Clinician communication: stories, trust and keeping clients on track

Hey guys, before we start the show, I wanted to introduce the premium version of the podcast. If you've not taken advantage of it, you really should. If you're a clinician, this is not for lay public, okay? So scroll down in your podcast player and you'll find a button that says premium version. It's very cheap and it's a monthly fee. You can stop whenever you want, but what you'll get in this is more specific case presentations and things that I wish I could have done better and things that I think that need to be said. And, you know, I'm a little bit more frank and direct on that one. And so what you'll get is more so what I talk to my interns about and kind of like internal office discussions.

Obviously, patient privacy is there. I think we all need to start learning from each other and I'll help you learn from my successes and my mistakes. And that's the pure intention of that premium podcast. It's about 10, 15 minutes every week. It releases on Mondays. Again, you can stop whenever you like, but I don't think you will because I think you'll like it. Now onto the show. You're listening to the Restoring Human Movement podcast, where movement experts discuss the latest evidence-based practices to help you and your clients move with mastery. And now, your host, Dr. Sebastian Gonzales.

Hey, everyone. It's your host, Sebastian, for the Restoring Human Movement podcast. Thanks for joining the Movement Movement. This is your first time on the show. Welcome. You have missed a lot. As I always kind of say, we're about 230 episodes in or so. The person I'm having on today is Alec. He is somebody who has been on the podcast quite a few times already. We're talking mainly about communication, how to improve our communication with our patients, clients, to really get them to succeed, to get them to the goals that they want. And sometimes just laying out the framework isn't always the best thing to do because there's other hurdles in the way.

This is your first time in the podcast. And also, this is mainly for clinicians as well as some clients, patients, who are really interested in what else is going on in their body and how to improve. This one might not be as useful to clients and patients, more so, probably for clinicians. And so, I guess if you're a client, patient, lay public, this one might not be interesting to you, although it's probably going to be a very easy communication conversation. So, I will put links in the show notes about the other episodes Alec's been in. So, I think that will really interest you guys if you like this one moving forward.

By the way, before we actually move on as well, I want to make sure that everyone knows that at this point forward, for an indefinite period of time, it's going to be released every two weeks of the podcast. We're still going to have the premium version coming out every single week. That's for the paid members, and you can find that in the link description as well. That's all below. I find that in this point in my life, there's other things I need to spend a little bit more time on is all. So, it's not you, it's me. I just have other things that are a little bit more pending, and I want to make sure that podcasts that I give you guys are really good, really good information, and not just kind of drummed up, you know, the day before.

And so, work with me on that. Go back and listen to all the archived ones, because they're there for you to have. At some point in time in the future, we might go to once every week or so. Let's get on to the interview with Alec. Can you hear me okay? Absolutely. Okay, good. So, let's, let me do, okay. We look okay now. The audio looks good. What's up, man? Doing good yourself? I'm good. Is that a, I can't tell if you're doing one of those things with your mustaches that, where you twirl it? I can do it if you want. It does work, though. I'm at this point where it absolutely, absolutely works.

If I get in, like, here it is. Okay. So, you don't put, like, the, the pomade in there to endorse? Oh, no, no, no, no, no. No, no, no, no, no, no. I have a very, very strict policy regarding facial hair. I don't do nothing about it. And it tends to do okay. Anyway, I'm wearing a mask all day. So, who cares how stylish I am behind it? I did forget about that. I was, I shaved, actually, right before I did this. Not for you, but for something else. And so, we're our polar opposites. Okay, okay, cool. Yeah, I cared enough, you know. So, I have already introduced you. I did say your first name. I remember in old podcasts, we didn't say your first name.

Are we good saying your first name? It absolutely is now. I'm actually going public. I now have a Facebook page and a website. So, I'm looking to build a tribune, a tribute. Is that a word in English? Contribute? A true tribute? Nah, I mean to a society. Let's have following. Oh. I'm trying to build a brand. That's what I mean. I think I see it. Is this, is that you taking a selfie in a mirror in a convenience store? Is that you? Yep. Okay. That's me. Got it. Well, I'm going to add you then. Cool. Good to know you're out. Wonderful. So, and I have a professional page, like a personal training page, but I'll push that forward once I'm done with the e-book, which by the way is getting quite pretty.

Sounds good. By the way, I'm wondering, why are you holding this chicken? I got to know about this chicken picture. Um, it was just, I actually need to go on my, it was a joke referencing Lion King. Oh, Rafiki, it says? Yeah, yeah, yeah. So, that was Simba. Yes, exactly. Okay. It didn't look like Simba, but I like the, uh, you needed a stick or something maybe. Yeah, we'll get there. Yeah. So, what are we, what do you want to talk about? You want to talk about that storytelling email that you sent? Uh, yeah, we can get there. Um, well, what do you think about it? Okay. Um, I thought it was good.

Um, I won't read the whole thing to everybody here as we'll probably discuss it a little bit, but so Alex has been sending emails, um, kind of like as excerpts from his soon to be book ebook that, uh, we kind of, you're kind of developing more for healthcare, specifically chiropractors. It sounds like, right? And so you're, it's, it's funny after reading these, I'm like, use all the words that we use. It's so good. Or at least that I use. And, um, this last email was about kind of the danger of telling personal stories, uh, to clients to motivate them. Not necessarily just not ensuring about your day, but like, Hey, I got better.

You can too. Right. Yeah. Which to, to an extent can be very useful. I just think the trap is to, um, it's just to be used wisely. I think just cause there's a, there's a, there's a level of, um, well, that's what I was saying in the email, but like resort to which when you don't have a better option, but I think there's, there's most of the time there's an option. There's always an option available that is more focused on the clients. Right. It just, it doesn't expose you to the same level of risk. And I also think cause, um, yeah, well, it's also cause I think it preserves, not resorting to it too often preserves us from just resorting to the assumption that cause we did it.

That means that our clients are able to do it systematically where, especially when we're healthcare provider or fitness professionals, like you got way more tools than your common clients. Right. Like your client is a, is just an accountant, you know, it's, it's nowhere near the same level of, of not, not, um, just we have more tools from the get go. So I think just being like, I did it, you should be able to do it. Just, it brings, I don't know. It brings a pressure to the client that is just, let's, let's focus on them. Right. Um, let me add, before we continue, check your microphone, uh, little, uh, make sure it's plugged in there real good because it's either that it's stuck on your massive beard.

