Episode 131 – Mindfulness, Hands-On Therapy, and Pain (with Bronnie Lennox Thompson)

Summary

Til Luchau interviews Bronnie Lennox Thompson, a pain management expert from the University of Otago in Australia. Bronnie shares insights on supporting people with chronic pain to live well, emphasizing pain’s complexity as a personal, multi-dimensional experience. They discuss the value of hands-on therapy, discussing both physical benefits and its comforting, human connection.

The conversation highlights mindfulness as a tool for managing chronic pain, extending beyond meditation to include simple, everyday practices. Bronnie and Til explain how mindfulness helps people observe pain without reacting, fostering a healthier relationship with their bodies. Bronnie also shares her personal approach to mindfulness through activities like walking and savoring positive moments. This episode offers practical advice for both therapists and anyone seeking a mindful, compassionate approach to managing pain.

Key Topics:

00:00 Introduction and Podcast Overview
00:16 Sponsorship and Special Offers
02:04 Guest Introduction: Dr. Bronnie Lennox Thompson
02:15 Exploring Pain and Mindfulness
05:40 Personal Journey with Pain
08:59 The Role of Hands-On Therapy
19:16 Mindfulness in Clinical Practice
25:13 History and Science of Mindfulness
39:17 Responding vs. Reacting: The Power of Mindfulness
40:12 Practical Applications for Manual Therapists
41:08 Guiding Clients Through Sensory Awareness
42:11 Exploring Sensations and Descriptions
43:38 The Role of Curiosity in Therapy
44:40 Hands-On Techniques and Client Interaction
47:17 Movement and Awareness in Therapy
48:52 Changing Pain Perception Through Attention
51:51 The Therapeutic Session: Beyond Touch
01:00:07 Incorporating Mindfulness into Daily Life
01:06:38 Final Thoughts and Resources

Episode Transcript

Til Luchau: Bronnie Lennox Thompson, so good to have you here with me today. I’m so sorry Whitney couldn’t join us, but I’m glad that you could. Yes. I want to talk to you about mindfulness and pain, inspired by your recent blog series. Welcome to the Thinking Practitioner podcast. 

Bronnie Lennox Thompson: Thank you. It’s great to be here.

Til Luchau: Can you tell us a little about yourself for people who don’t know you already? 

Bronnie Lennox Thompson: Um, so I’m Dr. Bronnie Lennox Thompson. I’m the, um, academic lead for post grad programs in pain and pain management at the University of Otago. And I’ve been blogging on my blog, um, Health Skills. Hmm. Since 2007, would you believe?

Um, and my professional life. My whole career is around chronic pain, self management, and helping people live good lives in the presence of pain, because that’s- It’s a reality for so many people. We don’t have effective cures or treatments for many forms of complex chronic pain. And, um, and that’s a problem.

So we need to not just look for how can we get rid of the pain, but how can we, when we can’t get rid of the pain, how can we help people have good lives? That’s what I’m about. 

Til Luchau: That’s such a key question. And you, you’re also a prominent voice or have been one in some of the discussions around pain. I remember first reading your probably social media contributions and then your blog many years ago.

And I always really appreciated your, your perspective, your point of view. There was, you know, things have calmed down quite a bit over the years, but there was quite a bit of controversy at different times. And I appreciated you as a voice of, what shall I say, uh, subtlety, nuance, and seeing the complexity of situations.

Bronnie Lennox Thompson: I think that’s the thing about pain. It is complex. We don’t have sound bites and we shouldn’t because these are human experiences. These are, um, complicated, emergent experiences that we don’t, until we can explain consciousness, I don’t believe we’re going to be able to explain pain. It doesn’t mean that we can’t get our heads around some of the contributing factors to the experience, and it doesn’t mean that we can’t, um, look deeply at the impact of pain on a person and how they express it, how they experience it, and, and hope to help people.

But we can’t, dumb it down to pain is this and pain is that because there will be someone who’ll say no, no, no that’s not my experience and pain’s a personal experience. It’s subjective, it’s always emotional. It’s always sensory. That’s in the definition. So if we want to come up with something, it has to fit with those parameters. Negative, unpleasant, here’s my, my definition: unpleasant sensory and emotional experience that’s associated with or resembles that associated with actual or potential tissue damage.

That’s the IASP definition and we, until there are good arguments against using that, I’m going to stick with it. 

Til Luchau: How’d you get interested in pain? How’d you get interested in mindfulness and pain? 

Bronnie Lennox Thompson: Um, so pain, I got interested in pain because I was working with people who, um, were returning to work.

That’s where I started looking at, at this whole thing about pain. 

Til Luchau: Was this in your context as an occupational therapist? 

Bronnie Lennox Thompson: Yeah. So I did, I did vocational rehab back in the, in the eighties, mid eighties. And I found that most of the people who had trouble getting back into the workplace were people who had trouble with their pain.

That got me fascinated. As it does. And I entered the rabbit hole and I haven’t emerged since. Um, and I’ve gone down many other rabbit holes aligned with it to get my head around what is pain. And how, how is it such a challenge for us to, to manage and live with? Um, and then I guess part of my interest was piqued by my own experience with fibromyalgia.

It wasn’t called that at the time, and I was very grateful to the rheumatologist. 

Til Luchau: Did you have a term for it? Was it called something else? Was it a mystery? 

Bronnie Lennox Thompson: Uh, at the time, the rheumatologist, um, who I saw, who was the, one of the directors of the, the Auckland Regional Pain Service, which was one of our two large pain services in New Zealand.

Um, he said that this is just called chronic pain. We don’t have a term for it. Um, but when we joined the dots, um, cause that was in the early days. Mid 80s, early 80s. When we join the dots, it looks like fibromyalgia, as we know it today. But at that time, that wasn’t a term that was used. So that was, that was interesting.

And he suggested I read the book, The Challenge of Pain by Melzack and Wall, which was, um, explaining the gate control theory. And a whole lot of neuroscience associated with that, which was an eye opener for me as a person who was living with pain, trying to understand why, when, when Mike said to me, we don’t have a, there’s nothing we can do from a medical perspective for you.

