The Conscious Clinician Podcast

Episode 8: Trauma Informed Pelvic Health Practice with Dr. Krystyna Holland, DPT

We are so excited to bring you this interview with Dr. Krystyna Holland, DPT!! She specializes in trauma-informed pelvic health practice for people across the gender identity spectrum. Her practice philosophy centers around intentionally minimizing our risk of perpetuating harm. We explore how this carries over into patient interactions including co-regulating, obtaining informed consent, and empowering patient autonomy.
We also discuss the equally important need to self-reflect, self regulate and modify our workload so that we can do no harm because providing trauma-informed care is more than just being nice. Dr. Krystyna also sheds light on shame as a healthcare provider and how she’s practicing trauma-informed principles in her personal life.
This is a must-listen for anyone interested in practicing trauma-informed care!
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Dr. Krystyna Holland is a physical therapist in Denver, Colorado specializing in the provision of trauma-informed pelvic floor care to individuals across the gender identity spectrum. In addition to helping folks feel confident in their ability to live without leaking and have pleasurable sex, Krystyna aims to change the fundamental patient-provider relationship from one that centers the provider as a problem solver to one that focuses on collaboration between the patient and the provider. She works at:
Inclusive Care: Her private practice in Lakewood, Co
Denver Health Hospital Center: As part of a post-operative vaginoplasty team and an integrative pelvic health team 
The Internet: As an Instagram educator (@krystyna.holland) and instructor of trauma-informed care webinars
Show Notes
Highlights from our conversation in Episode 8: Dr. Krystyna Holland on Trauma-Informed Pelvic Health Practice 
Krystyna’s intro and current projects (0:33)
Krystyna’s path into trauma-informed care (3:17)
What is a traumatic experience and what is trauma-informed care? (5:33)
How do you recognize a trauma response? (7:28)
How can you respond to someone who is dissociating? (9:51)
Obtaining truly informed consent (11:56)
Nocebic language and fear-based marketing (20:55)
Self-care when you’re triggered and/or ashamed (24:46)
Roots of medical trauma in white supremacy and patriarchy (29:58)
Techniques to stay grounded in session (38:22)
When to not push through “the suck” (41:24)
Lightning Round (45:23)
Thank you for listening to The Conscious Clinician. If you enjoyed this episode, please subscribe and write a review for the podcast to grow our community. Keep the conversation going by following The Conscious Clinician on Instagram and Facebook. 
Resources from Episode 8: Dr. Krystyna Holland on Trauma-Informed Pelvic Health Practice 
Krystyna’s trauma-informed webinars (1:41)
Playbook for Painless Sex (2:15)
The Body Keeps The Score: Brain, Mind, and Body in the Healing of Trauma (6:47)
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Episode 7: Cultivating Resilience for Pelvic PTs

In this episode, we explore resilience, professionally and personally. Well-being is a constant journey and resilience is like the health gauge of our coping skills at any given time. We each share examples of times we have been resilient and times we have struggled. Monika shares how her family upbringing affected her beliefs about work, rest, and vacation. Sammy shares how she thrived in graduate school for PT and how she can apply that to her life currently. 
Each of us realized that when we are resilient, we've found a way to keep the essence of ourselves fueled and engaged in the midst of a challenge. This includes focusing on what we can control, shifting to an internal locus of control, and affecting change to reduce our load and/or increase our capacity. Monika shares her strategies for separating from work while working from home. We reference our Myers–Briggs personality types (ENFP and ISTJ) to share our strengths and pitfalls. We end with a discussion around creativity and resilience. 
Highlights from our conversation in Episode 7
Defining resilience (1:30)
Burnout: when your load exceeds your personal capacity (3:18)
Patient resilience & locus of control (8:46) 
Turning “off” when your job is knowledge-based work (13:30)
Interpersonal/emotional aspects of healthcare work (16:01)
Work from home boundaries (18:09)
The struggle to shut work "off" (22:06)
Chasing happiness by striving (30:00)
Monika & Sammy’s Myer’s Briggs personality types & stress (34:05)
Cultivating resilience through creativity (51:52)
Thank you for listening to this episode of The Conscious Clinician. If you enjoyed this episode, please subscribe and write a review for the podcast to grow our community. Keep the conversation going by following The Conscious Clinician on Instagram and Facebook. 
Resources from Episode 7: Cultivating Resilience
Myers Briggs Type Inventory (34:05, 36:28)
Enneagram (34:05, 48:25)
16 Personalities Free Test (58:47)
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Episode 6: History Taking Pearls & Pitfalls

