You've done the work. You've read the books, tried the tools, and still feel stuck. In the Season 2 premiere of the PRT Podcast, new host Daniel Lyman, LCSW, joins clinician Gabrielle Jacobs for When the Work Isn't Working: 5 Reasons You May Still Be Stuck — exploring five of the most common and most overlooked reasons people stall in chronic pain recovery. From waiting to feel safe before acting, to living with intensity, to identity fusion with a diagnosis, this conversation is honest, practical, and genuinely useful for patients and practitioners alike. Getting stuck doesn't mean you're doing it wrong. It means there is another layer to look at.
Episode Title: When the Work Isn't Working
Season 2, Episode 1
Welcome to Season 2 of the Pain Reprocessing Therapy Podcast. Daniel Lyman, LCSW — founding member of the Pain Psychology Center and Executive Director of the Mind Body Therapy Center — takes over as host this season, bringing a deep clinical background in neuroplastic symptoms and chronic pain recovery.
For the first episode, Daniel sits down with Gabrielle Jacobs, LCSW, Associate Director of the Mind Body Therapy Center, to tackle one of the most frustrating experiences in recovery: doing everything right and still feeling stuck.
In this episode, Daniel and Gabrielle discuss:
Key concepts mentioned:
About the hosts:
Daniel Lyman, LCSW, is a psychotherapist and founding member of the Pain Psychology Center, where Pain Reprocessing Therapy was originally developed. He is the Executive Director of the Mind Body Therapy Center, a therapy and coaching practice serving clients worldwide dealing with chronic somatic symptoms.
Gabrielle Jacobs, LCSW, is the Associate Director of the Mind Body Therapy Center and a clinician specializing in neuroplastic symptoms and chronic pain. She has been deeply involved in the clinical world of Pain Reprocessing Therapy for many years.
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Interview
[00:00:00]
Daniel: Hi, my name is Daniel Lyman, and welcome to the first episode of Season two of the Pain Reprocessing Therapy Podcast. For those of you who listened to last season, you can probably tell pretty quickly that I am not John Gasienica . I don't think I have quite the same sexy voice that he does, but John and the entire team have graciously asked me to host this season, and honestly, I could not be more excited to be here.
So first, a big thank you to John, to the PRT Center team, and to all of you listening for trusting me with this role. If you're listening to this podcast, chances are you're either a clinician who's interested in or already using pain reprocessing therapy or you're someone dealing with chronic physical symptoms yourself.
Either way, you're in the right place. I myself, am a psychotherapist who has dedicated my entire career to helping people overcome chronic physical symptoms. Uh, I was a founding member of the Pain Psychology Center where PRT was originally developed, and I'm currently the executive director of the Mind Body Therapy Center, a therapy and coaching practice that [00:01:00] works with clients around the world who are dealing with chronic somatic symptoms.
This season, we're going to be diving deeper into how PRT works in real clinical practice, the challenges, the breakthroughs, and the questions that come up when people are actually trying to recover from chronic symptoms, because chronic symptoms can feel very isolating and confusing. My hope is that this podcast helps make the process of recovery clearer and maybe a little less lonely.
So let's dive in. For this first episode, I was thinking about what I myself would want to hear, and if I had listened to all of season one, which I think was a great season, and I was still not recovered, I might be feeling frustrated and wondering, why am I still stuck? And that's exactly what we're gonna talk about in today's episode.
We're gonna talk about five reasons why you might be feeling stuck, why you might be still managing these symptoms when you obviously want them to go away. So let's listen to this conversation that I have with [00:02:00] Gabrielle Jacobs. Gabrielle is a therapist who specializes in treating neuroplastic symptoms and chronic pain, and she's been deeply involved in the clinical world of pain reprocessing therapy.
Gabrielle Jacobs, I'm so excited to have you on the show. Thank you for being here. Long time, no see,
uh, Gabrielle's joking of course, because we work together very closely. Gabrielle is the associate director at the MINDBODY Therapy Center, where I'm the director. Um, and she's a clinician here on the team and has been doing this work for many years now.
So. It's great to see you again. It's been minutes since I last spoke with you.
Gabrielle: Thank you for having me here today. I am very excited to talk with you and hopefully this will be a helpful conversation for everyone listening.
Daniel: Yeah, when we were brainstorming what to talk about here, it felt really obvious because there's so much good information in the first season of this podcast.
Uh, John unpacks all these different tools and techniques, uh, and different ways of working with people through a PRT lens. And I wanna just address that sometimes we do [00:03:00] all the right things and we still feel stuck. We listen to every episode, we read every book. We work with many different coaches. We try everything and we still feel stuck.
That's not an uncommon experience for people. And so it felt like, let's start off season two here. Talking about when you're stuck, what it's like to feel stuck and how to get over being stuck. So, Gabrielle and I have five reasons you might be feeling stuck. Or if you are a practitioner, you might be experiencing some stuckness with one of your patients.
That is not uncommon. I know you, you, you've been there. I've been there. It happens where we're working with people and it's like, gosh, we're not getting where we want to go. So now this isn't a comprehensive list. There are a lot of reasons people can feel stuck, but we're gonna talk through, uh, five of them.
How does that sound, Gabrielle?
Gabrielle: Let's do it. Let's get started.
Daniel: Okay, great. The first one that I have listed here is no experiential safety. This is the first reason people might be feeling stuck. What does that mean to you?
Gabrielle: You and I talk about this one in particular all the time [00:04:00] because it is such a common problem that we see when clients come to our practice and they say, I have been doing everything, and yet it just not.
Daniel: Yes.