And I thought that was gutting. I was 22, maybe. Um, and when I read the book, I got this. Real understanding that my pain wasn’t about tissue damage. I was not doing harm to myself. What the book didn’t tell me, and the bit that’s been my kind of career ever since, is how do you live with this? If we don’t have a fix, how do we live alongside this experience that, um, is universally seen as a negative, bad thing?

Unless, unless you’re a, um, an extreme sports person, if you’re a marathon runner, if you play contact sports, if you go to the gym and you lift heavy weights, then, then it’s okay to have pain. But we see that kind of pain differently from the pain. Um, that we see in clinic and the attitude towards pain is, is fascinating to me.

It’s just really interesting. 

Til Luchau: We as, as hands on therapists, we’re usually hired as a pain mercenary. People want to help us get rid of their pain, kill the pain, eliminate it somehow. So that’s often the starting ground, at least in the client or patient spine coming in. 

Bronnie Lennox Thompson: Yeah. 

Til Luchau: Interesting territory. It’s  fascinating.

Bronnie Lennox Thompson:

It’s fascinating because I, I do. I, I spent a lot of time with hands on therapists, um, and yes, there were very outspoken, um, arguments against manual therapy and, and pain science. 

Til Luchau: Could you, could you summarize those for us? Cause I’m not sure our audience is familiar with those. Do you want me to try? I could, I could try too, if you want.

Bronnie Lennox Thompson: No, I can, I can briefly summarize my understanding. So there are some people that would say that hands on therapy is nothing more than an elaborate placebo. And that’s, and the, the efforts to change the fascia or to change what’s going on in the tissues from the hands is probably, um, overblown and misguided.

That’s an extreme position. And then there is the side that says that pain science, if we explain what pain is, if we give people an understanding, then, and we get them moving, again, that’s all you need. So I’m a, I’m a pragmatist. There are not very many health professionals that have an hour with a client.

Til Luchau: They have an hour to work with a client, yes. 

Bronnie Lennox Thompson: Where that client is usually disrobed, is willing and desiring comfort, seeking comfort. And we’re, as clinicians, your interaction is so powerful. We know, we know touch matters. That’s why there’ve been wonderful experiments with, you know, um, primates, saying if you don’t touch babies, their development’s stunted.

I don’t believe that goes away from us as we age. In fact, I’ve, I remember in my training, meeting a woman who was, She, her husband had died, she was an elderly woman, and she said she’s touch starved because nobody touched. We want to be held. We want to have that contact. So I think there’s a real need.

For comfort, and one of the ways that we get comfort is when our skin is being touched by, nicely by somebody else. That is an incredibly powerful, um, medium of communication. Alongside that, as a clinician who puts hands on people, you have the bundle. Not just the, what I’m doing with my hands, but the moment that person comes into your room, and you start that conversation with them.

And you observe, and you ask them what they want, and what’s their story, and you notice the effect of what you are doing when, when you’ve got your hands on that person, and then the impact, and then as they go away, what they go away with. That, that is powerful. That’s, you might call it, some people can call it, well that’s just placebo, but actually that’s the meaning that somebody’s deriving from your interaction.

What an incredibly powerful tool. And not everybody does it very well, and people want it and need it. That’s therapeutic. And in that time you can weave in all these lovely things about what are you noticing in your body. Um, you know, I wonder if we tried this movement, what would that feel? We’re asking people to inhabit their bodies again.

Especially important when somebody feels that their body’s betrayed them because their pain’s taking over. That’s powerful. 

Til Luchau: Inhabit the body again. And especially when It’s betrayed them. 

Bronnie Lennox Thompson: Because that’s what people feel like when pain takes over, this alien’s taken over my body and it’s not mine anymore.

And then when you have that opportunity as a hands on therapist to give people that nice input, to feel good, to feel their bodies again, um, and if that’s, All, and I use that in inverted quotes, um, if that’s all that happens, well, is that not enough? 

Til Luchau: Well, there’s some internalized, yeah, that’s important. I think there’s, there, that, uh, debate or controversy exists within our field as hands on therapists too, because there’s, uh, sometimes the argument about, is that indeed enough?

I think the, I’m just thinking how the irony of how if I’m objecting to manual therapy because the evidence for tissue change isn’t as big as we used to think, then I’m actually being fairly materialist or reductionist in saying that we would need to change the tissue to change the pain. 

Bronnie Lennox Thompson: Which is not the case.

Til Luchau: Which is not the case. We understand pain is an experience then that makes me a whole lot more interested in experience per se. 

Bronnie Lennox Thompson: Yeah, and it means that we can spend far more time looking at those interpersonal communication that interplay between, as a clinician, what you are observing and what the person’s saying, demonstrating in their body. Um, and some of, so Rachel Ah Kit is one of my students. She’s a Master’s student completing her, um, her research at the moment. And she’s been exploring, um, massage therapists confidence and their clinical reasoning around movement and, um, therapy and also what, what they’re doing.

And what she’s discovered is that we use some standardized measures. Looking at beliefs of massage therapists and finding that, um, massage therapists have this lovely biopsychosocial whole person belief about pain and the person. That is really good because it’s way more, more, um, the measures are higher in massage therapists than they are in some other professions that are, you know, supposedly more evidence based, but actually much more biomechanical and medical.

That’s fantastic. And then she, when she was talking about, well, how is it that you do this? We did some focus groups in this, this, um, this is constant observation. Massage therapists do constantly monitoring. What’s the effect of this? How’s this landing?

Til Luchau: moment by moment 

Bronnie Lennox Thompson: It is, and it’s absolutely magical because we don’t see that and it’s, it’s, 

Til Luchau: uh, I’m just, I’m fascinated by this right now in my own work.

How much of that monitoring or listening is happening? On the sub cognitive level, somehow. 

Bronnie Lennox Thompson: We’re not necessarily consciously aware of what it is that we’re seeing. Now that could be because it’s stuff that we’ve been doing a long time, so we can’t verbalize because it’s so automatic that we just do it.