Oh, I think it's hitting your beard is what's happening. Let's just put tight around your ear. Um, yeah. So, cause the whole thing that we've talked about kind of in the past is, you know, empowering the patient, you know, um, leaving, giving them some autonomy, making it so, you know, they are responsible for their own recovery. You're just there to help them and you're part of a team. Um, and yeah, like this one is kind of like, like, I know I've liked sharing stories in the past. I typically don't share, um, I tend to frame it with people. Uh, I try not to, I try not to get too into the weeds.

Like you kind of mentioned, they'll focus on you a little bit more, but just saying, here's what, here's what I did. Here's how it relates to your problem. Here's how it could, uh, maybe help you. Here's how the story could help you, you know, type of thing. Um, versus saying, look at me, you know? Yeah, well, I think this is where using yourself as a, um, or using your own story as a tool to educate is something else than, uh, taking yourself as an example to be followed, right? There's something weird of being like your own poster child. So I think just you, you going down that route this way and framing it, like when I had this issue, this is what I did.

This is the time it took me. This is how I think it, I think it can provide us guidance on what you expect regarding your condition. I think that works well. I think that's great, but it's not the same thing as, as, as preaching. It's really where I have more of an issue. Um, let's, let's maybe do an example of the preaching because some of the listeners might think, well, I tell personal stories in my preaching or am I using example, you know? Yeah. Well, um, well, it would be like, as soon as I think a red flag is like, as soon as you're trying, you're starting to tell people what they should do and you started that they should do more, that they should be more motivated or they should have more willpower.

Like when you, you started to get prescriptive and, and you, I think this is like maybe a red flag of where we're getting more into the preaching side of things. Right. So it's interesting. You say, you know, that like the kind of prescriptive, I guess there is, it's fun. I've, I've met a lot of people who like, will like, I like to be on a good personal level with them, give them choices, you know, here's the pros and cons of this. Here's maybe what, here's what I would have done. Here's what you might choose here. What do you want to do? Right. And then they come back, you know, from there, um, I've had this a lot with hips for some reason.

It's like, so I went to this hip ortho. He said, I have this and I should do this. And it's, and all of a sudden, like all bets are off. Like they're just, they decide they're going to do that because someone told them authoritatively, which we didn't necessarily do. So is there, maybe is there a difference between authoritative versus preaching or kind of, I mean, I think you mentioned in the email, you called it like parent, parently, fatherly or something like that. Right. Subordinate. Um, well, I mean, there's a, there's also a, there's a fine line where the, the traditional medical model is very prescriptive.

It's like, um, where the, the, the dynamic of the relation would say between the patient and the professional is like, uh, the profession, uh, the professional is on top and the patient as, as basically his job is to follow orders, right? Where like, um, maybe what you're doing, which I think is, is great is you give them options, which is, is more horizontal. You provide information, you provide possibilities and they have to make a decision within it. And this is great because this is how we build accountability, right? Um, cause once they decide to commit to something, then you can hold them accountable to committing to it.

Uh, and you remind them that it's their choice. I think that's good. There's also the point where if an ortho feels like this is what you have to do, or a surgeon feels like this is what you have to do. I mean, it's, there's a scope of practice there. There's a level of expertise, right? Um, if you told your clients, like you got this and you need to do that, um, I think that's okay, but you're going to run into the problem you get from the medical, traditional medical model, which is your clients. Some will be compliant, but those who don't, you're, you're going to lack tool very quickly. And I think this is where we need to turn towards something that is more patient centric.

So, and this is where I think the preaching is like, it's not patient centric. You're, you're telling them how they should feel, what, how they should, uh, get involved. And you put a standards that is unrelated to where they at. If someone has problem to commit to the process of treatment, well, you should start from where they at and make them go through a gradual sequence of smaller successes, even though it's slower. But if you just, so this is where I think you can tell your preaching, if you just, you set expectations that are consistently unmet by the client. Well, let's dig into why is it that you don't get there?

Okay. I don't know if that answered that was long winded. No, I think it answers. I think I'm trying to recall back on, on our last podcast. You really, you really started to narrow the field a lot when I gave examples and you started to pick me apart. So I think I'll, I think I'll just tell some stories and then we can dive into maybe how this is good or bad storytelling, uh, to motivate a patient to do, I guess something, you know, something that will help them on their journey. Yeah. Um, so, uh, I, so I don't know if I showed, I don't know if I shared with you or send it to you. So the first book I wrote was actually personal story of low back pain.

Did I ever share that one with you? You've read almost everything else. Yeah. So I read the whole thing. Okay. So did you find a lot of spelling errors? Cause I think there was some. Yes. Yeah. I think it's fine. It's so funny. Like there was a, there was somebody who just bought something of mine and she's, she's like, yeah, it's, there's a lot of errors in here and all this kind of stuff. And I'm like, I get it. But you know what? It's funny. I've read this thing three times. I've had an intern, two interns read it once. And I've had people actually hired editors to read them too. And this is what came out.

I'm like, I can't even imagine what real book writers go through, you know? So, cause they, they, they, they're acting like, oh, you didn't put any effort into it. Yeah. I had like five people read this damn thing, you know? Anyways. So that story was about my issue with back pain and, um, the steps that I took as well as the trials and tribulations that I had along the way, uh, to finally get to the end results of feeling better, but also realizing that pain, it will come back again. Um, so I know that I shared like steps, uh, some of the steps and exercises I used in the first week. And I also shared that I was not liking the idea of going on a plane flight.

Like it was freaking me out. Cause it was like 14 hours. Um, and so in the end, I obviously feel better. Like I do now is sharing a story similar to that. Okay. Or is it now, you know what I mean? I think, yeah, I think, I think that's fine. The, the, the, where, where I think I personally draw a line regarding preaching is once, once you, you, you decide to, you, you start to allow yourself to be in authority on what the patient should do. And you, you, you, this is where I think it gets like fatherly or patronizing is like, I know what's best for you more than you do. It's like, if you share a personal story and it gives a framework from which you work for your client, the client do realize finally, uh, I'm actually working better.

