Ep 5: Pain’s in the Brain, But Not In Your Head with Tyler Orr LPC
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This is a rough transcript created with Artificial Intelligence technology. Any misspellings and sentence errors are a result of imperfect Al.
Tyler or is a licensed professional counselor out of the state of Tennessee. He's an EMDRIA approved consultant in the creator of constructed awareness. And he offers an interactive here now, approach to counseling consulting and teaching the integrates mindfulness non-violence non-duality. EMDR and body centered therapy techniques.
I'm excited to interview Tyler today as his training had a really big impact on me as a therapist. Going through constructed awareness, really demystified mind-body therapies and really helped me build confidence in being able to bring mind, body techniques to clients with chronic pain. Mindfulness and acceptance, get an awfully bad rap in the chronic pain community. And for good reason.
Historically the mental health field has made a lot of us feel like we're making our pain up or we're not trying hard enough when we can't just will it away. So I hope this conversation with Tyler will help explain some of the really important nuances that this topic often overlooks and just keep in mind that there are really small minute nuances here. It's not a clear cut and dry conversation. So listen carefully. And if you're left with any questions at the end, feel free to shoot me an email and I'm more than happy to talk with you.
Hi, Tyler. Welcome.
Thanks for talking today.
So tell me then, yeah. How, what got you started in working with chronic pain and just give us a little background about your approach to working with chronic pain and chronic illness?
Um, well, my first training I ever did when I was still in grad school was a hypnosis training and a. There was like, at the end of the last day, it was a two day training.
Like the very end. There's like this 20 minute module on treating chronic pain with hypnotherapy. And you know, at this point, I can't tell you anything that they taught about how to work with chronic pain. I just, the takeaway for me was like, wow, I, is this something I could actually work with? Cause I thought, for sure, like, this is what doctor.
Worked with other PTs massage therapist, people like that, but not a mental health practitioner. Um, so that really stuck with me. And I was excited about that idea because of like personal experiences with chronic pain. Um, my grandmother had rheumatoid arthritis and passed away as a result of complications with that.
And, um, my wife and myself both have chronic pain. Well, we had, oh, I don't think I could say that I have it anymore. I have occasional pain, but nothing in a chronic way. Um, so that was really exciting. And I kind of held onto that. I didn't work with pain for a long time until I met a guy named Dr. Matt McClanahan and Chattanooga.
He's a Dio physician who works almost exclusively with, with pain, his, his private practices, exclusively pain. And. He just comes at it from such a unique way. It's not like the pain is a tissue problem. He was coming at it more like it could have more of an emotional root. And he taught a lot about pain science and met a, another guy named Jason, Jason, Terry.
And he's a PT in Chattanooga. He works the same way. So we got together and, um, well, first of all, uh, Matt just started sending me clients, um, because I was interested in, I didn't know much about it at the time, but it was at least interested in and he really liked to refer patients out to therapists. And so I started working with pain a lot more, just kind of overnight.
Cause I was like pretty much straight out of school. Didn't have any clients at the time. He kind of filled me up fast. So, uh, him a lot on a lot of different levels. Um, but as that was happening, I'm working with a lot. Patients, we just started to talk more and I started to learn more about pain. Uh, met Jason, the PT.
We started going around teaching workshops, um, along with a meditation teacher that we knew, we called it pain matters. And, um, we went to kinda went around different places, teaching that mostly in Chattanooga, but a few places outside that. And then me, Matt and Jason started a business for awhile that has dissolved since, since, but it's, uh, it was called insight pain Institute.
And our goal was to teach workshops and to develop educational material for larger groups practices. And, um, yeah, we went around and taught, uh, workshops with that. And so by the time all of that, I, as I'm hanging out with them and we're teaching together, I just kept learning things and things begin to click.
Like it took me some time, you know, the whole idea that the pain comes from the brain and not the body, which I'm sure we'll talk about. That, that didn't click for me for probably a year into teaching with these guys. And so I always kind of kept that in mind, this can be hard for clients to get as a concept because I was teaching it for almost a year before it really kind of made sense to me.
So, um, that helped me be patient working with people. So, yeah. And then I got to the point where I was just, you know, for a year or two that's, all I worked with was chronic pain. Yeah. And then eventually started teaching the NBR trainings on chronic pain. And, um, but then about last year, December, about a year and a half ago, I stopped teaching EMDR to work with constructed awareness.
And so I haven't taught that pain training since.
Um, well, I got lucky and getting one of your last trainings then, um, in 2020, that was a really pivotal, I don't remember exactly what you called it. I remember emailing you, like, I'm not an EMDR therapist, but, you know, can I take this training? And you're like, yeah, everything's still applies.
And, and it, it really did. And it does. And I can relate to when you're saying, um, you're teaching it, but not really understanding it hadn't clicked yet, like where pain comes from and how it's not all in your head, but at the same time it is coming from your brain. Can you speak a little more to that? Um, how do you, how do you help clients understand that?
Well, I remember I was, I wrote a blog for my website on pain and I sent it to Matt to proofread and he was like, I said, something about pain in the body. And he was like, he wrote back, you know, that that's not right. Right. And I was like, oh my God. Like, it just like the planets and the stars aligned at that moment.
It's like, okay, I get it now. It makes sense. And, um, I guess, uh, can I just talk kind of the way that they taught me? Sure. Um, and this is sort of how I talked to clients. So. If you go to the doctor with a runny nose, the doc, like I say, the doctor knows that like, that's a symptom of something deeper that's going on in your system.
They're not going to say that the problem is your nose, right? They're not going to say, you know, that you need no surgery. We need to fuse your sinuses or whatever. You know, they do vertebrae. They know that that's just a symptom and they, and like any doctor that's worth their weight with would know that.
But when it comes to like chronic pain, the medical profession, and I think really our society in general looks at it completely different. It's like, if your back hurts, that means there's something wrong with your back. And they don't go any deeper to exploring what that could be and what I've learned and what research has show and that the thing that's at the root of it, the.
The thing that's causing the symptom of pain. A lot of times it is an emotional component. It's an early attachment disruption. A lot of times is what I find that it is. So, um, in our line of work, that's what we work with. So that's th if that's true, if that's the case, then that's great because that then puts chronic pain into the scope of our practice.