In this episode hosts Monika and Sammy hone in on history taking. The beauty of the subjective is that each question is planting a seed in the patient’s mind. Sometimes we will harvest several sessions later, once the patient has had time to reflect. We can use questions to invite their curiosity, create an individualized blueprint for their care, and increase their engagement with treatment. We share our common pitfalls including: 
Asking leading questions
Making assumptions
Asking vague questions
And offer suggestions for each pitfall and additional tips for an insightful subjective assessment.
Highlights from our conversation in Episode 6: History Taking Pearls & Pitfalls
Common pitfall: leading questions (1:31)
Starting the interview & what to listen for (5:12)
Open-ended questions (9:24)
Ask to prioritize and avoid assumptions (10:34)
Planting seeds for reflection (15:06)
Waiting for a response (17:08) 
Creating a question funnel (20:08)
Questions for understanding your patient’s journey (22:37)
Questions for goal setting (28:37)
Using reflection/summarization statements (31:47)
Top tips for history taking (33:58)
Thank you for listening to this episode of The Conscious Clinician. If you enjoyed this episode, please subscribe and write a review for the podcast to grow our community. Keep the conversation going by following The Conscious Clinician on Instagram and Facebook. 
Resources from Episode 6: History Taking Pearls & Pitfalls
Episode 3: Readiness to Change (15:21) 
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Episode 5: All About Pain Catastrophizing

In this episode hosts Monika and Sammy examine pain catastrophizing through the lens of a patient, Sarah, who is experiencing vaginismus. Sammy shares how she came to realize that Sarah presented with significant catastrophizing, how this affected the plan of care, and what changes she made in her PT practice as a result. Monika and Sammy define catastrophizing, how it may show up in patients, and share practical tips for working with similar patients who exhibit moderate/high catastrophizing.  
Highlights from our conversation in Episode X
Case introduction: Sarah & vaginismus [0:33]
What is pain catastrophizing? [6:01]
How can you identify a patient who is catastrophizing? [10:07]
Strategies for pelvic physical therapists [14:56]
Sarah’s AHA moment [23:30]
Cognitive Behavioral Therapy in PT [25:06]
Psychologically informed PT practice [39:22]
Tips for building patient self-efficacy [44:31]
Sarah’s Case wrap up [52:51
 
Correction: in this episode, Monika referenced an article by Kieran O'Sullivan but incorrectly said Peter O’Sullivan. 
 
Thank you for listening to this episode of The Conscious Clinician Podcast. If you enjoyed this episode, please subscribe and write a review to grow our community! 
Resources from Episode 5: Pain Catastrophizing 
Pain Catastrophizing: A Critical Review (2010)
Pain Catastrophizing Scale (APTA)
Psychological factors in chronic pelvic pain in women: relevance and application of the fear-avoidance model of pain (2011)
Do Romantic Partners’ Responses to Entry Dyspareunia Affect Women’s Experience of Pain? The Roles of Catastrophizing and Self-Efficacy (2013)
Episode 4: The Fixer [12:32] 
Episode 2: Mountain Analogy [12:37]
Cognitive Functional Therapy for Disabling Nonspecific Chronic Low Back Pain: Multiple Cases (2015)  [27:00]
Association of Pain Psychology Provider Finder [34:09]
Psychologically Informed Practice for Management of Low Back Pain: Future Directions in Practice and Research (2011) [39:22]
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Episode 4: "The Fixer" Role of Healthcare Providers

