OTs In Pelvic Health

How To Use the KAWA Model In Pelvic Health

• Season 1 • Episode 95

Share episode

Resources mentioned in this episode:

More about my guest:
Dr. Kristen Springer, OTD, OTR/L, TIPHP, RYT-500, is a pelvic floor occupational therapist dedicated to enhancing the quality of life for individuals across the lifespan who encounter challenges with bowel, bladder, and sexual dysfunction. Her extensive educational background and commitment to lifelong learning are reflected in her advanced training in trauma-informed care, neurological and musculoskeletal rehabilitation, nervous system regulation, sensory modulation, somatic techniques, and cognitive behavioral approaches.  As a Trauma-Informed Pelvic Health Provider and a Registered Yoga Teacher at the 500-hour level, Dr. Springer incorporates mindfulness and movement-based interventions to support her clients' overall well-being.




____________________________________________________________________________________________
Pelvic OTPs United - Lindsey's off-line interactive community for $39 a month!
Inside Pelvic OTPs United you'll find:​

  • Weekly group mentoring calls with Lindsey. She's doing this exclusively inside this community. These aren't your boring old Zoom calls where she is a talking head. We interact, we coach, we learn from each other.
    ​
  • Highly curated forums. The worst is when you post a question on FB just to have it drowned out with 10 other questions that follow it. So, she's got dedicated forums on different populations, different diagnosis, different topics (including business). Hop it, post your specific question, and get the expert advice you need.

More info here. Lindsey would love support you in this quiet corner off social media!


Lindsey Vestal My guest today is Dr. Kristen Springer, a pelvic floor occupational therapist dedicated to enhancing the quality of life for individuals across the lifespan who encounter challenges with bowel, bladder and sexual dysfunction. Her extensive educational background and commitment to lifelong learning are reflected in her advanced training in Laura de Rose's An Eye Trauma Informed Pelvic health Certification. She also has a background in nervous system regulation, sensory modulation, somatic techniques and cognitive behavioral approaches. I am so excited to share today's episode with you. 


Lindsey Vestal Kristen, you can't imagine my enthusiasm and surprise and delight when we were on the trauma informed Pelvic health Certification Retreat weekend together in Sedona. You were my hiking partner, and we just launched this really beautiful discussion around how you incorporate the KAWA model into your sessions with Pelvic health. And I just leapt for joy because I speak with a lot of OTs who admire the KAWA model, are somewhat familiar with it. Like we know the metaphor of the river and like there's elements to it that we feel really drawn to and like appreciate that this is within our O.T. framework. But in terms of the details, in terms of like, okay, how are we actually using this in sessions Specifically in sessions with Pelvic health, I think largely remains a bit of a mystery. So thank you so much for taking the time today to kind of illustrate your process and talk us through this expertise that you have. 


Kristen Springer Sure, absolutely. I'm excited to talk about it. So as a brief background on my experience with the KAWA Model And Occupational Therapy School, I had a professor who is very passionate about mental health equity, and she often used the KAWA model with both inpatient and outpatient mental health clients, which was really interesting because it allowed her to take a step back and get to know them for everything they are as a human from the start of their life to the way they're living life now, regardless of the state there. We didn't learn too much about the history of it. So over the last few days preparing for this podcast, I've kind of been delving into that and to share a little background of what I know. So Dr. Michael Iwama, who introduced the KAWA model in the late 1990s, actually 1998, which was my birth year. So fun fact there. He introduced that as a culturally relevant and holistic approach to O.T. that kind of blended together both the Eastern and Western approaches to our O.T. evaluation, but also the intervention planning goal setting as both a model and a frame of reference, which is really interesting because some of the O.T. models and theories kind of stay siloed into like, this is just a conceptual framework or this is something we can actually use in practice. So his work is kind of translatable across the board. It's not something that you absolutely have to do on the first day with the client or patient. And it's not something that you necessarily have to do at progress now. But the way I typically use it is as an intervention or moment modality. So I wrote I wrote out a little bit of a case study, if you're open to me going through one of the clients that I've worked with and kind of how I use it with him, if that works. 


Lindsey Vestal I would I'm dying for that. I do have a quick question before we get into that, though. Like could you do I really appreciate you doing that research and kind of figuring out like when it got started and all of that. But before the case study, would you mind just like giving us a brief introduction to the model for those of us that are less familiar with it? 


