24. Interoception With KIM BARTHEL

Want more of Kim, check her out here: Kim Barthel

This is our first ever Guest Episode, and who better to talk to than Kim Barthel!!

In this episode we continue to discuss interoception and making sense of this in treatment. We had a glitch with our video feed this episode so it’s audio only, but we so very excited to finally share this.

Our conversation covers many levels, from trying to understand and discern interoception vs neuroception, to understanding interoceptive processing with clinical practice examples and hopefully offers everyone new insights into how we can support individuals with different interoceptive needs.

You can check out the full list of possible workshops from Kim here: https://www.kimbarthel.ca/event-calendar

You can catch and connect with Kim online in a number of places:

https://www.facebook.com/KimBarthelOTR/ 

https://www.instagram.com/kimbarthel.ca/

https://www.youtube.com/channel/UCK8PsNYNlakx1qx0BCqTg5w?view_as=subscriber

Don’t forget you can take the Spirit and STEPPSI Course through DFX's learning journeys: https://dfxlearningjourneys.thinkific.com/

REFLECTION WORKSHEET (CPD Resource)

TRANSCRIPT: [00:00:00] Michelle: Hello everyone. Welcome to our podcast. We are so delighted to have a special guest with us today, and that is Kim Bathel, who's from Relationship Matters in Canada. Exactly where I forget. Kim is an esteemed, OT and friend of all of us, and we have, um, had the pleasure of having Kim in Australia and in our clinic and, uh, we did some treating alongside of. Which was again, a real career highlight. So we are very honored. We also thought that she's brave and creative and very progressive, and she would be the ideal candidate to jump on and have a chat with us on our podcast. as our very first guest. So we're very honored that you're trusting us today, Kim, as we, uh, yeah, trial how four talkative people and very passionate OTs are gonna navigate a podcast So thanks.

[00:01:00] Cory: Just quickly, you as our beautiful spirited conversations, people that join us in this conversation and listen, you are getting an insight into Michelle and my. Uh, I wanna say OT upbringing, like the minds that have like supported and helped Michelle and I thrive in the way that we think and, um, the deepness that we like to go into in these conversations. And, um, I'm just so delighted that people get, uh, to join us in this 'cause it's just like we get it personally in our own kind of lives and the, the chance to talk to these wonderful women. Um, but yeah, well, let's hope that you guys can see some of this process and, um, be involved in it. So, yes.

[00:01:57] Sorry, I just had to add that in there, Michelle.

[00:02:02] Kim: Thank you. Thank you. Um, interoceptively. I'm like jumping out of my skin. I feel all of the excitement in my chest. My energy just went up. Um, I can feel a little bit of the hair on the back of my neck. Um, my stomach is excited and I feel like this is dreamy to have the opportunity to be in conversation with these three people that I just adore.

So thank you very much for having me here. And, uh, I look forward to

what, what we're gonna create together.

Tracy: Absolutely. Absolutely. Yeah. It's a joy to have you here and such an honor, but I think that it is like a reflection of the way that occupational therapists, especially in pediatrics, support each other and come together to learn in community. And so what, what a gift to be able to share this. And I think that each of us are kind of, you know, having that like rush of, just excitement and also it's like very ooey gooey me right now.

I'm feeling so, uh, I, you know, Kim, you and I have gotten to know each other better over the last few years. Years, and you spent some very generous time where you were in Colorado, this last year for something that you were immersed in, but you were so kind and generous to spend extra time on your own and to allow us to spend some time just one-on-one together. And it really, this year has been kind of an anchor moment for me in a year of a lot of upheaval. And so I think that the reflection of community and coming together and finding passion and joy in learning is such an anchor, but it's also like a reflection of, um, how the relationships that we form with each other sustain us as we grow, sustain us, as we look forward to each of our own journeys and paths. And I am saying a lot here that is just sort of coming from my heart to you, Kim, but I think Cory and Michelle, we've shared, you know, really a lot of intimate learning moments. And we do know that this spirited conversations community kind of resonates around that, that this community of learning that is global really is intimate. And so we're gonna talk about intimate feelings, but we're also gonna talk about it from a more, you know, therapeutic perspective and neuroscience perspective. So I'm eager to jump into that and I'll stop being gushy here. But anyway, welcome and thanks.

[00:04:58] Kim: Well, I think Gushi is good because when we think about spirited conversations, one of the things that the three of you do is create a safe learning environment. And in that safety, I've been thinking a lot about safety lately, and thinking that safety is not enough, actually, that it's more about the sense of love, the sense of loving what we do, um, and really stepping into the deep willingness to connect with each other from a place of love, which actually just exponentially expands one's own capacity to take in new information and, and evolve as an individual. So, I feel, grateful for the safety that you create for your community.

[00:05:59] Cory: Very cool. have about a gazillion questions, so, um, I'm not sure which one,

Kim: I think you always do, Cory, you always do. When you're, when we're together, I just take a deep breath and next?

Cory: but let me allow some space for somebody else to talk Um, did you have anything specific, Michelle or Tracy that

Michelle: Cory, ask about the book. You genuinely asked about what books Kim was reading.