Gabrielle: When we talk about no experiential safety, essentially what I'm thinking of is people waiting to feel good in their body before they start doing Yes. Like the before, right? Mm-hmm. They're waiting for this magical cue that says, now it is safe for me to try.
Daniel: Mm-hmm.
Gabrielle: And for many, if not most people, that magical sign is not going to come.
Daniel: It rarely comes. Yeah.
Gabrielle: And I wanna be really clear that we don't want anyone to feel completely overwhelmed. I always say I'm afraid of heights.
Daniel: Mm-hmm.
Gabrielle: Right. If you told me, let's go bungee jumping today, I'd be absolutely petrified.
Daniel: Right. That's okay. That's not, that's not today. That's episode two. That's, [00:05:00] we'll save that for next time.
Gabrielle: You're gonna coach me through that. Oh gosh.
Daniel: Actually we should do that live. That'd be great. Okay. Well that's a, again, another episode.
Gabrielle: Um, but. We do want to start really challenging in session and between session clients to start learning that they can start out a little bit scared and then find safety.
Daniel: Yes,
Gabrielle: absolutely. Um, and that's where we actually start to feel safe because I, you and I have both heard so many clients say, I never feel safe in my body. I never feel safe. I don't even know what safety would be like. Mm-hmm. And we have to start somewhere. And that's sort of the creative magic that I love is like, where, where is that place that we start and what does it look like all around it to, to get there.
Daniel: Yeah. Let, let's, let's talk specifics here. So what you're talking about is making some behavioral change with some, with people encouraging them to behave differently than they have when they're showing up [00:06:00] and talking to us. Um, and so they might be experiencing some. Or they are experiencing some physical sensation in their body that is stopping them from behaving in a certain way.
And what you're saying is, let's try and inch our way towards behaving that way. Even if it doesn't feel safe at first, we'll find safety after we start doing it or while we start doing it. Is that right?
Gabrielle: Exactly. Yeah. And you know, let's take someone that is experiencing pain while standing or walking.
Daniel: Yes. Common. Mm-hmm.
Gabrielle: And again, so many people fall into the trap of all or nothing thinking, right? Yeah. Zero to 100. And they're like, well, I can't go walk a mile. And it's like, yeah, well, we're certainly not going to start with a mile.
Daniel: Absolutely not. Absolutely not.
Gabrielle: You are maybe going to start in session with, can you fill your feet on the ground, right?
Daniel: Yes.
Gabrielle: Can you start even pushing into the ground?
Daniel: Mm-hmm. Mm-hmm.
Gabrielle: Can you close your eyes and imagine what it would feel like to press, and I'm actually doing this right now. Press your [00:07:00] beat as if you are about to stand right. We might be starting there.
Daniel: Right. Absolutely.
Gabrielle: And maybe while we're doing this, we're listening to like your pump up Jams playlist that puts you in a good mood.
Or we have your dog right next to you and you're petting your dog.
Daniel: Yeah. So for I know that means for you, that means listening to Beyonce and petting both dogs.
Gabrielle: Yeah. Beyonce, Taylor Swift. You know Me too well. And then maybe it's just standing.
Daniel: Yes.
Gabrielle: For a while.
Daniel: Absolutely.
Gabrielle: And that could be a whole session, honestly.
Daniel: Oh, I, I think many sessions. I've done that with so many clients. And what you're talking about here is, you know, behavioral exposure work, um, to build experiential safety, to build safety in the things that we're doing. Um, I can think of one particular client, but I have done this with so many clients that have problems sitting, um, like because of, you know, butt pain or various other things, sitting is difficult.
And I can think of one particular client, this was many years ago, um, where I told her, I was like, why if we just sit for literally [00:08:00] one second. 'cause we would meet and she would be laying down and, and we spent 45 minutes or 30 minutes or so just building up the courage to sit for a second because it was so scary.
And I wasn't about to push her to do it too fast. 'cause we don't want to re-traumatize. But we just kind of sat with the, the fear, the discomfort around it. And then she finally sat for literally a second burst into tears. The anxiety dropped and she felt a lot better. Now, did that mean she was magically able to sit for hours on end after that?
No, of course not. But that was the start of building experiential safety
Gabrielle: and one, you know, caution here is if it's going well
Daniel: mm-hmm.
Gabrielle: Call it while it's going. Well,
Daniel: yes,
Gabrielle: I have young kids and I always say, you wanna leave? Before the meltdown, right?
Daniel: Totally. Yes.
Gabrielle: When the party's good and you're like, everyone's having so fun.
Get outta there. That's when we go. And so thinking about it in this context, [00:09:00] really, it's. If it's the one second, and that was the goal. When the one second is done, then that was the exposure. We are finished for the day, and now we've had the corrective experience that has taught that safety is possible.
That will give the courage to try for two to five seconds the next session.
Daniel: Absolutely,
Gabrielle: and we build from there. But if it's going well, there's that temptation I think to say like, okay, let's sit now for the whole second a hundred
Daniel: percent because this is the all or nothing. Thinking again, it's like, great, I did that second.
Well, now I can do 10 seconds in a minute. And we try and do that all in the same day, and that will bring us right back to that place of fear. Then we're not actually building safety. I say like, let's do the exposure and then we throw ourselves a party, like a mini party, whatever that may look like, but we're just proud of ourselves for doing that.
I'm laughing at your example because I have learned the hard way that when I go out skiing, uh, it's best to finish my ski day, uh, on a, on a really high note when I'm feeling good before my legs start really screaming at me. Because if I go one more run, that's when I hurt myself.
Gabrielle: And you [00:10:00] have to learn the lesson the hard way.