Kristen Springer Absolutely. So as I mentioned before, Dr. Michael Iwama introduced that KAWA are also known as a model in 1998 as a culturally relevant and holistic approach to assessment and intervention. So originating from his diverse practices and experiences and recognizing the limitations of the Western models or like the medical model of health care, that color model became the first significant model and rehab science that blended together both both Eastern and Western methodologies. So in Japanese culture, rivers hold deep symbolic significance, symbolizing the cycle of life and the interconnectedness of various aspects of existence which is ever so present and pelvic health, as you know well, so seen as dynamic and ever changing rivers reflects the fluctuating nature of clients experiences, and rivers also embody the themes of renewal, renewal, growth and adaptation, aligning with the holistic worldview present in Japanese society, which emphasizes that harmony with nature and the interconnectedness of all phenomena. So with this cultural metaphor that helped him develop the KAWA model, it allows us to recognize the journeys of our clients. Acknowledging the fluidity and the ever changing ability to grow, transform and heal within the context of the therapeutic process, whether that be O.T. speech, language pathology. I think it has implications for all of those fields as well as psychotherapy. But of course it's an O.T. model. So he has form. Elements as well as some side main elements of earth side, secondary elements of the model. So river, like we mentioned before, symbolizes an individual's journey and the context in which they engage with their environment and experiences. So a lot of cities are familiar with the PEO model, so it's kind of based off of that which we use that model and shape in the kawa as well. The rocks within this model represent the barriers and challenges clients may encounter along their life journey which hinder occupational performance and participation. So identifying and addressing these rocks is essential for promoting that functional engagement and well-being. So that awareness will sometimes, from a bottom up perspective, you can look at body attunement with that. All sorts of things can be rocks, driftwood. So driftwood signifies the personal strengths, resources and coping mechanisms that the client currently possesses to navigate their challenge and overcome obstacles in their occupational goals and pursuits. So their driftwood contributes to resilience and supports adaptive responses to adversity. So what that looks like as we draw out the cover model on paper, even if we're talking through that, if someone is really struggling with a narrow river, driftwood is something that can kind of pave the way and expand their rivers. What then? Depth. So again, looking at that cognitive flexibility and resilience, the space between the rocks and the river represents opportunities for growth, adaptation and occupational exploration. I'm going to encourage clients to seek alternative pathways to achieving their all to an occupational goals and aspirations. So once again, fostering that cognitive flexibility and creativity as well as the problem solving. Sometimes we fall victim to the all or nothing thinking cognitive distortion. So this allows people to see that there are other ways of kind of meeting the goals that we aspire to achieve. There's also turbulence that he talks about in his model, which reflects periods of instability, challenge, maybe trauma experienced by clients in their occupational lives, which may disrupt occupational functioning. And this is a necessity at adaptive strategies to support and navigate effectively. So we kind of ask in this moment, what is the peace of the water and your river? Does it feel like the turbulence is too much to handle? And then from there, we can talk about trauma responses, all the fun things that we talked about in our trauma certification with you and Laura. But overall, oh one more element. I forgot the water level. So the water level represents one's overall well well-being and occupational functioning. So changes in the water level may reflect fluctuations in one's physical and emotional and psychological state influencing their capacity to engage. So water level might be synonymous to some is resilience. So current level of resilience. So the KAWA model emphasizes the importance of understanding clients within their cultural and contextual contexts, honoring their unique life experiences and perspectives, which that phrase in itself and the way he describes it. And so I'm kind of paraphrasing the research that he's done on the Kiowa model and put out there. But I feel like that's the most O.T. thing that I've ever read, because we look at everything that makes someone who they are, where they are now, and it provides the framework for OTs to collaboratively assess their strengths and challenges, identify meaningful goals, and develop interventions that promote wellbeing and participation in everyday life. So with that as a background, I'm absolutely in love with this model and that it does give somebody something pragmatic and tangible to work through. That's not necessarily the typical top down approach. It's kind of a sideways approach in nature. So I'm not entirely sure what he initially considered it to be, whether a top down or bottom up approach. But I think that depending on how you use it, it can be both. 


Lindsey Vestal Oh my goodness, it is so beautiful. I can I can see why it's O.T. I'm so proud that it's OT. It's so playful. It's just so visual. I want to make sure I accurately, like, remember actually remembering all the elements. So I have written down rocks, driftwood, the space between turbulence and water level does that sound right? 


Kristen Springer Yes. And so he kind of added on to that. And there's what he considers to be flotsam and jetsam, too. So those elements are kind of tertiary ones, which symbolize the contextual factors and influences present in an individual's life. So one's cultural background, social support and environmental circumstances which impact one's engagement in society or hinder progress in their journey. So I think those are two ones that are important to use too, to reading about that. That was actually something that I initially considered to be addressed to. But breaking it down a little bit more, I could see how that might be a different element altogether. 


