SPEAKER_00 0:01

Hello and welcome to Skull Portal, exploring psychospiritual horizons with your hosts Cedric Speyer and Deanna Magel. Cedric is an optimal therapist who developed the interview guidance model and is a pathfinder in the psychospiritual realm. Deanna created the essential skull care model, a model suitable for therapists, coaches, and healers. The monthly episodes of Skull Portals feature guests sharing insights from their personal paths and professional practices. Thank you for tuning in for the Soul Talk with all kinds of trailblazing teachers and guides as Cedric, Deanna, and guests explore new evolutionary landscapes.

SPEAKER_03 0:45

Welcome to Soul Portals. And our portal today is Dr. John Yafi, a family physician with who will introduce himself a bit. And uh he's a family physician with a difference because as per our theme, he he doesn't look at patients in terms of their illness or pathologically, and we'll explore all the dimensions of that. So I usually open with a quote that pertains to the theme, and this one comes from uh Peter Sage, who wrote this book, The Inside the Track. Because it's his letters from prison. He he he's a motivational coach uh who took on a corporation and ended up in prison in a very rough, uh violent prison for contempt of court, which the judge didn't like. So once he was in prison, he started doing a lot of coaching for the prisoners and had a lot of success. Anyway, here's the quote that relates to our theme. If someone goes to the doctors and is told they are diabetic and they choose to believe that and adopt that identity, they adopt that identity is a key phrase, they become stuck as it is now who they are, and they can only manage the symptoms. If instead they don't see themselves as diabetic, but rather a person whose body is suffering from the condition known as diabetes, they stand a far better chance of treating and curing it successfully as many thousands of people have. It is this sense of separation between your identity and the disease that creates a gap, allowing a greater possibility of healing to enter. It is also the sense of separation between your sense of self and your mind and body that allows for greater and deeper meditations. That pretty much sums up your approach.

SPEAKER_04 2:51

Yes, it does. That's great. I I have to get a copy of the book. So if you put the the reference in the chat, I'll write that down and find a way to find a way to get a copy. That's great, Cedric. Thank you.

SPEAKER_03 3:01

Yep. So a brief professional intro or including what you're doing now before we get into your journey.

SPEAKER_04 3:11

Right. Well, well, welcome to all. Um, my name is John. I'm a family physician, a friend of Cedric. As we said in the warm-up, we've known each other for 56 years and played street hockey on the icy streets of Montreal many, many years ago, but grew up together and went through a different uh educational path. We'll get to that. But I did my medical training at McGill University in Montreal, then went on to do family medicine training for four years and specialized as a family physician. Uh, did 27 years of general practice, mainly rural general practice, uh focusing on the biopsychosocial model, which I'll touch on briefly. And 17 years ago moved to uh Portugal, where I'm now an associate professor of medicine in the School of Medicine of the University of Minho, and mainly teaching on the psychosocial determinants of health. Just to touch on the professional journey along the way, I had the privilege of doing a sabbatical year at Western University, then called the University of Western Ontario in London, Ontario, where I worked with some wonderful people on patient-centered care, person-centered care. And also did a year in Oxford with the DipEx team with the database of individual patient experiences, uh and McPherson and others who who influenced my my career as well. So uh again, it's it's learning medicine through patient stories. So those those are two milestones. And and um currently I'm uh doing supervision for master's students in psychology in Canada through online work, helping uh master students fulfill their uh their requirements for supervision, 150 hours of supervision in the final year. And I'm able to infuse the supervision of psychotherapy students with the biopsychosocial model and then interview guidance, which is the theory that uh Cedric and I developed and turned into our book. Yes, along the way, we've got this book with uh we were all gonna do this at this moment.

SPEAKER_03 5:23

The long academic title applications of a psycho-spiritual model in the helping professions. So covering all the helpers and its principles of interview guidance, one of which is the inclusive self, which Dr. John practices daily and teaches. Right. You actually do your teaching in Portuguese?

SPEAKER_04 5:44

I know I do my teaching in English, although my students speak to me in Portuguese. The joke was on the first day when I tried to speak Portuguese, one of the students said wisely, and in a small group, speak English. We want to get home before midnight. So I I took that in kind, and uh, I tell that joke every time I I lecture, and they're very kind here, very inclusive, and very supportive of my efforts to speak Portuguese. I can translate if needed, but uh, but I do my teaching in English. But it might help at this point for me to share the meaning of the word spiritual as I use it in the medical context. Say what it isn't, what it isn't is it's not religion, it's not any specific religion, but it is what's most important to you now. I think I got that definition from Will Miller, um, a family physician from the Lahio Valley in in uh Pennsylvania, in the steel valleys of coal, coal mining valleys of Pennsylvania. He said spirituality is what's most important to you now. And this harks back to Victor Franklin man's search for meaning. When you help people find meaning, determine meaning, and then apply that on whatever journey they're on or whatever they're trying to accomplish, then uh it becomes so much easier.

SPEAKER_03 6:56

Right. So it's not pie in the sky.