Um, it all goes back to the guy, Rene Descartes, he's the guy that, the philosopher that said, I think, therefore I am. Yeah. So he was a philosopher and he's also a scientist. And, um, he had a lot of talents, but this back in his day, it was like the first time that in history that it was, uh, legal, I guess you could say to dissect cadavers, you know, before that the church wouldn't allow it.
Um, it was immoral or sin or illegal or whatever, but he and his colleagues were some of the first people to like, Like openly dissect cadavers for scientific purposes. And they found these white strands that ran through the body. We'd call them nerves, but he referred to them back then as pain tubes. And there's this kind of famous, it's famously some paint world.
It's not famous most people, but there's this little cartoon illustration that you drew of this naked man. I'm not sure why it had to be naked, but his, and he's his foot is in the fire. Um, there's like a little fire pit is puts in there. And the idea this is from this was the Cartesian model of pain. The idea is that the guy's foot is being damaged by the fire pain happens in the foot as a result of it.
And then the pain signal shoots up the pain tube and goes to the brain where the person recognizes that there's pain in the foot. So then they can move their foot up. It's totally sounds right. This is how we think about pain, but it's actually totally wrong based off what we're learning from current neuroscience and, and I'll warn you, Matt and Jason, the guys I presented with they're the neuroscientists.
I'm not. So as, as you know, I'll talk about the brain and that's about as deep as I get with neuroscience. So, so forgive me. Um, let me say, I've been to dozens of trainings where they teach what the amygdala does. And I still don't know, so I don't get into it, but what we know what what's right about, um, how pain happens is, okay.
The same example, the guy's splits being burned in the fire. There's there's, there is nothing in the tissue of the foot that can create pain. There's only receptors that detect what's happening inside of the foot and on the outside of the foot. And so when the tissue there is being damaged, There's no pain that happens in the foot.
There's only receptors that. And so those receptors detect, okay. Yeah, there is potential damage happening in the foot. So those receptors send a signal, not a pain signal, cause there's no pain yet in the process, but it's like an alarm signal and it's like an alarm that says, Hey, there's potential damage here.
So that goes up the nerve to the brain, the brain processes, that information and determined. Yes. Damage is being done and special attention needs to occur. Um, the brain doesn't send pain down to the foot. There is no downflow to pain. There's like, uh, a motor signal that goes down that motivates the guy to move his foot.
But there's no downflow to pay. Uh, in this whole process we're talking about, there actually is never pain that happens in the foot. What actually happens is the person's brain projects, the experience of pain into his consciousness, productive, projected into his awareness, that's associated with his foot.
But this is, this is how something like Phantom limb pain can happen. So imagine that guy's foot burned off or they had to amputate it because of the damage and, you know, but he feels pain where his foot used to be. Well, there's no tissue there at all, like right away that rules out that pain's coming from the tissue of the body because there's no tissue there for her to hurt.
Um, what's happening is the person's experience experiencing, and his consciousness that was associated with this.
It's it's fascinating. And I think even when you explain it in very clear and easy terms to logically understand our emotions still get wrapped up. A lot of us have heard, you know, it's all in your head, you're making it up, um, that that all starts to, to come up.
But what I'm really hearing is like the work that you do that we do in the therapy room is not about helping someone say this doesn't hurt. It's can you maybe even speak to, you could talk about constructed awareness and, and that's your, your approach to therapy and how the different parts of that process help the receptors themselves, not turn your body on fire.
Um, you know, when you, when you start to have an experience that that typically causes you pain,
Yeah. Well, you said like it's all on your head was on your brain. So technically your brain, you know, most of it, I guess, is in the head. So, um, in that sense, yeah. But like, you know what their meaning is, you're making it up.
Like it's not real pain, there's no such thing as real or unreal pain. It's just pain. Pain is completely a subjective experience. You know? Like we don't have any way to measure pain scientifically, other than a subjective scale of like, what's your pain, zero to 10,
which is totally irrelevant because what's one, person's 10 to
another that's right.
You know, even like imaging, like MRIs and x-rays and stuff like that, you can measure like tissue pathology and inflammation, but that's not measuring pain. Right. Because you can experience tissue damage and have no pain. And you can have no tissue damage and have pain. So that's a big part of working with clients because they'll say, but I've got my x-rays, I've got my MRIs and it shows this voltage disc or whatever, you know?
Um, so that's another area where people kind of, if you can help people to separate the idea that like, um, if the imaging shows pain, it doesn't show pain, it just shows tissue. And, um, that's not where the pain is happening. The pain is not happening in the tissue it's happening in the brain. Right. So there's no guarantee that like that is actually what's causing the pain.
Does that make sense? Does
it makes perfect sense. So where do you go next? What do you do? How do you help clients move from, from that place of, I still don't understand why, like. Okay. So how do, how do I change my brain then? How do I change my thoughts? How do I change my experience? How do I, how do I work in that way?
Where do you go next?
Good question.
I guess the next move, cause I don't have to get complete buy-in for, you know, looking at pain this way. I don't think it's required because like at least a logical buy-in because the part of the system that's creating the pain, isn't the logical part, but it sure is useful to get a little bit of buy in at least from clients.
So, but again, I'm not going to twist their arm to believe it like me on one thing, like a side note is usually I'm not the first person to call when somebody has pain. Right. You know, you know, nobody's going to sprain their ankle and say, I want to call my counselor. Um, they'll call me after. The, you know, the ankles healed and it's been two years and it's still hurting and they've tried everything that's medical or holistic, holistic.
And so usually by the time they get to me, there's enough of a desperateness that allows them to be a little bit open. I hate to say it that way, but I think that's just true. You know, there's enough. There's like this desperation where they're willing to try an idea like this, or to explore this, at least it opens up a whole new avenue to treatment that they haven't experienced before.
And the cool thing about working like this as, I mean, I've had clients who spend time at the Mayo clinic, Vanderbilt, these big hospitals and no success. And then they come in this little private practice office and after few months they feel better. Um, and that's because we're actually getting to the source of it rather than just treating the symptoms or being like really tunnel vision focused on.