This is working more for me. Well, take that into account. I think this is where the preaching line for me is like the red flag is when, when someone does not take you into account. This is actually very funny. This morning I was, uh, I was having a physio appointment cause I, I had knee surgery last month and, um, and like today I was actually asking for structure. Cause I, I have like, like 19 different exercise for my knee right now. And like four sets of each to do like true two different sessions. And I was like, okay, cool. I, I have, I have like 45 minutes a day of like very low level exercise.

Like, could we make that a little bit more dense and structured for me? And she was like, well, do it throughout the day. And I was like, um, I get it, but I would love to have a set number so I can check the box that I did. And I repeatedly asked for structure and she's like, no, but I've been doing this for 18 years. You need to trust me. Do it throughout the day that works. And like, I swallowed that pill, but it was there. Cause I'm like, why don't you give me what I want? I know how I'm structured. I know, I know I would like things to get done. I'll do it. I'll be compliant. I just, I wanted to have a clear view of what's going on.

Right. And maybe for someone else, just do it throughout the day works good. I was like, why would you deprive me of a strategy that works good for me? So I know myself on that point. Right. So that's a good question. Like, so actually I've run into that a couple, uh, quite a few times. And so I'm curious to see what you think when, so on, on my side, I, the sets and reps don't as matter as much as the effort. And so I would tell you, yeah, here are sets and reps, but I want you to go to the point where you feel like, oh my God, I want to stop in one exercise and then move on. Is that structured enough?

Or do you need actually force like eight reps, three sets? I mean, for me, I know that the, the numbers get monotonous. I don't want to count, you know, for me, the counting and structure. Yeah, yeah, yeah, yeah. But so how do you feel about more of the one? Wait, so, so what, what about the effort-based one? We're giving you the, the power to decide when to stop still, but it's not a hard number. That would, that would work with me. Like that would be very clear. Actually, that's kind of what I'm craving. Cause I'm, I'm at the point where I'm like, okay, cool. I want to do squats. And she's like, okay, cool.

But narrow squats, uh, both toes, uh, both of your toes, your feet are pointing forward. And I'm like, why I got more range with a wider sense. I got more range. Well, I live a little bit of, like, I think my hip structure is not built for that. I don't care if I, my knees go past my toes. I, it doesn't hurt. So there's a part where like, it's just, we're, we're like, I'm annoying for that stuff too. Cause I think I know so much. Right. So that, that must be annoying for her to manage, but, but I'm actually craving for more intensity. So I would respond greatly to just like go to exhaustion twice a day on each exercise.

Like, this is super clear for me. I know that will work for me. It's just that, oh, do a trial today and it'll be enough. And I'm like, what does that mean? So anyway, but yeah, I think that would, that would be great. Okay. So that's too, it's too vague. So you want the, you want the structure. Um, how do we get on this topic? Oh, so you were, um, let's see. How do we get on that topic? Of the 18, 19 X. Uh, we were talking of like, of, of preaching. We were talking of preaching and where I, I think the, the, the, the, the line is like, when you stop being open to the feedback of like, you do your best attempt and then you get feedback from your clients and you should integrate that feedback to see what, what type of methods they like.

And I, I made me tell my appointment this morning where I'm like, oh, got it. We're, yeah, we're talking about the preachy. So, so it's funny. Um, so recently I had a few people that they, they, uh, one person discontinued care. And so, uh, I called them recently and I said, uh, you know, what's going on? And I always think that in the beginning, we try to start with the things that are the highest probability of working and also things that they have not done yet. And so usually when I ask, you know, what have you tried? Well, I've tried massage and tissue work and, you know, stretching and all that.

Okay, good. And so I'm going to, I'm going to, I guess it was my fault of assuming, but I'm assuming you're here because those didn't work or else you'd be at the person who did it with you and default better. And so we did, you know, not that we did something else. And so the person decided they didn't want to come back. And so I just called and said, what's going on? And, uh, they said, well, I know what my body needs and we didn't do it basically. And I'm like, well, we can do what you think your body needs. What do you think your body needs? Well, I think I need soft tissue work. Oh, okay.

So we could do that. We have no problem doing that, you know? And so at some point though, because you bring up the preachy thing. So they mentioned, they mentioned the, this has been 20 years. I know what my body responds to, I know what will get me better. And, uh, I'm like, look, we can do tissue work, but I just kind of stopped. And I was like, but I completely disagree with you. Like there's like, and so I don't know if that sounds preachy, but also too, you know, it's like, I completely disagree with you. Like, like respectfully, but if you want tissue work, we could do the best darn tissue work that you ever found.

Um, but we've had a few people over the last year who, who say the words, I know my body better than you. And I totally get it, but at the same time, you're asking for an opinion, right? And then, so where's the line becoming preachy versus just, we're a vending machine. You know, you pick B12 and then that's what you get, you know? Yeah. And then you're just a provider of services and you don't, you know, you're not, you're not paid for your judgment at all. Yeah. Well, I mean, there's like two things there because change, change like resistance, which is what you met with that person, right?

Is, is kind of a, I view it as a mechanism that protects us from like constant chaos. Cause if we were just, if we had no, no mechanism to protect or to slow down change, we would just be like unstructured at all. So this is something that kind of helps to slowly change your meals where we need to dance. What, what may be, and some people, they just, they, they zone in on something and you not force someone's change, right? What might, might be cool to do with them, but would be to be cool. This is what you're used to. This is what you like. Wonderful. And I would maybe take like five minutes to understand what, where are you getting out of it just to understand?

Cause to an extent, it's true that they know, they know better than you, what their body feels like. So on that side, like if they're looking for relief, this is what they know best to get it. Probably that core stiffness will not make them feel relieved. Like they, they picture it. Right. So then I would go into negotiation with them. Like, okay, cool. If you know, that's for you, we can put some of it. How, how would you feel about, about dabbling slowly into some complimentary technique that would try to, to, to have you not spasm that much or whatever, get muscle tension. And I would negotiate it so that there you don't, you're not in, um, it's not you against them.

And we're, we're kind of getting into like a little experimentation. We're both there to witness the effect of soft tissue work. And, but, and then I would challenge them to call, but what's the duration of it? How long lasting is the benefit you're expecting from it? Cause I personally think that we could extend those by having you do tension drills. How would you feel about that? And then I would try to like negotiate with them. Just, I think that way there's more chance than just, okay, I think you're wrong, but let's do it. Like, that's like, oh, okay, well, um, maybe I'll not come back. Yeah.

