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Kate O’Brien Minson and Karen Onderko had the opportunity to speak with Kim Barthel during the iLs 2016 Conference in July.

Follow along with the transcript below.

Transcript

Karen:

Hello and welcome to the ILS conference in Denver where Kate O’Brien-Minson, co-founder and President of ILS and I, Karen Onderko, Director of Research and Education are honored to be speaking with Kim Barthel. Kim is an Occupational Therapist and oh so much more. She’s a life long learner who incorporates emerging science from the fields of neuroscience and developmental biology into her practice and her teaching. She’s the author of two books and many chapters in different books related to occupational therapy. Kim has traveled to the furthest reaches of Canada to share her teaching, and she has a passport full of stamps from all over the world. Most recently, China, Hong Kong, Malaysia, Indonesia, and Singapore, where she’s teaching other therapists and developing services for children with developmental disabilities and trauma.

A great example of her practice and her nature comes in the form of a book Conversations with a Rattlesnake, which she co-wrote with hockey legend Theo Fleury. In it, he describes Kim as the “Wayne Gretzky of therapy” and a person of “relentless positivity”. Relentless positivity means so much more than what it sounds like on the surface and I hope we’ll get to that. The book is characterized in the prologue as a series of engaging conversations like you’d have with your most trusted friend over the kitchen table, and indeed, the tone of the book is just that. Readers are privileged to an intimate, honest, and informative ongoing dialogue about trauma, recovery, therapy, and what it means to evolve as a human. Thank you Kim for joining us.

Kim:

Thank you for such a incredible introduction.

Kate:

Thank you Kim. It’s good to be with you again and taking time out of your very, very busy schedule. I have a question that I’ve wanted to ask you for some time and that is that when I first met you, which I think was about 5 years ago, I was thinking of you as an occupational therapist who was really, deeply involved in the neurophysiology of your profession. The neuroanatomy, neuronal function, all of that and bringing that to bear on sensory processing disorders. It seemed that it evolved to be associated with attachment issues, and you have worked with numerous people with attachment issues, and now I see that so much of your work is involved with people who have trauma. Deep trauma. Did I miss something 5 years ago or is this been something that has evolved for you over time?

Kim:

You’re making me grin at this question because you’re going to ask me to reveal some things about myself in this question. I think that, in my view, things have always been connected. The challenge has been when is the audience ready to hear that? I think for me, there has been a deep desire for integration of these ideas for a long time. In the late 90’s, I started to speak about these concepts holistically, and experienced resistance to those conversations. As happens to so many of us, we become afraid to have those conversations because they are so vulnerable in our own selves. As time has unfolded, it has become apparent that he world is more ready to have these integrated concepts put together. And as each speaker that I listen to personally starts to pull the pieces together, it contributes to the courage that I gather in supporting my own thinking as how things have always been in my own mind.

I think the truth of the matter, to your question is, it’s always been there. But the courage to put them together and stand out there in the world, in the big picture, and bring forth ideas that are kind of on the edge of how people think takes a lot of impetus and motivation, and as I said, courage. And so now, I’m ready.

Kate:

What’s happened? Do you have any thoughts about how we’re now able to talk about trauma firsthand?

Kim:

I think that the emerging science of the brain has helped significantly. Because, as we have been listening this morning in the conference to Dr. Norman Doidge talk about: the mind and the brain are not separate entities. As we understand how the mind shapes the brain, we are becoming more comfortable with mental illness, trauma, and challenges in the way people behave as being something that is much more scientific, and less about your psychic self, that it allows people to feel safe to have those conversations. The dancing on the razor’s edge that I call it, of speaking about emotions has become easier as neuroscience has opened those doorways for the general public to feel that level of openness and vulnerability.

When they know that it’s their brain that’s contributing to their behavior, it doesn’t create so much shame. I think that’s the readiness that the world and our society is stepping into is that we all have these experiences that contribute to our being and that it’s part of our brain’s architecture that allows us to look at it with a much more objective view, rather than sink into the shame of, “Oh this is my fault and I could be different.”

Karen:

You’ve said, and I think you say many times, that we’re all doing the best with what we have. When I read that in your book, it resonated so much with me because I’ve spent years studying neuroscience, and I would say that my biggest takeaway is just that -increased tolerance. Because we all are in a place that our genes and our life experiences have brought us to. In a way, we’re all on some spectrum of dealing with trauma in some way or another.

Kim:

Absolutely.

Karen:

I wonder if that mindset sets the stage for your concept of relentless positivity.  What do you think?