Lindsey Vestal Do you know whether PTs or speech therapists or any other discipline is using this model? 


Kristen Springer I don't currently know. I'm not entirely sure. But on his Duke profile, he said that it's being used in over 600 health professions programs worldwide. 


Lindsey Vestal Wow. Okay. 


Kristen Springer So with that number, I'm guessing it's in more than just O.T. because he speaks it being in rehab science programs. And I think it's spread pretty far. So good for him. It's a beautiful model.


Lindsey Vestal If you had to ballpark how many times you've used it with Pelvic health clients, what would you imagine that to be? 


Kristen Springer Probably between 10 and 15. At this point, I've been a clinician for about a year, and when I use it with patients, I've only used it once with each of the patients that I've used it with. But after reading about how it could be used as a progress note or in preparation for discharge, it makes me want to use it so many more times. 


Lindsey Vestal Yeah. Okay. So right now you're using it as an intervention like you had mentioned. And would you say you're using it like in the evaluation session? 


Kristen Springer No. So I use it a little bit down the line when I'm working with specifically pelvic pain patients or people who are exhibiting a lot of cognitive distortion, such as catastrophizing or that all or nothing thinking when talking about their healing process and progress so far. So if I notice that people need more of that mental health intervention and they're doing all of the physical tools and even some of the somatic practices, but it seems difficult to realize like, okay, well, what are my supports in this moment? What are my current challenges and barriers that helps them lay it out in a way that's different than just like the talk therapy narrative review and that I give them lots of colors. I love school supplies, so I have. So many colors available for them to use as well as a blank piece of paper. So there are templates online that you can use for the KAWA model. But I really like seeing how people draw their river and I give them a little bit of shaping and scaffolding and cues to help them figure out how to draw the river if they need it. But I kind of like to see what a person comes up with and I meet them where they're at with that. And if they need some cues, we go from there. 


Lindsey Vestal That's incredible. So you're using this a couple of sessions in if you're really noticing there's some mental health barriers or some things that we can kind of, as you said, kind of do a sideways approach. And when you do it, are you then writing goals like, how does this translate? Obviously, it's a very meaningful activity and I'm sure your clients love it, but like, what's your next step clinically with it? 


Kristen Springer Absolutely. So as we go through it, I try to allow them to share what comes up for them. And we talk about it together. But a lot of that involves holding space for them in that moment. I try not to offer that analytical lens while they're going through it because that kind of has that acquiescence bias where they feel they may feel like they have to say something in particular for fun and hide other things. And so I try to make it as playful as possible. And at the end, once we kind of regroup and go over it, typically I recite back to them kind of what I heard from their sharing. And then we reflect on our goals depending on what it is. So the goals that we have already pre establish kind of checking in with where they are and if new goals come up, that's totally fine as well because that speaks to what is actually meaningful to them in the moment. So I might revisit their goals. I might invite. So as an O.T. in general, I'm pelvic health. I typically offer both a physical tool or takeaway or a physical homework assignment as well as a cognitive homework assignment. So from what we learned with the college model, we sort of develop goals together based on what's most important to them in that moment, and then find a physical tool for how they can hold space for what they're working on, as well as a cognitive tool. 


Lindsey Vestal So beautiful. I think we're ready to jump into the case study now just to kind of see all this in action. I would love for you to kind of take us through from like how you introduce the model to your client to then the implementation of it, if you don't mind. 


Kristen Springer Sure. So to start that off, I did write a little occupational profile just to give a background of my client. And we'll call him Ryan today. I thought it would be fun to choose a male client because female clients are often talked about in Pelvic health. But Pelvic health is for all genders and all bodies. If you're okay with me, starting with the occupational profile. 


Lindsey Vestal That'll be amazing. 


