracking their autonomic expressions and asking, kind of like, "Where is their nervous system on the map? What are they experiencing in their own body? Are they starting to feel activated, or are self-protective responses arising as they're kind of making realizations about their past and their experiences throughout their life and how that could be relating to their current pelvic health symptoms?"

Now, sometimes it's more simple than that, right? Sometimes a client had an injury, a fall, or maybe, you know, recently gave birth to a baby. But I have found in my experience that even in those situations where it's maybe a little bit more acute or recent, there still can be a history that is affecting our client's current experience. When I say that, what comes to mind for me is the book Pelvic Liberation by Leslie Howard, where she uses yoga and breath awareness for pelvic health. She has these sections throughout her book called Pelvic Inquiry, where she asks you to kind of pause and reflect on past experiences that perhaps you've taken for granted or maybe you're not thinking about in your current day-to-day activities.

For example, some of the questions that she asks are: What was your attitude toward doctors when you were growing up? Have you ever felt a conflict between common sense and medical advice? Have your interactions with medical professionals increased your knowledge, curiosity, and decision-making abilities, or have these professionals taken over? What was the language around your menstrual cycle? Do you remember any of the events around your first period and emotions that went with them? Did your parents encourage bodily exploration? Did they merely tolerate it, or was it something that happened behind closed doors in silence? How did you feel when you visited the gynecologist for the first time? She goes on and on with these incredible questions that kind of help us to pause and reflect on what she calls the "story of your pelvis."

In my experience with working with clients, all of these things do matter and can often bring up a sense of self-protective response as they're beginning to explore how some of these issues could be affecting their current condition. This is where I find "one eye in and one eye out" is an incredibly important resource. Over time and with enough practice, this kind of question of "Where are we on the map in terms of nervous system regulation?" will become a part of your orientation when working with clients.

Some ways that you can answer this question: Are you regulated, centered, and grounded? Or is there activation in either you or your client's system? What tells you this is the case? Practicing this idea of "one eye in and one eye out" helps keep one part of your attention on yourself and your own experience while keeping part of your attention on your client's experience. You can then start to ask yourself, "What do I need to do to become more regulated in this moment?"

When we discover tools that kind of help reground us—well, let me take a step back. First is recognizing that you're dysregulated, or you're starting to be activated, or that your client is. And then the second step is finding some tools or some resources that help bring you back into what is called the window of tolerance, or that place where we feel engaged and social and available to what is happening around us. You can see how vital that is as a pelvic health professional—being able to be present for your client and not activated is a really important part of the therapeutic process.

I really believe that de-stressing daily helps to build capacity. The more capacity we have to be in our internal environment, feel our sensations, and of course, notice our thoughts really does help to anchor us. This is a practice that, if we can get in front of—not just wait until our systems are activated—it is incredible how much longer and frequently we can come back into that window of tolerance.

Now, it is a huge misnomer that we're supposed to be blissed out or resentful all the time. A normal course of a day involves kind of like an up-and-down wave of emotions that, hopefully, we don't go too far up or too far down, but we certainly oscillate up and down throughout the course of the day. Then we end up back in that middle through resourcing of tools that we have at our disposal to help us feel more regulated.

Obviously, a key part of this is sensing when that's about to happen. A beautiful picture of this is actually what you might call a sine wave. Now, the reason I know this is because my husband, Doug Vestal, is a mathematician. I remember when he was working on his dissertation to get his Ph.D., I saw him spending time with this image of a sine wave. It's basically a line going up, oscillating, going back down, up and down, up and down. I remember looking over his shoulder, and I thought, "That is a good-looking nervous system," right? There's flow. There's a stressor that happens, and when that stressor is gone, it comes back down. It can go up. It has the capacity to feel really positive and vibrant emotions.

When we have a healthy, regulated nervous system, we actually want this variability. In fact, when we don't have the variability, we kind of get stuck in what is called a very small window of tolerance. Increasing the capacity of our nervous system really does mean more self-awareness, learning how to orient, and bringing back body awareness. Once we've increased our capacity, we've increased our ability to feel, to notice, to see what's around us, and to pause. That kind of frees up a little space in the system.

In other words, we have more capacity as we grow. We have more capacity to feel. The more we feel, the more we can be with the uncomfortable sensations that are going to show up, and this is really good. All of this contributes to growing our capacity of our nervous system so it has more space to heal. Ideally, we're integrating practices into our daily life. For example, you may wake up, it's Monday morning, and you might think, "My gosh, I have so much on my schedule today. How could I actually build in some time? What can I do today that is so simple but is actually reminding my body to release a stressor?" De-stressing in real time is a remarkable tool for the nervous system—not waiting until we need to do it, but getting ahead of it. This really does help increase that window of tolerance over time.

Remember, the goal is a flexible and adaptable nervous system, and this happens in those small steps throughout our day. Self-reflection and building a sense of introspection or internal awareness of what we're feeling throughout our day so we have the capacity and the wherewithal and the self-realization to recognize when we need to stop, pause, and reorient back to a sense of self.

Thanks for listening to another episode of OTs and Pelvic Health. If you haven't already, hop on to Facebook and join my group, OTs for Pelvic Health, where we have thousands of OTs at all stages of their pelvic health career journey. This is such an incredibly supportive community where I go live each and every week. If you love this episode, please take a screenshot of this episode on your phone and post it to IG, Facebook, or wherever you post your stuff, and be sure to tag me and let me know why you liked this episode. This will help me to create in the future what you want to hear more of. Thanks again for listening to the OTs and Pelvic Health podcast.