I totally, I totally feel you. There was, um, and we didn't, we didn't negotiate a little bit, you know, actually I think I suggested what you said. I guess I didn't ask, how do you feel about it too much? I mean, I did, I guess I know I did a couple of times, you know, they didn't circle back around and, and agree with that type of negotiation. But, um, but yeah, it's, I don't, I don't know. I like, like, can we, how we started this conversation too? It's like, I like, maybe, maybe this is just me. I go to my bookkeeper, my accountant, and I say, what do you want? It's not a negotiate. Like, they're like, okay, so pay this, do that, donate to that.

Right. I'm like, okay, good. I'm paying you for your opinion and I'll do it. Um, obviously when it comes to what do you want to donate, how much, you know, like that's negotiation too, cause they won't really say exactly. Um, but at the same time, there is, uh, I guess I'm sure there's two different mindsets or two different, or there's a few different mindsets that people have when they're trying to solve a problem. But, um, I really appreciate when people say, look, like not force me into it, but like, I would strongly do this. You could do that, but this is probably in your best interest. You know, whether I understand the reasons why or not, I don't want to know tax law.

I just want to not pay as many taxes, you know? Yeah, yeah, yeah, I get that. So, I mean, I, I think clients sometimes for, as you mentioned healthcare, we don't have, they don't have the background to really make a really educated decision. Um, and you're kind of guiding them. So I guess there is that line of being forceful, but not forceful, right? You see the, yeah, well, I mean, I mean, I mean, I mean, I think it's so good to have an opinion as a, as a professional. Like I, I recently started working in a commercial gym and like very clearly there are some clients they, they do expect me to like, just take, they want to have guidelines and they want to be told what to do.

And it's, it's helpful for them because they got something to hold on to me being very confident and they're very directive is, is appreciated from them. And if I get pushed back with that, I do, then I'll know I need to change, to switch it up. Right. But if it fits good, let's, let's go along with it. I think also there's a part of, um, I, when it involves money, some people have like, um, I don't know what it is, but some form of, um, like almost a bias that the, um, they need to watch the people they give their money to so that they get something that is worth with. I find sometimes. So. You do it like physically.

I don't know. I doubt. Uh, no, more like, um, like work for your money. Like they're, they're afraid to not have, um, to have a return on investment. Like they're not willing to risk putting money into something that they don't know what to expect out of. So, I mean, so a client coming in with not very accurate knowledge of what massage and soft tissue will do is feeling more confident, uh, to go toward that choice versus I'm going to do a glue bridge and my back will feel better. I don't understand how it works. I've never done that. There's, there's a level of uncertainty that I think maybe buys them to just sticking to what they know.

It's funny. Yeah. So, um, there was actually, you've spoken to Sarah before and, um, we were talking the other day about, so there's this guy that comes in. Like he's, he's been coming on and off for years. Like I've helped him through a few things and he's smart, dude. We always talk about, you know, where did Bitcoin come from? And all, you know, like all these like technical things and everything. He's an engineer. He's a smart guy. We don't know. Yeah. We don't know. We're like, why are they selling things that don't really exist? I don't get it. Um, we don't know that who, who coined it. That's, that's a, that's a whole other thing, but like, I'm just like, like, what if, well, anyway, yeah, we don't know where it comes from and it got, it got so much traction, but anyway, this guy comes in here.

Yeah. So, so he, uh, he's an engineer, a smart guy. And so he, he had a problem about a month or so back and he's like, well, I think it's this. And I was thinking it's that and blah, blah, blah. Right. And I'm like, okay, so, uh, why don't we just try this? Are you, is that good? Yeah, sure. And so he just does stuff. And they're like, um, Sarah was like, how do you get him to just do it? He just does it right away. And I said, I don't know, let's ask him. And I said, why do you just listen to me and do what I say? And he's like, well, I just trust you, you know, like you, you've helped me through these other things and, and you, I have no reason to doubt what you say.

Um, so he does not fully understand why the thing I suggested will help him, but he's very open to doing it, you know? So I guess in the, is there a way to maybe get the trust early with those people versus having them choose the thing that you think might be wrong? Yeah, actually, this is, um, this is the exactly that is the whole first chapter of, of my book, which is like, at the very beginning of an episode of care, you cannot, uh, you cannot capitalize on successes to build trust. So I think you need to do it through, uh, you can't capitalize. Yes. Cause I mean, you have no historic, there's no, there's no, you haven't done anything with them yet.

So, so not that you shouldn't, it's just cause like that guy, you said he, yeah, that's, that's what I mean. Exactly. Cause that guy you're talking about, if he's been in the office often on and off for four years, I mean, you can remind him of that thing we did with his ankle that worked. Right. So you can just refer back to it, but once you start with someone, that's not possible. So I think this is where like some, um, like social, so psychosocial shenanigan can be helpful where it's just about being caring. Um, taking time to like, uh, for active listening, just making sure we understand what they expect, uh, taking the time to identify explicitly a goal and to validate that this is their goal and to then explain, okay, cool.

Going forward, I will take my decision based upon the fact that this is where we're going. And I think that's how, how you can, you can like clearly position yourself as an ally and then it's easier to, uh, to build trust based on your, your, how engaged and you are towards them. So that's like, I think what you, what you use until you start to get some results. And then as soon as you get results, you just, it usually gets way easier to, to build trust. But in the beginning, I think it's about like doing basically your first good impression. And that's, that's like taking time to listen to them and, and taking time to validate that, to make them feel understood, I think is a big, big part of that.

And, um, yeah, I, so I think that would be, that would be it with, with a new clients coming in. Okay. That sounds like a good first chapter to start with. Um, uh, and I know that the past emails were kind of surrounding that. So that's, uh, how much, by the way, how much of the old emails did you use verbatim? Did you revamp the whole thing? Um, nothing. I rewrote everything. Um, I'm closing on like 50 pages now. So, um, I, I still keep, cause my second chapter is just about like, uh, the way I structured it is the first chapter is just, is about like all the, um, basically the seeds or the components to develop, um, uh, interpersonal, uh, critical judgment, just cause it's impossible to, to like give that to someone.