Daniel: I wish I was smart enough to learn lessons from just reading a book or something, but no, I've had to learn them all the hard way. Yeah. So what are ways, so this is what, you know, people are getting stuck in that, in that they're. What would you say? Is it because they're too, uh, the anxiety is too high to start challenging those behaviors?
Or where does the stuckness come from?
Gabrielle: I think the anxiety can be too high. Mm-hmm. And again, I think that there is sometimes, you know, we've all in this community seen some just wild success stories.
Daniel: Mm-hmm.
Gabrielle: Mm-hmm. That it feels truly like magic and Right. I think many people are like, I want that magic moment where I, yeah, wake up and there's no anxiety, and my eyes blink open.
I have perfect energy. My body feels great, and I'm like, today is the day
Daniel: I want one of those days.
Gabrielle: I know. I really want one of those dates. We make our own magic. Right?
Daniel: Right. Mm-hmm.
Gabrielle: And I [00:11:00] think that is what we do with these exposures is we are truly just, the magic is in our willingness to try and to be open to the experience.
That's the radical acceptance piece of we don't know what that one second of sitting or the pressing in of the feet into the ground is going to feel like.
Daniel: Totally.
Gabrielle: But we're willing to give it a go, and that's when we teach our brain to actually feel safe.
Daniel: A hundred percent. I love that. I think a lot of people, and I'm guilty of this myself, is, uh, we think, well, I used to be able to do this activity like this, so I'm just gonna try and do it that same way, and that can really set us back.
We want to lower the expectations on ourselves, uh, because that's, that's self-compassion, right? Is recognizing where we're at and just taking it one tiny step at a time because then actually things snowball and they can start moving pretty quickly. But not if we force ourselves to move quickly right from the get go.
Gabrielle: I always tell clients I want them to live, and this will feel very uncomfortable for many people in that [00:12:00] plus to be minus place. Mm
Daniel: mm-hmm.
Gabrielle: Of let's do something badly, right? Yes. Yes. You used to run ultra marathons. Let's start with a walk around the block.
Daniel: Right.
Gabrielle: And I know that you, every part of you is going to be screaming for that felt, okay, can I do another round around the block?
But we do want to do this really strategically.
Daniel: Yes, absolutely. We're not building safety if we don't do it strategically.
Gabrielle: Exactly.
Daniel: Yeah. If we can, if we dive in head first and we're like, I'm just gonna do another round of the buck, another round, another round, we end up retraumatizing ourselves.
Gabrielle: Yes.
Daniel: All right, so that was reason number one.
No experiential safety. Let's look at reason number two and reasons why people might be stuck. And this is feeling feelings, but not actually changing relationships. Ooh, just that feels like a big one to me, that
Gabrielle: Yeah, I know. I think a big inhale there. There's a lot.
Daniel: [00:13:00] There's a lot there. And, yeah. Let's, let's start.
Do you have, how would you explain that?
Gabrielle: Again, anyone who has been in this space, who has, you know, quote unquote read all the books mm-hmm. Knows that a big part, especially of emotional awareness and expression therapy is getting in touch with what the natural, authentic emotion is. Mm-hmm. Identifying it, experiencing in the body, experiencing it, and.
Oftentimes that is really focused on what we're doing in the session or what we're doing on our own, like mm-hmm. Right. Writing the unsent letters. Yep. But if you are still in a relationship where the dynamic is disempowering to you Yep. Where you are being talked down to where you are being controlled.
Mm-hmm. Where you are being disrespected in some way. Right. Right. You can feel all the feelings and that's great, and that's certainly the first start. But [00:14:00] then we want to kind of put those feelings into action. Yeah, yeah. By working to express and then change the relationship.
Daniel: Yeah. What I think what's so great about PRT is getting people to understand their feelings, recognize how they show up in their body, and then the next step though is honoring those feelings.
As you said, if we feel these feelings and there's like, well feel that feeling continue to go to be in this relationship that is disempowering to me, that is abusive, that is, that doesn't feel very good. We're not really honoring those feelings. And to be clear, like relationships here we're talking about, it could be with a spouse, it could also be a relationship with your work, it could be your relationship with your family,
Gabrielle: friends.
Daniel: Yes, absolutely. Any, anybody. Anybody. Any kind of relationship.
Gabrielle: Absolutely. Fr the relationship you have with the place in which you live your community broadly. Right,
Daniel: right,
Gabrielle: right. There are all of these different relationships, and again, I think about it as empowering the client [00:15:00] to mm-hmm. Make change that is authentic to them in the way that they want to move through the world.
Mm-hmm. And be a relationship with others.
Daniel: Yep. Yep.
Gabrielle: And knowing that change again, like isn't going to happen magically, overnight.
Daniel: Totally. Yeah.
Gabrielle: And it will be scary, right? If you've been in a relationship with someone where they've expected you to behave a certain way. Right. Mm-hmm. And they're so used to that.
Yep. You doing something that kind of breaks out of that pattern will be jarring.
Daniel: Yes, absolutely. Absolutely. And we
Gabrielle: can't necessarily, we can really never control what is going to happen next.
Daniel: Mm-hmm. Mm-hmm.
Gabrielle: We have to be willing to find out, but. Recognizing that there is something within that wants change, and then facilitating that change.
Daniel: I think of [00:16:00] that in terms of also just my relationship with various projects or things in my life, um, where the feelings I have towards them. I may start to grow resentful towards certain projects. I think of like, I don't know, even just like home projects. This is really boring of me, but like a home project that.