Kim:

Absolutely. This beautiful conversation around epigenetics and how thoughts and experiences shape, not only the brain, but the very cellular structure of our DNA matter is a powerful sense of empowerment for people to understand that they have independent control, to some degree, to shape their own outcomes in life. I feel that that is deeply embedded in this concept of relentless positivity. When I can shift my perspective, my perceptions, and allow myself to look at things in a bigger, broader way with a view that keeps me slanted towards the positivity that I am affecting many levels of myself.

Rick Hanson in his book Hardwiring Happiness, he talks so muck about the brain being velcro for the negative and how much effort it takes to be positive. I often say to others, “I’m going to love you until you love yourself.” That level of seeing others through those glasses allows them to have a window into their own beauty of themselves through the eyes of another person reflected back at them. I think when that can be taken in incrementally then there’s an internal shift that happens inside a person’s architecture.

Karen:

Something that you say in the book, and I don’t know if it’s your number, or Rick Hanson’s, is that for every negative thought you need at least 3 positive thoughts to combat it.

Kim:

That’s right. That is definitely from Rick Hanson’s thinking. That is a scary idea that when we hear, I mean one thing that Rick Hanson speaks about all the time is how oriented and language shapes so much about what it is that we think. That if I’m in an MRI scan chamber and you say the word, “No,” by the third “no”, my cortisol is off the charts and the negative aspect of my brain is escalated, and my amygdala is lighting up. When you say yes, nothing happens in my nervous system. We are so survival-driven, and unless we can consciously and mindfully plug into that positivity, we are so driven by those negative forces.

Karen:

Relentless positivity can help turn it around for somebody else. The unconditional love that you show to somebody can help guide them to start shifting their own thoughts to the positive.

Kim:

It takes consciousness because many times in Conversations with a Rattlesnake, Theo and I will say to each other, “I know that you know that I know that you know that I know that you know that yeah, yeah, right, whatever,” because neither of us were capable of taking in positivity. It’s something that we feel ashamed of when people say positive things about us. When we have become so habituated to believe the negative, the positive just isn’t believable. It takes effort, and mindfulness to begin to absorb it, to believe it, and to live it.

Kate:

I’m just kind of, as you’re speaking about that I’m thinking about another of your mantras in addition to relentless positivity, which is: “Hurt people hurt people.” You have to say with the right intonation right, or else that sentence comes out differently.

Kim:

Right. Differently.

Kate:

Yes. It would seem to me that forgiveness has to be a big part of that equation, but that’s one of the biggest leaps I think for people to make. Do you agree?

Kim:

Absolutely. I think there’s a step missing in that question or comment. That’s compassion. Compassion and forgiveness are slightly different because I think that the word forgiveness is a common trigger for people because they see forgiveness as action. Meaning forgiveness, I remember I wrote an article called “Compassion for the Offender” and I collaboratively wrote that with my husband, Bob Spensley and Theo Fleury, and no other piece of literature that we have written created more public outcry than that particular article. People were completely negatively impacted by that idea that compassion for the offender would be something that we would promote, accept, or condone in any way. What they were believing in that statement was that it meant that I needed to excuse you or excuse the offender from the experience.

Really what it means is putting my mind into the mind of the other. That space of empathic connection deeply allows the opportunity for forgiveness to even be possible. It is not a simple process, but a journey of discovery where I can begin to take on another’s perspective and imagine what it might be like to be in their mind for a time that opens the way in my brain and in my being to entertain this idea that forgiveness is possible. Forgiveness is not a conscious, cognitive decision. It is an emotional process and it demands that I feel all the feelings along the way. Excuse my language but we have a chapter called “Learning to sit with your shit”, which is the words of Theo Fleury.

Learning to sit with your shit is connecting to every emotion that I experience in relationship to the things that I have experienced. You can’t skip those steps. In that process of learning to sit with your shit, forgiveness is a byproduct of that. Because as the emotional frequencies have less charge, the ability to sit in another person’s chair just happens as a natural state of being. That’s where compassion comes into play. I don’t have to allow that person back into my life. I can continue to maintain boundaries. It’s my internal state of being that changes. That’s where I think the misunderstanding of this process comes into play.

Karen:

I wondered if you had heard back from any of the people who gave negative reactions initially to this concept of forgiving your …

Kim:

Many, many, many, many, many, many, many, many, many, many.

Karen:

I’m so glad to hear it because you might not be ready to even hear of that concept where you are in your process. I’m glad to hear that as they’ve proceeded in their process, they’ve come to open to that.