SPEAKER_04 6:58

No, no, and it's it's it's not uh supernatural because again, my dad was a microbiologist and taught me science, uh, organic chemistry and biochemistry at the kitchen table in Canada, first in Halifax and then Montreal by drawing on a napkin. But he he used science because it could help people. Microbiology is all about studying infectious diseases by my microbes, but you do that to make people's lives better. Um, he studied the molecule of uh auger that comes from seaweed that helps to grow the bacteria so that we could make diagnoses and help help people. So it's about science for people, it's helping people. That's keep that in your focus, and and you can study anything. So then my medical school, my medical school training was how can I apply this to make people's lives better? And and the obvious choice for me was to go into family medicine, which was the most holistic of the, even though I didn't have any formal family medicine training in my medical school in McGill, now that's changed. And but I chose that as a career that would fit in with my choice of a lifestyle and and and my work. And so then the four years of med of family medicine training after medical school were included things like the biopsychosocial model. How do we combine our biology with our psyche with the context in which we live, put them all together and and do work that that really has meaning?

SPEAKER_03 8:28

Right. So yeah, go ahead, Diana.

SPEAKER_05 8:32

I'm just curious because you defined spirituality, but um, how how did your own personal sense of spirituality um influence your career choice?

SPEAKER_04 8:46

Well, um I grew up in a in a Jewish home in Montreal and had the values of my grandparents who were refugees from Russia, from Lithuania and Ukraine, who came to Canada and preserved their cultural background within the Canadian mosaic. And I got that from a very early age and learned Hebrew, Yiddish, English, French, and and the songs and the foods and so on. So that's who I am and where I'm from. So my religion, without even believing in a supernatural God, because my parents didn't, but they said, but your culture is important and your values are important. And so the values and the the humanistic side of things really determined who I was and and where I was going. And medicine was was a natural choice for that. And I continued to be active in my community during my my medical school training and and afterwards, certainly during my career. So there was something in the the universal values in humanity of we we're trying to fix the world. The world was shattered at the Big Bang, and we're always trying to get those pieces together. The term in Hebrew is tikkun. We're trying to fix the world, and it's a really difficult task, but we can't give up. This idea of tikkun, then it it comes into to medical therapy and psychotherapy, and so um the Leonard Cohen said, well, everything has a crack in it, but that's how the light gets in. So it's like Kinsugi, you know, we we've got to we put the pieces together, and the pieces that come together may be stronger and more beautiful than what was than what was shattered before. So these are these are kabbalistic concepts as well from Jewish mystical and familiar with mystical and spiritual traditions, whether or not I believe literally in what it says, there's value in that. And and again, as we we say in the book, and then in Deanna wrote a nice book that she asked me to write a chapter, and I'll give her a plug too, about how you use spiritual concepts in counseling. Well, I use biblical images in my counseling. Now, even though I'm not an Orthodox Jew and I don't wear a keeper, I know the stories, and they're great stories, like the story of Joan and the whale. I mean, he tried to run away from responsibility, but his mission, his purpose in life was to prophesy. And so he got swallowed by a whale and he had time to meditate for three days and think. And then afterwards, he was spit up on dry land and he had to go and do what he was meant to do. That was his journey, that was his path. I think everybody has has got something, they don't quite realize it, but there's something good that they're meant to do. So by doing that, he changed people's lives. So I use that story when people are stuck, or or Elijah in the cave. Elijah also had a job and he couldn't do it. He was really afraid. So he went into a cave to meditate, and and the answer came to him. And it didn't come to him in a big, flashy, bombastic way, like a volcano or a hurricane or a wind. It came to him in the form of a still small voice. So that that inner voice that we hear that we're listening for, either in meditation or in prayer or in psychotherapy, you have to hear that voice that tells you, okay, it's time to get out of caves, time to stop meditating, it's time to get back to work. Now go out and do what you were meant to do. And isn't that what psychotherapy is? Isn't that what healing is?

SPEAKER_03 12:03

Did you have a mentor or somebody who influenced you on your path, set you on your path?

SPEAKER_04 12:10

Or so I many, many minutes. I mentioned my father, who I uh late Well Fiafi, who I have to as as I hear his voice when when I'm uh talking biochemistry, uh during my um residency training, and later, uh the late Arthur First, a Scotsman from Glasgow, who had uh uh socialist values, and and and uh he was a real uh changer. Then he said you you have to treat people in their natural context. That's that's what family medicine is. You treat people in their natural context, which is the family, the village, the factory, the school, where they are, because context he said context is everything. So there's so many wise things that he said that so he's he's a mentor. Uh Michael Weingarten, who was um also the late Michael Weingarten, who was an Orthodox Jew, but also one of the leaders of family medicine that uh I ended up working in in his department, he was able to apply uh religious concepts to to people of any religion, the the again, the humanistic values. So I say that these were so and and and I mentioned London, Ontario, where a Western uh Ian McWinnie, who wrote uh the textbook of family medicine, um, a man from uh Stratford on on Avon from Shakespeare, Shakespeare, he was a he's a brilliant writer as well, who again spoke about person-centered care, knowing the person as a person and not as a patient. That quote about diabetes really resonates with me. You no more have diabetes than diabetes has you. And people say, I'm depressed. Well, no, you're not depressed, you're merry. And now tell me, you're you're feeling sad. I understand. That's that's a wonderful feeling. That's a that's an important feeling. That's that's a terrible feeling. Whatever, that's a feeling. Feelings come and go. They're like the guest house, the the poem, a roomy poem that Cedric once shared with me that I use continually. So, but you're not identified with your your disease unless you choose to be. So you're not an alcoholic. You may be someone who currently abuses alcohol, but you're you're something else and you make other choices. So we often get so confused between the diagnostic, or some get so confused between the diagnostic label and who the person really is.