Um, but I'm, I'm trying to go through all the, the requirement I think to, to nourish an attitude that will make you develop it on your own over time. So that is like, uh, being genuine and being authentic, being, uh, just being nice, asking good questions, organizing your, your, your physical space in a way that, that sends a message of, of importance to your clients, uh, which is something that is fairly overlooked. And just also being able to, uh, monitor small body language, um, in that you give with your own body and that you receive from your clients, just so you can like figure stuff out.

Um, second chapter is pretty, pretty much the email I sent you with, uh, we're going through, um, uh, rewarding, uh, mirroring and open-ended question. Just so we, we, we have like tactical, technical, uh, just techniques to apply to, to, to monitor an interaction. And this third chapter, which is like the artist wants to write, cause it's so hard to synthesis like big, complex phylas of you. I go over empowerment, motivation, and also learning just, um, there's a very simple model of learning that I learned when I was doing my, uh, special care counseling, uh, scholarship. Uh, so, uh, yeah, so I, I did, I did use them like most of the, like the three emails are in the second chapter, but at the very beginning it was something like, I don't know, like five pages and now pretty much each email turned into something like five pages each.

And I changed the example and I take time to, I, I take the time to refer back to what we learned in chapter one. So, uh, I think it's going to be fairly, uh, a fairly good product. I'm, I'm hopeful it will, I'm pretty confident actually. It's going to be helpful for anyone trying to bear their, their, like the relationship with their clients. I really liked that there was an email that where you, you, you made an example of a person, fictitious person named Ray and you're like, Ray comes in, here's what Ray wants. You know? Um, I like those examples and stories in there. This email didn't necessarily have that, but there is a couple of things in here.

I like, um, but it's, it's funny. So Dawne Costantino is going through, she's currently going through something called the, uh, primary spine practitioner or the, uh, P S program. And so the first, uh, module they're doing is on like, kind of like a motivational interviewing and things like that. Right. And so we kind of have like every couple of weeks we have an in-service in the office where somebody teaches something and it's like, Dawne Costantino, you're doing this, just teach that. Right. And so, uh, she went through it and so she, she explained how maybe these tactics would be used with a client to get them to wherever we, we want, or they want to go.

And it's funny after doing it, uh, so she was, she explained how the, the one, one aspect it was in regards to pain and how a pain might or might not be actually detrimental to this person. And, uh, so she explained the mechanics, uh, in, in layman's terms for the person. And then, so I said, Oh, that's really good. So can you tell me more about those stations that amplify the signal? You know, like as like a patient, like an engineer who wants to know, and I was like, what would you do at that point? She's like, shit, I don't know. You know, like, so the reason I'm bringing this up is because, um, in these examples in like reading some of your, your, uh, stuff in here, uh, you can see we've asked questions back and forth on emails.

I kind of like when you like, if you have, well, if they ask this, if they say this, if they react this way, um, what could you have done better? How can you mitigate this tangent conversation? This regards that we don't need this person to understand more on a chord. We just gave the example to give, to get them, you know, you know what I mean? Right. So do you, do you have any of those? I know that the one with Ray, you seem like you had something of that, but let's just say in this example, the email that you gave me, if you, you mentioned, if you tell, if I tell my own story about myself, the problem is that it starts to focus the attention on me versus them and they might start to ask you personal, uh, personal questions and, um, let's see, there's, there's nothing wrong with having our patients know us.

It's just, uh, develop, uh, dependent upon the context. It's time. It's time that we don't spend on doing something basically for them. So my, how in that situation, how might you flip that back on them? If you make a mistake, uh, I would straight up, I would straight up address it. Like, uh, I don't know. Um, let's say I'm working at a gym. Someone comes in, they have neck issue. Uh, I do tell them I add some, they, they ask me, Oh, okay, cool. Uh, and we talk about it like for one minute or two. And at some point I'm like, okay, cool. He keeps asking me questions about my stuff. Um, if I feel like he's, he's trying to gauge what will be his progression based on what was mine, this is where I'll draw a line and I'll say, let's say, let's call him Ray again.

I'll say, okay, Ray, I see that interests you. Uh, but you do need to know that how, how my care, how my recovery went is not predictive of yours and, and let's refocus on, on you. All right. So we can make something that works for you. I would just address it basically. And just go like, just go ahead on boundaries. So what, so then what if they say, well, I really, not in, not in a way that, uh, Oh, sorry. So what if they say, well, I'm, I really want to know more about what you did because I'm wondering what I should do. Um, well, I, I would, I would insist on, well, we'll go through an assessment and that's going to tell us what works for you.

If we still got time at the end and you won't, um, if we got room or yeah, if we got time left, we could go about that, but I would prioritize what is going on with your neck. Cause this is how we're going to know what will work for you. And then I can share you, uh, what, what worked for me, but let's, and I would just like refocus it on them. And if they insist, like, if I need to go about it a third time, I would just address it. Like you're really focusing on, on, on my case. Like you pay good money for this time. Why is it that we're, what is it that like, let's focus on you. All right. This is, this is your time.

I'll tell you about it another time. I will not forget what my recovery was, but let's zone in on you if that works. Okay. And I really can't see a context where Ray will, will go through like a fourth time. Yeah. Okay. Um, yeah, there's, there's, um, I've only had a few situations where I feel like I've, I've had to be kind of direct more like that. Like you're just keep volleying back to them. Um, but I kind of, I kind of, yeah, usually when I'm trying to, to talk about a, like a difficult topic with people, um, and I'll, I'll say, look, this, this is sound bad, or I might sound rude when I say this, or, um, you know, kind of framing the conversation.

Like, look, I'm not meaning to sound rude, but I, I, I don't agree with you, you know, like, or something like that. Right. So they understand that I'm not trying to be a jerk. Um, you know, so I don't know if that's helpful or not, but it sounds, it sounds like you're kind of restructuring. Well, I, I think, I think, go ahead. Well, I think, well, do you have an example actually of like, what, what, what would be a difficult conversation? Um, there, there's been, we haven't had this in a long time, but there's, there's a few, there's a few people in the past that have come in who they, uh, well, actually I'll give you one example.