Kristen Springer Okay. So Ryan is a 42 year old male seeking pelvic health occupational therapy services and presenting with significant pain, pelvic and perennial pain exacerbated since July 22nd, coinciding with a particular challenging period in his life. His symptoms encompass discomfort, including sensations akin to sitting on a golf ball in a minute, sharp groin and genital pain, persistent post urination and throbbing pain, as well as post urination dribbling while maintaining a urinary frequency of every two and a half to three hours. His frequent urgency occurring approximately every 30 minutes on average. Constipation is a recurrent challenge for him, especially during periods of stress or dysregulation. Wright encounters issues related to intimacy and sexuality, perceiving a disconnection between his physical and mental states, which is adversely affected his relationship per his report. In terms of mental health, he copes with difficulties in nervous system regulation and anxiety management. He has recently learned about public health and is enthusiastic about integrating vagus nerve toning strategies to downregulate his nervous system, believing it will positively affect pelvic health. He is active daily with a routine CrossFit and yoga schedule regarding his social and occupational background, Ryan dedicated over 20 years to military service, consistently exposed to high stress situations with a lasting impact on his daily life. In his current role characterized by prolonged periods of sedentary work, he experiences a relatively low stress level compared to his previous career. Ryan is married with two young daughters and feels supported by his family dynamic. Moreover, he hopes pelvic floor therapy will help decreases leakage, anxiety and pelvic pain so that he can functionally engage in daily activities. So when Ryan came in to me last year, he was super excited about Pelvic health because he had been watching videos about nervous system regulation and breathwork and all of the things that he was sort of missing in his CrossFit routine, but also really frustrated because he noticed that he was having a really difficult time managing and processing his emotions that were tied to his previous career. So he kind of had a split perspective of his life before in his life now after he finished serving. And so with that, he was very intrinsically and extrinsically motivated to engage, but he often found himself experiencing a pretty narrow range of emotions that would sort of oscillate between that excitement and motivation and kind of like manic symptoms of setting everything under the sun to not being able to socially engage and really exhibiting in that freeze response. So after a few sessions of working with him, I decided to introduce the Carlisle model, which at first he kind of, as you can maybe imagine, looked at me like, okay, Kristen, let's see where you go with this. But he was open to engaging, and especially since at this point we had already done the feelings we we had done some vagal toning techniques. He was well-versed on probably legal theory. So this wasn't too far fetched from more of the alternative healing interventions. So with that, I kind of broke down what I remember from his river rocks, driftwood and so on. So breaking it down into the collar elements. When we first talked about the reverb. Ryan was able to share how his life journey has been marked by significant challenges and transitions, including his most recent transition is being finished with the service after 20 years and shifting into a role that was more of like a leadership but sedentary job and an office space which he had never practiced in an office space before. So that was a major transition. And his river, these experiences had shaped his occupational engagement and influenced his pelvic health concerns, especially since he had more time to really sit with the rocks that he is experiencing and feel the pelvic pain and have to make intentional time for movement based practices throughout his day. So he went from a very highly active physician to a fairly sedentary one. So with the river, his supportive family dynamic provided a context for his healing journey, offering both resources and constraints and navigating his pelvic health and overall well-being. So he was able to sort of lay everything out right away. But when he went to draw out the rocks, he found a few big ones that kind of stuck out to him in terms of physical symptoms. So he automatically went to the sitting on a golf ball like pain as well as the genital pain. And specifically after engaging in intimacy with his partner, because any time he tried to socially engage in that way, he enjoyed that experience to a certain extent. But afterwards he would kind of anticipate and expect that pain to be there. So that was a big rock in his life, as well as the post urination, discomfort and trouble. So he was able to list the very physical symptoms, which is common with a lot of males and pelvic health as they're going through things, especially not just males, but in the medical system we're used to listing physical sensations or dysfunctions right off the bat. So with as an O.T. who tries to pull out the mental sides and emotional sides without being overbearing and being a therapist who kind of like cues into what we are trying to draw from. I let him first draw the rocks that made most sense to him. Because those are the symptoms that are obviously inhibiting his engagement in what he wants to participate in throughout the day. But from there, trying to draw out some emotional rocks. So cuing him like, okay, well, what are the emotional barriers that you're facing right now? And so he was able to talk about how if he's in a meeting and he's feeling that sense of urgency, he feels himself becoming very flighty, slash fight like and that he would be very reactive even if someone asked a very routine simple question so he noticed that in himself. So drawing from the physical symptom, he noticed that a big rock was he could come off as more aggressive than he wanted to be as a leader in time. So I found that pretty interesting. 


Lindsey Vestal Yeah, that, that is, that is incredibly interesting. And I can really see, based on the occupational profile that you set up for us and the Segway into this, just like how meaningful this can be for for this client. All right. I want to hear more. This is awesome. 