SPEAKER_03 14:20

Yeah, that's why we have a chapter called The Presenting Person, as opposed to the presenting problem. Right. And it's from treating problems to freeing persons.

SPEAKER_04 14:30

And and I like that thing about being solution focused rather than being problem saturated. Yeah.

SPEAKER_05 14:37

Because yes, and staying above the wildness line as much as possible.

unknown 14:41

Right.

SPEAKER_04 14:42

What's that line from Maria Kondo? What sparks joy? You know that line?

unknown 14:46

Right.

SPEAKER_04 14:47

Not not what you not what you're symbolism, not what's wrong with you, what's right with you.

SPEAKER_03 14:50

Yeah, it's important to say that you're not bypassing the issues, especially the medical ones, right? You you treat what you have to treat.

SPEAKER_04 14:59

No, we will we will uh do the the biological diagnosis. I'll ask those questions, maybe not first, maybe a little later, because some people get get tied up in those machine gun questions of do you have fever? Do you have diarrhea? Do you have constipation? Do you have burning when you pee? Okay, we'll ask those later. But who are you? Yeah, and where do you live? Who do you live with? And what's most important to you now? Where would you like to go? What'll it be like when you're cured, when all this is done? Tell tell me about your preferred state. Who will be there with you? What will you be doing? Uh, those are all great questions, and then we'll get to the symptoms later. So we'll make the biological diagnosis, we'll make the psychological diagnosis, and we'll make the social diagnosis in the biopsychosocial model, and we'll have a more holistic description of what's going on now, and then figure out where you'd like to go with that. And what would you like to change? And what would that be like?

SPEAKER_03 15:53

Maybe this is a good time to bring up the the inclusive self uh the diagram.

SPEAKER_04 15:59

Maybe Sebastian or Irwin can help you with that.

SPEAKER_03 16:01

Yeah. And a screen share.

SPEAKER_04 16:05

Oh, thank you. That's perfect timing.

SPEAKER_03 16:06

Here it is. Right. So this is what you're talking about, all these little clouds around the identity story.

SPEAKER_04 16:15

Right. Chap from chapter two of the book. So again, knowing a person's strengths, well, you know, you you've survived abuse. That took a lot of strength. What are your strengths? What what helped you get through that? Because those are probably the same strengths that are going to get you through the next where did you your strength came from? You believe it came from God, or it came from your culture, or it came from your family, it came from your values, it came from your love for your children. What where does that strength come from? What are your strengths? Um, what are your resources? What are the things that are external to you that helped you get from to where you are now? Because here we are. So strength, resources. Now, what worked for you before? How did you cope? Must have been amazing. You got through that. What what worked for you?

SPEAKER_03 17:02

Yeah. And then that's seeing that little piece, the devalued aspects, the part you know, that's sometimes known as the shadow, the rejected part of the self.

SPEAKER_04 17:12

Right.

SPEAKER_03 17:14

And it's surrounded by all these other uh resources and possibilities.

SPEAKER_04 17:20

But it's important to ignite acknowledge that. And I think Carl Jung said that because if you don't, it'll come back to bite you. I think he said it nicer in German. But but the idea of the shadow coming back to bite you, you acknowledge it, you accept, yeah, we we carry that within us as well. There is aggression and there is hatred, and there are mean, nasty things, but that doesn't have to determine your life. The more you're aware of it, the more you can control it rather than it controlling you. Because if you look outside, you dream, but if you look inside, you awaken.

SPEAKER_03 17:50

To quote young again.

SPEAKER_04 17:52

Yeah. Forever young.

SPEAKER_03 17:56

It's amazing that you teach this to medical students now, right?

SPEAKER_04 18:02

Well, I don't know. What's what's amazing about that? What's important, you know, knowing more names of muscles or more names of you can look that up on your iPhone has all the world's knowledge. You don't have to spend a lot of time teaching memory work, but you do need time guiding people to look inside to find out who they are, what their values are, and how they use themselves uh in in helping others to heal. There's another very influential figure in my training, which is um Michael Ballant, a Hungarian psychotherapist who came to England and began to work with English family doctors. And he developed this philosophy of the Ballant groups, where that is all interview. That's all people looking inside to find out, especially when they get stuck in family medicine or general practice with patients. And where they get stuck is is where they have issues themselves often and where they can learn the most about themselves, get unstuck and get their patient unstuck.