Um, it could also be that there are some things that are so below conscious awareness because they’re just, they’re just reading body language. That’s really what we’re doing. Um, and that’s something that humans as social beings do. That’s something that our brains are particularly tuned to do. So I suspect that, that massage therapists who self select to go into this field um, constantly refine and update that skill.

Because they do it all the time. How cool is that? 

Til Luchau: That’s really cool. A story came across my feed, I actually didn’t read it, I just saw the headline, this is a research project that said, uh, people can discern emotions without seeing the face. This was the big takeaway, that you can actually discern someone else’s emotions without the facial expression.

And I’m like, of course, and that’s what we’re doing all the time, moment by moment with our hands, with our listening, with whatever else it is. 

Yeah. 

Til Luchau: And that experience of being listened to, you’re saying, or being heard, is a, is a, is in itself therapeutic, is in itself helpful. 

Bronnie Lennox Thompson: Absolutely vital. One of the things that I’ve, I’ve never heard a patient say to me, Oh, they listened too much.

People want to be heard, and in the desire to kind of streamline and, you know, see more people and all that sort of stuff, at times in our health systems there’s this push to automate stuff. Actually, patients don’t want that. What they want is connection with a person. And to devalue that connection with somebody, um, devalues, something that humans need and want as part of being human, and part of healing.

I don’t use the term healing very often. I, well being, getting healthy, might be another way of saying it, but actually, it is a therapeutic thing. In Occupational Therapy we talk about, um, the therapeutic use of self. That thoughtful and deliberate way that we are present with somebody. How we communicate, how we talk, how we observe that interaction is really part of being an Occupational Therapist.

And I think it’s part of a therapeutic encounter in any situation. It’s just that some people don’t, aren’t as thoughtful about how they are As clinicians. 

Til Luchau: Okay. What does this have to do with mindfulness? 

Bronnie Lennox Thompson: Well, so mindfulness. So I’m not a good mindfulness advocate in many ways, because to me, I, I don’t find doing extended stationary mindfulness, um, works well for me.

Til Luchau: Oh, that’s what mindfulness is? Extended motionlessness?

Bronnie Lennox Thompson: No, that’s one form of mindfulness and that’s what people can, can think of. And if you think, um, if you Google mindfulness, you’ll find lots of, um, You know, pictures of people sitting cross legged on the floor doing a, doing an OM or something like that. Which is one form of mindfulness, and for people who find it useful and have practiced it, it’s great.

It’s just not the only form. So for me, it’s that intentional, um, awareness of what is. Without trying to change it, without deciding that it’s good, bad, or indifferent, just being open to what is present. That’s my reading. That’s your reading. 

Til Luchau: Okay. Yeah. Intentional awareness of what is without trying to change it or judge it.

Good, bad, indifferent. 

Bronnie Lennox Thompson: Yeah, just to be with, with what it is. And so I use that approach with most of my life. That’s something I’ve done for a long, long time. And I didn’t even know that that was called mindfulness. It was just noticing because I’m curious and that’s part of being curious is to notice.

Well, and to. become aware of what is present in my body. And that came about when I first developed pain, when of course pain happens and we start to notice that area and it becomes really prominent and we think, do, and our attention’s grabbed by it. And so that can be the start of a mindfulness practice, if we want to, or it can become the start of a mindless practice of how can we get rid of.

This shouldn’t be there, the judgment there, is not noticing that alongside these areas of pain are also areas of comfort. So my approach to developing my own mindfulness practice was to be, to dip in and out of noticing where I’m sore, where I’m not sore. Noticing the contact of my feet on the ground as I walk, what I’m seeing around me.

And I’m lucky I live in a beautiful part of the world that is not, that is, that is not, that is a fake window. Um, but I live in New Zealand and we are surrounded by gorgeous landscape. And, and there’s something about, um, New Zealanders connectedness to the landscape that’s. That is unique to us as a country and as a people in, in walking around in our world where I can see stuff in my garden, I can, you know, look at the sky, which is constantly changing and notice the air, the wind that’s constantly changing.

Those things are, um, up around me all the time, as much as my own body experience and be able to move my attention from one thing to another is incredibly valuable. I think it’s a really important part of being in the world. 

Til Luchau: Mindfulness gives a sense of being able to direct that where you’re, what you’re paying attention to and include more than just the pain.

Bronnie Lennox Thompson: Oh, absolutely. And it can be. Be for extended periods or not. I think it’s that not trying to control or reject experiences that are present. It’s just noticing that they happen to be present. That is the, the ingredient for me anyway, in my case. Yeah. 

Til Luchau: I am a total fan. It was, it was a big part of my own pain process having lived with chronic Lyme disease for quite a while.

Not that I had pain associated with that, but the my, the. Basically, mindfulness practices were a big part of what helped me, uh, live with that. I felt like it was turning corners and, and learning and changing from that. And then it was also a big part of my initial education because I was, uh, learning hands on work in a context where there was a lot of, uh, meditation and mindfulness practices and body practices.

Yeah. And that was always part and parcel of the practice itself, both for us as practitioners, but also what we’re looking to evoke in our clients. 

Bronnie Lennox Thompson: There’s this difference between mindfulness and mindlessness that I think is a distinction that I find quite useful, that mindlessness is this autopilot that we can go into. It’s mindlessness, it’s this autopilot. Autopilot. Yes. Yeah. I’m just doing it. Just doing it. I’m, you know, I’m not really. immersed in it. And I’ve, I think that it can, that’s problematic when we’re doing clinical work because if, because then we start to see the, the, um, people as one dimensional and that’s not helpful when we are humans interacting with other humans.

Til Luchau: I want to dig into the nuts and bolts on that, especially in a clinical setting, because it’s, it’s complicated to say to a client who says, I want help with my pain. We’re going to be with it. That’s what I do. So that’s a, that’s a tricky moment. Let’s get to that. But can you tell us something about the history of mindfulness and pain management?

Your, your blog mentioned a couple of things in there that are interesting. 

Bronnie Lennox Thompson: Yeah, I mean, probably the first formalized study was Kabat Zinn Mindfulness Based Stress Management. Um, and I think in, in a sense, he used people with low back pain as a convenience sample. Here’s a bunch of people who are not going anywhere very far and let’s see what happens.