Kristen Springer Of course. So driftwood wise, despite his challenges, Ryan demonstrates resilience and possesses personal strengths and coping mechanisms. So he came in with a few that really worked for him. He knew and I'll continue with that in a moment, but he knew exactly what he needed, especially in the family dynamic when he was starting to feel that trauma, responsive flight or fire, and that if he was starting to feel like he was about to yell at his kids or burst into anger after having like that sitting on a golf ball, feeling or the urgency, he knew that was a moment to sort of step away and sort of delegate tasks to either his partner or kind of tag team out, which a lot of my couples seem to do postpartum. It's a very healthy way to navigate parenthood. I'm not a parent, but as you can probably relate to, sometimes tagging out is needed. So he had that coping mechanism as well as he gave himself time and space to go through the vehicle toning strategies on a really regular basis. He was someone who loved routine and building his tool kit, so he didn't want to just have the exercise as his coping mechanism, so just do it. Wise He was very committed to daily practices, which demonstrated his proactive engagement and the self care that he really needed to help him feel present and embodied and aware of what was going on. So he had several strengths at play, which I think were helpful for him to write down, because coming in he would very much see the physical symptoms, especially in the early sessions, and say like, okay, well, I don't know why I'm so leaky or I don't know why I still have pain after sex. And he would kind of cling to those very physical instances, kind of with similar with like central sensitization, as I know you've talked about in a few of your interviews in videos before. Like when we are above baseline, it's hard to really see things other than pain or other than always leaking. And we kind of have that all or nothing distortion. So being able to draw that just words and write several examples of them. So that's another thing that I try to encourage is like if someone has ten pieces of wood and only two rocks that come to mind, I tell them that there's not an exact number that has to be like the standardized way to do the column intervention, because in that, like if there's only a few pieces, they just return a few rocks that really come in mind. Well, we can kind of try to elaborate on them and think of different ones. There's not a right or wrong way to draw them out and so as far as the space between the rocks, within the challenges of his Pelvic health journey. There obviously exists opportunities for growth, adaptation and exploration. So his recent interest in Pelvic health education and his openness to integrating the different pelvic health strategies, whether they be physical or cognitive, really signified his willingness to explore alternative pathways to achieving his goals. So this space for exploration really fostered that flexibility and problem solving abilities. So being able to see the rocks and just when and where they are and drawing lines, something that I like to do with the collar for the space between is drawing lines in different culture or different colors based on where the space is leading to. So you could even draw lines between a rock and addressed. What about what healing tools have been really working for you in order to find that sense of softness or growth, healing, whatever? Where do you want to put in place there? But the space between the rocks is a beautiful way to bridge those connections and help people understand that they are on their path to healing. And healing is an ever evolving process. So some days it seems like our rivers have a ton of rocks in them and the next day maybe not so much, or that the rocks are smaller and kind of move with the turbulence that's present. So with the turbulence, Ryan has obviously experienced periods of instability and challenge per his report, particularly in managing his pain, urinary symptoms, constipation, intimacy challenges and mental health. And these turbulent experiences disrupt his occupational functioning and necessity adaptive strategies to support him and navigate them effectively. So his engagement and seeking pelvic health reflects his resilience in the face of adversity. So the turbulent factors that go into play was where the job transition that he recently went through that brought a sense of issues in some ways, but also distress in either's in other ways. So kind of describing the two different types of stress being used, stress and distress with a you stress being more positively connected and the distress being where maybe some of the trauma responses kind of boil up, that's a good way to talk about it. So turbulence wise, Well, you can think of like pragmatic things or actual objective things that are happening. And I kind of like to give education about poly vagal theory in that way and talk about the trauma responses that might be present and how we can really facilitate that flexibility to be able to move throughout the seats of arousal. 


Lindsey Vestal One of the things that's really clear to me as you're talking and is that just the fact that this entire model really gives so much space for how to reflect on, appreciate and understand change? You know, it's it's everything about it is demonstrating how things can be temporary, how things can move. And I think people with chronic pain challenges can often be a little bit fearful of change. You know, whether it's positive or negative. It's been part of their life. It's been part of their current it's been part of their story for so long. And I just hearing, you know, just how beautifully you're talking through and making connections for this client, I'm really aware of how it can help a client reflect on their feelings of change for both for both positive and as well as what that could mean if they're uncomfortable with change. 


Kristen Springer Absolutely. Thank you. And yeah, that space that's present within the model, I think is there very intentionally because it's not a model that says like, okay, this is the strict set of standardized rules and this is the only thing you can do with it, which I think is such a beautiful thing. And it offers space for people to recognize like, where are the healing tools that they've already been working on can be incorporated to either make the rocks a little bit smaller, lighter or make more room for that river expansion and just want to be able to kind of pave the way for where they want to go next. So with the space in between the rocks, I often mention the quote, which as you were talking, I kind of thought of this, but the Viktor Frankl quote that is ever so popular in the therapy world, but that between stimulus and response, there is a space in that space is our power to choose our response. And then our response lies our growth and our freedom. I always try to bring that up with the Kiowa model, even though I know it's not part of it. When talking about the space between the rocks, because we're a person that is able to be autonomous and have agency and shoes are able to connect and reengage and integrate tools that work for us. 