SPEAKER_03 18:59

The amazing thing is when you the the the scene of the doing rounds and the doctor with the clipboard and coming to the patient's bedside and not even seeing the person. That's the that's the classic on the cleaning. Right.

SPEAKER_04 19:13

That's the old bio biomedical model, the linear model. You have a sore throat, we find the streptococcus, we give you the penicillin, and you get better. That's a but it's not because it's circular, it's it takes place in a person in a context. If you don't ask who do you live with, you don't find out why this person keeps getting infected. If you don't find out what their internal conflicts are, you don't find out why they don't take the medicine that you so brilliantly prescribe for them. They used to call that compliance and non-compliance. Now, the word compliance from the Latin means bending someone to your will. The new word, and we don't use the word compliance in pharmacology anymore when the patient doesn't take the doctor's prescription. It's now called adherence. We make a plan, we stick to it. Or an even nicer word for that is concordance. We reach we reach an entente cordiale, a concordance between us. We've got this agreement. Um, someone said that the the patient gets, Alfred Adler said the patient gets well when the doctor and the patient agree on the diagnosis. So we've got this shared vision of what isn't functioning and what needs to be changed, and a shared vision of where you're going. And then I hope change change happens. Uh, Michael Ballant, who I mentioned earlier, said that in one of his chapters is the doctor is the drug, which is a nice way of talking to family doctors about the healing relationship. So if the doctor is a drug, you have to know what the dose is, what the side effects are, what the interactions are with other drugs. But you think of yourself as an agent of healing. And another thing my orthodox patients told me, which which I really like because it took a lot of pressure off me, was that I don't heal patients. The first time I heard that, I said, What do you mean? I said, you're just a channel, you're a tube, you're you you're you're a conduit. They said, healing comes from above, from Hashem, one of God's names. And and you're just a good person who channels that healing, and and that's what makes me better. And I said, Wow, that's great. That really takes a lot of pressure off me because I thought it was my fault if you got better, or or my even my my credit to my credit that you got. No, it has nothing to do with that. I'm just a channel.

SPEAKER_05 21:28

So John, one thing I I note in the United States is that it is true that doctors are being taught more person-centered approaches, but the corporate atmosphere that has taken over our medical model means it's so incongruent for the doctor to treat the patient the way they've been trained. There doesn't seem the closest thing I've seen that might be a quick fix is motivational interviewing. So the the doctor at least spends a few minutes asking some person first questions. But other than that, even with my experience and my doctor is you know, she's very person centered, but in the setting she's she works in, it's next to impossible.

SPEAKER_04 22:18

I agree with you 100%. I the context is everything, as my tutor from Glasgow said, as Arthur first said. So something basic has to change in American medicine, in American society first. Someone said a society gets a medical system that reflects its family structure. So I'm living in Portugal. Portuguese family structure is extremely strong. Maybe it relates to the centuries of Roman Catholic culture here in which the family is central, southern European culture, like like Spain, like Italy. So the the the medical system, the family medicine system is very strong because they have this concept of a family solidarity. So the the medical system then reflects the family structure again from the context. Now, when you base medicine on a for-profit system, so the more diagnoses you make and the more treatments you give, the more money you make. So then it's a no-brainer. You make more money. So you make people sick. And your drugs and surgeries often make people sicker than they were when they and your diagnoses may make people sick with the label. So something has to change. So I've worked all my life in um nonprofit systems, in prepaid medical systems, where if you in a health insurance system, if you make the patient independent, if you teach them, if you make them responsible for their own health, they don't come. They don't come to you because they're taking care of themselves. So you're getting the same salaries, you're actually making more because you're getting paid, but you're not working.

SPEAKER_03 23:45

Bernard Shaw called it the doctor's dilemma. Exactly, yes.

SPEAKER_04 23:49

A wise man.

SPEAKER_03 23:50

If you if you if they get better, it puts you out of a job.

SPEAKER_05 23:54

Well, that's the therapist's dilemma, too. And and therapy, you know, psychotherapy and counseling is becoming very much motivated by for-profit efforts. So I'm seeing it across the board here.

SPEAKER_03 24:07

Right, right. By the way, Sebastian, you can take go back to the original screen note. Yeah. Yeah.

SPEAKER_06 24:14

Right.

SPEAKER_04 24:16

Um, yeah, the the economic system then also determines. So in in Canada, at least there's a system within the Canadian where family doctors are paid to do psychotherapy and paid a fair wage so that they will put aside time to do the long interview, to get to know the whole person, to get to know the life story of the person. Michael Ballant said that as well. If you spend 50 minutes to an hour with a person, let's say a person's coming to visit 10, 12 times a year, way above the national average of three visits per year, something's going on in their lives. So if you take that one hour and invest the time and getting to know them as a person, develop a healing relationship, the whole person, their backstory, then it may save many visits because you finally are there for them. You listen to them, you know their essence, you're present, you're witnessing. I think Cedric would also make a comment here about this this model of witness, presence, essence, guidance, yeah, as another podcast.

SPEAKER_03 25:19

Right, okay.