[00:06:40] Is that [00:06:40] helpful, Kim?

Kim: Yes. I mean, I think one of the reasons that I am deeply connected to this conversation right now is that I have been tasked with this writing of a chapter for the Childhood Trauma and Dissociation textbook. And so I have been eat, sleeping and breathing dissociation. And, you know, for, for those who don't use that word, uh, in their everyday language, my perception of it is a sense of disembodiment. And disconnection from oneself in their consciousness and in their being. And to me it is a disruption of interoception and can happen for so many different reasons. And as I was writing this chapter on trauma specifically, of course, uh, the other half of my brain is thinking about all of the children that we support, whose brains are wired differently, who live in spaces of disembodiment or fragmented embodiment, and how that impacts their self sense of self, uh, connection to the world.

Uh, and their connection to the people around them. So what am I reading? A million different articles. One article that I know, I've been reading about the default mode network. been reading, uh, works of Ruth Lanius and Sensory Processing. I know that Tracy, that, you know, that Article too, from stuff I've been reading from you, of course, uh, the Interceptive Mind by Securus.

It's a book, is another deeply informative, uh, thought provoking, text Antonio DeMaio and his thoughts on consciousness. And I'm also thinking about consciousness, the self and the vestibular system. And all of the emerging work, uh, Jeff Blank comes to mind as an author who's really looking at, how impactful and integrative the vestib system is to the foundation of Interoception.

So there's lots going on in my head in this moment that is just kind of evolving, uh,

as I am reading and preparing and thinking about all the things that relate to this Was there anything that caught you by like surprise or that felt really like on the edge of something new or

You know, one thing that I was grateful for, and I, and please don't ask me exactly where I read, I read this in this moment. 'cause I don't think I can pull that out of my brain in this second, but I have always, um, Felt like interoceptive perception involve much active thought. And in the most recent, review of Interoception Neurobiologically, it seems that it incorporates more cognitive awareness than I thought.

And, and so I, I mean, actual thought based awareness and that was both, uh, evoked, frustration, surprise, appreciation, and relief. Those emotions came up because for so long, I have a confession. I felt quite irritated by a focus on trying to teach interoceptive, perceptance cognitively, the primary point of entry.

and how, the underbelly of sensation and the flow of sensory, information was seemingly not equally as emphasized. And so as I start to appreciate the breadth of the circuitry, as it's starting to become more teased out specifically, it, it really is a circular process. And so that made me rethink.

I love it when I come up with a hypothesis and then I have to go in a different direction.

It's very humbling, uh, exciting. And, and also, uh, dysregulating.

Tracy:  absolutely. I think that, is so beautiful to share that and, you know, just how it is this continual journey as the science unfolds, but also what can happen as the science unfolds. And this may reground or, or be an interesting thought, Kim, for you and I to kind of wrestle with. And as the science unfolds, sometimes new findings pull everyone's attention, like the shiny object in the room. And there's so much focus right now. On the anterior parts of the insula and these higher structures that connect interceptive processing to thought and to mind. And the, kind of seeking for what is consciousness and what is mindfulness lands us in this beautiful place of understanding that interoception is sort of the mind-body connection in so very many ways. And yet that's the shiny object that catches a lot of attention. But we have to remember that interoception is also pre-perception and it's the primary fodder of neuroception. And so much of what happens in the lower parts of the insula before it becomes conscious is actually where the action happens around safety and love. And so, our awareness builds on that, but it's always both. It's a both and it's not an an either or, or, and I, I just wanted to bring that out because I think it'll, um, be important for us as we think about this work in our own clinical applications, but also in the mind blowing way that it influences our own, moving away from stress, moving back to restoration, moving through moments of dissociation that any of us may experience. So, yeah. Yeah, that's where, uh, that's where my mind went,

Kim: You know that term that you just used of rounding it out? When I come back to my thinking around disembodiment and my experiences clinically with children and adults who have experienced so much survival in their lives, that talking about  what do you feel in your body just doesn't get it. Doesn't create any of the sense of safety and uh, awareness.

And it is so much that pre, conscious perception that allows the person, I think, to begin to land in their body from the place of beginning to trust again, being in my body. And to me, this meeting multiple levels of input sensation from the body, from co-regulation and attunement. Something I know that we all love in our conversation here, which I think and know is interoceptive and how interoception begins, as well as the language and meaning that we make. Out of what we feel, what we see. And to me, uh, the dialogue that we are having around interoception is holistic, which brings us all back to, the whole brain working as a, an integrated way of processing, rather than one direction or another. Interoception from