Til Luchau: Really put mindfulness on the map with some of his academic research and the media picked it up. Stress management, pain management, this was his bailiwick. 

Bronnie Lennox Thompson: It was, and that was, that was where mindfulness based practices and pain management first, I think, grew to prominence.

That’s not to say that things like hypnosis, um, progressive muscle relaxation, and breathing practices, and mindfulness, and imagery, as a bundle, um, weren’t being used because they’ve been part of, at least since the 70s, from my readings probably earlier. But that’s, that’s, when I started working in the mid 80s, um, we weren’t at that stage using mindfulness per se, but we did do a lot of this physiological down regulation.

And we could put Um, some people can analyze mindfulness as, as within that bucket. 

Til Luchau: I like, I like “physiological downregulation.” I like that. Yeah. 

Bronnie Lennox Thompson: Yeah. I mean, what we’ve, when pain is, is an experience that is stressful, we know that we’ve got good ways to even measure it should we want to. And so when we can help somebody downregulate, that’s a jolly good thing that helps with a whole bunch of mental health issues.

Responses to pain. I think mindfulness is broader. Um, it has a quality of, of beyond I’m trying to achieve a thing. So hypnosis, there’s a deliberate purpose to using hypnosis. I’m going to change the way I experience this thing or, um, I’m going to change the quality of it. Breathing practice, I’m going to reduce the, you know, I’m going to slow my breathing down.

It’s going to be better for my body. That there’s a purpose for it. Mindfulness is much broader in that it is about noticing and being with. Um, and that’s the quality of being is what I appreciate about mindfulness. That quality of, um, making room for what is present. In all of its mystery and variability, knowing, in my experience anyway, that it’s constantly changing.

What is present is constantly changing. And when pain is difficult and intrusive, to know that it will change is, I think, opens windows to seeing it’s not necessarily an imposition. It’s just present. 

Til Luchau: It’s just present. To know that it will change, perhaps. And then, in my own experience, there’s also a moment when I’m willing to turn towards it rather than pull away from it, or contract, or protect, or guard.

But that mindfulness process, or whatever it is, paying attention process, actually allows me to, we’re using the term be with, which is what’s said a lot, but that the somatic experience is opening to, or relaxing to. Or allowing. 

Bronnie Lennox Thompson: And be curious about. 

Til Luchau: And so much of the suffering around pain is the withdrawal or is the contraction, is the fears that get triggered and the reactions.

Bronnie Lennox Thompson: Pain is, is inherently unpleasant, that’s, that’s, That’s just the deal. And we don’t like, humans don’t like unpleasant things, that makes perfect sense to me. And yet. We experience things that we don’t want to experience and it’s almost like opening up to the presence of an unpleasant experience allows us to notice the pleasant even more.

It’s a contrast. And that sounds terribly philosophical and a wee bit kind of, you know, pretentious, but that’s my experience. When I notice where I’m sore, I’m also able to notice where I am not sore, where I am comfortable, um, and where, yeah, the immense variability inside my own body, even when there are times, and I’ve just had COVID, and believe me, for me, COVID, it boosts my pain.

It just makes it so much worse. And to be able to be inside this body when I had COVID, I could notice there were bits that were more painful and bits that were less painful. And that’s wonderful to know that. It’s not this solid, um, um, What’s the word? Immovable, sort of blank thing. It’s not, it’s much more messy and permeable.

And that’s nice. 

Til Luchau: Well, and thank you for joining me today, even though the COVID wasn’t that long ago from what I understand. 

Bronnie Lennox Thompson: Well, I’m running around about 60 percent at the moment, the fatigue is quite a, um, quite a thing to deal with. 

Til Luchau: Well, let’s, let’s respect that. But I also want to say just also based on my, and I’m sure you have your own version of this, but based on my experience as someone dealing with a chronic, painful, fatiguing condition, There was such beauty and just following and bringing that to whatever I did, following what was the capacity I had and really listening to that carefully, but then also not needing to force myself to be a hundred percent of what I thought that should be.

But the vulnerability and the presence and the, the, the depth of actually going ahead and living life at whatever percentage I had that day. 

Bronnie Lennox Thompson: Yeah. And that, that’s a constant learning for me. Because my mind wants to do all the things all the time at full speed, and I can’t do that. Um, and you know, nobody can actually. We’re fooling ourselves if we think we can. Um, because there are, there’s natural rhythms to the world. And we forget that, you know, as we have spring and summer, we also have fall and winter. And we have seeds that grow and then they eventually blossom and then their fruit and then they die. And it’s like we are not always that willing to notice that that might also apply to us as humans in terms of what we can and can’t do.

Til Luchau: And that’s true, nice metaphor. 

Bronnie Lennox Thompson: It’s kind of as you get older too, you start to see that there are things that, you know, the things, the form of the way that I lived my life when I was younger, as I get older. I can change the form to be more respectful of the changes that I’m noticing in me as a human.

Some of this is physiological, there are some things that a 60 year old female body can’t do that she might have done when she was 20, but then there are a whole lot of things that I can do now that I could never have done when I was 20, and that’s a, that is a wonderful thing. 

Til Luchau: Let’s go, let’s go physiological for a minute.

I mean, we got philosophical and metaphorical, I want to get back there, but do we know things about mindfulness and how it works with pain that we didn’t know in Kabat Zinn’s day? 

Bronnie Lennox Thompson: Yeah. So functional MRI wasn’t really, wasn’t really developed until the nineties. And so the explosion in neuroscience.

Imaging, particularly in the last, since then, has meant that we can now have a look at some correlates. So what is, what we think is going on were blood flow changes when people practice meditation or mindfulness or, um, meditation. We know that there are different active actions, different areas of activity in the brain that differ between hypnosis, for example, and mindfulness practices, various forms of mindfulness practices.

So we know that there’s a lot of, um, activity that’s going on and there’s lots of guesses about what that might mean. And so bearing in mind that all, all of our functional MRI. studies are we’re inferring based on what we can observe. We’re not actually directly measuring or noticing, we’re just observing.