SPEAKER_05 25:20

But this brings up an interesting point, I think. All three of us worked in an EAP setting at one point, doing short solution focused online therapy. Um, and we didn't get the opportunity for those long intakes. In fact, somebody else did them for us. And yet we were able to be person-centered in our approach.

SPEAKER_04 25:46

Perhaps if if the audience isn't familiar with the the um abbreviation or the acronym, EAP is employee assistance program. So we were we were the agents of large corporations who didn't have a psychologist, psychiatrist, family doctor in-house, and they would hire our services and pay us to support their workers. Well, Deanna, the the interesting thing that, and and and Cedric and I worked on this a lot in the in the text-based counseling that we did was that I could do a long interview by asking a number of questions. Tell me about your life and tell me about what's important to you now. And that little box on the computer was actually limitless. So some people wrote me 5,000-word letters. I would get 10-page letters, which would rarely happen in an in-office. I'm a great fan of text-based counseling.

SPEAKER_05 26:35

Me too.

SPEAKER_04 26:35

And and emails. So people were able to pour their hearts out and their life tell their life stories in text. And in fact, one of the first 5,000-word letters that I got at the end, the client said, Well, I actually don't care what you say to me in reply because I already feel a lot better. I love that. And I said, Well, thank you very much. That's I'm really happy you're feeling better. But I still wonder what would happen if you told your partner this, or what would happen if you told your boss this, or what would happen if you tried this instead? So we engaged, and and we have what Sedra likes to call non-local presence. He said, It really feels like you're there with me, but we're doing it in writing because there's something in that healing relationship where they know I'm really listening, I'm really witnessing. Uh, I know their story. People would tell me in in text-based counseling, I've told you things in writing that I've never told anyone before. I've never told my psychiatrist this. Right. I don't know why I'm telling you this. I said, Well, that's great. I'm still listening, and I'm really hearing what you're saying, and I respect you for that. There's no embarrassment here. I can't see your face. I don't know if you're blushing or crying or keep going. You you've got it. Keep going, you're on the right track.

SPEAKER_03 27:52

That was the empowerment.

unknown 27:54

Thanks.

SPEAKER_03 27:54

That's all that's called the disinhibiting effect, which we put to positive use. It's often used, you know, in a negative way.

SPEAKER_04 28:02

Oh, yeah, when people flame each other on uh on Facebook or on TikTok or whatever. Yeah.

SPEAKER_03 28:07

But we turned all these things to our advantage in text-based counseling.

SPEAKER_04 28:11

Right. So all the things that I learned when we worked together in that employee assistance program are things that I'm teaching my students now because those are universal human values in developing a healing relationship. It's fun that we were able to distill that in writing because we had none of the external, no office, no pictures on the wall, no carpets, no building system. And just just me and you, as the as the kids say, you and I are together in this in this ink in this healing relationship. Let's see what works. Now, the fact that I have the complete transcript of that exchange means that I'm able to look back and see what did I say that triggered a healing response in that person? What worked? Or the opposite. Or the opposite. Yeah. When Cedric was the supervisor, he was in, well, how might you have said that differently? That's a polite way of saying. And there was a series of letters that I that I took out of that that I use currently in the medical school. People with uh chronic diseases who were identified, who had to label diabetes, multiple sclerosis, uh cancers, uh, inflammatory bowel disease. I took those letters out and saw how could we use these spiritual values, these healing terms in helping people cope with chronic disease? And that that was another fascinating point, which has a direct application to the training of medical students and medical residents.

SPEAKER_03 29:36

Yeah, there's an interesting question in the comments. So oh yeah, sure, sure.

SPEAKER_04 29:40

Why don't we open that up? I'm not watching the time at all.

SPEAKER_03 29:42

That's okay. From the patient's point of view, do you have advice for someone who's being treated the traditional quote Western way UK and is frustrated by it and wants to be treated more as a whole person by their doctor, and it's someone who's uh shares serious COVID vaccine injuries, but the doctors just want to give me painkillers and shoe me away. So just as a patient's point of view, if they have a doctor who's not doing everything you've been talking about, what do they do?

SPEAKER_04 30:13

Yeah, just as a disclaimer, I can't give medical advice to anyone here in the group. We can talk in general terms about what I've done in my own situation working with certainly when I was working with this EAP, uh, there is something sacred in the doctor-patient relationship. And in medical ethics, we learn not to criticize another physician or colleague because a patient has to go on for years with that patient, with that doctor, with that physician or therapist. So I won't criticize a colleague uh ever in public or or to another colleague or uh to certainly not to a patient. But what I did when I was the third party in the employee assistance program, and people would write to me with legitimate complaints about the relationship, the relationship needed healing. I would say, well, I wonder what would happen if you said that directly to your physician and said, I need to talk to you about something that's troubling me. May I do that? Or this may be difficult. Can I say that? Here's what I have to say. And how can we work on this together? We're we're a team. How can we now it takes a lot of courage to do that and requires lots of empowerment, especially in hierarchical, patriarchal? Uh, there are many other terms that I could use that that to push people down for various reasons, but there are ways of coaching people and helping them to take the reins and and to work together with the therapist to to heal the relationship, to heal the rupture, and and to get the care they need. And then there are other kinds of therapists that you're free to consult, uh, in addition to your your primary care therapist who who primary care uh physician who may adopt that view and and look for other ways of dealing with um the current issues that you're facing.