Lindsey Vestal That is so beautiful. I love that you brought that quote up because yeah, it's I think it's one that probably many of us have come across, you know, in and various readings and references. But like, yes, in the context of this conversation, in the core model. Yeah, it does. It makes so much sense. And the other thing that I'm picking up on, and again, this is why I'm so appreciative of you kind of talking us through how to use this and making it so tangible is I'm wondering like if clients, when they see that they, you know, unconsciously drew a rock, a certain color or a certain size, I wonder if it helps them realize, like, for instance, the rock was bigger than they expected it to be. And they might think, this is actually carries more weight in my life than I anticipated before this exercise. 


Kristen Springer Absolutely. I've seen that happen many times. And I've also seen people draw rocks really big. And when they are able to talk through it, they say, Actually, I think I've done a lot of healing and I have painted or depicted this rock as this big barrier in my life. But I also think it's kind of a mask that I've clung on to and can soften and let go of a little bit. So both ways. 


Lindsey Vestal It's so beautiful. 


Kristen Springer Like formative. 


Lindsey Vestal I love that. All right. Beautiful. What's next? Okay. 


Speaker 3 So as far as the flotsam and jetsam, Ryan's life's journey is influenced by various contextual factors, including his military background, current work, environment and family dynamics. He's a dad of two daughters, but he's a very manly man. So it's funny that he was blessed with two little girls who make him do dress up and all the fun girly things. But all of these elements impact his occupational engagement and pelvic health experiencing experiences, shaping his perceptions, behaviors and responses to challenges. So him being able to lay out all of his roles and contextual influences is really critical for tailoring the interventions and supporting him effectively because he's not just one. Like, he doesn't just wear one hat, and sometimes one hat can feel bigger than others. But as you wrote in one of your most recent emails and your functional pelvis email, and you mentioned how you're very intentional about wearing the hat for the hours that you serve and setting effective boundaries and saying no and all of those things. And so I feel like I was able to do some of the work there for him when it came to his work, because he felt like by the time he got home at the end of the night, he had he didn't have any more space for his wife. He didn't have any more space for his kids. And when he did make space, he felt very inflammatory in nature with them. And so while he did have some tools and practices to be able to step away and delegate tasks, one hat, which you consider to be might consider as like the flotsam seemed to overpower all of the other ones. So being able to pause there and work through that and ask him about what it means to play that role and be in such a different realm than his former or his previous 20 years. That was a way to kind of pause and kind of evaluate priorities in a sense and set some emotional self boundaries as well. 


Lindsey Vestal So beautiful. I love that. 


Kristen Springer Thank you. And I loved your email that came out with our posts that came out with that because it's so true. We don't make enough time and space to sort of sit down and evaluate where our boundaries are, where our priorities are. But I think that our model opens a space and a platform to do those techniques as well. 


Lindsey Vestal 100%. And I think the creativity that's there, whether or not, you know, because I often think about some of these tools in terms of like, you know, this is this person this client has a military background, right? And sometimes you might think, right off the bat, maybe maybe you have a preconceived notion to think. I'm not sure this would be the right client to take out a myriad of colored pencils with and markers and highlighters. And it goes to show you that actually when we when we when we as the therapist bring it out with a set of confidence and a set of we're going to give this a try today. Let's be curious together. You know, the client kind of doesn't. Even. They're just like, Let's do this. This is someone I trust. This is someone I have been building a therapeutic rapport with, and it might have been a very long time. I don't know. Maybe he's taken out some colored coloring pencils with his beautiful daughters. But. But maybe not. Maybe not in the context for himself. And so there's just like this, almost this alternative meditative state that I think we can go into when we're given time and space in this in this, you know, therapeutic interaction to kind of start leaning into some of these principles and seeing them in a new way that gets us out of that almost like rote, routine perspective that we're always seeing our challenges in. And now we're seeing it in this way that's movable. And I'm not defined in the way that we've kind of locked ourselves into. And I could imagine that it that it kind of brings out some some other additional ways to look at the life, to look at the status of his urinary frequency, to look at the constipation, the challenges with intimacy in the whole context of the person that he is. Right. Because we don't live in isolation with these issues. They're rippling over into our interacting with with our partners, with our children, how we're showing up at work. And so I could imagine that for some of these clients and probably all of the clients that to do this with you like it really is that moment to kind of see it in that cohesive structure that it is. 