And we assume that if there’s this activity in this part of the brain or there’s a shift in blood flow, then that area is active and that’s explaining why, what this person’s experiencing. We have to bear this in mind that there’s huge error likelihood in there and imprecision. Yeah. Caveats aside. Yeah.

Til Luchau: Caveats aside. Okay. 

Bronnie Lennox Thompson: Caveats aside. So there’s some things that we know, um, and I’m a fan of sort of a network analysis approach to brain imaging. So we look at the default mode network as a network of areas that are active when we’re just kind of gazing out the window. And then we have the, um, the salience network that’s, um, pulls into action when there’s something to notice.

It’s interesting or hits the interest, captures the attention. Um, we’ve got areas of the brain that are about decision making and Um, and emotion. So a lot of these areas are interacting. What it, what the studies seem to show is that with mindfulness, there is a decoupling. So instead of this automatic response, there’s a decoupling, which means that the judgment part, the appraisal, decision making part.

Til Luchau: Good, bad, pleasant, unpleasant. . 

Bronnie Lennox Thompson: Yeah. And, and the actions that I’m gonna take in response to can, gets decoupled from the, um, this is the salience. This has grabbed my attention. This is important. I must notice. Um, and probably some of those emotional responses as well. The limbic system says, Oh, that’s unpleasant, yucky, I don’t want it.

Versus, Oh, this is lovely. So what seems to be shown is with mindfulness practice, those areas are being decoupled. That’s a really good thing. Um, because when things are over learned and we can automatically, then we’re inadvertently capturing parts of brain processing that perhaps don’t necessarily help us though. 

Til Luchau: So you’re saying they’re decoupled meaning they don’t move in synchrony as much. They don’t activate or deactivate their blood flow and blood flow at the same time, quite as much, a little more independent, like being able to notice something’s intense without automatically assuming that it’s also bad for me. 

Bronnie Lennox Thompson: I think that’s really valuable across lots of things.

Um, because it means that we can be aware of. Okay. Something without necessarily having to act on that awareness. We have a bit more of a, of room between the stimulus and our response. I think that’s one of the things that our forms of mindfulness can help. In fact, Kevin Vowles, who is one of my, my gurus, act, um, trainer and he talks, he, mindfulness practice and, and act as messing about with attention.

Kevin. We’re just messing about with attention, which I really like, because it’s just messing about. Let’s, I wonder what would happen if we just noticed this for a bit and then we shifted to that for a bit. So openness, curiosity, um, the almost playfulness about becoming familiar with this experience, before we have to decide what we are going to do about it.

Isn’t, isn’t that amazing because one of the things that we develop as we, as we mature is, um, this ability to hold off our impulse controls become better as we age. So we know that a two year old who’s hungry is probably going to have a meltdown in the supermarket. And it’s very hard to get to help a two year old self regulate.

But you don’t expect to see that in a 40 year old person going, who’s hungry. Who’s going to the supermarket. They may still feel it. 

Til Luchau: We wait till we get home. We go home for the breakdown. Yeah, 

Bronnie Lennox Thompson: They’ll still feel it, but they don’t need to act on it. Ah. And that ability to be aware and notice, both interceptively but also extraceptively, means that then we have ways to stop and think about, What are my options?

What are my choices? So instead of reacting, we’re responding. Um, and if that’s one thing that. Mindfulness helps with. And that’s a really helpful thing for people. Instead of automatically assuming and reacting with disgust and avoidance to something that feels uncomfortable, we can choose to stay with it and nudge into it and explore it and be curious about it.

Um, that gives us many, many more options because we can still choose to say, I don’t like this. I don’t want it. I’m going to move away from it. But at least we’ve had some, a moment or two to have other options. 

Til Luchau: If this was a two or three hour conversation, I would just keep digging into this because this is the richness here.

I think these subtleties of the approach and the direction of our attention and how we mess about with it. But if it’s okay with you, I want to get practical. Yep. I want to get clinical. So how, I want to hear something about how you suggest we, as manual therapists, incorporate these ideas into our work with clients, particularly in the, in the, with a, with a client who doesn’t have this, uh, bias or point of view or mindfulness.

How do we, uh, include that in what we might be interested in trying with them? 

Bronnie Lennox Thompson: Well, first thing I’d suggest is don’t use the word mindfulness, because it comes with a whole heap of baggage. People will assume that they know what you’re talking about, and words have acquired meaning. So I wouldn’t even use that term. 

I would say, notice, or can you be aware of, or can you be curious about, or what does this feel like compared with that? So, and I guess as a hand, for hands on therapists, and I don’t touch people at all. It’s never been my game. Um, I think that’s a wonderful opportunity to say, I’m going to place my hand on you.

Tell me what that feels like. Show me, you know, tell me, tell me where you’re feeling that. And when I’m touching you there, I wonder if you can notice, pay attention to somewhere else on your body. Let’s notice the difference. 

Til Luchau: You just took two steps. One is, notice what happens when I put my hand on you and tell me something about that. That act of describing or labeling is itself a mindfulness practice. 

Bronnie Lennox Thompson: Yeah. Yeah. It’s also, it’s, it’s, it’s a, it’s a skinny, thin, thin edge between describing and then judging it. Yes. Can’t do that without, you know, as soon as we label it, we’ve judged it as appraised it as something. However, it can give us an opportunity to explore and be curious about it.

And that curiosity is the thing. 

Til Luchau: That’s right. And when we ask about it, we, as a client, I need to turn my attention. Yeah. Towards it. I hopefully get curious. And then I, I reveal my judgment about it if I have one and, uh, the questions that I might ask at that moment might be about sensation per se. 

Bronnie Lennox Thompson: Yeah. What does that feel like? Is it deep? Is it? Yes. Is it achy? Is it? And when you use the word achy, what does that actually mean? You know? What’s achy. What is achy? And actually, I’ve, I actually asked, um, I did a very informal survey of what people mean by the term aching. And actually, we don’t have very much agreement. What does aching actually feel? We use it all the time. 

Til Luchau: That’s right. I think it’s that bucket word that everything we don’t know how to describe goes into, in a way. Aching. 