SPEAKER_03 31:50

And let us know, you know, Justin, if that speaks to the question. It sounds like it does.

SPEAKER_04 32:05

I love opening things up because I learned so much from the questions that uh if other people would like to chime in either I don't know if it's okay on mic or on chat. I'm happy to either I'm happy to take questions.

SPEAKER_05 32:26

Well, and to the point um that we were just you were just speaking to, it's there's a also a movement here in the United States. It could be global, but in the United States there's a big movement for patient advocacy. Um and you know, as a coach and a therapist, I'm always speaking in terms of empowerment when when I'm talking to clients who are patients and and they're they're not they're not standing up for themselves. And so that that is also just so important to be able to find that resilience to say, you know, yes, but here's what I here's my real question, like here's my real concern. So yeah.

SPEAKER_04 33:10

Yeah, yeah. You're on the team, uh, Diana, you're doing you're fighting the great fight. And and that's what I do with my with my medical students when we're teaching them doctor-patient communication. That's another course that I'm involved in. One of the cartoons that we have is the the doctor in America reading the patient your your Miranda rights, and he says, You have the right to remain silent.

SPEAKER_05 33:32

I've seen that one.

SPEAKER_04 33:33

Like, like in the TV shows, the police shows, anything you say maybe held against you. But and so it's it's like these doctors from the hierarchical, patriarchal, whatever system are are saying, I'm the doctor, I know it all. You just answer my questions, simple questions, and and I'll tell you what you've got, and I'll tell you what you have to do. No, that's wrong. That's this is it's your life. And we have to work together to to to to to make a model of what needs to be changed and and where you'd like to go and and find the resources, whatever they are, to help. And hopefully, because I'm I'm a scientist and I use evidence-based medicine, there will be evidence that this is helpful and not harmful. So that anything that will suggest, but you know, we'll try anything. So um in in our doctor-patient communication workshops, we ask those um, and anything else? Is there anything else? And you've you've talked about back pain, but is there anything else you'd like to discuss with me in the time we have remaining to us that that's important to you that you'd like to to hear about? And and and then check in, check out, like in a hotel, and use anything from the mini bar. Um, was what I talked about today helpful to you? How was that helped to you? Um, or as my my doctor Arthur first used to say, if I were a smarter doctor, what question would I have asked you today that I forgot to ask you or didn't ask you? Patients will laugh and then say, well, what you really should have asked me is about my relationship with my partner, because that's what's really bugging me more. The the back. And then there's the thing about the doorknob. You know, the the the the patient has the doorknob question. The patient has a hand on the doorknob and is about to leave the room and says, Oh, one more thing, doc. Oh, it's probably not important, so forget about what talking. And the correct response to that is, no, leave the doorknob. Please come in and sit down again and just tell me what that is, because it may be important, and it usually is because it's natural for us to to to put aside the uncomfortable things and leave that for last.

SPEAKER_03 35:28

That's what leaves the rest of us in the waiting room.

SPEAKER_04 35:31

Right, right. And so, and so my my patients would routinely say to new patients, oh yes, John takes a lot of time, but it's really worth it. So when you're in there, you'll feel like you're the only person in the world with him in that room, that his only patient. That's a great compliment. Again, Max Polliak, uh, my professor, uh, again, who patients said to him, When you're with that doctor, you feel like you're the only person in the world with him. So we we learn to to be fully present to learn the essence. And and yes, it does take time.

SPEAKER_05 36:05

And that is what is not the corporate settings, the for-profit settings, don't necessarily allow for that. And as therapists, at least over here, we're taught the 50-minute hour. So if there's a doorknob issue, okay, well, we'll talk about that next week.

SPEAKER_04 36:22

Yeah. And I mean, so there's a certain flexibility because because you can even train those for-profit uh managers that in in 50 minutes in general practice is very, very rare. Many, many uh general practice consultations or book bookings are 10, 15 minutes, maybe 20 minutes in Portugal. But if you spend four sessions, that's full hour, full therapy, you may be saving unnecessary CT scans, MRI scans, uh uh coronary angiography, uh medication referrals, and so on by listening to what's really important.

SPEAKER_03 36:57

Okay. And the devil's advocate a bit. Yeah so chronic pain. So someone who says, I know I'm a good person, I know I'm a whole person, I have all this going for me, but I'm in constant pain, and I it just everything else doesn't matter. So, what's your response?