[00:15:45] Cory (2): Can we clearly distinguish neuroception or is it just like, is neuroception a whole bigger process, circuitry, brain, body process, um, that involves, you said, interoception is fodder for neuroception. I think you said Tracy, but, um, I'm just, I like I think my head's not fully wrapped around the neurological process that is neuroception So, and I know it's really strongly based in sensation and process of sensation, and so that's not just interoception, but maybe you can, we can tease that out a little bit. Is easy to We that I think know to some levels. Go ahead, Kim. I'd love to hear your I'm, I'm, I'm thinking about words again. Like you always, you know, remind us that the language that we use I think it's important for your thinking that we all might not share words. We might share words, but this is part of what the intention of your wonderful podcast brings is a shared vocabulary To me, neuroception is assessing into something that is got a perception to it, that is fed by the sensations of meaning at a very sensory based level, as well as a, an affective level that create the perception, sort of like a raw rudimentary perception that you might call neuroception, but a, a neuro perceptive radar. I always have a picture of a satellite dish on my slide when I'm talking about neuroception because it's like, A satellite dish that is looking for tracking, uh, becoming aware of the sense of what it is that I'm experiencing in the context that I'm in. And I, I feel that Tracy elegantly said there, that interoception is part of what feeds that intuition,

[00:18:20] different things. Yeah, I think they are as well. But

[00:18:23] I couple of

[00:18:25] the idea of neuroception is that,

[00:18:28] satellite dish, I love that. I think that using the concepts that it's this continual surveillance for the purpose of detection, for the purpose of mobilizing whatever resources are needed, related back to what's surveilled and detected.

[00:18:47] So it's not a single thing. It's this very kind complex function. And interestingly, Dr. Porges is really quite Specific in saying over and over again that it really isn't perception, it's below the level of perception. And so, you know what's so tricky about sensory integrative processing is that we have processes that become perception, it just in nanosecond later. And so it's really hard to draw the line. And it feels like in our learning, we want things to be kind of identifiable in a clear sequence. But what happens is that it's continual processing. So even if we could sort of say, okay, we're gonna arbitrarily start here so we can say there's sort of a sequence, immediately it becomes non-sequential because the feedback happened from what just happened shapes what just that hear the seeking of the sequence in my question. said. Well said. Mm-hmm. One One of the things that's been really blowing my mind lately is, and uh, Tracy and I talked about this when we were together in Colorado, was of the work of Lisa Feldman Barrett, and I just heard her say the other day that we never live in the present moment. That our, uh, brain is always 15 milliseconds ahead. Of the present moment because we are a predictive brain and circuitry of the nervous system is putting into, awareness of a sense of what happening based on what it thinks it's happening. And I think that that is like a feedforward loop, and that's part of what blows my mind with this concept of sequencing of order, is that I think it's more of a comparator or a reconciliate or a, um, the brain is, is looking for dissonance equanimity

[00:21:10] based on what it knows and what is happening. That is so non-sequential, makes this

[00:21:19] hard to tease it out in the way that we often think about the brain.

[00:21:24] Tracy: Yeah abolutely so that future oriented processing is also one of those things when we work with kids either who come from experiences that end up disrupting the ability for the brain to stay in future orientation, pulls them into this very sticky place of not being able to catch up to that. And so you see that perpetuate. We also see that in kids who have weakness in their modulation or discrimination processes, and that could get really into the weeds. So we won't go there too much, I don't think. But. When we have kids that don't come from necessarily a trauma background or other disruptions to their neurobiology that we can understand externally, or internally, but where it's coming more from this basic disruption in sensory integrative processes that also can cause this sort of dissonance and this inability for the comparators to make sense of what's happening. And then you get this widening disparity that is so hard to reconcile and kids get confused and lost and they can't make progress. So I love that description because it sort of applies to really the whole breadth of the clinical populations we would see for one reason or another. And it's what just experience when we attune to

[00:22:58] felt experience that there's a mismatch happening so massive.

[00:23:03] michelle: Can I go back to the Interoception, neuroception just for a moment? I've always, considered neuroception external to the world. So can Neuroception be internal? So my sense of, you know, my, um, Chrome needed updating 27 times before I logged onto the podcast. Can my sense of worry about missing out that was internally driven.

[00:23:30] So my heart rate up is Neuroception. is Neuroception applying to internal environment or is that a little bit different? Is that more clearly interoception and neuroception is the outside world. Can I, can I think about it?

[00:23:48] That, or Cory and I like still wanting to box all these concepts.

[00:23:53] Kim: Oh, I just love that question. I'm gonna give you a go as to how I think about it, but we'll see if what y'all think. Um, I think about input of all kinds, whether it's I'm lying in the bed in the middle of the night, it's 3 o'clock in the morning, and all of my sensory input is perfect from the perception of my, my body's state of comfort.

[00:24:22] I can be in an absolute state of chaos from what I'm thinking about and how these circuits that we talk about are loops. I think of them as loops of integrated interaction that can be entered into from any point. That can influence the other aspects of the circuit and cognition, darn. It is a really influential, neurochemical feed that biases, I think the system and changes the valence of the perception of what you're experiencing.