I feel committed to completing myself, but I can recognize that I'm resenting that project more and more and more, and it's not going anywhere and it's not getting better, or the project feels more and more daunting, and so I can recognize, okay, man, I hate this thing. I've got a lot of anger towards whatever this project is.
But if I keep forcing myself to do this, I'm not actually honoring those feelings. There's a part of me that's like, you know what? I could ask for help with this. Or I could, uh, in certain projects, like if I have the money, I could pay somebody to help me with this, whatever. But I'm not honoring my feelings here.
I've learned what they are and I can recognize them and label them, but I'm not giving them their credit.
Gabrielle: Yeah. Learning to let go.
Daniel: Learning to let go
Gabrielle: is a big one. Oh my gosh. I, I mean that's, that's another way to change the relationship. I, I was coming up with an even sillier example [00:17:00] than your home projects, which is Uhhuh, the English major in me had such a hard time.
Mm-hmm. Not finishing a book I didn't like and I would be, yeah, avoiding reading at all because I had to finish a book and when I finally was like, no, I can absolutely read four chapters and just say, it's not the book for me. Totally.
Daniel: I can
Gabrielle: move on to the next one.
Daniel: Yes.
Gabrielle: It was so freeing and allowed me to read as much as I want to read.
Daniel: Sounds a lot easier. Yeah. Yeah. And these are the kind of places I think like when we talk about home projects or we talk about reading a book, those are places to practice this, because then when it gets to harder things like actual relationships we have with people, our spouse, our family, whomever.
That's a lot scarier, as you were talking about before. It's a lot scarier than putting down a book and being like, I'm just not gonna read this. Not to discredit you or the work that you've done to be able to set down a book, but, but it is a lot harder. So we think of these smaller areas as practice. We think of these areas as like, okay, this is how I'm actually listening to my feelings, [00:18:00] honoring them and making appropriate change.
Because it is very difficult for people. Let's just cut to the chase here. It is very difficult for people to feel better when they're in a place, when they're in a toxic relationship of some kind that is not serving them. And they may recognize all of their feelings towards their spouse, their work, whatever, their parents.
But if they're not changing anything it, they're gonna continue to feel not well. Yeah. Uh, because there's really a lack of safety in that really.
Exactly. Yes. Thank you for bringing it back. You know, PRT, one of the major tenets of PRT is finding safety. And if we are literally in an unsafe environment, even if we find safety in the feelings in our body, the actual environment's unsafe with this, or the relationship's unsafe, things can't change.
Gabrielle: Mm-hmm.
Daniel: Yeah. Should we move on to number three?
Gabrielle: I think so, yeah.
Daniel: Okay. Number three, uh, is, you know, this is one that I struggle with myself and this is what keeps me stuck. And I go back and forth on this because sometimes I like come across as not this person and other times I'm very much this [00:19:00] person.
But the number three reason that we came up with here for reasons why people are stuck is living with intensity. Um, I imagine if you're listening to this, you can probably relate to this a little bit, but there are certain things in my life where. Maybe actually like reading a book. It is so hard for me to not be all in.
It is so difficult. I mean, I'm a marathon runner, you know, I'm kind of those, you can roll your eyes and be, I totally get it. I'm one of those people and it is so hard for me to not do it intensely. I tell everyone when I run races, I'm like, oh, I do it for fun. It's like, it just feels good. But man, if I.
Don't beat my friends. It's so hard for me. And I get really, I can, I can sense that competitiveness, that intensity in my life. This is just one small example of course, but uh, living with intensity is not a way for us to feel safer in our bodies. It is not a way for us to heal.
Gabrielle: And I'm a couch to 5K dropout for all of you.
Daniel: You're my inspiration.
Gabrielle: Um, I think. A fear that comes up for many clients is, again, going back to [00:20:00] that idea of C plus B minus mm-hmm. Is that we're saying, you know, settle to not be good. Mm-hmm. Or settle to not be great at think.
Daniel: Right. Yeah, exactly.
Gabrielle: And that is certainly not what I am ever encouraging clients to do.
Mm-hmm. But what I often find is that people are living with intensity in all areas of their lives. Everywhere.
Daniel: Yes. And
Gabrielle: you don't have the ability to pick and choose what are the things that really matter to me that I mm-hmm. That is like so core to my authentic values as a person.
Daniel: Yes, yes.
Gabrielle: And then, sure, let's of course show ourselves self-compassion and a lot of grace, but let's be intense about those things.
Daniel: Mm-hmm.
Gabrielle: But then. Not be so intense about the laundry having to be folded. Perfect. Yeah. Oh my gosh. And every leaf having to be raked and swept up in the yard, [00:21:00] and you know, the kids' hair has to be done perfectly. Like all the ways that perfectionism and intensity can show up everywhere. So the picking and choosing, I think it can go a long way to calming down that sort of nervous system Hypervigilance.
Daniel: I love that idea. Like, let's, let's allow ourselves to be intense about certain things because that's what our, our, you know, a lot of us for. That's like, our personalities drift that direction, but let's not encourage it everywhere. So if we're really intense at work, let's not come home and immediately be really intense about eating just the right macros in our food, and then making sure that we read.
30 minutes of a self-help book and then go to bed at exactly the right time and make sure we're not looking at those screens for exactly the right time. I mean, that's just intensity all day long and that's keeping us in a hypervigilant fight or flight state, um, which is going to decrease the sense of safety we feel in our bodies and increase our symptoms.
Gabrielle: Yes. And the things that, again, we, we are choosing to [00:22:00] be intense about. Can we still focus on fun? Yeah. And self-compassion. Yep. Um, I'm a big Olympics nerd and so just coming off of the Winter Olympics here. I think observing Alyssa Lu's story, right? Mm-hmm. Where she actually left figure skating and left the rigors and the intensity that were imposed on her outside in.