In this episode, hosts Monika & Sammy explore “The Fixer” role that providers take on. They describe how being The Fixer shows up in clinical practice, signs and symptoms, origins and benefits, and tips for transitioning into The Guide role. 
Sammy describes it as “feeling like you need to be someone's hero [like] you need to be the one that solves all of their problems.” With this mentality, a provider must focus on how and what to change so that the patient improves. This is a great deal of pressure to perform. Instead, providers can shift into The Guide by asking “How can I support this person’s change?” which centers the patient in their own healing. 
At its core, helping somebody change is acknowledging their humanity. Acknowledging that they're an autonomous person, independent from what we may tell them to do. They have their own story, background, beliefs, and we can honor them as people by walking alongside them through their pain and/or rehabilitation. 
Highlights from our conversation in Episode 4: The Fixer
[2:29] Sammy’s experience as The Fixer
[6:13] Monika’s experience as The Fixer
[9:03] Blurring Boundaries
[19:45] Signs and symptoms of “fix-it mode”
[27:47] Possible origins of The Fixer
[33:51] Becoming a Guide
[37:54] Noticing when you are in fix-it mode 
[43:07] Visualizations and grounding techniques for The Fixer
[45:59] Final thoughts on changing 
Thank you for listening to this episode of The Conscious Clinician. If you enjoyed this episode, please subscribe and write a review for the podcast to grow our community. Keep the conversation going by following The Conscious Clinician on Instagram and Facebook. 
Resources from Episode 4: The Fixer
28:34 - Burnout by Emily Nagoski and Amelia Nagoski 
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Episode 3: Identifying Patient's Readiness to Change

In this episode we break down the myth of “non-compliance”, introduce the Transtheoretical Model (i.e. stages of change), and provide practical strategies for working with patients at each stage. The “non-compliance” myth propagates a hierarchical relationship between the Provider / patient and doesn’t take into account natural human ambivalence when it comes to change. 
Instead, we’ve shifted to assessing all patients for their readiness to change. We briefly describe each stage from the Transtheoretical Model, how to listen for “stage talk”, and share our strategies for working with patients in each stage. We also explore common misconceptions when implementing this model in clinical practice.
Our goal is to “meet people where they are”. We’ve found this improves our rapport, collaboration, and minimizes stress on both parties. In doing so, we may support patients moving to the next stage. However, change takes time and not everyone will end up in Action / Maintenance. With this understanding, we can reduce the shame that so commonly comes up with change and instead empower our patients to begin where they are. 
Highlights from Episode 3: Readiness to Change
[0:46] Non-compliance
[5:03] Introducing Stages of Change 
[6:34] Precontemplation Stage
[8:25] Listening for “stage talk”
[14:14] Biggest caveat to stages of change
[15:25] Contemplation Stage
[17:34] Preparation Stage
[19:44] Action Stage
[22:33] Relapse 
[25:00] Empowering vs shaming change 
Thank you for listening to this episode of The Conscious Clinician. If you enjoyed this episode, please subscribe and write a review for the podcast to grow our community. Keep the conversation going by following The Conscious Clinician on Instagram and Facebook. 
Resources from Episode 3
[6:19] Transtheoretical Model The Transtheoretical Model (Brief)
The Transtheoretical Model (Long Version) 
Transtheoretical Model of Health Behavioral Change: A Systematic Review (2019)
Stages of Change Model for Participation in Physical Activity during Pregnancy (2013)
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Episode 2: The Mountain Metaphor for a Healing Journey

Hosts Monika & Sammy break down the subliminal scripts and healthcare practices which set providers up to be the gatekeepers of wellness. In this medical model, “we are the gatekeepers of wellness” and patients must go through us to “receive” healing. 
Using the mountain metaphor they redefine pelvic PT and patient roles. The healing journey is depicted as the “The Mountain.” Rather than dragging patients up the mountain, PTs are guides who walk the path alongside their patients, guiding them around common pitfalls, exploring new paths, and supporting the hiker (i.e. the patient) along their journey. 
They share why the Mountain Metaphor is so powerful, from clarifying responsibilities/boundaries to reducing emotional exhaustion and increasing compassion in pelvic health PT. Neither of them were able to “unsee” this once they learned it and began changing their practice patterns. 
Highlights of Episode 2: The Mountain Metaphor
0:00 - Intro
0:36 - Exposing the underlying subliminal script in healthcare
3:59 - The Mountain Metaphor 
5:46 - Pitfall #1: Understanding the terrain 
7:06 - Pitfall #2: Assessing patient readiness & psychosocial factors
9:19 - Assembling a team 
12:09 - Each hiker is unique 
15:44 - Reimagining PT plan of care 
18:32 - Pitfall #3: Underdosing patients 
20:41 - Hiker independence & wilderness training 
23:20 - Dr. Monika shares how The Mountain Metaphor helps her 
26:25 - Dr. Sammy shares how The Mountain Metaphor helps her 
28:35 - Applying the metaphor to your practice 
 