[00:25:04] I, I think that's a lot. What we try to do with things like mindfulness with self-reflection is we try to take care of that piece of the circuit, by managing our mind. In my experience, it's the slowest path, most difficult path in my personal experience. but I do feel that it has a tremendous feed. Into the whole of the system that can influence a readiness to be more hypervigilant or more oriented. My sister has Crohn's disease and the internal sensations of pain are, she would report that there's no question that that pain is influenced by thought in both a positive or a negative direction. So I, I do think, that's my opinion, that there is a circular aspect

[00:26:16] Tracy: absolutely. absolutely. You know, neuroception, as is true with most sensation, it's the inside, the outside and the in-between. Sometimes when we think about the in-between, we think about that as the in-between me and the environment, or me and you guys, or me and the folks around me, the beloveds or the, folks that I'm curious or wary about or the, or whatever that might be, right?

[00:26:43] That's a landscape. But we have that actually with our own minds. So if you think about wariness that you meet yourself or the ease with which you meet yourself, it's a state and Neuroception responds to that.

[00:27:02] sure.

[00:27:03] Cory: Whew, this is getting deep!

[00:27:05] Kim: Well, and I think trauma is a great example that if you, experience especially a developmental trauma, it implicitly and perhaps explicitly influences how you perceive the world and can set you up to experience relationships and people and the environment as inherently safe or dangerous and it's kind of like a entering into point of being that can influence and shadow aspects of your life. So I, I feel that's part of the neuroceptive influences is your history lies in there in what the neuroception is going to detect.

[00:28:02] Cory: Oh, I'm trying to think about where we apply this holistic

[00:28:05] approach to this concept, in the moments with the individuals that we are with. Um, because what I'm hearing is that there's this preception meaning like before my really thinking mind is even aware that something's happening, things are

[00:28:28] happening, and then there's the actual event of my brain being involved in. Figuring out what's going on. And I'm guess I'm talking about my interceptive experience. So there's pre and then there's the brain that's involved, and then there's the, oh man, we're talking about the comparator of the brain, like the brain's expectation of what's gonna happen versus what actually happens. Um, and then also like if I have disruptions in the way I process the sensations internally, externally, whatever, then my, um, I guess the brain might struggle to figure out what might happen next or what happened might next might be scary. Um, I'm just trying to think like how, so I've gotta keep in mind all of these pieces when I'm working with a kiddo.

[00:29:21] So I've gotta think about, uh, I guess I need come to an example so I can piece it out.

[00:29:27] can So

[00:29:29] michelle: 

[00:29:29] I've got one.

[00:29:32] oh, session yesterday. Well, I've got, I think I've got one I was in session yesterday with gorgeous little neurodiverse kiddo, three and a half years old. He, was in the ball pit. We were playing, um, dinosaur games, and he's starting to think about numbers.

[00:29:51] So we were counting the dinosaurs and adding a stroke to the board of, for, you know, number one dinosaur. So it was squishy, and then he'd throw it in the ball pit. And then after we counted 13 dinosaurs, we hid them and then he had to dive in and collect them. We're improving somatosensory, uh, and meeting his somatosensory needs there. Uh, he was really into the game and, um, his attention can wander sometimes, but he has had multiple weeks where he is with me the entire, as long as I follow his lead and attune really well, he's with me the whole session. This session, I could tell he was really interested in the squishy rah rahs he calls them the squishy dinosaur rah rahs that we were throwing in the pit.

[00:30:39] But he kept going back to mom and he'd go back and just kind of grimace. And then mom's like, whatcha doing buddy? Go get the rah rah with Michelle. And so, um, he was coming back on the third or fourth time, he was like, oh. Um, tummy, he's probably got 50 words, but he came out with tummy and then, um, I was like, oh, something's happening with your tummy buddy.

[00:31:08] And so he held his tummy and and then, um, you know, we kind of soothed him and then he perked up and then went to get the rah rahs. And as he was in there, he just looked up at me and mom and did this, um, uh, he passed a bowel movement and so he, and he had a continence aid on, but he was like, oh oh poo. Sorry for the example.

[00:31:39] But it was, it was, um, And then, so we went back over to mom and we all looked, and then I tried to thread the interceptive loop because he was feeling a, my guess is he was feeling a thing. It was pulling him out of the activity. It was pulling out of relationship with me. He was sitting on mom's lap for co-regulation from mom that was more than I could offer.

[00:32:04] Like he, so I, even though he is super invested with me, he went to her in this, I guess whatever was gurgling in his tummy or the pressure sensation, I don't really know, but he was like, oh, interrupted by something internally that pulled him out of the activity, go to his, you know, primary co-regulator mom. And we, he didn't have the words or the, probably the interceptive, mom said later that he's never paired that together. Um, so we, I think it was a new interceptive sensation for him that we were able to put some words onto and then look, it got messy. So I think she said he'd been much quieter over the last few days, so she eventually, you know, as she was leaving, so there was a quick exit.

[00:32:48] She was like, I, I think it's a diarrhea. Anyway, it was awful experience. But I just wonder that all this happened in this little experience that unfolded that he became very aware interceptively of something and he sought a co-regulator and then he went back to the activity and it kept persisting. He did have moments of what is going on. I don't think he had the words or knowing of what this sensation, what was coming up next. I don't think he knew what was coming up next. And then we put it all together anyway. I wonder whether in there there's a little bit of a, um, an experience of this coupling, I guess, of all the concepts that we're talking about. Interoception, his perception of I think he neurocepted woooah, something's not right. You know, regulation, co-regulation, that forward planning of what's coming up next. I don't think he knew, eventually till the stool was occurring and it was like, oh poo. And then, you know. Anyway, that's my example that happened yesterday. Nearly lifetime.