It must be something wrong with the tissue. Yeah.
I think I'm hearing several different aspects that could be probably all work in tandem together, but even just being curious and open, you know, up until that point, it's let me go to a doctor who's going to fix me. And you're kind of giving all of your power to some kind of external source and saying like, can you fix me?
And while they may be coming to you with that to you, your job is under kind of put that back on them and say, well, actually you, you have the power inside of you. There just hasn't been anybody to support you in figuring that out. Right. It sounds
like that's what you do.
Yeah, totally.
And just kind of help them learn to be with their experience in a new way. And like how to, because like what I would with somebody with chronic pain, what, what, um, typically. Like, you know, the treatment plan, I guess you could say, would be to, to find out, okay, well, if there is isn't these, you know, we mentioned before earlier experiences that could be fueling this present experience of pain.
We want to be able to process those, but I want to spend some time like getting them ready, do that. And that's like, that's where constructed awareness kicks in. And I don't know if you know this, but there's a level two for CA now, which is, um, processing memories. So there's two phases of treatment.
There's one is more the resourcing, like helping the client bring a deeper awareness to their experience, to connect with themselves in new ways. And then the second phase of treatment is the processing part. We call it reconstructing of those memories. And so, yeah, it's like, um, I'll explain to clients a lot if imagining your nervous, system's like a bucket it's almost full of water.
It doesn't take much extra water for the overflow. And when that overflows. The water that overflows is like, that's the symptoms. And that can be things like anxiety, panic attacks, depression, stuff that counselors usually work with, but it can also be like these chronic health and chronic pain disorders.
And if we're a therapist who's listening to this and is interested in working with pain, if you could separate, if you could break that idea that those are two things that there's mental health problems and physical problems, they're all just symptoms that are the result of a nervous system. That's overwhelmed and can't handle it.
And so a lot of therapists just spend their time like cleaning up, like mopping up the water and thinking that that's the best that we can do, but I'm more interested in like what's in the bucket and the buckets full of past experiences and like daily life stressors. Like you can use your normal way of doing things to, to approach the life stressors.
But it's really useful to have some sort of process oriented approach, like EMDR, like somatic experiencing or constructed awareness to empty the bucket so that their system can handle more without the symptoms occurring.
Yeah. I mean, it makes perfect sense. Um, I can see how it still is just something so hard to wrap your head around because it's just complete it's, it's so different than anything we've been trained in as therapists, as doctors like the mental or the physical, which they are.
They're just one thing. But even as we talk about it, we still have to separate it because that's how our system works. It's like go to a physical health doctor or you go to a mental health professional. And so, yeah, we're just, we're trying to, to blend the two. Um, and it's
hard.
They're all just symptoms.
And a lot of times, like, I, I of first realized this because I would work with like, say somebody came in with. Anger issues or panic attacks or something, but they also had neck pain. And so we would work on the anxiety or whatever it is that we're working on. And all of a sudden their neck pain would get better too.
And so that's, what's led me to theorize that, like what if in that, you know, in those cases, what if both of the symptoms were coming from the same source? Yes. What, what if the physical isn't any different than the emotional problem? Yeah. So I think that's the big thing. Yeah. I'll just let that go. And, and you can work with chronic pain.
Yep. Yeah. Cause I, and I think that answers the question to kind of like, what do you say to a therapist? He was like, well, that's, that's out of my scope of practice. I can't touch that. And it's like, you're not, you're not telling them you're, you're going to cure their neck pain. But in working with what we do work with attachment and unprompted process memories and trauma, those things do start to resolve.
Yes, because they're all, it's just like, if you, if you treat, uh, a virus, multiple symptoms can alleviate, right. So once you treat the thing, that's at the source, all the symptoms can change.
Yeah. That's I think about that with inflammation and people who have like several different diagnoses, um, especially stuff like pots, um, that usually goes hand in hand with like Lyme disease.
And, um, and so I'll have clients who have like several different diagnoses. And to me it's all the same. It's all one, like you're, it's one dysfunction in the body and these are all just different symptoms that are, that are coming up.
Yeah. I, I view that as a good sign. Actually, say more about that
when someone comes in with multiple symptoms like that, that's usually just like an indicator that it is a sensitization issue. That the nervous system is it's too sensitized. It's overwhelmed because of what's in the bucket. Um, so for me, that's just
tilt them work. We
can do there. Yeah. I would rather, uh, that'd be the case personally, that if somebody just comes in with like one diagnosis or one symptom, cause that might point it more toward, it's like a tissue issue, you know, whenever you get like four or five different diagnoses and it's, it's because the doctors can't make sense of it and they can't make sense of it because it's not a physical problem.
They're just throwing labels at the person trying to make sense of it when really it's just, it's just multiple symptoms springing off the same thing.
Yeah. And do you find in your work that you're, you're working more with lots of developmental, repetitive traumas or are you looking at like one type of shock trauma?
Um, usually the first option, it's more attachment attachment issues. Think about it. Like two people can have the same accident, same injury, and they heal different. How come or even research shows that early life experiences, adverse life experiences can imp it can definitely affect how we heal. Um, they've done studies where they measure adverse childhood experiences for people.
Who've had surgeries to see if there was a connection between successful and unsuccessful surgeries. And it showed like, do you had, I think two or more? I can't remember the exact numbers, but like two or more adverse childhood experience, um, that it drastically, I mean, like over 50% drops your success rate for surgery.
That's fascinating. Right. And so, yeah, I think. I put my money on the early attachment experiences when it comes to chronic pain.
Yeah. I'm with you there when you, um, so in level one of constructed awareness, how are you setting up the therapists who are getting trained by you? How are you setting them up to help them then help their clients?
Okay. Um, can I talk a little bit about CA yeah, absolutely. Like the easiest way to set it up that I found is just to talk about the three principles of it.
So the first one is if you bring awareness to something, it changes. You know, the easy thing to is to point out, it's like, you're going to behave completely different when you're home alone than you would, if you're in front of me or someone else. And that's because you're being observed and like little kids behave differently when they're being watched versus when they're not.