Kim:

Sometimes you can see that shift in a second. In many of our Conversation with a Rattlesnake Forums, you can see that transformation happen in a second based on a conversation that another person has said which will shift a perception for yet another person in the room. I remember being triggered myself by a person saying, “I reserve forgiveness for the waitress who forgets to put ketchup on my hot dog. No one in my family will ever, ever forgive somebody beyond those levels of transgression.” I remember the trigger in me of counter anger, and then something very special opened up for me because I was able to put my mind in the mind of that person and realize the level of hurt and pain that was experienced behind those words and it stopped me from taking it personally.

That’s the compassion I’m talking about. When people say things that are hurtful, it’s really our own inner triggers that get ignited in response to the words, or the energy, or the experience, or the emotion of the other – and that’s an experience for us to transform. It’s never really about the other person.

Kate:

It’s just like in any relationship; if somebody, and I’ve heard this a lot over the years, when people say, “You made me angry.” That doesn’t happen. Somebody cannot make me angry. It is just my own trigger that got jump-started somehow and then I always know that that’s not a truth because if it were a truth, that means that you could say that to every other human being and they’d have the same response. If it’s pretty individual then it doesn’t have any real substance to it other than what’s going on internally.

Kim:

One of the things that’s become so fascinating for me, and it’s a working theory, I still have another 20 years I guess to work on this one, but I think there are 4 basic early developmental traumas that bring us to a place of our triggers. The first one is the right to even exist. Do I even matter? Second one is: not good enough. Third one is: abandonment. The fourth one is: not lovable. These themes seem to sit underneath our responses. Our negative emotional responses. And they are becoming evident for me in people’s non-verbal communication. Where when someone is triggered, it’s becoming observable in their face, in their body, in their eyes, in their vocal tone, as to which one of those developmental traumas has been hit. How that has led them on this cascade of events that evolves in their personality and the way that they respond in relationships.

I think that we get activated and the path back is mindfulness and being able to be curious about why I feel the way that I do about what’s just been evoked for me. That curiosity is a powerful word because it’s an open lens. It keeps me from judgment and opens me to wonder about why I might be experiencing things the way that I do.

Karen:

That path from being triggered by negative thoughts and emotions to one of curiosity is a difficult one to travel because negative thoughts and emotions can hijack your executive functioning, disabling your ability to have impulse control and to think normally, and yet you want to move to a place of curiosity to help overcome that. That’s a hard row to hoe.

Kim:

You know I think that question is the most important question you could ask because that’s why we called it Conversations with a Rattlesnake because I believe that’s in this place of conversation that opens you back up to those executive functions. When you can be in a safe conversation, it doesn’t have to be with a therapist. I’m having one right now with two beautiful beings. When you’re in a safe conversation and that parasympathetic nervous system availability for relax comes into play, you hear yourself differently.

You’re able to speak out loud things that you might not otherwise hear yourself say because mindfulness is different than analysis. We often mistake that. We think that when we’re in our own head, analyzing, or I say anal-izing ourselves, that that can look like mindfulness. When we are in conversation and people ask us the right questions, or they look at us in a certain way, or they say something themselves, it’s a dyadic social engagement experience that prepares that brain to be in a “just right” state to truly receive information differently. I believe that opens up and accesses a structure called the anterior cingulate which really allows that frontal cortex to process information better.

Karen:

It starts with a sense of safety which comes form community and safe relationships.

Kim:

I think, you know I used to believe, that you could do it yourself. That was my A strategy attachment showing up. You don’t need anybody else to shift yourself. I think that part of my journey in Conversations with a Rattlesnake was, it’s really a lot more effective when it’s in conversation with another person or with other people in general.

Karen:

Yeah, you don’t get stuck in “analysis paralysis” when you’re with somebody else, which you might be prone to if you were just trying to sort it out in your head without your body.

Kim:

My husband always says that every moment is a moment of reflection. Each person we meet has information for us, and if we are present to that, we learn more and more about ourselves. I think it’s that it can’t be by yourself. It’s in that engagement space, we were not designed to be here by ourselves.

Kate:

That’s beautiful. So beautiful. It feels like quite a shift actually. There is a question that I wanted to ask you while we still have time for sure. That is something that I’ve observed over the years that when, and because this is going out to so many therapists. What I’ve seen is that in the process of receiving therapy and I’ll talk about the child we know it happens for adults as well, the child will regress and the parents become alarmed. That creates, I think, an alarming response in the child and it’s hard for them to bind their anxiety long enough to see that something deeper is going on. Do you have a way of bringing some understanding to what’s going on?