SPEAKER_04 37:15

Well, uh chronic pain is is um several workshops uh worth here. Again, you have to get to know the life story, you have to get to know the context, you have to know what came before. As Victor Frank says, you have to know the meaning of the pain to them. If the pain is associated with off work from a job that they don't like and never want to go back to, uh using opiates for a long time, it may null the pain, but it won't resolve the issue. So it it's it's a world in itself. Every person is a world in its in in his or herself. So you really have to get to know the whole story. And and chronic pain changes the the physiology. The different fibers call are called into play, different parts of the brain are changed by chronic pain. So you really have to know a lot. And that's why the best pain clinics in the world use a holistic approach that involves the biopsychosocial model. But it's the same principles. It's tough to do in 50 minutes, especially if it's it's a story of years. But the the example of the person trapped in a job that they don't like, injured by that job, and then suffering from that injury, um, it is quite complex. So you you really have to then you have to call in uh occupational therapy, um uh retraining, uh sometimes getting in touch with managers and and colleagues at work, uh colleagues at work to to allow for re-entry and allow for healing. And yes, and opioids, opioids work. We we you know we we have the poppy on the planet because it's got the most powerful drug that we have. And sometimes that's necessary to help people um get past that debilitating symptom that that anybody who hasn't who's never really experienced chronic pain doesn't know how much that beats us down. So we need the best tools available to deal with well, biological tools, but we also need the psychosocial tools to help people to cope with.

SPEAKER_03 39:12

And one more thing, when you focus on the person like you do, um, what what happens when it clearly to you crosses the line into psychiatry that there's a psychiatric issue? So, how do you bridge that or how do you manage that if you're there in the past?

SPEAKER_04 39:29

I I don't draw those lines. I know that that's a separate profession, but every family doctor, I said the biopsychosocial model is three overlapping circles, and and most, I guess almost all of medicine is in that the Venn diagram, is is happening in the middle. I can't say that belongs to a psychiatrist, rather. No, it it belongs to you, it's you and your life. We all have a mind and a body and a soul and a context, and we need to get to know all about that. So um, my my beef with uh modern psychiatry is that it becomes biological psychiatry, it becomes drug pushing. It's SSRIs, it's prozac uh medicine and proxychology. And I'm really looking for the good psychiatrists who take all that they've learned about the mind and the body and the soul and who practice psychotherapy. It's very hard to find. That's why currently I'm investing a lot of my time with these master students in psychology who understand the importance of counseling and coaching. Those are the people I'm happy to work with. I don't know, maybe I should be investing time with psychiatrists and get them away from that drug-based therapy and more into the the what Freud did in the beginning. Although he was a neurologist to start out with, he studied the nervous systems of worms, and his dream was to put together the biological and the psychological in a healing art.

SPEAKER_03 40:50

There's some really good comments, Deanna. I'm sure there are.

SPEAKER_05 40:55

Okay, just heads up. I'm in Florida, storm is coming, so if I mute, that's why.

SPEAKER_02 41:01

Um starting with Francisco at the top. Uh no, there's Justin again. Anyway.

SPEAKER_05 41:08

Um, Justin, we we heard from Jill says most patients, as with clients, just want to be heard. They feel better by just being listened to. Um and Justin says again, I have copied, I have coped by simultaneously being been seeing a functional Islamic doctor naturopath, and uh one-to-ones are always a positive experience. Um Francesca says some individuals and communities have a high level of respect for the authority of medical professionals, even to the detriment of their well-being, and avoid any form of holistic support or questioning, and perhaps lack the confidence and vocabulary to do so, kindness first would be so helpful. I agree.

SPEAKER_04 41:56

Lovely, lovely.

SPEAKER_05 41:58

Yep. Um people can be too poorly to advocate for themselves or engage in the battle with the absolutely um really enjoying the conversation. Mike says, do you have any thoughts on situations where identifying with a diagnosis may be experienced as helpful for some people, such as the accounts for some people with a diagnosis of autism who seem to find some solace and solidarity by identifying with autism as an intrinsic part of themselves?

SPEAKER_04 42:31

Yeah, yes. Uh that just to go with the last one first. That's what I was thinking, the autism and ADHD, example, people who suffered and were marginalized and discriminated against. And suddenly, when they're given the diagnosis and the label, that has meaning. And and again, but we'll we'll not focus entirely on the label. It said we have an explanation because that's the heuristic value or the and the human and the hermeneutic value. There is a meaning in your suffering, and here is a way of explaining it as um here's an explanation, and so that that can be a source of solace. And not only that, there are ways to move forward. There are resources that can have maybe medication, it may be accommodations, it may be uh explanation to your family, to your partner, to your workplace, to your teacher. And that allows us, uh I love that to move forward with kindness. I think about being listened to is really important as well. You know, it but a lot of what happens in medicine is it's again the doctor is the drug, it's the role model, it's how we behave in our in our consultations. So when a kid comes in and and I run off some uh cartoons, some Superman or Batman cartoons on the printer and get out the crayons and start craning, but get down on the floor and play with the trucks and don't wear a tie and don't wear a white coat. They know here's a human being who wants to engage with me on a human level. And that was a great fun in general practice for so many years is meeting people. I I would meet people on the farm. I'd go into the greenhouse where they were raising their flowers and examine them there and see them there. I said, I know you're busy. So it would be getting away from the three-piece suit and the Harley Street in the UK, isn't it? Those fancy offices that are so expensive. That's not me. I mean, look at Dr. Finley's case book or James Harriet all, Creatures Great and Small. It's getting down and dirty with the boots on and in the mud. And and and that's what creates the healing relation. We have to get off our pedestal of the that's 19th century.