Daniel: Right. She said it was just like way too intense for her. Right. Wasn't that intense? You know the story better than I do. Yeah. Being
Gabrielle: driven by her father, the coaches, the whole system around her left entirely and then came back and did it on her own terms and was really prioritizing finding the artistry.
The fun doing it because she enjoys it. Yeah. And so really, you know, kind of going with a magnifying glass over all these areas of intensity and coming back to that question of, am I the one choosing this and what. [00:23:00] Does my pursuit of greatness look like?
Daniel: Yeah.
Gabrielle: Or is this being imposed by others' expectations of me and society's expectations?
And then can we let go a bit of that to strive for something really great, but incorporate more of the self-compassion and the patience with ourselves and the ability to mess up at times. Right,
Daniel: definitely. I think for me it takes a certain amount of ego strength that I'm still working on, but it, for me, like being able to laugh at myself through things that I'm starting to get a little too intense about, um, that's a, a really key part of keeping that intensity in check.
If I'm not able to laugh at myself about this, I'm probably taking it too seriously.
Gabrielle: You laugh at me all the time. I, I think I, uh,
Daniel: you mean that in a loving way, right? Not in,
Gabrielle: I was searching for the word effervescent and I think I settled on effer. Which you did is a fun combination.
Daniel: Absolutely.
Gabrielle: Yes. Other words, but certainly not a word.
Daniel: So let's just talk before we [00:24:00] move on to the next one though, let's talk about, let's say I'm listening to this podcast right now and I am. At home and I'm nearly bed bound because of the, the discomfort, the pain, the symptoms that I'm feeling, whether it's fatigue, whether it's intense back pain, migraine.
And here we are saying like, be less intense. That's hard to sit with, right?
Gabrielle: Yes.
Daniel: I can empathize with that. That's a, that's a hard thing to sit with in that moment when you're feeling a lot of pain. Yes. How can we translate that for the person who's really struggling right now? So it doesn't feel quite, I don't know.
'cause this, I can understand how this might feel like we're talking down to somebody in some way and that's not what we're trying to do at all.
Gabrielle: No, no. Again, the self-compassion that allows you to start exactly where you Yes. Are.
Daniel: Mm-hmm.
Gabrielle: Right.
Daniel: Yeah.
Gabrielle: Um. I've recovered from surgery in the past, right? Mm-hmm.
And it's so humbling, right? Mm-hmm. Everyone here has had an experience that they can think of where
Daniel: mm-hmm.
Gabrielle: Their body does is not where [00:25:00] they want it to be.
Daniel: Yeah. Mm-hmm. Absolutely.
Gabrielle: And honoring that place of this recovery might not be on the timeline. I want it to be. Mm.
Daniel: Yep.
Gabrielle: And it may not be as smooth as I want it to be.
Mm-hmm. But here's where I am and here's how I can show up for myself today. And again, sometimes it is working with someone like ourselves that gives you permission to start with the one second.
Daniel: Yeah, totally.
Gabrielle: Because that internal voice will say, well, that wasn't enough. Right? Right. You're not doing enough and.
Sometimes that is exactly where you need to be is the start with the one second or the five seconds.
Daniel: Mm-hmm. Absolutely. So what, what I'm hearing you say, and what it resonates with me is, um, self-compassion is really an antidote to the intensity.
Gabrielle: Mm-hmm. And if you can't find it for yourself immediately, the question that I always use with [00:26:00] my clients is, if you can think of someone you really love, whether that's a child, your best friend, a sibling.
Even, you know, I think of my dogs as little people like my dogs, right? How, how would I approach this for them? Yeah. How would I approach them through this process? Mm-hmm. What sort of patience and grace would I show them if I was my best self in that moment?
Daniel: Yeah, absolutely.
Gabrielle: And that often helps us get to an answer.
Daniel: Definitely most people, not everybody, but most people will be like, oh my gosh, I would never talk to somebody that I care about the same way that I'm talking to myself here. I would never expect them to be as intense about these things. I'd be like, just have fun with it. Who cares? Um, great. Alright. That was, we've, so, so far we've had no experiential safety.
We've had feeling feelings, but not actually changing relationships. We just talked about living with intensity Number four, the fourth reason people can feel stuck is trying to [00:27:00] eliminate symptoms instead of changing patterns. Um, I like this one a lot because of course, every time someone comes to talk to you or I, or anybody at the Mind body therapy center, or any therapist working in the chronic pain space or chronic symptom space.
They're there because they want to get rid of the symptoms. It's like, help me to get rid of this. But what's, uh, what we always wanna draw our patient's attention to is that the patterns that got you here, there are patterns that got you here. And if we focus just on getting rid of the symptoms, what we're doing is trying to turn off the check engine light in the car versus actually trying to fix the engine.
Gabrielle: Exactly. The. Way that I describe this to clients is, okay, let's say you want to, uh, you know, build muscle, right? You want, let's say some bigger biceps.
Daniel: I'm trying to look like Arnold Schwartzenegger. I've been trying to look like Arnold Schwart since I was like 12. So
Gabrielle: I feel like this would be a huge shift in direction for you, but okay.
Uh. You don't go and do [00:28:00] bicep curls and look at the mirror and say, where are my huge Arnold Schwar maker bps?
Daniel: Wait, I'm not supposed to do that.
Gabrielle: Be a hard day for you. Uh, what you wanna focus on is, can I consistently.