And I think our internal experiences the same way without awareness without you watching it, um, your nervous system is just going to respond habitually like on autopilot. Right? And so that's why we find, I believe ourselves doing the same things and the same experiences over and over and over again, because it's a lack of awareness of what's actually happening.
And there's just countless examples that we see in reality. We just don't pay attention to it, of how awareness brings change. Um, and you know, we're, so we're taught growing up that if you work hard, you can get with. Yep. And that's like the American way. And a lot of our popular therapies in our field are focused on that.
They like willpower to overcome emotion. That's the way I see like CBT and therapies like that, you know, where you come up with a plan.
That's probably why, so many of us still think when we hear even this conversation, it's like, you're telling me to just like, will the pain away.
Yeah. But that's like the medical model that we work in.
It's like, we're supposed to create these treatment plans and we're supposed to do these things and everything's supposed to be moving toward change. And, um, but there's some things that just don't work for that. I think it's most things don't work for that. But a good example is like trying to force yourself to fall asleep.
Have you ever been able to fall asleep through willpower? Like nobody ever has? You know, what happens when you try to force yourself to fall asleep? Cause you're fighting with sleep and I think that's what happens emotionally for people. It's like you're, if you're trying to fight the pain and you're trying to, you're trying to force it away now, you're just in a battle with it.
You know, we can look at it that way. And um, so in CA we don't really do any of that. You know, the goal is to actually create the least amount of resistance with a client as possible. And so instead of trying to like overpower the symptom where there's pain or whatever it is, um, we're, we're not looking to change the client's experience.
We're looking to bring a deeper awareness to their experience and allow the awareness itself to transform love. Let the awareness itself, bring about the change that the individual's looking for. Um, you know, and people say, well, you know, you're all on your head or you're doing this to yourself. Why in the world would they?
Yeah. You know, and like, um, our emotions they're there, they're dictated by the autonomic branch of our nervous system. And so is pain by the way. Um, it's the automatic auto, the autonomous part of our nervous system. It's involuntary. And I'll tell clients this all the time, you know, I'll speak for myself.
If I was actually in control of what I thought and felt, I would only think and feel great things. I would never feel bad again. Like I would be blissed out and euphoria every second of my life. I never have neck pain again. Right. I would only think of positive, original thoughts, and, but that's not my experience.
So part of what we talk about in CA it's new, we actually have the control over our experience that we think we do. Um, I think our internal world and our external world are just mirror images of each other. Things happen outside of us that are spontaneous and unpredictable. I think internally it's exactly the same way our parents have taught us that we can't control it.
They said things growing up, like, don't be upset, don't worry, don't cry. And it gives us this impression that we can control what we feel and think. So then when we try it. Especially, if we go to a therapist, that's like, let's come up with a plan to overcome this and it doesn't work. Right. Then you get double whammied with these thoughts, like along the speed week, I must be worthless.
Why can't I control this? Mom said I could. Yeah. Right. And so I always tell people if telling clients what they should think or feel worked, we wouldn't have clients because their friends and families would have solved all their problems for them. So in CA we don't put any effort into you. I'll tell clients, like I'll make a deal with you.
I'll never tell you what to think or feel all right, because I'm more interested in what are you thinking and feeling and bringing awareness to it on a deeper level and letting that change. So what are we changing or what do we bring in awareness to, um, CA the way we view it is that your entire conscious human experience is made of three things.
There's thoughts that come to mind, sensations you feel in your body and external senses that these are the three building blocks of reality. And, um, I don't know if you've chewed on that since our, you know, the training you did, but yeah. I've never experienced anything that, wasn't one of those three things, for sure.
It's wild to think we can boil it all down to that. Um, so the third principle is that everyone's naturally more oriented to one of those three building blocks. So some people are more mentally oriented, like I'm mentally oriented. I live in my head, uh, regulate myself through thought, not connect with other people through thought I'm just driven by my mind.
What were you, what was your
orientation? Um, yeah, same, same thing. Yeah. It's interesting as you like, because I brought so much awareness to my body and sensations and things of that nature, uh, I would just get it started to get confused. Like maybe I am more instant sensation oriented, but now when I'm in stress, mental mode all the way.
Right? Yeah. So maybe second place for you sensation. Right. I think so. Yeah. I mean that you're more cut off from your external, but we'll come, we'll come back to that. Uh, we use you as a case example then, um, the other people like my wife she's sensation oriented. So she's all about her body. Like she's inner feeling.
She expresses herself in a much different way than me. Like she'll emote, you know, she's upset. Her body will move. It might even like shake. There's big emotional expressions where I'm ups when I'm upset. I'm all up in my mind because you're not getting much of a read from me physically. It's the opposite for her lot.
Going on, physically for her, she connects with her body. She likes to be like close, like, you know, to touch and things like that. Um, some people are externally oriented, so they live outside of themselves. They're, they're focused more on. Reading the environment to figure out how they need to adapt themselves to meet the needs of the environment, or they're reading the environment to see who's who they need to take care of.
Right. So their focus is much more outward. It sounds like you destiny, your, your focus is way more internal mind, body,
even as you're explaining it again, I'm remembering how I struggled. I struggled to, to type myself before too, because so like when I'm stressed one, I'm all in my head and I want to like talk it out and I want to talk with somebody, but I also I'll start cleaning and I need my environment to be very, like, I'm very focused on what it looks like around me.
Um, so I think I might actually gravitate a little bit more towards that
external.
Yeah, that's a good segue. So what did the constructed awareness we've got the three primary orientations mind, body external. So each time. Grades orientation has two different types associated with it. So there's a, there's one type that's more like hyper, like, so like motivated, driven, forward, moving bigger energy.
And then there's more like a hypo around. So it's like more of a stabilized, sometimes stuck, um, slower moving energy. Cause not everyone operates the same in the world. So if you've got the three primary orientations and then two types for each one that creates six orientation times. So now I think I thought I remembered you as an M E.
And then, so, um, MES, so the is for mental ease for external SS for sensation, and we put them together in order of the amount of time that you spend in that orientation. So for us, we spend most of our times in our mind, second place, our environment, least in our bodies. So M E S so that type is called achieving.