Kim:

Wow that’s a huge question. That could take us hours of conversation. I’m going to succinctly do my best with that question. You brought up earlier in your comments around my love of the field of attachment theory. For me, attachment theory is a science of the brain. One of my favorite subjects way back in OT school was Therapeutic Use of Self, which in the 80’s, I wasn’t going to confess that, but in the 80’s was a very fluffy concept. In this era, the science of interpersonal neurobiology has shown us what happens between brains when we are in different states in a relationship. This is not fluffy, conceptual ideas that we affect each other when we are in different emotional states. Children and their parents have a very strong back and forth, I call it “serve and return,” that goes on between them dyadically that are phenomenon that’s translated in the brain.

The very architecture of a child’s brain evolves from and shapes from these early dyadic “serve and return” processes. This is what kick starts the right side of the brain especially into its regulatory functions. The right side of the brain is highly sensitive to negativity because survival depends on it. What is existent in a caregiver’s brain, I use that word caregiver carefully, it doesn’t always have to be mom, is mirrored in the developing infant’s brain. We have so many neuroscientific studies now that are showing us that what is alive in mother’s and father’s brain, is alivened in baby’s brain.

These are called early attachment patterns. These threads of hardwiring, that’s a really strong word, are default programs that we can access quickly when we are in survival mode so that in relationships that feel scary or threatening we will go back to those early default programs that we acquired in those developmental processes. Bruce Perry always says, “What we see in mom’s face, we can see in baby’s face. What we see in dad’s life, we see in baby’s life.” These are the transgenerational transmissions of trauma. This is a hard one for parents because they want a fix. They come to therapy often for a desire of change that looks like a cure or a fix. Their role is not neurologically easily understood by them. How they regulate or dysregulate a child based on their own role in this healing process for their children. I think that’s become part of my mission is to help families understand and see through a detached lens, not a ‘blame’ lens, how the work of the parent changes the inner life of the child. That is a very big piece of what it is that we do in our therapeutic process

This morning, Dr. Doidge said, “By helping parents understand their children,” and Ron Minson said, “Helping parents understand their children creates a huge gift not only for the parent, but for the brain of the child.”

Kate:

So eloquent. Thank you. I want to come to Part Two, that was kind of a very loaded question and Part Two of that is that the regression that’s going on within the child. Do we understand anything about what’s going on? Why there’s that retreat and outwardly, it appears as if going backwards.

Kim:

When you speak of regression, I’m curious what you mean specifically there because I think I may see regression differently than you. Can you be a little more specific when you say regression and what you mean by that term.

Kate:

It’s interesting because we differentiate between regression and reorganization, right. You’re right. Thank you. I will reframe my question because regression often happens when there’s too much stimulation. The reorganization seems to happen when, it may look like regression but in a milder form, when there’s just this internal process where I think healing is going on underneath all of that. That’s the one we stay with. that’s the one we allow to be there in a comfort zone, which is outside of our comfort zone, and allow the brain to reorganize its perceptions of the world.

Kim:

That was an example of my relentless positivity right there because words have so much connotation to them. That term ‘regression’ has a negative frequency and has then an alignment with fear. Is it really the over-stimulation or is it the fear that’s the cause or the creation of the disturbance. That beautiful term ‘reorganization’ has a positive frequency or a possibility to it and enables us to stay in a much more curious space about what will unfold. One of the things that’s very important for me as a therapist is being in this process of healing, to me the definition of healing is being in alignment with what is rather than fixing or curing.

The term regression, which of course is something that therapists become fearful of because we don’t want to do harm, is that fear of a parent that you have actually harmed your client or the child. If I stay true to my definition of healing – of being in alignment with what is – then I can walk with my clients through every state of their journey which may in fact look like some kind of reorganization or a negative space with the same simultaneous space of faith that things will move and change because they always do. That’s the part, I think philosophically, that is hard for therapists. To stay connected to the belief that they have not created harm, but that there is this wonder around, wow, look at the power of the interventions that we do energetically and let’s be curious about what’s going to arise here.

And to hold space for parents as they enter to fear without joining them in that space. That’s really tough. It takes a lot of inner work for therapists. I don’t really like to think of it as regression. I also love chaos theory, which means I used to be fearful of triggers and any type of negativity that would come my way. Now it’s my screensaver that I see those types of events with celebration. I call them ‘champagne opportunities’ because that’s where change happens. I don’t see it as negative at all. I can’t wait for it to happen because that’s when I know I’m in that system and there is an opportunity for shift.

Karen:

Is there space for a question that has something to do with changing course. There are signals that you see that should cause you to be alert to maybe considering a change in course?