[00:34:03] Cool. Great example. I wonder if Somatosensory sensation pre the event Michelle helped him to find the language suspect it would like, you know, in the processing for him. Um, but also wonder 'cause if the Neuroception piece is kind of preception and he had that mobilizing or the stilling. Then I'm trying to piece apart bits of what applies where. So like, I guess he's got that whatever the signal is internally, that from his gut, whichever part of his gut that's maybe cramping or something's happening. Um, and each time he does that, he mobilizes towards mom. And I don't know, seems

[00:34:48] almost like in that, um, space where it's not an intentional strategy, that

[00:34:54] makes sense. So,

[00:34:55] you know how we talk about like strategies regulation? It's like, I thought was like, something's coming up and I don't have a predictive knowing of what that is. I'm just going to mom, I'm Yeah. I,

[00:35:10] think I agree with Yeah, I was thinking. But what is that, right?

[00:35:14] are.

[00:35:15] Kim: Well, I want, I wanna to jump in and say something here about about attachment, because what you're describing from how you're describing it, uh, speaks to secure attachment. That when there is a perception, a neuroception of danger or discomfort, that the approach mobilization comes only in the conditions of safety with a co-regulator.

[00:35:50] If a, caregiver or a co-regulator is perceived to have more danger than the danger that I'm feeling, I will not approach through that nature of,

[00:36:04]

[00:36:04] Kim: In order to be able to make meaning out of my, or have someone hold space for me. So, you know, there, there's that element in what you're describing and, and what neuroscience is telling us is, especially through the right orbital frontal cortex, is that when I experience pain, danger, lack of safety, and I am in the presence of someone holds space for me.

[00:36:35] I learn hold space for myself and through that tolerance, experiencing what I'm experiencing, the interoceptive connection grows, and I develop a greater sense of connection to me, connection to my own, uh, living experience every day, as well as how it balances my emotions. Because in this conversation back to the beginning of dissociation, um, I always talk about there's a thousand faces of dissociation.

[00:37:11] Uh, it can be little shades of it. If a parent said, oh,

[00:37:16] stop. Don't worry about it. Just go back to being with Michelle. Get back in that ball bath and, you know, carry on with a little bit of intent. You know, dismissive, intonation in the that can. Be a cue that can disconnect interoception. So the, this attachment rule has a place in either, I think, in either accentuating the interoceptive trust. Or minimising it ah dependent on how that's received.

[00:37:59] michelle: just on that Kim, that there was a little bit of a flavor of that when first came because it was less obvious. So it was a bit of a, what are you doing buddy? Like, where do you go back to play? So it wasn't a sharp dismissive, but it was a, I don't understand what you're doing here, sooth, sooth, but off you go. But it, it did change. So he was resilient. And I guess what I was gonna say, that he was resilient enough to go back. He probably went back two or three times and we were like, oh, what is happening? Like this is a little unusual. And so there was a real softening then to, oh, this just isn't him being distracted or getting a bit dysregulated 'cause Michelle didn't find the rah rah fast enough. Like it, it, we both understood there's a different flavor here. And so it, we both softened in and um, yeah. Yep. So that, that kind of did happen. The two things happen. It was a smidge dismissive initially that he was attached, um, and resilient enough to go back to the person, to beautiful mom who to try again and again to have his needs met.

[00:39:08] Kim: You know that's the scaffolinding, that wonder of repair, by the way

[00:39:14] michelle: Yeah. Yeah.

[00:39:16] Tracy: it absolutely is it's t attuned relationship, The brain and human beings are simultaneously processing multiple goals. We're processing, let's be regulated in our bodies so that we can be safe and explore. And I'm interested in numbers and that's so cool. And I'm interested in this play with you in these dinosaurs.

[00:39:45] And so you have all of these goals going on. And when we as, observers or participants with children, we tend to assume that those lower levels of regulation are being held when there's higher levels of participation and engagement. And we have focus on the game, on the higher level, play on the high capacity, so that wooing to higher level capacity is a part of our interaction. And what happens when we have a child who gets a cue from their body something's changing physiologically or emotionally or their intention or whatever is changing. It takes them a little bit of time to shift and it us a little bit of time to shift. And that process

[00:40:39] toggles based on cues and the stronger the cues are and the kiddo, more likely we're gonna start to pick up on them.

[00:40:49] But it, it often isn't in the first or second trial. And we know that, you know, that experience of kind of like, this what I need, but I can't quite tell you why is actually matching where his little brain was getting a cue from downstairs brain. And it was competing with what was happening in his upstairs brain. And it was starting to draw the resources away from the play and the ideas and the cognition and drawing heavier resources into uhoh my tummy really hurts. I'm really uncomfortable here. Something's happening that I am not in volitional control over anymore. And all of that's competing with what I really wanna be doing.