Kristen Springer Exactly. And thank you for bringing up the point where occupational therapist might be a little bit nervous bringing this up with clients who have a rigid or structured background, but those are some of my favorite clients to bring this activity up with because it allows them to feel playful and curious for some of the first times in a very long time. So with that, if someone is a little bit hesitant at first, I definitely tread lightly and I try to incorporate and weave in some of the trauma informed principles that we talked about. And I said vacation in that I want a person to feel safe engaging in an occupation in this therapeutic activity. And if they're absolutely not into it and they don't really seem to connect with it, we kind of shift gears and it takes our therapeutic use of self. So really know that balance and kind of read the room sort of thing. But it is worth a shot to bring a model like this up, especially if a person has found benefit from the somatic techniques or the bottom up techniques that allow them to work through intuitive movements or playfulness in a different sense. Because sometimes and actually often from my experiences working with people who are very intellectually driven and accomplished and all the ways top down approaches aren't always the best option because they know how to intellectualize it. But this is a way to sort of slow their roll and approach it through that sideways approach like we were talking about earlier. 


Lindsey Vestal Exactly. And so I really appreciate you helping us see that benefit, right. That even if it isn't, I love the fact that you really enjoy using it with with that more rigid thinking client, the client that maybe hasn't had a lot of time for play in their life recently. And then to just hearing how almost giving us permission, if you will, Christian, to kind of be a little bit fumbling with it, a little bit awkward with it, and to give it a try and, you know, kind of like we talked about in the trauma informed certification, there's this beautiful quote from Kim Barthel, who's an occupational therapist, too, that like, if it if it doesn't work right, it's it's an evaluation. And if it works, it can be part of treatment, meaning we've got this flexibility to experiment. And I think in that it renews our sense of joy for our profession. If we're doing things on broke routine, we're always approaching things the same way. Where's the joy in it for us? Where are we learning and being curious and approaching this with this this sense of playfulness? Because clients pick up on that energy as well. So I just really love that. We were talking about the fact that, you know, it can be awkward. We may not always know the ideal client to bring it up with, but to give it a try. And thanks to this conversation today, we're seeing in a really clearly illustrated way how to try it. 


Lindsey Vestal Thank you. I really do appreciate that. And that quote speaks volumes to our profession. I feel like we're in the best career ever, which hopefully we feel that way because we devote a lot of our lives to it. But with that, I think it's a tool that all of you should at least play with, whether that's with themselves to try it out a few times, but with a kind that they trust, that they feel open with, that they're ready to partake in that co regulation process with. I think that's kind of where to start in a way, and it's okay to fumble through it. I think it's better if you sort of fumble through it and be like, okay, well is this a rock right now or is it a just one? And maybe it's both and it can be both. So using some of those dialectical behavioral therapy elements of like two things can exist at once and we can hold space for both, even if it's in the same color, like right next to each other. There's not a perfect way to do this. And I think that in itself works on one's cognitive flexibility. 


Lindsey Vestal Yeah, just the very act of going through it. You're working on the cognitive flexibility in this idea that there is space for both because we know that life isn't black and white, you know, and it has, it has so many of those nuances. That's so it's so delightful. 


Kristen Springer Yes. Thank you. And so in the very beginning of the interview, you asked me about goal setting and treatment planning, so to speak. A little bit of about that if you have time and space. 


Lindsey Vestal Yes, please. Okay. 


Kristen Springer So with goal setting, I truly feel that the KAWA model provides a structured approach to collaboratively set goals with patients and trauma informed pelvic health care therapies and clients can really identify specific areas where distress or trauma related challenges are affecting their pelvic health and develop goals from there to further address these goals. So by analyzing the elements within the river metaphor, clients can really gain clarity and awareness and body attunement sometimes on their goals for healing and recovery, as well as the steps that are needed to really achieve them within a safe and supportive environment. So often I invite clients to go home with their kids and talk to their spouses if they have a spouse about what they found and sort of the goals that they set and develop their own short and long term goals based on what they find with the color model. And so when I have clinicians, patients, I always preface, I'm like, it doesn't have to be a Coasters smart goal format, but think about like, okay, well, what do my short term goals need from me in this moment and what is my long term goal from there. So I kind of flip the table and turn it on them and even have a second intervention session where we talk about the goals that we developed from the KAWA model. They don't have to be perfectly written out, but based on that, that can really see scaffold our treatment planning. So based on that and insights gained from that assessment or intervention, OTs can further develop trauma informed treatment plans that address the unique need of the clients. So when interventions are designed to navigate the challenges represented by the trauma triggers or stress triggers which are the rocks in this metaphor, they can better leverage the strengths and resources symbolized by the driftwood so their supports and coping mechanisms. I do feel like it is a really trauma informed, client centered approach, which when he developed that trauma, informed care didn't have the language and the detail. It does now and it still needs to be so much more research and program development in that realm. But unknowingly I really feel like his blend of Eastern and Western methodologies and the shift to holistic health care in general really caters to everything we do as an occupational therapist, and we're also being culturally sensitive and open minded in terms of like that collaborative intervention planning piece is when we try to be very stringent and have that power dynamics, that hierarchy in the medical field. I feel like healing the chances for healing are minimal and people start to distress the medical field even more at times. So having that delicate balance between the professionalism, like, of course our clients want to know that we know what we're talking about, but leaving it up to them to be open to writing their own short and long term goals and figuring out where their treatment needs most. Support with can allow occupational therapists insight into how to be a better guide in their healing process. 