This one's a good one, I think. So this lady was, she was, she was, she had, um, she had a lot of concerns. Uh, she had a lot of questions, you know, we try to answer those questions, but we also try to get something done too. And, um, she had come four or five times maybe or so. And so, um, she was driving a long ways to get there. And so I, uh, I think, I think there was, there was a couple of sessions where she was in there for like, we usually have 30 minutes. We try to in and out in 30 minutes after the first couple of times, all the questions should be generally addressed. We should be on the same team, same page, blah, blah, blah.

Right. And so I want to say like her third, fourth time, she was in there for like an hour and a half, right. A long time. And there was an intern there, right. And so finally, when I asked her about, I said, Hey, do you, do you want to come in again? Right. And so she's like, I don't know. I don't know if I have time. It just takes a lot of time. And I was like, okay, this is, I'm pretty bad, but, um, I'm just going to tell you, we don't need this much time. Right. Um, when you come in, like we're, we're all talking a lot, you know, and we do care about how you feel and how you've been doing, but also too, most of the time with, within the first two minutes or so of you telling us what's going on in your week, we have enough information to do what we need to do.

And then we just have to get you to do it. Um, so these sessions don't need to be an hour and a half and, and, and actually your, your session just wants to be 30 minutes. And so when you come in next time, let's maybe spend a couple minutes talking about how things are going, make sure we have enough information to give you the things we got to have you do. And then we just do them and we'll troubleshoot. So that was an example of one. And how did she react? Cause I mean, that sounds pretty good. She came in, she came in another time. Um, and it was 30 minutes in and out the door. The next time was about 45 minutes.

It started lengthening out again. Um, uh, her, her care had stopped after that point, but if I were to guess it was going to elongate even further, unless I had that conversation again, I think she just liked to, to, to talk a little bit, you know, which that's fine, but you know, it's, it's the time. We just don't have the time. It's not fair to the other patients either. Yeah. I mean, I mean, at that point, this is one of the things I tried to address. In the first chapter, which is like, uh, behaviors are, there's no, we behave for a reason. There's all, it's always fulfilling a need, right?

So there is something behind that for her in the talking, uh, and I don't know, some, many of us have, have a tendency to bring up difficulties of our problem. Cause in the past it's been rewarded by attention, like a, like a baby, a baby that cries and it brings the parents over to make like a, an analogy, right? So, so wondering or being anxious or, or having questions is a way to maintain interaction to a point, right? Maybe that's something that played a role in there for her. But once, once you had like a good touch point where, I mean, you could bring her, bring her back to it. Okay, cool.

So today again, I will, I'll, I'll recenter it. I would even like announce my intention about it. Like every time we're going to steer away from the work we have to be done, I'll bring you back to it. And it's not a lack of care. It's my way of holding you accountable to, to what we, we, we said we'll do, which is to focus to your, to the care that you need. All right. And to ever agree on that. So that every time then I, in my mind, I got, okay, cool. That's been 35 seconds standing up, blah, blah, blah. And not getting, okay, cool. We're going to focus in back. I actually have a client right now, which he, he really does like to tell me about, like recently he had a lot of problem with his, his, his bike shop and how they charge him.

So he decided to change to a new bike shop to get his bike repair. And like, that's fine, but this is stuff you can tell me why doing stuff. And I'll, and I, I, I, I'm, I'm bringing him back and I, that's something I go and do every week because he's like that. Right. He likes to talk and he wants him. He wants me to agree, but I'll, okay, cool. Well, that that's nice, but like, let's do windmills. Let's work on your Jurassic spine. Let's, let's, let's, let's work. Okay. So I'm curious. And if that person then is like saying all those things there, like you mentioned, they're fulfilling some type of need, right?

And so if you just say, yeah, man, I agree. The bike shop card charged too much. That sucks. And then can, is that full, how do you fulfill that need? So it, it, I know it sounds, it sounds rude, but how do you stop? How do you stop? Because like, it's, it's, I know they're there for personal and physical development. But at the same time, you might be nurturing, um, like, like hateful thoughts to the bike shop. Right. So it's like, this isn't, you're not going to. Yeah. And if, if I tell him, oh, poor, poor you, you're right. These jerks, you did good to switch up. I'm like, I'm actually, um, uh, I'm responding like what he usually gets out of the behavior is getting it.

So we'll do it next week too. So then I just, um, this is where you have to like reverse engineer a little bit, but if I had to guess what he's trying to do is to get a sense of belonging that we, he want us to meet onto something, to agree to, to like share point of views. Right. He wants, he wants to develop rapport with me. So the way I try to fulfill that is I, I, I, I try to limit and set boundaries to that behavior, but I, I try to fulfill that need to something else. And in that case, it would be about like, um, like being, uh, let's say I see like that, that little more protraction I want when you reach with his windmill, which is something that actually happened.

I saw him at some point, like he was going to have fast a rep and then he, I know you, you remembered it and he pushed and I was like, okay, cool. Good job. I saw you there. Like, this is good work. This is what I like out of you. And there, um, um, I'm engaging myself to what in my relationship with him. So I'm hoping that this has him keep to keep coming back to training and to, to keep hiring me as his personal trainer. Cause I, I showed him, I do care about him, but it's, it's made true the way I coach him and not by talking and not working together. Right. And at the end also, at the end of the session, we can talk, but we're going to talk about what happened during the session.

So it's, it's focused on the role I'm having in his life. So, so I'm trying to limit how much we talk of his outside. life and we focusing on the training. So, so that's how it would, cause I, it's a very good question. They were still going to look to fulfill that need. So it's about like trying to not encourage it, but to fulfill it in an other way that is not cumbersome for, for the care we need to offer. So they're kind of seeing it as bonding, but you're creating the bonding in another aspect of your time with them. Yeah, exactly. Exactly. Okay. Interesting. Very good. Rewarding. Oh, that's how I can do another one.

Ooh, that session sounds really challenging for you. That is, is that mirroring? Is that mirroring? Not rewarding? No, it would be, uh, cause you don't, you don't, you don't point out to an emotion. So you, that would be a mirroring. No, a rewording. Yeah. A reword. Okay. All right. I was just trying to clarify. I wasn't trying to help the listeners. So I guess I should do every conversation I have with everybody as a rewarding. So what I'm hearing is, um, so let's jump back towards the storytelling because I know that's the obvious, the, uh, the, the, it was the main focus of the conversation today.