Bronnie Lennox Thompson: Yeah. So it’s sore. What does sore feel like? So I think in the first thing I would invite, um, a hands on therapist to do is just to ask the person to notice they’re aware I’m touching you here. And, and just to notice that and then maybe describe it or to bring their attention to it. They don’t have to use words. Yeah. 

Til Luchau: And some people don’t want to talk much in their sessions or whatever. So it’s this, that, maybe nonverbal noticing, maybe description. But then you also, in your example, you gave us a second step, which was what else is going on.

Bronnie Lennox Thompson: So I’m touching you here. I wonder, I’m curious, what are you feeling? What are you noticing? And, and you can name another body part, the parts that you’re not noticing. I mean, their hands are only so big, right? So there’s going to be a whole area of skin that’s not being touched. And that’s still sensory awareness.

And then we’ve got the weight of the body on the table, or the surface. Let’s notice that. And let’s notice inside your body. The breathing. The, no, yes, your tummy’s gurgling. That’s normal. Um, you know, are you noticing the sounds around it? All of those things we can touch. guide people to notice and become aware of.

We don’t have to use a script. Um, in fact, I’d encourage not using the script when you’re dabbling and you’re starting to develop this. Let’s just be curious. Because when we start to go into a script, then we tend to go down this, there’s a recipe to follow and I’ve got to do it right. Um, and it’s good, bad or indifferent when. When initially, both for the person who you’re guiding and for yourself, we’re just being curious.

Til Luchau: Would you, we’re talking about it, would you be willing to, to guide us for a moment here now? 

Bronnie Lennox Thompson: Well, I’m, I’m sitting in my office at home on a saddle chair. So because I find that most, most comfortable and so I would just, um, invite you just to notice the weight of your body on your butt cheeks. Where you are sitting, let’s just notice there’s parts of your body that are contacting that surface and there are parts of your body that are not.

And you bring your attention to an area that’s contacting that surface

and then bring your attention to a part of your body that’s not contacting surface.

And if you could give some words to the feeling.

Til Luchau: Yeah. I’ll jump in. I was, there’s a, there was a surprise to feel a kind of numbness where my butt was contacting the chair. And then when you invited me to broad and then feel something that wasn’t, there was a tingly feeling on say the backs of my arms that were just feeling the air. 

Bronnie Lennox Thompson: Isn’t that interesting? Yeah. Isn’t that cool? I feel, um, weight in sort of a, And a warmth, it’s a little cool here, so the parts of my body that aren’t touching the surface feel cooler than the parts that are. And I’m also noticing that while I have my weight on the chair, I’ve also got my weight through my feet. So I can feel the contact of my feet through my socks, um, on the footstool.

And in doing that, I’m noticing where are, where am I balancing? Where is my weight? Is it coming backwards? Is it coming forward? And, and in playing with that, I’m moving to notice. So I wonder what it feels like if I shift my weight forward and back. Am I noticing when I do that? And so to therapists who are, who are listening, the pace, so taking the time, because It takes a moment to shift attention to the area into another, like give people time to, to notice and then maybe guide with a bit of curiosity, I wonder what would happen if you just shifted your weight a little bit forward, a little bit back, what do you notice then?

Just, it’s really just drawing attention to what is actually present in the moment. And, uh, another thing I noticed is that as I do that, we both slow down. So our, our language, our speed of speech slows down. I would be ready to lay money on your breath rate slows down, just from noticing. And that is really interesting.

It’s helpful, well, it can be helpful. So then we can ask the person, so what, what showed up for you when you did that? What did you find? 

Til Luchau: Okay, let me bookmark that question because it’s important. What showed up for you when you did that? What are you noticing? You didn’t ask, does that still hurt? 

Bronnie Lennox Thompson: Probably will. And does it matter? Yeah. Because I’m, I’m not looking to change a person’s pain experience. Cause they are the ones that change their experience. What I do is guide curiosity. I’m not, I don’t believe that I can, from the outside of a person, change the quality, intensity, location, or anything about somebody’s pain experience.

I can guide them so that their bodies can do what their bodies need to do to help them be more comfortable with that. 

Til Luchau: And you’re like a pain expert. You’re like a pain mucky-muck and you said you don’t feel like you can change someone’s internal experience of pain. 

Bronnie Lennox Thompson: I don’t think I can. I know it changes, and that’s wonderful, but I’m, I’m not, I can’t, and I don’t think anybody can directly change somebody else’s pain experience. Drugs can, but they also change consciousness, but we’re not directly changing the, the, We’re not changing the nociceptors, we’re not changing inflammation, we’re not changing cortical stuff. We’re just drawing attention to, or we’re creating the conditions in a therapy session for the person’s own body to do what it does.

Til Luchau: This is where we run against some of the manual therapy narratives that we’re changing tissue density. Right. Or, uh, or tissue qualities, and maybe we are, and maybe that has an impact on pain, but it’s, for myself, it’s so Much more effective and liberating to, again, imagine that I’m helping someone change their own pain experience as opposed to trying to change the stuff they might be made out of.

Bronnie Lennox Thompson: Yeah. That’s been my approach. Maybe partly because I touch people. Um, and I don’t do things to people like we do stuff together. It’s a communication. It’s an exploration. Because ultimately that person will walk out the door and I would like them to be able to bring some confidence in some curiosity and some skills to their life outside.

Til Luchau: Well, that’s, that’s great. You like to take that, take it with them. And that’s one of the critiques of manual therapy, isn’t it? That it’s out there. Passive experience, in quotes, this is, uh, passive experience on the client or patient side that is, they’re having something done to them. And yet, and certainly that, that model, that way of thinking is embedded in a lot of our historical context.

Yeah. But I think most, maybe all masterful practitioners would say, no, that’s not all what I’m doing at all, if any of that, that I really am catalyzing whatever’s happening for my client. 