So it's like really driven, mentally motivated. Um, then we, we could flip the S and the east. So then the hypo version for that is M S E. And we call that the thinking. So this is like the deep thinkers of the world. These people think just as hard as you and I destiny, but the problem is like they have a harder time, like, cause their ease and last place, they have a harder time, like manifesting those ideas.
And so it's harder for them to follow through. So they, what they end up doing is they ended up just thinking really, really deeply, right? This is my son's type, by the way, he's got a garage full of unfinished product projects. He has more ideas than he can keep up with them. They're all brilliant, but he struggles to finish them.
Um, and then the external types we, that the hyper version is, um, EMS that's adapting. So these individuals, they read their environment to adapt themselves, or they adapt the environment to meet their own needs. So they're always sort of like manipulating youth themselves or the things around them to regulate themselves.
It's almost like a D environment. Okay. I'm okay. And then the other external type is M E S M giving. And so these individuals, they're reading their environment to see who they need to take care of. Yeah. All right. So there's a kind of a slower movement to them. Uh, this was my grandmother with rheumatoid.
This is a really common type with chronic pain, by the way. Um, there are certain personality traits that are common for people with chronic pain. And a lot of those you find in that giving time, because these are the people that put their own needs aside to help others. This is my grandmother through and through.
Um, also
constantly neglecting your own body, your own needs. Others are coming first. So of course your body's screaming out to you. Yeah.
Um, and then we have the sensation time. So the first is, um, the hyper is what we'd call feelings. So this is the deep feelers of the world. A lot of times you hear people that are highly sensitive, this fit.
I think people of other types can be highly sensitive persons, but this is common, really common for this type. It's like, they just feel so much. And a lot of times that can be kind of overwhelming and hard to manage. And then the last one S E M, which is trusting. So, um, this is a real similar type to giving, but with this one, there's more like innocence kind of gullibility.
They just trust and go along cause their minds, least SCM. So they really struggle to, um, use their own mind to bring meaning and rationale to what they're experiencing. So they tend to just reach out a lot to people and ask, what do you think, what should I do? These are the people that read books and listen to podcasts and like just, they take in all this information to try to make sense.
Oh, their internal experience.
Yeah. And I would imagine just like other type ologies like the Enneagram or their personality things. Um, you're you have several different ones inside of you. You can put in different, different traits of different, um, pieces are all inside of you. So if you hear yourself in multiple of these, that that's normal, it's just, you know, when you actually get assessed by someone trained through a constructed awareness, you'd have a better understanding of like, this is my main type.
Right? Yeah. And like you said, you got, you felt like you kind of connect to all of them and that's fine. And that's normal. It's actually a problem when someone's too fixed. And one orientation style, you know, I would say like, cause we talk about when someone's Intune or dissonant, which is a different way of saying healthy and unhealthy, but it's like you and you're in tune, all three building blocks are equal or closer to equal.
So the person can like, um, Connect with the different parts of themselves, the full experience of themselves, of all three parts and, um, use them in ways that are like appropriate. You know, it's not always appropriate to use my mind to solve a problem. Right. Sometimes it's better to use the environment.
And so if I don't have the ability to connect with the environment, I'm going to be really limited. And that's example of like a dissonant state where you're just relying on just one or the other style of this. And it would be fragmented where there's no sense of center where you're just bouncing from one bill and block to the next kind of with no sense of control over it.
Does that make sense? Yeah,
it does. Yeah. Um, and so, okay. So you had mentioned, um, there's three, like philosophies as well and, and, and constructed awareness. The first one was awareness changes, um, awareness alone changes. What did you say the second.
Yeah, it was the, um, the three building blocks that the whole experience has made of those three things.
Okay.
And then number three, the philosophy would
be, everyone's naturally more oriented to one of the three building blocks. . And this is the reason that this is useful is because it, you know, the, the first phase of treatment for CA is, um, like resourcing. So this, if you understand their orientation, then that helps you understand, like what kind of resources could be useful for them.
So like I'm mentally oriented and I did therapy for years, but it was like cognitive therapy and it was helpful, but it wasn't really, you know what I mean? I didn't like learning much new stuff. It just, because it just bolstered up that part of me that I was really good at already. It wasn't until I got into the somatic therapies and like mindfulness approaches that focused on like external awareness that that's when the big shifts started happening.
In my life, but that's whenever, you know, I felt like I was starting to tune up, I guess, depend to be in tune. I was able to operate from a broader perspective rather than just one narrow way of doing things. And I first saw this when I was doing EMDR and I waved my fingers and I say, what are you noticing now?
And some people would just answer with all thoughts and like, they're trying to figure it out. And they're trying to like rationalize the way they're paying. Or sometimes I weigh my fingers and I say what he knows now. And then they would say like, you know, where they would just have these big emotional expressions and they, they would shake and cry and not say much they couldn't access words very well.
Um, and sometimes I would, you know, do a set of bilateral stimulation and say, what are you noticing now? And I could tell that they were like, worried about me. They would like, they were editing themselves to make sure that I was comfortable. Right. They don't want to be too much, you know, or they're like, you know what?
He knows. He, now that sound machine in the hallway is just too loud. I can't con you know, so they're outside of themselves and that's when I started to see, wow, this person is, is trying to fix it all or trying to do it all from this one narrow perspective, what would happen if I started to focus on resources that brought up the other two to a more equal level.
And then when we did that and we got back into processing, I could say, what are you noticing now? And they could connect to their full experience rather than just that one part,
getting yourself out of autopilot, bringing intention into, even into how you're processing, you know, in therapy.
Yeah. And so you can build these resources around.
Okay. What are they what's most developed, what's less developed and then just focus more on what's less developed. Um, and we do something in CA call it tuning and it's. So you basically got the three building blocks. So we practice moving from one point of awareness to another point of awareness. So if the person's noticing a thought, we would connect with the thought there's ways that we learned in the training, how to really go deep into like, understanding what a thought is and how to connect with it in a really like practical almost, almost like bottom up sort of way so that they will connect with a thought for awhile and then, excuse me, and then invite them to shift their awareness to like their body.