Although I like everything we're covering so far. Um, you mentioned, so actually after reading this, I had, I think you CC'd Sarah on it as well. And I shared it with one of the interns and we were talking about how telling a personal story might not be a good thing. And they're like, huh, that's weird because we tell stories and I was like, yeah, but we tell stories of other people's successes versus our own. And, um, you mentioned in the, we're, we're kind of discussing it a little bit in the email back and forth. Uh, and then you took the approach of saying, well, you know, stories might be okay, but it's a high reward, low risk or high reward, high risk.

I think you said, and perhaps we spend the next working on other communication strategies. So the other communication strategies, I know we probably covered them already, but instead of telling stories as clinicians, what are other ways we can, um, motivate our patients and get the same result, but with less high risk, high reward? I think, well, this is basically buy my book. That's the whole point. I'm still trying to figure that out myself, but yeah, but, um, there are a lot of things, which I mean, stories are fine. And I think it's a great vehicle for, uh, like it's a very nice way to transmit information.

It's just, I, I, my main concern also is like, is about what, when used repetitively, when constantly referring to oneself, what that effects has on the dynamic of the relation of the relationship, which is where, uh, like one of the thing I've been taught when I got trained in, um, when I had, uh, internship and internship and in service about motivational interviewing is one of the indicator of how good of a job you make to being, uh, to doing, uh, motivational interviewing is how frequently you use the word I, and the less you use it, the better you're doing, because the better you're focusing about the other person.

And like, that sounds extreme, but it's, it's stuck with me. And every time I catch myself saying, I, I, I, I, I, in the, where I'm providing service to someone else, not when I'm just having a discussion, it's, uh, okay, it's not about me. And that's the whole point. Like one of my teacher was telling me, um, like, you should not, you should not have a lot of mic time. It's their show. So, I mean, that's just a very basic rule of time, which is as much as possible, keep them engaged. Uh, so, uh, but I think telling story works great. Another thing to do is to just, um, set a baseline. Like a lot of stuff is to start with the, just on the right foot.

So on a first session, let's say once we identify, identify clearly what a goal is, we want to make sure we do it in a way that is relatable to them. So if, if I deem with a client that it would be nice to have a little bit more pelvic, uh, posterior pelvic tilt, cause he's going to reduce their, their low back pain. Um, I'm going to make it very clear for them by like exaggerating posture and like telling them and having them try to do exercise in that posture and to see, is it making your back feel better right now? Yes. Cool. So, so, and I'll validate. So is reducing your low back pain within activity, something you want to work towards?

Yes. Okay, cool. Well then every session going, going forward, I'll ask you where you're at in terms of discomfort and I'll have them tell me if progress is made rather than me telling them it's, it's subtle, but it's, it's getting there and more involved. And it's also like me telling them something is getting better can be encouraging, but if they are to witness it themselves, it's way more impactful. So that would be another strategy where I, I don't, I don't need to tell a story of progress necessarily. Like I give them the responsibility of, of, uh, archiving when things get better. So that would be one strategy.

They're kind of creating a, a weekly or however often you see them, a weekly occurrence of successes that you can then, uh, leverage a little bit later for trust, right? Yeah, yeah, exactly. Okay. Um, so what I'm hearing is I'm just joking. Um, the, um, I was thinking about when you, when you were, when you were saying you would ask them to gauge their improvement. Um, sometimes the verbiage that we use, uh, not on purpose is we walk in, how are you doing? You know? And they're like, ah, it still hurts, but you know, and you got to drag out a little bit more of if they improved. And sometimes it's like, ah, it's still there.

Um, I remember this one kid, he was, uh, he's like, yeah, I don't know. My shoulder still hurts. Well, are you able to swim? Yeah, I can swim, but I can't do breaststroke. Can you swim the other strokes? Yeah, I don't have a problem with that. When you came in first, you couldn't even swim, you know, like it was like three weeks ago. So, um, is there a way of wording it instead of how you doing is, Hey, what are your improvements this week? What can you do this week? You couldn't do last week or something like that. Yeah. Um, yeah, well that a good way to ask it will be, I think you're on the right track.

Just like, where are you compared to last week? Cause maybe they have a tendency to like focus on, on, uh, like, I don't know if that ever happened to you, but like, and Oh, you cut out real quick. Um, pause one second. Let's see. Hear me. Okay. Yeah. Always fun to have a little intermission. So we were, you were starting to say, uh, you can ask them where you're at today or things like that. Right. Compare to ask them to compare it directly to last week. Where are you like, given that we, before that we asked, we decided to get where we're going to be the, the criteria we're going to evaluate to, to, uh, monitor progress to monitor change.

So if it's his shoulder pain, well, where are you compared to last week with your shoulder pain? And even if someone that tends like, um, what is it? Is it like negative Nancy? Is that the same? Anyway, if it's someone that, yeah, something like that. I think that's it. Um, if he has a tendency to focus on the negative, framing it that way, it's kind of forced, like admit, I'm getting better on most of my, my, my swimming strokes, but like, okay, you're getting better. Cause there are some, some, like oftentimes if you feel like you're powerless, when it comes like a kind of a, like a victim mindset where you've like, if you feel unempowered, you're, you have more chances to, to, to just be defeated and to you, I'll say that way you're, you're, you're more trained to see limitations than possibilities.

So that's what you're focusing. But so I think that asking it that way takes, like, it gets them out of that, that, um, that pattern. Like if you're better, you're better. Uh, I, I don't think your client is going straight up light to you. Like, like they got no more pain, but like, oh, my upper, my upper back hurts. Like no one does that. Yeah. The, um, I, I do find that a lot of people tend to focus more on the things they can't do versus the things they can do. Um, you know, God, I can't leave the house today. Well, how come, uh, my foot hurts. Well, can you go in the garage and work on your car?

Yeah, sure. You know, you can leave the house. Like there's a lot of things you can do, you know, does it hurt to rollerblade? No, it doesn't. Okay. We'll go roll. You know, so many things you can do. Um, by the way, things that you can't do, I realized, uh, actually, I guess what you could do when you have, uh, I, I cut my ankle with glass one time and I had crutches. I couldn't walk for really like, uh, uh, about a month. And so I had to go shopping. And so I'm like, okay, so I'll get a cart. That didn't work. Is that when you smash some of the bottles you had to do own beer? Yeah, that was the home beer one.