Daniel: Go to the gym,
Gabrielle: get myself to the gym.
Daniel: Yes, exactly.
Gabrielle: And so it is really focusing on the practice of showing up.
Mm-hmm. And not the outcome that day.
Daniel: Yes. Yep.
Gabrielle: And I always say, you know, take somatic tracking, which is such a key focus in PRT and deservedly so,
Daniel: yep.
Gabrielle: But everyone gets really stuck on, well, I'm tracking right now and my pain hasn't moved, or hasn't moved enough.
Daniel: Mm-hmm. Mm-hmm.
Gabrielle: And I, and I tried to really drill home if we were even able to touch sort of that curious, neutral observer.
Daniel: Yes,
Gabrielle: we have. Started to create a neural [00:29:00] pathway that can go there and it might not be really evident to us today.
Daniel: Totally. I, it usually isn't, we start small and it's not evident those biceps don't look bigger the first time you go to the gym.
Gabrielle: Yeah. I, I was a dancer and I, there are so many memories that I have of not being able to get something and just drilling it in the studio.
And finally having like they're closing down the studio and I'd sleep on it and the next day it would come easier to me.
Daniel: Of course. Yeah,
Gabrielle: exactly. 'cause that that work was not in vain, even though I couldn't see the fruits of that labor in the moment.
Daniel: Totally. Yep. Absolutely.
Gabrielle: So we're, we're practicing. It's, we're not looking for perfection.
We are not trying to make the symptom go away in the moment we're practicing getting to that place of curious, patient, present with the symptom.
Daniel: Mm-hmm.
Gabrielle: And that
Daniel: matters. I am thinking of a, a recent patient that I've been working with who [00:30:00] is, uh, dealing with fatigue. And right from the get go, right from the beginning of the session, I noticed that he was showing up in a very intense way.
And, uh, I would ask him about like, is this how you show up for work? Is this how you show? He's like, this is how you show up for everything. He's like, I just want to do it. We're going back to number three, living with intensity. But he would be like, but I just really need to get rid of this fatigue so I can continue being, essentially what he was saying is so I can continue being this intense with everything.
And the pattern that we actually wanna look at is his intensity. Then that will change the fatigue. Now it's really hard though. It's, it's easy for me to say. It's really hard when that those patterns are embedded and ingrained in our daily behaviors. We've been living this way for a long time, so it takes time, as you said, to change them.
But we really wanna put our attention on that intensity versus putting attention on the fatigue because this particular patient, he would, you know, go to work and, uh, sit at his desk on his computer for seven hours straight. Just be staring at the computer and then come home and be like, I'm exhausted and I don't understand why I'm feeling fatigued.
Be like, oh man, if I stare at the computer for more than, I mean, I do 50 minute sessions. At the end [00:31:00] of that 50 minutes, I look away from the computer, I get up, I stretch, I move, I gotta do something. I can't be that intense this whole time.
Gabrielle: Mm-hmm.
Daniel: So really shifting our attention away from the symptoms to the patterns that might be perpetuating the symptoms.
That's the goal here. And it's really hard to do when we're in a lot of pain because we're like, I just need to get out of pain. So I get why it's frustrating.
Gabrielle: Yeah. And sometimes we don't even see the, our patterns ourselves. Right?
Daniel: For sure. Oh my gosh, I, I am the number one most guilty person of that.
That's why I've been in therapy myself, of course, many times,
Gabrielle: and. Then, you know, whether you're working with a, a therapist mm-hmm. Like us. Um, sometimes even though enlisting the help of a roommate, a spouse, a family member, a colleague.
Daniel: Yeah.
Gabrielle: Um, who can help really identify, okay, you're going into that intense mode, right?
Yep. You are locked in, in a way that is not serving you.
Daniel: Totally. Yep.
Gabrielle: Can help you bring awareness if [00:32:00] it's not immediately there, and then give you that opportunity to decide, well, could I take a break? Could I sit down? Could I get myself a glass of water?
Daniel: Yep. Mm-hmm. Small example, because I mentioned that I'm a runner.
Small example is, uh, the first marathon I ran, I was having a lot of knee pain, just, uh, my knee was screaming at me and I was running a marathon for the first time, which is I think kind of a crazy thing to be doing anyway. And I was trying to do it under a certain amount of time. And I was also working two jobs at the same time.
And I was being super intense about training for the marathon. And of course my knee was telling me like. Calm down, like, what are you doing? But I wasn't listening to it and I was like, I just need to fix my knee pain. So I was looking into all kinds of things to do to fix the knee pain, and it wasn't until basically my knee was screaming at me that I was like, you know what?
I'm gonna let go of trying to finish this marathon in a time and just see if I can run a marathon and have fun with it. Then my knee started. Calm down a bit. Then it started to feel better. Yeah, it's a story that stuck with, it was so obvious to me at the time that it was like, man, when I really actually [00:33:00] shifted my attention away from trying to fix the pain to shift, looking at patterns as to why I might be here.
When I was able to finally do that and make change things felt better.
Gabrielle: And going back to another PRT principle here, that leaning into positive sensation. Yes. Like when you said, I'm not going to worry about time, but I'm just gonna have fun with this experience. Yes. Went away. Yeah. And so I find it often really helpful to provide a different prompt, especially if we're going to do.
Let's say an exposure that introduces someone to like a movement where there's pain, where we might say, okay, if that pain say is like around your feet when you're walking or your knee when you're walking. Um, can we have fun with our hands, right? Yes. Can we feel our shoulders going back when we're walking?