[00:41:32] So you kind of tension as the brain shifts that dissolution away from high level

[00:41:40] brain to lower, you know, signals, the signals get louder down here and says, stop paying attention to the dinosaurs So takes a, high degree of flexibility and attunement, which is also what builds capacity anyway, through the little mismatch and the little error and little repair happens. So it's all such a beautiful way that whole system interoceptively neuroceptively is pairing to help us find Need.

[00:42:13] michelle: You've made me think of Kim was that, um, feed forward component because he's just got this emerging interceptive skills. He's in continent. Um, so because that, He hasn't paired those sensations in his bowel bladder with Oh, I know what's coming in next.

[00:42:34] That predictive component, you and I would go, oh, I've gotta go Michelle Session's over. Like, foresee what's next, and hopefully in this live podcast, it's like, we would just be a, I'm done with that now and I think done it with Cory, stop the conversation. I really wanna do it, but I go where he didn't have the predict predictive element to know. So he did dance back to me multiple times. Yeah, so I was, felt like I was witnessing that pairing of downstairs body cue with a cognition of poo toilet time to go. You know, that we don't, we are not always in, certainly in the clinic able to experience that, particularly for the bowels and bladders as you know, in the moment as there. that's why I think it was a bit, um, backwards and forwards to Trace is that he didn't, he hadn't got that together yet to go. This equals that. So we just gotta go and stop playing around with that really juicy rah rah game Michelle. It's the time to go signal.

[00:43:41] Oh.

[00:43:42] Yeah.

[00:43:42] Cory: Uh,

[00:43:43] it was

[00:43:43] such a good example. No, I just, the only reason I thought maybe another example is because we've talked really strongly here, I love about the bodily signals in relation to bowel and like taking care of my, um, basic like, like the need for toileting or thirst or, but I'm also wondering about the emotional, um, interceptive labeling and experiencing that we often have in our sessions.

[00:44:06] And so I was thinking of another example I guess to highlight maybe a more of that flavor and just to really, um, simple example, Which we, I think a lot of pediatric OTs will come across just, you know, you have a, a child sitting on a, an exercise ball, and maybe you move them in a certain direction and you see the, a bit of a startle or the eyes are the, the widening of the eye and the arms come out and, you know, when there is a resilient c in that, or if it's not too big a mismatched to their capacity, and, if you are attuned, you can catch it and sort of say, whoa, I moved you a bit fast, or oh, that might've been a bit, a bit scary. You know, so you can sort of catch it and, and connect the cognition to the moment. Yeah, so I'm thinking like there's the preception mobilized response and then there's me narrating and catching the processing cognitively around the experience. Um, but then there's also, if the mobilization is bigger, so say that happens, maybe they're on a swing and it, for whatever reason, experience was not, um, enjoyable or it felt scary or whatever, and they mobilized fully away so they flee, um, and hide. Um, or maybe they're angry as well. So, you know, I guess it's trying to, um, catch the what, where did the processing, create a bump? Where was the bump in the processing? Noticing that, and then also helping them with that created a certain feeling and whoa, I'm really sorry that I. I went a bit fast and that was kind of scary. No wonder you're a bit mad at me is that a good example of sinking these pieces of the process together? Yeah. I'm just wondering how we can think about it in lots of different ways, I guess in treatment.

[00:46:05] Kim: I feel like there's another layer

[00:46:08] michelle: Good.

[00:46:10] Kim: as I'm listening to you, and it's our non-verbals, you know, um, because in that circuitry, the words, are late, uh, sometimes in the arrival of the sequence such that there really isn't a in the arrival of the integration of the information and, and, the nonverbals are processed very early in the layers of the brain and so much of how we feel felt. By another is through their nonverbals, through their eyes, through their voice, through their expressions, through their bodies. The tension. You know, we do so much with our hands in our work, our hands on kids, and we communicate affect through our own bodies touching their bodies, sitting next to them even that, those pieces of sensory data, contribute to the holism of the awareness of information. And this can be helpful or actually can make it worse, that if a child has an experience in interoceptively, that feels quite intense for them. If we join them in that intensity, uh, for too long, then we can exaggerate their experience just in the same way that dismissing an experience can cut you off from your perception of what you're feeling. So that's where co-regulation comes back in here again, in attunement is not just what we say but how we say it. That allows the child's, integration of the experience to have a meaning that expands their resilience and to be comfortably uncomfortable.

[00:48:25] Cory: You moved directly into my question prior to this podcast that I brain dumped all my stuff over in the hope that I wouldn't continue to try and, oh, sorry,

[00:48:36] continue try and like get my word in in

[00:48:40] this. I was like, how am I gonna keep myself quiet? Um, I, one of the questions was when you don't have the words, so we have kiddos that don't have the words.

[00:48:52] And then I was like, is the interceptive capacity built through the attunement matching of the affective state, the mirroring in that, and then maybe labeling with like a, a yucky or noticing that it's yucky,

[00:49:08] Kim: Well, I think that's how it for infants.