Thank you for listening to this episode of The Conscious Clinician. If you enjoyed this episode, please subscribe and write a review for the podcast to grow our community. 
Resources from Episode 2: Mountain Metaphor
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Episode 1: Welcome Conscious Clinicians!

Hosts Dr. Monika Stefanowicz & Dr. Sammy Steele welcome us to The Conscious Clinician Podcast! Sammy introduces us to the origin story of the podcast when the pair worked closely together as mentee/mentor. Their vision for the podcast is “to help pelvic floor physical therapists create an enjoyable and sustainable practice through the lens of exploring relationships with patients/clients.” 
Monika shares, “we think that relationships are at the very heart of healing.” However, most pelvic health therapists receive minimal training on the interpersonal aspects of patient care. These soft skills are essential in pelvic health, given the intimacy and complexity of the issues people present with. They hope to shed light on burnout, resilience, and a paradigm shift that encompasses psychologically informed care. 
Next, each host highlights the experiences which led to this change in perspective. 
Dr. Sammy Steele, DPT is a pelvic health physical therapist practicing in an outpatient clinic in Davis, CA. She graduated from UC San Francisco and San Francisco state in 2019 with her DPT. She describes feeling burned out and emotionally exhausted with pelvic health during her first year of clinical practice. At the time, she had 1:1 mentoring with Dr. Monika for a trimester as part of the Agile Women’s Health Physical Therapy program. Sammy opened up about her experiences and the two embarked on an exploration of relationships between provider/patient. They focused on professional boundaries, processing emotions, examining biases, and challenging assumptions. These tools helped Sammy embrace a new paradigm of patient care and become more resilient in her work. She’s excited that “this podcast is addressing a missing link in what we do, and hopefully providing a space that's sacred for people to explore these topics.”
Dr. Monika Stefanowicz, DPT, WCS is a pelvic health physical therapist practicing exclusively telehealth out of Austin, TX. She graduated from Springfield College in 2013 with her Bachelor’s and again in 2015 with her DPT. She describes similar feelings of burnout during her residency at Brooks Rehabilitation in 2016/2017. “I didn’t realize reliving people’s trauma with them was affecting my well being because I thought it was the stress of residency.” This connection dawned on her while working with a personal relationship coach. As she studied codependency and healthy relationships, she began changing the way she practiced. Mentoring Sammy accelerated these changes “10X” as she was able to observe the relationships between PT and patient. 
Both of them felt compelled to create a sacred space for pelvic health providers to start and explore the interpersonal and spiritual aspects of care. And so The Conscious Clinician Podcast was born! At the same time, they are clear on the scope of this podcast: “We are not trying to become psychologists. We want to bring psychology into pelvic health because the mind, body, [spirit] connection is so strong.” 
They end with a lighthearted lightning round of questions for each other. Tune in to find out their favorite drinks, books, alternate career options, and definitions of a Conscious Clinician.
Highlights from our conversation in Episode 1: Welcome Conscious Clinicians!
0:00 - Podcast Intro 
0:33 - Welcome & The Conscious Clinician backstory
1:50 - Their vision for the podcast 
3:57 - Dr. Sammy’s background story
7:16 - Dr. Monika’s background story 
11:40 - Podcast values and professional boundaries
14:10 - Sammy’s lightning round of Q&A 
16:38 - Monika’s lightning round of Q&A
Thank you for listening to this episode of The Conscious Clinician. If you enjoyed this episode, please subscribe and write a review for the podcast to grow our community. 
Resources from Episode 1: Welcome Conscious Clinicians!
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