Yeah. Can you roll your head in circles, like leaning into something positive or neutral or silly? Yes. Can be so liberating. Mm-hmm. From that laser, focus on the [00:34:00] symptom as the problem.
Daniel: I'm just smiling as I think of Daniel Gaines, a therapist that we work with who loves to dance with his clients, which I think is amazing.
I've done it to myself, but I just love watching video of him dancing with his clients, having fun, reminding them to lean into those positive sensations.
Gabrielle: Yeah.
Daniel: All right. Let's move on to our last one here. This is a big one. Um, and this is again, the fifth reason why you're stuck is that your identity might be attached to the problem.
And what I mean by that is it could be attached to a diagnosis, uh, like a specific diagnosis, or it could be just attached to the pain that you're experiencing. Like, I am someone with back pain, that is who I am. And that means X, Y, and Z.
Gabrielle: Yeah.
Daniel: What, yeah. What comes up for you?
Gabrielle: Well, I start with. That is the least interesting thing about you.
Daniel: Absolutely. Uh, there's so many, all of us have so much more to offer than being somebody with symptoms or somebody in pain.
Gabrielle: Yeah. And it, it's both a joke and it's not, but
Daniel: totally.
Gabrielle: When that identity gets [00:35:00] fused, it takes someone kind of sitting on the other side saying, you are more than your pain.
Daniel: Yes.
Gabrielle: You are a person with interests and strengths and a personality and a sense of humor and a history, and you are so much more than this problem.
Yeah. And can we start bringing that in to your worldview?
Daniel: Yep.
Gabrielle: And that can start to shake things up quite a bit. Definitely, like even definitely in the question, who would you be and what would you be doing if you didn't have this pain problem in front of you?
Daniel: Mm-hmm.
Gabrielle: And then kind of like, how, how do we start reminding you of that through the, the way that you are moving through the world, the choices that you're making, the way that you're spending your time, um, or energy.
So I think that that's kind of that way in.
Daniel: Mm-hmm. Mm-hmm.
Gabrielle: Um, but we [00:36:00] also have to explore in many cases how people are being served by this pain problem. And this is a spicy one.
Daniel: Absolutely. Yeah. Let's get into it though. This is spicy. Yeah.
Gabrielle: But our pain often is getting us things and
Daniel: Absolutely.
Gabrielle: And it's not in like the, I I really wanna be clear here that the vast majority, if not all, and I just shy away from saying all or nothing statements.
Daniel: Right. Totally.
Gabrielle: Um. Are not intentionally saying, I want this pain so that I can get X, Y, and Z. This is happening very much on a subconscious level.
Daniel: Totally. Yes, absolutely.
Gabrielle: But I, how many times have we heard someone say, well, what happens when I get a migraine? Well, I get to go lie in a dark room and be by myself.
Daniel: That was me during my migraines. Yep. I was really stressed out and I got to just like check out from the world.
Gabrielle: Exactly. And so that's what it got you, was that ability to check out from the world. Mm-hmm. And I always say like, [00:37:00] let's make that problem irrelevant.
Daniel: Hmm.
Gabrielle: So before you get the migraine. Can you give yourself time, whether it's every day or once a week, to check out from the world, lie in that dark room.
Yeah. You know, binge Netflix, if that's what you wanna do for the hour on,
Daniel: or literally just lay and stare at the ceiling as I oftentimes do.
Gabrielle: Well, I'll be the one with Netflix then.
Daniel: Yeah.
Gabrielle: That we can get for ourselves and give ourselves the gift of whatever we are getting from the pain.
Daniel: Yeah.
Gabrielle: And put the pain out of a job.
Daniel: Yeah. And, and absolutely. I think if we can conceptualize what, uh, what is this potentially giving us that might feel good and can we just give this to ourselves without the symptom or before the symptom, if we can conceptualize it, that it's really helpful. Um. Secondary gain. For those of you that are familiar with the term, um, is not always a conscious process.
Of course, sometimes it can be, but generally speaking, uh, this is not what people are, are going through here. They're not saying, oh, I want this pain so that I can get this. [00:38:00] No, of course not. When I gone through, like when my migraines were absolutely terrible, I was, somebody told me like, oh, you're. You want this because it gives you a chance.
I'd be like, no, screw you. It's not, I don't want this at all. That said, there was something helpful that it did give me, which was, as you just said, a chance to check out from the world and kind of relax, which I was not relaxed at that time in my life. I was super stressed out. Mm-hmm. And so identity is, you know, identity attached to the problem is, is.
Both related to that and also specific diagnoses. And this is also a little spicy to talk about. Um, but I think it's, it's helpful that when we work with patients that have certain, a certain diagnosis, it can feel as though that is their middle name.
Gabrielle: Mm-hmm.
Daniel: Like I am Daniel Fibromyalgia Lyman, and this is a key part of who I am.
Gabrielle: And there are so many gifts that the internet has given us
Daniel: uhhuh.
Gabrielle: Um. And the ability to connect with people all over the world is certainly one of them in many ways. Mm-hmm. And yet, I would say that a challenge that I often find is to your point [00:39:00] around like building identity around diagnoses, that's spending a lot of time in an online support group where you have a lot of people that are really scared,
Daniel: very terrified.
Mm-hmm.
Gabrielle: So it's like on the one hand, yes, there's something beautiful around you are not alone in this experience. And so I understand and empathize with that. Pull toward groups like these. Yeah. But it's both building a life around the diagnosis that our goal is to make it relevant, right? Yes. We want put that diagnosis out of a job,
Daniel: right.
Gabrielle: And. Putting, spending so much time with people that are fearful. And so going back to that idea of safety, it's how can we build an identity outside of this diagnosis in a place where maybe you are around a lot of people that are not scared, right?