Bronnie Lennox Thompson: Yeah. And they try to take what they have experienced in that session away with them in memory. And that is incredibly powerful. That’s why when I’m looking at how manual therapists work in my practice. The active ingredients. That whole therapy session from the moment the person walks in to the moment they leave the clinic, that’s the therapeutic session. It’s not just the bit where I’ve got somebody putting their hands on me. All of that. And so if we count that whole experience, then we’ve got all that conversation and we know that talk stuff gives people ideas, changes the way that they’ve used things. That’s, is that not an active therapeutic ingredient? We already know that if we tell us if we say a word to somebody and we’ve got them wired up to functionally MRI and they start thinking they will, there will be a whole lot of word associations and concept associations that come up with that one word that’s sort of suggest that we are not doing something active that’s changing the way a person is in their own experience, just because what we’re doing is touching somebody, um, it’s minimizing the enormous impact that we have that is well beyond that touch receptors, you know, where there’s far more there and we do a disservice to the value of that part.

That we probably have not even started to explore in a good deal of detail in manual therapy. We’ve been so fixated on peripheral stuff and what’s happening to the fascia and what’s happening to the, these tissues out there. All we’ve forgotten is all of the stuff that is occurring that’s interpersonal.

But also is about how this person’s interpreting that whole experience. And that includes what we say. We’re giving people a new experience. And that’s cool. If we guide them through that, hey, how powerful is that? 

Til Luchau: See, I think you touch people. You say you don’t touch people. I think you’re touching their experience with everything you do.

Bronnie Lennox Thompson: I just don’t use these. 

Til Luchau: You just don’t use these in your hands. 

Bronnie Lennox Thompson: Yeah. Same way. 

Til Luchau: And I think there’s a, I think there is a manual correlate for everything you’ve described. I think when people feel us feeling them, when they feel our hands listening, that’s like. Uh, that’s bringing the attention in, in the way that a question might, our hands are asking questions. Our hands are underlining. 

Bronnie Lennox Thompson: Yeah. It’s, it’s using a different sense for that person to explore what’s happening in their body. Other ways we can do it, we can ask the person to move, say, Hey, I wonder what would happen if you tried this? And so one of the questions that Rachel has been asking in her, her research has been, you know, how do you use movement?

As a massage therapist, how do you use movement? And it’s incredible, massage therapists use movement frequently. They don’t feel confident to prescribe exercise. That is not the same as- And one of the things that 

Til Luchau: Active engagement in the work is different than that, yeah. 

Bronnie Lennox Thompson: One of the things that massage therapists describe was when they’re looking at the impact of their work, what they are measuring it by is this person doing- moving differently, doing something in their own world. Now that is such a powerful thing. It’s so much more powerful than, um, you can do three sets of ten exercise. It’s, I’m feeling my body differently and now I’m hanging out the washing. And now I can put my jacket on, you know, without hurting my shoulder. Or without being worried about my shoulder. 

Til Luchau: Or even, yeah, even like pain scale changes. Because one of my favorite stories is a woman that I worked with for quite a while. I had, uh, radicular neuropathies based on some neck injuries and histories. And after a couple years of fairly intensive focused work, she said, uh, Til, this has helped me so much. Of course I hurt just as much as before, but it’s so much better. 

Bronnie Lennox Thompson: And that is something that these guys were saying in their research. So you need to get Rachel on to have a chat about her research because it’s pretty darn good. Well, they were describing that people were saying, well, I feel better.

Doesn’t necessarily mean that the pains change, but I feel better. I’m moving more freely. I’m able to do these things. Um, and one of the things that we can Get hopped up on is the words and the measurement and using formal kind of structures. But what we’re actually doing, and I think all hands on therapists can do this, is guide people to notice the way that their bodies are moving.

You can do that when they get undressed to go on the table, and then when they get dressed again, notice the difference. How, you know, what’s happening? What do you see? What are you feeling? What are the qualities of these experiences and you’ve got the the knack is not to give words to that person or suggest what they should be feeling.

What are you noticing when you do this? So we were going to come back to that question of what shows up for you and what shows up is a broad kind of thing. It could be, what do you notice? Could be, um, could be what feelings are coming up for you or emotions coming up for you. It could be, Um, what thoughts are popping into your mind, what images, it does not matter.

What we’re doing is inviting the person to be open to what is there and giving them that space to do that. 

Til Luchau: And you’re, you’re highlighting for me the difference between two approaches. I think you could take either one with either hands on or a guided session. There’s a, you’re describing a process of inquiry.

All of your suggestions are questions. Yeah. You’re evoking the client’s awareness and curiosity, which is really different than giving them a training or giving them a corrective movement to make or doing or pushing something with our hands into the correct place. 

Bronnie Lennox Thompson: And we know this already.

If we ask somebody to try two different ways of lifting a box in one way, um, we tell them you must, you know, do it this way. And then we ask them just to do it. We ask them to notice the difference. They will be able to tell you. And that is a really cool way that people can then take that awareness, their ability to notice how their body is out into daily life.

So instead of the recipe, you will tighten your core and lift properly. All we’re doing is giving people that awareness of how they feel when they’re moving that then is far more translatable. You know, if you lift a box one way in a clinic, you don’t know that you can do that when you’re struggling to put your two year old into the car seat, or your groceries into the back of the car, or you’re climbing underneath the house to check on the plumbing. You can’t do the same movements, you can’t use the same recipe of, this is how I should lift. What we want people to develop is this confidence in their own body feedback, so they can say, oh, that’s what it feels like when I’m feeling free.

And that’s what it feels like when I’m not. And how can I get to that place of flexibility and freedom, movement variability and all of that good stuff in their world. Ultimately people live their own lives in their own world and that’s where we, we want to help people develop skills from there. Not stuff that can only happen when we’re with them.

Til Luchau: Brownie Lennox Thompson. Thank you, Brownie. What do you want to leave us with? 

Bronnie Lennox Thompson: Um, if we take the, that term mindfulness and remove it and instead say, let’s pay attention to and notice and be present to what is. That might be a good way to be curious about what’s going on in somebody’s body. Um, that might be more useful.

We can build on that practice over time. We can extend, so we can do longer and longer periods. But we’ve got to start with this curiosity about what is actually there. What is actually occurring? Let’s begin there. 

Til Luchau: Thank you. 

Bronnie Lennox Thompson: Did I answer the questions right? Because it’s not a, um, I’m a terrible mindfulness practitioner.