How's your body responding to that. And then we connect with the sensations, um, describe it, accurate nonjudgmental non-violent sort of ways. And then they, we might go with. And notice something in the room, connect with that for awhile. And then we might go back into the body or back into the mind and just kind of do that over and over.
Cause we're what we're doing is we're showing the client how the mind, the body and their external environment, all come together. There's this dance, there's this thing, this way that they influence each other. And they all come together in such a way that creates this experience that you would call it now.
And all of that is yeah. And all of that is training the client to have a much broader perspective of themselves and they're improving their ability to be aware of themselves. And that goes back to the first principle cause that awareness itself starts to change. And what I see in the work is, you know, once a client connects on a deeper level, they just know what to do.
I don't have to come up with a plan as a therapist to say, this is what we're going to do. They just start knowing. Yeah.
Yeah. That's something that I really liked about constructed awareness is, um, it there's, it's such a beautiful blend of structure and open-endedness so that you're giving the client complete autonomy to lead and do whatever it is they need to do in the session, but you're guiding them.
So they don't just come in kind of feeling like they're floundering. That was my own experience within even somatic experiencing which I am. Um, I am getting trained in, um, and I, and I like it a lot. It's nothing against the, the approach at all, but even within my own somatic therapy, it just felt like I was floundering.
And what I felt like I was paying my therapist to do was like, help me, not flounder. You don't have to tell me what to do. You don't have to tell me like how to, you know, how to just feel good that that's not what I'm looking for, but I want to process these things. And I want to, I want to do the hard work.
I just, I need the teacher here to kind of guide me. And that's what I found in constructed
awareness. Awesome. I did a year of, of SC training and I felt like there was no structure. It felt that way. To me almost, there were lots of times I'm like, am I even doing se you know, but then, you know, my big background is in EMDR with.
A really intense structure, at least for phases three through eight or three through three through eight. Um, but you know, I was teaching EMDR trainings and, um, I got, I remember the first training I ever taught at the end of day six during the Q and a time somebody raised their hand and said, what's a resource.
And I was like, oh crap, you know, a mist of messed up here. Um, but after that, every training, no matter how hard I tried, there was so much confusion around phases one and two, which is the history taking and resourcing. So actually CA was originally intended to be like an adjunct approach for EMDR as a way to put structure around phases one and two, because you've got all this structure and phase of three through eight and then no structure for phases one and two.
So that's what it was originally. But as it developed, it just grew into something that wasn't EMDR. I couldn't even. I couldn't even meet the definition of EMDR anymore. So I decided to go ahead and just let it be its own thing. But, but yeah, I'm saying that to say that wasn't the intention, that is the intention.
Like how do we put structure around resourcing and history taking, but in such a way that it leaves a lot of freedom and wiggle room for the therapist to use their intuition and their gifts inside of that. So it works really well with EMDR. Anybody here does EMDR and you feel like, yeah, I don't really know how to do phases one and two really well come see me.
Cause it works great for
that. Or even somatic experiencing because yes, I mean, we started talking about resourcing on day one and it's still something that sometimes I catch myself getting caught up in the vagueness of it. And I actually, I have to go back to my constructed awareness training to help me kind of bring that piece back.
Cool. That's great.
And what about level two? What does that entail?
That is, um, processing memories. That's what the whole level twos now. So both level one, level two, they're both four days 30 hours training. Um, so level, level two, we use that tuning technique that I mentioned before. We're going from mind body to external mind, body to external as a way to kind of titrate the experience.
So we're working with a memory. The problem I have with the EMDR is a lot of times it felt like you were just sort of like kicking the client into the deep end. You know, it's almost like you wanted to keep them as activated as possible to move through it. A lot of the research that I've done since I've stopped teaching is there's plenty of evidence that shows there's a big benefit to more like a graded approach.
That's what SC does, you know, the, the titration. Um, and so we use the tuning as a way. To kind of slow down the, to keep it keeps the client and sort of a Goldilocks zone of activation where it's not too much or too little, they're not overwhelmed or underwhelmed because we're never staying in one place for too long.
Like a lot of clients like with EMDR, I found, what are you noticing now? It's too big of a question. Yes. It's overwhelming. Same with
se it's
too bad. Yeah. Yeah. So what we do is we will say, what do you notice that, that thought, what he noticed about that thought? Tell me the colors you see, how far away is it?
Do you see shapes you shift? Like we just play around a lot of different ways to connect with a thought and then we'd move to, so when you notice that thought, how's your body responding? Where do you feel that sensation? What's its temperature. What's the shape. What's his weight. And we might go back to the thought or we might go external.
We use a lot of like random objects. And level two, just on like toys and rocks and stuff like that to help connect. Um, and that helps to enhance that dual awareness, you know, the ability to be here now while you're recalling the memory. So we don't want them reliving it. We don't want them to go too deep.
We want to keep them as present as possible. That's actually what they found that all trauma therapies that are effective have in common it's that, that dual awareness, um, that's why actually in EMDR, they don't call it BLS anymore. It's no longer bilateral stimulation. It's DAS dual attention stimuli, even in Shapiro's book, the big book, um, the last edition before she passed, there's one sentence in there that says that, that they're finding that the bilateral, the eye movements may actually have nothing to do with what's effective.
The it's all about the dual awareness and the eye movements. Just help the person stay present.
There's similar research in, within the act framework. There was a, I cannot remember now where, where I read it, but they were looking at CBT versus act. And that even when CBT works, it's typically as a result of that client gained a level of true inner awareness, which could have happened through the, um, the relationship with the therapist or just the, the client, you know, we can come to awareness on our, on our own.
We don't, we don't always need a therapist. Um, we just, so, yeah, that was really interesting too. It's, it's the awareness piece that makes all of these therapies work and the way that I, um, conceptualize that piece is like, when we're in a room with safe people or we're in a safe environment, we can then be more aware if you feel unsafe, where you feel like you have to be on guard, then.
You're not able to bring this, this level of awareness that's needed in order to start to,
you're going to retreat to the one domain, the one building block that you're really comfortable in. You know, it's, if I'm uncomfortable, I'm going to go into my mind and I'm not going to connect with my environment, my body very well, but if I'm safe, I'll be able to, right.