Daniel: Yeah, yeah, yeah.
Gabrielle: That are,
Daniel: and
Gabrielle: yeah, go on. Sorry.
Daniel: Well, well, to, to your point about it being the least [00:40:00] interesting thing about us.
Why would we want to be spending all of this time in this scary, fearful place, uh, uh, absorbing what other people are saying and telling us when it's the least interesting thing? Why would we wanna put our time towards the least interesting thing about us? We wouldn't, we wanna let go of that, not be that, that be part of our identity, even if it is something we're dealing with, we don't want it to be part of our identity.
Gabrielle: I will say that, you know, one of the most surprising things about this work is how much I spend, uh, with people figuring out what they should explore as a hobby.
Daniel: Yeah, I know. It's, uh, it's actually like a deep joy of mine when people really start to me to feel when they like, get glimpses of feeling better than we are able to explore, like.
Wait, who am I without this?
Yeah.
Daniel: Who do I get to be? What an amazing feeling.
Gabrielle: Yeah. Or, but even before to that point of like, sometimes you just have to make the magic yourself.
Daniel: For sure. Yes. Even before you start to feel better. A hundred percent. I should agree. Yeah, that's correct. Yeah.
Gabrielle: That there are so many people who are like, well, I don't know what makes me feel good.
I [00:41:00] don't know what I'm interested in. Yeah. And so sometimes we're starting with a really blank whiteboard of. You know, have you tried X, Y, and Z? Yeah. What did you like to do when you were a kid? What did you wanna do when you were a kid? Mm-hmm. But you didn't have the time or money or support to do.
Daniel: This is all coming back to you trying to convince me to do Pilates with you, isn't it?
This is, get a new hobby. It's called Pilates. Do it with me, Daniel.
Gabrielle: I'm gonna get you into a ballet class. I think you'd be great.
Daniel: Oh boy. That is, that would be you. So I'll take you bungee jumping. You can take me to a ballet class. We'll work through, over work through our fears in those spaces.
Gabrielle: Uh, the feeling of me bungee jumping.
I know what it, oh, I think I know what it will be, which will be she terror. Oh,
Daniel: same in ballet. I
Gabrielle: follow that in advance. Um, but exploring these hobbies and interest because again, when we can enter into something approximating a flow state, the brain feels really safe.
Daniel: Mm-hmm. Yep.
Gabrielle: And you know, again, going back to my love of Netflix, I [00:42:00] love tv, right?
Daniel: Yeah.
Gabrielle: And just saying if you love tv, if that makes you feel. Actually happy and laugh. I'm certainly not saying spend 24 hours in front of the tv. Right? But can you let yourself be really present and enjoy it and not be multitasking on your phone and folding laundry and doing all of the things that you can actually let your mind kind of feel safe?
Daniel: Mm-hmm. And
Gabrielle: have fun. If you can be really present for any hobby, it really doesn't matter what it's, if your hobby is folding laundry, be really present. Have a blast.
Daniel: What I'm hearing you say is that you're giving me permission to have TV be my hobby, which is great,
so that I will now, my identity will be, uh, as someone that loves TV like yours,
Gabrielle: all of my guilty pleasures are coming out
Daniel: here. Yeah, it's, oh, that's great. It's great. All right. I think we've covered, we covered all five here. Is there anything else you feel like we, we missed for this?
Gabrielle: No. [00:43:00] And the one thing that I would just wanna add is that sometimes the idea of changing behaviors can feel so scary.
Daniel: Oh, for sure.
Gabrielle: And I hope the one takeaway from this is that we can figure out creative ways to make it fun.
Daniel: Totally. Absolutely. I think that's a key part of the, of the healing process. Yeah, for sure. Thank you so much for being on the show with me today, Gabrielle. This was really fun as always, and I love your insight and your clinical judgment here.
It's really, really helpful, so hopefully the audience found it as useful as I do.
Gabrielle: Thank you. This was fun.
A quick note before we wrap up. One thing I see again and again in this work is that getting stuck doesn't mean you're doing something wrong, and it definitely doesn't mean recovery is impossible. Most of the time, it just means there's another layer of the process that needs attention. So if you recognized yourself in any of the patterns we talked about today, try to take that as useful information rather than a sign of failure.
And if you'd like to learn more about this work, you can visit the P RT [00:44:00] center@painreprocessingtherapy.com, or you can visit me and my team at the MINDBODY Therapy Center where we offer therapy and coaching for people dealing with chronic pain and other neuroplastic symptoms. You can find us at.
MINDBODY therapy center.org. One more thing before I wrap up here. Um, we're going to try something new on the podcast and honestly, I'm pretty excited about it. Many of you send emails describing your symptom journey, the diagnoses, the confusion, all the things you've tried and, and we thought it might be helpful to occasionally bring some of those stories onto the show and have our team of therapists talk it through together.
Almost like case consultation, but for the podcast, we'll choose a variety of submissions and discuss how we think about it clinically and what treatment directions might make sense for each case. Of course, we're going to keep it anonymous, and just a reminder that anything discussed on the podcast is for educational purposes and isn't a substitute for individual medical or mental health care.
So if you are open to having your story considered, email us [00:45:00] atDaniel@mindbodytherapycenter.org. That's me, daniel@mindbodytherapycenter.org, and tell us what symptoms you've been dealing with, how long it's been going on, and anything you think would help us to understand your situation. Thank you so much for listening to the Pain Reprocessing Therapy podcast.
I had so much fun on this first episode, and I can't wait to see y'all next time.