You know, I don’t do the formal practice. I do it, but I don’t call it that. I don’t go and say to somebody, I’m going off to do my mindfulness and I just say, I’m going to go for a walk or I’m working on the silver. I’m working in my studio or I’m going fishing, you know, and fishing, fishing’s where I do my best mindfulness practice. It’s awesome. 

Til Luchau: I’m interested in that because that’s real life. It’s, and that’s the, I mean, there’s many parables about, yeah, you can do something on the meditation cushion. Does that mean you can do it in your life? You’re talking about just going to your life and doing it.

Bronnie Lennox Thompson: While you are cleaning your teeth. And that’s one of the first things that I ask somebody to do is just notice when you’re cleaning your teeth in the morning, just stand there and just let, let’s just notice the sensations and what you notice when you’re doing that. ’cause it’s such an easy, routine thing to do.

We all, well, hopefully we all do it. I like it. And yet it’s, it’s a sensory experience that we’re, we can be mindless tuned. But what a cool thing to be able to do and then you can bring it to when you’re waiting for the jug to boil while you’re making yourself a cup of coffee. 

Til Luchau: Uh huh. 

Bronnie Lennox Thompson: Um, and then when you’re waiting at the traffic lights.

Til Luchau: That’s a good one. 

Bronnie Lennox Thompson: And you can’t go anywhere. What a cool time just to notice your butt on the seat. How cool. So it’s very, I guess that’s the weaving that awareness into every day is. where I think I want to go with my practice. And then being able, I would like to at some point develop more extended mindfulness practice, but I’m not sure that for me sitting still isn’t that great.

You want to notice. So I’m better off to be walking and I can be fishing for hours and I’ll have not said a word to anybody. And I don’t know what I’ve been thinking. All I’ve been doing is casting, casting, pulling back at cast. And occasionally I catch a fish. The river’s going by, and it’s, that’s, that’s where time just goes.

And that thing goes on to flow, and that’s another hole. That’s another whole thing. That’s- let’s not start. So yeah, I get awfully metaphysical. Sorry. 

Til Luchau: I, it was great. And I want to have these conversations while walking or while fishing. 

Bronnie Lennox Thompson: Oh, yeah. 

Til Luchau: I actually worked for a little bit during COVID with trying to figure out the technical part of that. How could I do walks with people? And we couldn’t figure it out, decent sound, but I’m sure there’s a way. I want to do it. 

Bronnie Lennox Thompson: We don’t, I don’t do, so clinically I used to do that a lot with people. We would go, go for walks. I’m not doing clinical work at the moment, but, um, when I’m doing supervision with, um, with clinicians, we will walk if we want.

We can go out to the, you know, out to the pier, which is five minute walk from home for me and stand out there and we can talk. Nobody knows what we’re talking about and where we are having this lovely experience and it’s just, um, we can do that without even having to make it hard. Yes. You know, it doesn’t have to be, Oh, I’m doing this intervention.

Til Luchau: Exactly. Don’t need the meditation cushion to do mindfulness. Don’t need the practice room to do therapy. 

Bronnie Lennox Thompson: I mean, it’s not saying that it’s a bad thing to practice those things. Um, there’s something about the discipline of it and- 

Til Luchau: And the ritual. 

Bronnie Lennox Thompson: Yeah. Yeah. And you know, almost every spiritual practice has got some form of long form meditation, Christianity, Judaism, you’re right around every kind of convention and that’s what I, so when I’m trying to modify the mindfulness language, I will be mindful of that person’s religious experience because we can draw on that too. Um, and that’s, it’s respectful, um, and it’s culturally appropriate and it extends this whole idea to people that might otherwise just say, no, no, that’s, that’s really bad. 

Til Luchau: Yes. Or even non, non religious traditions and practices have contemplative or reflective processes or observational or curiosity practices, whatever it is that you said. 

Bronnie Lennox Thompson: And then that brings us to savoring and then that brings us to all of these lovely positive psychology things. Ah, yeah. 

Til Luchau: So I wanted to talk about savoring. We didn’t get to savoring. 

Bronnie Lennox Thompson: Savoring is just that, um, immersion and sensory and then being able to bring it back. That’s the way I do it. I’m going to really relish this. 

Til Luchau: Well, I should now so that I can access it. 

Bronnie Lennox Thompson: Yeah. And if we do that, like, when I’m making silver jewelry, that whole process means that now, because I’ve got crappy eyesight at the moment, I can remember what it feels like and savor. That was what was like, we can do that with meals and friendships and, you know, like this.

You know, those are the things that we’ve thought about life as humans as this problem to solve, like it’s some kind of maths problem. But it’s, it’s actually a life that’s full of moments to relish and savor and, and to be fully present to. Even when sometimes those things are stressful.

Til Luchau: or to grieve and to lament, but the savor, the relishing, the celebrating to-

Bronnie Lennox Thompson: To love something we risk losing it, don’t we? 

Til Luchau: Yes we do. If people wanna know more about you or what you’re talking about, what would you suggest for them? 

Bronnie Lennox Thompson: Um, head onto health skills blog ’cause it’s been there for a very long time. I’d say, 2007 was when I started to. To write it, and I post most weeks, sometimes when I’m sick I haven’t.

Um, but there’s a wealth of stuff on there. I’m also on social media, um, I’m not on the dreaded X. I am on Instagram and Facebook and LinkedIn. Um, and Threads, very intermittently on threads.

Til Luchau: I’m so glad we got this conversation. Thank you for taking the time today. 

Bronnie Lennox Thompson: It’s a pleasure. A real pleasure.

Til Luchau: Books of Discovery has been part of massage therapy education for over 20 years. Thousands of schools around the world teach with their textbooks, etextbooks, and digital resources. Books of Discovery likes to say, learning adventures start here. They see that same spirit on The Thinking Practitioner podcast, and they’re proud to support our work. Knowing we share the mission to bring massage and body work community enlivening content that advances our profession. Check out their collection of e textbooks and digital learning resources for pathology, kinesiology, anatomy, physiology at booksofdiscovery.com where thinking practitioner listeners like you save 15 percent by entering “thinking” at checkout. Thanks Books of Discovery. 

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