[00:49:10] Cory: Yeah

[00:49:11] Kim: know, I always think about infant that I. Is in their crib and they're crying and their tummy hurts or they're hungry. And you know, imagine if I stood over the crib and just looked in silence and the baby continued to cry, versus if I say, oh, and my face, you can't see my face right now.

[00:49:36] But it's matching the affect of the child so that the child's brain, not just, not just their cognition, their actual brain, the von economo cells, which are part of the mirror neuron system actually light up like, okay, you're, you get it. We're in this together. And it's through that mirroring. I think that the baby's circuitry starts to

[00:50:12] say, okay, what I'm experiencing has meaning to you, so has meaning to me.

[00:50:17] Cory: mmm

[00:50:18] Kim: And that that on, goes on I'm just thinking my, my elderly mom who has dementia and, and how profound it is even now in state of being

[00:50:36] Tracy: Yeah. Well, it's also, it's absolutely all of that, and it's also that you're continually inviting a return to safety in order for the information, the meaning to be able to take shape that creates the meaning that will stick for future orientation.

[00:50:59] The thing that's so tricky is that, you know, the valence that happens, the tipping that happens whenever you move out of comfort and you move into whatever that trigger is, however big the discomfort is. But if it's big enough to mobilize the person to move away from engagement on whatever level, what really happens then is that the meaning that gets laid down on top of a lack of comfort is entirely different than the meaning that gets laid down on the base of comfort. And so with babies, we really intuitively know that soothing and the queuing of our match, the queuing of our face, but it's also the total incubation of comfort.

[00:51:48] We're really offering the neuroceptive cues of safety of you. You belong here, I'm here for you. Things are gonna be okay. And we do all of that. And then the meaning starts to take shape in a really beautiful way. I think sometimes with our older kids, we forget that we have to land it on that foundation of let's make sure you're feeling so connected to the safety that you and I can create together. And meaning comes from there. Sometimes what happens, especially I think as any of us are working to offer, interceptive awareness or whatever, that we start to focus too high in labeling and naming and bringing about awareness without remembering that you have to begin at that base.

[00:52:43] Kim: I'm so grateful for that. Thank you.

[00:52:46] Cory: I have a burning question this over attuning to, or not attuning, maybe caught up in the emotion as the co-regulation. I don't know, but I have a question about, um, too long in it with kid. And I'm wondering about, um, our autistic individuals

[00:53:10] or individuals with autism, however, the name wants to fall.

[00:53:14] Um, but sometimes I notice if I attune, I it's almost like the affect or the trigger kind of re triggers or something. Yeah. And I don't know, and sometimes I feel like unsure how to let them know that I'm okay if you have that feeling. Um, and how do I help you get forward out of the feeling without dismissing the feeling? So, I

[00:53:41] dunno, like sometimes I'm not sure I get that balance right.

[00:53:46] Tracy: I think it's also, it's one the things that I do really feel like the, the A in the spirit model, the way that that's conceptualized is that at the foundation you have this really basic neuroceptive valence of safety and comfort. But what we have to remember is that the top parts of the insula, the top parts of the dorsal lateral prefrontal cortex and other parts of our executive functioning system, it's a motivational biasing system and it works off of the same valence. And one of the things that happens when you get tip, uh, in a negative direction, away from comfort, away from safety, is you, the brain starts to rapidly produce a lot of protective, automatic negative thoughts. Those are those ants, right? Automatic negative thoughts and those little ants and they crawl and they, they get really abundant. So what happens is then you start to see and hear negative affect. You may see and hear negative language, you may see and hear a lot of stickiness around things that are coded in this space of hard,

[00:55:02] And it's all just a reflection of the valence. And so it's easy for us to get hooked by those automatic negative thoughts too. We see the negative affect we sometimes overly empathize with the negative. It's not that you wanna dismiss it, but what you wanna remember is that that's the color that's happening because the valence got tipped. So we have to return to attunement and safety and mother and kindness, and openness and compassion, and allow that.

[00:55:34] And what happens positive is the aunt scatter and that it allows for the positive you don't have to soothe every thought, every worry, every memory, every anything. You just have to allow the nervous system to remember that the foundation of safety's available I'm again, I wanna come underneath a little bit and speak presence. Just, you know, nevermind, Cory when like I have to get this just Like you know, that, that idea of, uh, responding in the best way, I think the intention to be present, by the way, the word intention is, I'm using it very intentionally is all about priming the, the state of the brain to be ready for something. And if I have the intention to be present, that in of itself is a feeling that I matter. And, it, in a sense cuts us some slack us as clinicians and parents, thank goodness and grandparents, uh, that we can actually, be not quite perfect in what we say or how we attune, but that there's a felt sense of love connection that kind of, supports the holism of what's unfolding.

[00:57:30] You guys, I have a really interesting story to share maybe you can, help me unpack that was quite magical. That happened just this week. So I was at our moving to higher ground camp, there was a little guy with his therapist that was supporting him.