So we're basically in CA in level one, we're training clients to be able to do the processing from level two effectively. And a big part of it is like bringing in the attachment piece in level two. Um, we teach a technique called the attachment bridge, which is sort of a spinoff of the affect bridge. Um, and so, and you know, and Shapiro, she, she took that that's been a around, that was around before.
Um, I think she called it the, what is it? The affect scan is that right? And I'm thinking about that, the float back technique, um, it's a similar thing as that, but instead of like, a lot of times with that they'll float, they'll connect with a sensation and float back from there to their memory the previous time that he felt that way, um, what the attachment bridge does is, and we can tie this in with pain here.
So, well, you could say like, so imagine you're with a client. I have like excruciating back pain and that's what you're working on. So you could, when you're looking to find the memories to work with, you could ask, you know, so when you're experiencing that pain, what do you want that you're not able to get?
And a lot of times I started to realize, like, learn more about the attachment piece with this, because with chronic pain people, I usually get like a behavior action as a response. They say like, well, I can't get in the floor and play with my grandkids. So then I'll say, so when you can't get in the floor and play with your grandkids, what do you really want?
Like a deep, emotional level from the people you care about. And that's when I started to hear responses, like, you know, I just want to feel like I'm good enough or something like that. So, and so that's way different because like, when you're finding targets, you're looking for memories with pain, it's easy to like, just focus on like when they had their accident or their surgery or something like that.
Um, you know, I had, I had chronic neck pain that started when I was about 20. Um, before that there was nothing, there are no memories to work with for pain, but if I did the same thing and I said, you know, when you experienced that night pain, what do you want? And I say something like, I just want to feel like I matter
like, that's what comes up. That's what's at the root. And I can trace that back to before I could remember experiences like that. So we're looking for an attachment longing. It's not being met, I'm looking for a lack of safety, um, connection, support, or personal power. And that's, that's the way that we would approach it.
So instead of looking for memories of times, you were in pain, we look for memories at times in your life that you wanted that attachment and you weren't able to get it. And then we float back from there. So we have the clients say that statement in CA we call it actual affirmation. So I would, if I was the client, I would say, you know, like I want to belong or I want to feel like I matter, or I want to feel safe or whatever it is, I want to be myself.
And then I'm ask the casual body, respond to that. What sensations do you notice? And then connect with the sensations for a bit, and then float back from. Yep.
And if you don't have that, even just that initial ability to stay in awareness, you miss all of that. Like have your therapist can be doing such great work and bringing you back to even positive memories to help you again, resource and stay present and grounded.
But if you don't know how to hold that awareness, you don't have those skills, then you lose it, you lose
it. Yeah. Yeah. And so like in that, what we just talked about, we're actually doing the mind and the body we're asking the mind, you know, with words, what do you want, or you're not getting what's that actual affirmation.
Then we ask the body how it was responding. And then we use, we go from there to find the, the visual memories of those past experiences. And then once we get one, then we can start processing it with the constructed awareness way of doing it or. EMDR or se or hypnosis or whatever somebody does. Yeah. Yeah.
Yeah. I think going back to kind of just the awareness piece and how awareness is really the thing that creates this change. There's so many ways a client can get the results they're looking for from some, you know, again, you CBT might, it might work for you. If you find a therapist who is really attuned to you and really connected.
And that that's how all of these, I think work. Um, but I do think that there are some modalities and, and again, the constructed awareness for me was that, that bridge, like it added that piece of, I might be attuned to you in the sense that I, I understand the pain you're feeling I even might know, like from what you've told me, some of your attachment experiences, but how do I help you now connect those two pieces so that you can walk away from here feeling.
Whole and not fragmented. And there's just going to be different, different trainings are going to resonate better or differently with different therapists. Um, it goes back to your
style. Yeah. And I saw in our field, you know, there's almost like, and, um, retaliation, if that's the right word, but like, you know, CBT was such a big thing for so long.
Obviously it works. It wouldn't be, it wouldn't be what it is. And, but in response to that, the somatic therapies were created and it's like, they threw the mind out. Yeah. That was a big problem that I had when I was doing SC training. It's like, well, what about the mind? You know, as a mentally oriented person, maybe I was feeling a little, a little hurt, hurt by that.
You know, it's like, I just felt like there's this big part of the experience it's being cut off from. It's like we threw the baby out with the bath water, you know, CA. And attempt to pull it all together, but we're not working with thoughts in a CBT kind of way. It's almost like we took like sematic approaches to the body and applied those to the mind.
So it's a very, it's very much like bottom up. Like you're looking at your thoughts, you're hearing your thoughts, right? Just like you would, if you were looking at or hearing things that are happening externally.
Yeah. Makes sense. I think this feels like a great stopping point and yeah, maybe just a, a piece of. I don't know if advice is the right word, but like a piece of something that people with chronic pain or chronic illness can kind of take away with them.
Um, when they're like, if they're leaving this podcast, okay. What, what do I do next? Um, obviously if you're a therapist, then go sign up for Tyler's training. Um, if you're not a therapist and you just have chronic pain, uh, where can people find therapists who are being trained under constructed awareness?
Um, well, I would say you should probably go see destiny
I'm in Georgia. Yeah. Taking clients in Georgia.
You can always reach out to info@constructedawareness.com and ask for me. And, you know, we'll see if we can find somebody in your area that works for, um, with pain with CA um, we don't have like a, uh, Yeah, thanks a directory or anything like that at this point.
But, you know, I would just, I would say that, I mean, you can get better. There is hope. Um, I'm sorry for all the ways that people have told you that this is your fault, and you're doing this to yourself, I know that that's ridiculous. Nobody would do this to themselves, you know? Um, it's just your nervous system is confused probably because it's overwhelmed from past experiences.
And, you know, even if he couldn't get in with somebody with CA I mean, there's other approaches like, um, se EMDR that could be really helpful for this. I mean, EMDR, I did a lot of pain work with EMDR for a long time. You know, if it's the result of sensitization will, the D and EMDR is desensitization. So there you go.
So there are options out there that could fall outside of just a traditional medical or more. Holistic body focused approaches, I would say. And it's something, my friend, Matt told me once. He said, if you've tried the tissue related, like, you know, approaches and they didn't work, then it's probably not a tissue problem.