Lindsey Vestal Absolutely. Kristen, This has been so illustrative and so clear. And again, like to. So appreciate being able to see this and to imagine this with this session you've had with a client. And for us to be able to do that, we'd be possible to include like a picture that maybe this client drew for their river or any supportive notes or goals that kind of came out from this session just so that we could take this conversation one step further. 


Kristen Springer Absolutely. I can send you an example of something they developed as well as their goals. I think the visual would be so powerful to see how it's laid out. And this visual could also be used by OTs when they're describing the KAWA model to a client or in an intervention. And so the client kind of has a visual to work off us, not that they would copy from it or use the same ideas, but just so they could see like, okay, this is what it looks like in practice. 


Lindsey Vestal Well, exactly. And we could even say, you know, would you like to? I've done this before with my clients. They've really enjoyed it. Would you like to see a picture and, you know, pausing and getting that permission first because some may want to see it, others may want to really kind of have their own creativity associated with it. 


Kristen Springer Definitely. I think just as you phrase that, that such a trauma informed way to approach it, because some of the rocks that might be present on this model might not be appropriate or welcomed into their mental or physical space. So asking for consent first, another thing that OTs could do that I would recommend is making a blanket, one that you have done for yourself as a therapist. You can be as specific or vague as you like, but sort of giving an outline that clients could pull from or like an example of language that they could use. Because when they do this whole model and language that feels safe and empowering to them, even when talking about their rocks and barriers, at least they have a framework to pull from. So the KAWA model is both a model and a frame of reference for that reason, and there are plenty of resources online, but I can absolutely send you what I have, as well as like a little description of how I would describe each of the elements, if that would be helpful. 


Lindsey Vestal My gosh. Yes, that would be amazing. So would you say that it's both a model and a frame of reference? 


Kristen Springer Yes. 


Lindsey Vestal Yeah, I still I had the amazingly brilliant Joanna Seeber on the podcast and she's spoken about this at last year's OTs and Pelvic health Summit. And I always need as many reminders as I can about models and frames of reference and theories, because I think that the academic side of my brain, you know, is a little a little disassociated with it, like in just in terms of all like the client care. And I really appreciate any conversations around bringing that kind of back into that, the academic model because it's like it does get lost there and notice that I know are actually doing it pretty authentically and organically. We don't have the words for it. So just hearing them in context of this conversation is helpful so that like I can continue to recognize that what we're doing is grounded in these practices even if we don't remember the terms. 


Kristen Springer Absolutely. I definitely resonate with you. When I was studying for the Nbcgetty, I was like, Okay, theory, model, frame of reference, what are the differences? And frame of reference is really their intention is to help clinicians link theory to intervention strategies and apply clinical reasoning, whatever that might be in that given moment to pragmatic practice. So with that, I think that this is a very tangible resource for clinicians to pull from and really evolve in any way they see fit. And I think that the author of the model, I don't know him personally based on what I've read, like he's very much open to that. He wants it to be holistic and integrative and pragmatic for use. 


Lindsey Vestal Absolutely brilliant. Kristen, is there anything else that you wanted to mention about the model or this client or anything before we conclude our episode today? 


Kristen Springer I don't think so, but I really appreciate you having me on and I love talking about alternative interventions and I am endlessly grateful for the trauma informed certification. I highly recommend everybody under the sun taking it so. 


Lindsey Vestal That means the world to Laura and I. It was an incredible, incredible program to go through. And you guys, as our inaugural cohort, will always have a very special place in our heart. So grateful for all that you continue to bring not only to our community, to our podcast listeners and to your own clients that you serve. Kristen You're just an incredible human being and practitioner and so grateful for today and your time. 


Kristen Springer Thank you. I appreciate it. 


Outro 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 posted to IG Facebook. Wherever you post your stuff and be sure to tag me and let me know why you like 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. 



Head Shot

Lindsey Vestal

Host