[00:57:49] He's about five non-verbal autism spectrum disorder with big open eyes, eyebrows glued to almost the top of his forehead, bouncing around on his toes, eyes up and out, gazing at a distance, pacing constantly. You, you, I know you feel 'em as I speak 'em. And his clinician was absolutely magical in her capacity to gracefully connect and orient her body and use her voice and things that we try so hard to do all and all of a sudden I thought, he doesn't know this is what happened to me. I was watching them from a distance and I thought, he doesn't know what feelings are hers or what are his, and I decided in that moment to support them by introducing the Safe and Sound Protocol music to her. So I put the headphones on her and he stopped dead in his tracks, feet came down.

[00:59:07] He oriented in her direction. He put his hands on her cheeks and he started to cry and it was like he was looking into her soul and then she started to cry and her response to me was, I feel so responsible because he was feeling my sadness.

[00:59:33] And it was just a reminder of how permeable some of our kids are in their interoception disembodiment, that they actually feel things you and I are even less aware of, I think. And this, he then took her hand and dragged her over to the lycra swing for the first time in his entire, know, life of therapy and was. It was kind of wild to watch and, and It just, I speak to it 'cause I'm wondering if you can can all on how you think we play the neuroception landscape and the interoceptive landscape of our kids

[01:00:28] Cory: That's probably why I was asking the question. I have a kiddo at the moment that, little things upset her in a big way and I wanna let her know, like, I can see you're

[01:00:40] upset, but um, we'll go when you're ready. You know? And I'm trying to play around with like, how much do I look at her directly in this process and how much do I, um, play with my tone of voice or how much do I reduce the language altogether?

[01:00:56] Do I pretty nonverbal. She's 13. Pretty nonverbal. We have a great time. I really, really enjoy her. And I'm just trying to figure out, like sometimes I, I feel like, oh, I'm just exacerbating it. Um, and then, and then there's like on one part of me that's wondering like, how is it, how much of it is it me?

[01:01:14] Just uncomfortable with the fact that she's upset. Um, and, and, and you know, obviously when she's upset, she uses all the strategies that she has, which include hitting her legs and, you know, whacking things nearby. And never in an aggressive way. I just know she's just trying to manage the intensity of the experience. Um, but Tracy, you are comment around that. You don't need to continually attune to the, the affective experience, but just to continually offer

[01:01:49] the safety anchor, um, as the option. And so that helps me now probably navigate that landscape. Kim, your story is just such powerful reminder of, your

[01:02:03] comment around know, the only person that you can change is yourself. And so the process of coming to master, like what is it about this experience that's maybe a little tricky for me? Or why am I thinking, why, why do I feel like I need to push in that direction right now? Or that, um, that's so true, and it's always really good to be reminded that individuals that we are with sometimes, like our they're at at Susceptible to our stuff

[01:02:35] Michelle: I have a similar experience to that Kim and I was pretty tired. On a particular day last week. And mom had said, how you going? I was like, to be honest, I'm tired, but I'd had my fine face on and I had my game, you know, I was ready to play. But, um, we've known each other for years, so it was like, oh, I'm not fine. Like, I'm tired, but I turned up and anyway, she left the room and her little cherrub saw straight through me. He didn't hear, he wasn't in the vicinity to hear me say that. And my faking fine was he was all over it anyway. In your example, I guess Kim, I just can say even though, I think it's that that really neuroception really base level of safety, not safe, that I didn't have to be off much. And he was like, well, the landscape has changed. And have you got me today, Michelle? And because it doesn't feel like you had me, like you had me last week. And the truth was I didn't. And it's fascinating in your example, Kim, that in trying so hard to be so fully present and they were having an interaction, even though from an outsider, well you saw, but he's, he looked like he may not have been attuning to her, where in fact he, he was possibly very neurologically like, um, from that felt safety fundamental level was neurocepting. I see you, I feel you, I feel you have me. Even though I'm looking away, I'm, you know, I'm, I'm looking like I'm over here, but I know you have me over there. And when you pop the headphones on, I am sure. Oh, it feels like he perceived that and, and the shift in that, what that happened to her. Anyway, I I, I don't have the words on the neuroscience or the whatever, but time and time again, I felt they get that they've understood there's a shift here. Um, either way, you know, I see them shift very subtly and I know they've perceived my shift subtly as well. Um, so it's this and forwards piece. And, and I think that shows that it's not always us that are holding them you know, they're perceiving and holding us to.

Cory: I, I love that. I think that's such a great way to end. I don't wanna end this episode to be honest, and I have all these questions about like, resiliency and then where is the interoceptive experience in the effort when we are a little bit frustrated, but you know, the outcome is what we want and, and how do we manage that with compliance? And oh my gosh, I've got 10 more episodes worth of questions, but that means you just have come back Kim and we can have another conversation.

[01:05:29] Kim: Thank you for the juicy, uh, inspiration. And I’m carrying this with me in my heart. So much gratitude for the three of you. Thank you for having me today.

[01:05:44] Michelle: Beautiful, Kim. Thank you.

[01:05:46] Tracy: Absolute Pleasure, Thank you. Thank you. Thank you. Thank you.​