Right. And so that was a good point. I liked hearing that. And so if the stuff that you've tried, hasn't worked give the mental health stuff a try, because like I said, I've seen it work really well in the past.
So I appreciate this.
Yeah, me too. Thanks so much. And we'll be in touch. Awesome. All right, bye.
A few extra things to note here. Therapist's if you want to join tellers, next construct awareness training. It's May 6th or seventh and 20 through 21st in the, in 2022. Um, you can use the code destiny winters for $200 off. It's all virtual. So it doesn't matter where you are. You can attend it anywhere.
And he also holds free monthly consultation meetings for therapists and you don't need to be trained in constructed awareness to attend. So definitely check that out. And for everyone, Tyler gave some really good book recommendations at the end here. Um, that got cut out. So if you want to read more about the science behind pain,
Check out on learning your pain by Dr. Howard Schumer. And I also really like freedom by freedom from pain by Peter Levine. To there also has a two day training for anyone who would be interested. To purchase this on his website. It's called, what are you noticing now? Integrating EMDR and constructed awareness. That'll be on July 22nd and 23rd.
Episode Summary and Notes
Meet Tyler Orr: Tyler is a licensed professional counselor out of the state of Tennessee. He's an EMDRIA-approved consultant in the creation of constructed awareness. He offers an interactive here-now, approach to counseling consulting and teaching that integrates mindfulness non-violence non-duality. EMDR and body-centered therapy techniques. Tyler's journey into working with chronic pain started unexpectedly during hypnosis training. A brief module on treating chronic pain with hypnotherapy sparked his interest and planted a seed that would grow into a passion. Personal experiences with chronic pain within his family and his own life further fueled his curiosity. As Tyler recalls, "I thought, for sure, like, this is what doctors, PTs, massage therapists work with, but not a mental health practitioner.
Shifting Perspectives: The Brain's Role in Chronic Pain
Tyler's journey took a significant turn when he met Dr. Matt McClanahan and PT Jason Terry, who shared revolutionary insights into the nature of pain. Their approach challenged traditional views of pain as solely a tissue problem, emphasizing that pain originates in the brain. As Tyler explained, "I kept learning things, and things began to click. The idea that pain comes from the brain and not the body didn't click for me until a year into teaching with these guys."
This new perspective transformed Tyler's approach to chronic pain treatment. It also provided him with the patience needed to work with clients who were grappling with understanding the connection between their brains and their pain experiences. He shared, "It helped me be patient working with people because I was teaching it for almost a year before it really kind of made sense to me.” The collaboration between Tyler, Dr. Matt McClanahan, and PT Jason Terry resulted in the creation of "Pain Matters" workshops. These workshops were designed to educate and empower both clients and fellow practitioners about the complexities of chronic pain.
Looking Forward: A Deeper Understanding of Chronic Pain
Tyler's dedication to understanding and treating chronic pain has led him on a transformative journey—one that has influenced his practice, approach, and perspective. Chronic pain is a multifaceted experience that demands a holistic and empathetic approach. Tyler Orr's journey showcases the potential for therapists to make a meaningful impact by recognizing the brain's role in pain perception, advocating for clients, and providing a safe space for healing and growth.
A Paradigm Shift: Pain as a Constructed Experience
Tyler's realization that pain doesn't originate in the tissues but is instead constructed by the brain marked a pivotal moment in his journey. This realization prompted a paradigm shift that has transformative implications for individuals grappling with chronic pain.
Dispelling the "All in Your Head" Myth
Addressing the skepticism that often surrounds chronic pain, Tyler underscores that pain isn't "all in your head" in the dismissive sense that it's imaginary or exaggerated. Instead, he emphasizes that pain is constructed in the brain, which is a real and intricate process. Constructed Awareness invites individuals to explore the emotional underpinnings and cognitive pathways contributing to their pain perception.
A Holistic Approach to Pain Management
Tyler's insights challenge the traditional medical perspective, offering hope to those who've felt misunderstood or dismissed. Constructed Awareness acknowledges the interconnectedness of emotional and physical experiences, offering individuals a holistic understanding of their pain. By guiding clients to deconstruct and reconstruct their pain narratives, Tyler illuminates a path towards a transformed relationship with pain—one that's empowered and informed.
The Constructed Awareness Framework: Building Readiness for Change
Constructed Awareness offers a structured framework to guide clients toward reconfiguring their relationship with pain. Tyler outlines a two-phase treatment plan that begins with resourcing—an essential step in preparing clients to address their pain experiences on a deeper level. Through this process, clients develop a heightened self-awareness that forms the foundation for their pain transformation.
Phase One: Resourcing for Self-Connection- Tyler introduces the first phase of Constructed Awareness: resourcing. He likens the nervous system to a bucket filled with water, representing accumulated emotional experiences. Resourcing helps clients connect with themselves more deeply, allowing them to observe their pain experiences from a place of self-compassion and understanding. This phase establishes a strong foundation for further exploration and healing.
Phase Two: Processing and Reconstructing
The second phase involves processing and reconstructing memories. By examining past experiences, clients gain insight into emotional attachments and cognitive patterns contributing to their pain. Through guided processing, individuals reconstruct their narratives, empowering them to reshape their pain experiences.
The Three Principles of Constructed Awareness
Tyler introduces the three core principles of Constructed Awareness:
Bringing awareness to something leads to change.
No one can control what they think or feel.
People naturally have an orientation toward thoughts, sensations, or external senses.
Navigating Client Orientations
Tyler discusses the significance of client orientations—whether individuals are more thought-oriented, sensation-oriented, or externally oriented. These orientations influence how clients perceive, express, and process their emotions. Tyler provides examples, revealing how CA's principles are tailored to the unique needs of each orientation, fostering more effective therapeutic outcomes.
Conclusion:
Chronic pain is a multifaceted experience that demands a holistic and empathetic approach. Tyler Orr's journey showcases the potential for therapists to make a meaningful impact by recognizing the brain's role in pain perception, advocating for clients, and providing a safe space for healing and growth.
Click here to access the full episode and open the door to a new understanding of chronic pain and its management.