Kim:

Oh definitely. I mean there is a fine line here between, I’m smiling as you’re asking me that question because I am such a scientist, but I am such an intuitive. I do believe those two can meet. That we take the two parts of information and they inform our clinical reasoning. This scientific knowledge that we have, the protocols that we learn, the clinical experience that we gather, combined with intuitive information. I’ve spoken already in this conversation a little bit about non-verbal communication. That is a real biggie for me because deep listening is also deep looking. The term listening for me is listening with my whole being, where I am hearing, observing, and experiencing the client that I’m with, the person that I’m with. And they are giving me the answers all the time.

Norman Doidge said this morning that when we are listening the information is revealed. I think that the change of course comes from that state of deep listening where I will see things, hear things, feel things, and I will say, “Hmm that was too much. I can see red ears, I see a red nose. There’s too much swallowing. The child is beginning to blink too much. There is a furrowed brow. There’s a shift in the hands.” These are the subtle, soft signs that we often think of as intuitive. Once we become better detectives of that information, we can use that data to inform our clinical reasoning to say, “I don’t have to be so pushy here.” Sometimes, less is more for this delicate nervous system to allow it to do its own work. I think that all have information, it’s a matter of how much we pay attention to it.

Karen:

You’re so right. I find as you were talking about this that I was actually being quite conscious of my own bodily tells. Wondering what signals I was giving to you, but I think it takes great presence and confidence to be able to pay attention to small signals like what you’re saying. Eye gaze, and facial expressions, or noses and ears changing color. I think it’s experience but, plus, being comfortable and confident in your ability to read those signs that allows you to get that information.

Kim:

I always think about “Fake it until you make it.” I’m very mindful of the fact that that term ‘confidence’ is a relative term. One of my favorite people is Brene Brown, who is always very elegant in this conversation around vulnerability. I believe that the more vulnerable that we are, the more confident we become. Using the term Kim and confidence in the same sentence is an oxymoron because I don’t feel that way, yet there is a state of something that is greater than myself, I think, that enables me to drop into that space of assuredness that my information is accurate. Whether it’s really true or not true remains to be seen, but it’s that space of connection to that information that allows me to feel safe in what it is that I’m choosing clinically in that moment. It’s again, a continuous state of ongoing development that I think probably never ends.

Kate:

Kim, as we’re kind of bringing this to a close, I would like to just ask about perhaps some things that would be helpful to our audience which consists of therapists of all kinds, educators working with students of all levels, and of course parents who are schlepping their load as well. What are some of the, to start with, what are some of the early things that you like to tell people? What is a message that you want them to walk away with on that first meeting with you?

Kim:

Wow. That’s a question that I probably really need to drop into to answer. Because I don’t know that I actually deliberately think of a particular message. I think for me, each person that I’m with tells me what that message is going to be. I think it’s about really being present to who you’re with that allows you to have the information that you need in the time and space that you’re with. Your question about, I’m thinking specifically here, about Integrative Listening Systems ironically because that’s the nature of this conversation. When people are coming to us for intervention, there is an implied state of readiness or a window because typically they are seeking help. That window is a great gift for therapists, teachers, educators. People who are in that journey with clients and it’s that willingness to walk that journey with your client that really makes the difference.

I have a quick story that might really illustrate your question. I have a client, I started seeing him when he was 24 weeks premature. He’s now 27, which makes me feel really old. He has cerebral palsy with athetosis. Recently – he’s in law school – recently we were having lunch and I said to him, “What did you think about having come to Labyrinth (the name of my clinic) for 15 years, 3 times a week for more than half your life?” I expected him to say all the things, the tasks what we did. He smiled and he said, “You know that saying, ‘Give a man a fish, feed him for a day; teach a man to fish, feed him for a lifetime.’? That’s what I learned in therapy.” He said, “Now that I’m 27 years old, and I’m in law school, and I’m preparing for court, do you think I waste any of my energy dressing myself?  But I sure know how to tell someone else how to do it. I learned more about myself in the process of the therapy context than I did the skills, and that’s what’s given me that path for my lifetime.”

So, I think all of us who support families or any human who’s coming to us for help, it’s really just willingness to be fully present to them. I make that sound so simple. It’s so difficult and I appreciate that.

Kate:

It’s very clear to me that you are a deep listener. Your patients are very blessed by that and so are the therapists and others who have an opportunity to train with you. I’ve been sitting on the edge of my seat this whole time. It’s just been so deep and profound. Thank you so much.

Kim:

Thank you so much for having me. Both of you.

Karen:

Kim, yes. Thank you so much!

 

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