That was a, that was a bad experience. Okay, cool. We still haven't done home beer in a long time, but, uh, but yeah, so I went to Trader Joe's and I was, I tried, I tested a push cart, you know, a real cart and I'm like, well, that's not going to work. And then, so I thought, well, maybe a basket and I won't work either. And so I'm like, I'm just going to have to go with my jacket. I'm going to start putting shit in my jacket. Like I'm shoplifting, you know, cause I didn't have a backpack or anything. And so, uh, so I realized the things you can't do is go shopping really for a lot of things, or you're going to make multiple trips, but you can make a lot of you can make a lot of damn friends.

Cause so many people are willing to help you when you're on crutches. There's a lot. I think, I think like three people asked me to ask to help me out to the car. Do you need some help, son? Okay. So it's a good way to find friends. Even if you don't have, I mean, that's, that's, uh, yeah, that will, that then this is where like, we kind of get like further from more of the, the, the, like this, this is regarding attitude just, and that's hard to change, but it's, uh, yeah. Yeah. I agree on you. It's just, it's so much easier to work on people that focuses on possibilities. Like those, those are the clients that tends to have better outcomes.

Yeah, I totally agree. It's tough with, uh, people who are a little bit more negative with, um, they, they, I know that they say this about like working with chronic pain people. And I know not all of them are like this. I don't want to stereotype them, but they, they kind of weigh on, on the providers sometimes, you know, you become the sponge. And so like, I love people who have more energy than me because they, I'm probably, you know, dripping on them and I feel better when I'm done with them and they feel good. You know, I'm not trying to be too negative on them, but, um, uh, as we start to finish up here, is there anything you think we need to talk about that we haven't yet?

Um, and also before we get to the end, you know, I know people tune out, how can we find the book when it'll be a book? Cause you have a website now you said it will be available. Yes, it will be available at, um, actually just give me one. It's a new venture. Um, uh, I want to carefully choose how I give the information cause it's technically a, uh, a website in French. Um, I can link it. You want to link it? So yeah, that's probably the best, but it's, it's basically, it's my initials with which means personal trainer. Um, well, we need to do a Facebook link or something in here. Yeah. I'll link it in the, under the show notes for everybody.

By the way, all these pictures are really artistic where you like, you know, the chicken one and there's an upward looking one in a position of power. Look at the underneath part of my chin, you know, and then there's staring off into the distance wearing a jacket that no longer has the sleeve or the, uh, the rope for the hoodie part. Very Jesse Pinkman. Yep. Oh man. Okay. That is dark. You want to, you want to, I thought you last time you want me to bust your balls. No, you brought that up, but yeah, um, we can link to my personal Facebook page. I'll give you also my email, um, my website and my like, uh, personal training, uh, Facebook page.

Right now it's pretty much a draft. I'm, I'm working on that. I'm really trying to just focus on getting the book done and then I'll try to be more, uh, about creating content. And, um, but yeah, um, I think the best way would be for people like if someone wants to let, let's say go through the series of email. Um, I'm very willing to, to just, uh, distribute that and collect feedback. That's always nice or people just want to, cause it likes in the next month or so I would like to have the book done and I'll start to like distribute it just to get a first round of feedback before I, I go to like one last phases of re-editing and then selling it.

So, uh, anybody that's interested, just like they can just contact me by email and, um, we'll figure it out from there. Okay. Sounds good. Yeah. Um, I, I plan on, uh, I don't know if I told you. I have a syllabus for, uh, interns that come in my office. Like here's rough timelines of where you're, you're, you should know certain skill sets. Here's things you should read. Uh, here's things you should watch and so on. I'm going to put your, your, your book on it that way they can just all know. Ah, that's very nice of you. Nice. Cool. Um, and I'll also say, I'll probably just send you the book as soon as I'm done.

I get a signed copy. Wait, these aren't print. These are e ebook, right? Yeah. It's going to be a, an ebook for, for now. I don't, uh, like if I can make like $250 out of that, I'll be so happy. That's going to pay for my PayPal button on my site. I'll break even. The, uh, would you have to buy a PayPal button? It costs 250 bucks. Huh? Did you have to buy it? I don't, I don't know how much it is. I do. I think I do. No, I actually, I could, I could work just like people sending me an email and then they give me a, like a, uh, uh, interact, uh, payments. And I just send them documents. The only thing I still need to figure out is like how to get something copyrighted.

That's the only real big step, but I haven't given much time. I'm pretty sure like there's a wiki page that will lead me through the, all the steps in like 20 minutes. Probably. Yeah. The, I started doing one of my books as, uh, as a hard copy. We just mail it to the people. And so, um, it doesn't cost too much to actually make, uh, the shipping is a little bit of a pain and I know international shipping is a bigger pain. So, um, E is the best way to go. You wake up and then you send out a couple copies. You're like, I didn't do anything. It's great. All right, Alec. Thanks so much for being on.

That was great as always. Uh, you always have a lot of things you can teach me because I, it's funny, uh, thinking of sometimes we have to really think about how we're speaking to people. If we're trying to, um, navigate the conversation as, as we kind of talked about, uh, in the way today. And so thanks for being on. Um, I'm sure we're going to do another one very soon. Uh, as I mentioned in the beginning, uh, we are moving the podcast to once every two weeks. Again, it's me, not you. Um, please go back in the archives and listen to all those. Uh, I'm going to make, uh, my, I'm going to make a big effort to make sure that every podcast that you do get every once every couple of weeks for the, in, uh, uh, I'm not sure how long this will be, uh, is only the best information.

So, uh, again, if you want more of what I give, we do have the premium version. The premium version is you can scroll down. It'll say premium version. It's very cheap. It's a monthly fee. You can do one month and drop it after that. If you don't like it, it's all good. Um, but in that I try to share case presentations, uh, as well as, uh, I'll share a little bit of the end of this interview after we stopped recording a little bit more about what me and Alec talked about. Um, nothing incriminating, I promise Alec, because I don't know if you knew the recording was on and, um, yeah, I'll share all the things that are just more than in a 15 minute format on the drive home from work.

So thanks for being part of the movement. We'll see you guys next time. Uh, you can always find Alec's information in the show notes as well below. Talk to you later. Bye.