SPEAKER_05 44:34

That's you know, in the South, here in the deep south, when I did in-home counseling, we called it iced tea therapy. Get your get your glass of iced tea, let's get on the porch. And it worked. So Dr.

SPEAKER_04 44:50

Yeah, well in Canada, we need hot tea. So I would say to people, imagine your armchair is in front of my armchair, and we each have a cup of hot tea here, and the fire is going. And now tell me what you're feeling and what you're thinking and where you'd like to go. So yeah, but I love that iced tea therapy. That's like a mid-link.

SPEAKER_03 45:08

When you help or guide people, do you see yourself as a lamp, a lifeboat, or a ladder? And you're not allowed to say all three. Which one? A lamp, a lifeboat, or a ladder.

SPEAKER_04 45:20

I I like the lamp. Um, and it would be the lamp that the mountain guide is carrying. So uh there's an uh James Hilt, uh, not James Hilton, no, Sean Hilton wrote an essay uh from priest to mountain guide. Not a priest standing up ex cathedra on the I'm a mountain guide. Now, a mountain guide, if you've ever gone hiking in the peak district in the UK or in which I've done, or in in the lake district, which I love, um, and I walk with guides, they walk beside you if the path is wide enough, and they take the steps one after another. So you they're taking the same steps you are, they can't walk for you. They show you where the safe places to walk are, where the stones are where you can walk safely and where the the the risk of falling, but you still have to do the work and and put one foot in front of another and walk, and they'll get you safely to your destination. And and they're carrying a lamp because, well, this is a little bit dark and tricky here, so this will light the way to show you where we're going. And you know what? When you get to the end of the path, and you're gonna go on to Derwentwater or to Windermere or to Newcastle. I went on to Newcastle after my my trip. Well, you're gonna shake hands or give a hug or a kiss or whatever's socially appropriate and say, thank you for guiding me. And now they say, Well, I have to go back and guide somebody else now. Now you've got it, you're on your way, you're safely past this. So it's the guide with the lamp, and and that's what good family medicine is.

SPEAKER_03 46:51

So I should add Sherpa to the list of the in the candle questionnaire.

SPEAKER_04 46:56

Right. Well, no, the lamp is fine. I I understand what you're saying. Or I that's the way I interpret it.

SPEAKER_03 47:02

Yeah, good analogy.

SPEAKER_05 47:07

Um really enjoying the conversation. Let's see. Oh, sorry. This has been truly inspirational, Anne says. Thank you. I'm a counselor, psychology background in the UK, and have just started a PhD looking at medically unexplained physical symptoms. Oh, love that.

SPEAKER_04 47:28

Yeah, mops. Yeah, I've done research on that too. I'd be happy. Look, if anyone wants to share, and and I've got references and I'll be happy to send, maybe we can share my email because I'm not shy. And I answer my emails. I love email. So if you'd like some references on mups, what are you doing on mups? Can you tell us a little more? Can you read that one? Medically unexplained physical symptoms.

SPEAKER_05 47:46

Um I also did master's dissertation on the subject, and there are a lot of overlaps regarding context and psychosocial issues and also the issue of identity, such as what would your identity be without the symptom? Right.

unknown 48:00

Right.

SPEAKER_05 48:00

Yeah.

SPEAKER_04 48:01

And it was Salmanuchin from Families and Family Therapy who talked about the function of a symptom within a system, like the child has asthma, which is not being resolved, the kind of wheezing. And when he went into the family system, he saw that the unit of the parents were dysfunctional as a couple. The couple was, and every time they began to fight and there was a risk of them breaking up, the child began to wheeze. And it wasn't until they did the basic work of marital therapy and couple counseling that the focus was taken off the identified patient, the sick child. It's a classic example from systemic family therapy. So, and MUPS can often be, you know, what will your life be like without the symptoms? We have to think about what is the symbolic function of that symptom, what's that about? And and and what will happen when that symptom is gone. You have to figure out what function is that symptom is serving within the system. But if that person would, I would love to correspond with them and share my references on mups.

SPEAKER_03 48:55

Is it okay if I put your email in the chat?

SPEAKER_04 48:57

Oh, absolutely.com and anybody wants to write. And I've got tons of references and I've published on that. And and I'm interested in supporting that research because there's gold in them, their hills, as the Americans say. The more research we do on that, MUPS can be this incredible that that's medically unexplained physical symptoms. It's like the migraine headache or the low back pain or the pelvic pain, uh, that or or the IBS, the inflammatory, the irritable bell syndrome. The more we learn about that, the more we'll learn about the use and misuse of medicine and how we can liberate people from symptoms and get them on the path to where they're supposed to go. So I encourage that research, yeah.

SPEAKER_05 49:42

Um yes, somebody referred to IBS as and fibromyalgia.

SPEAKER_06 49:49

Yeah.

SPEAKER_04 49:50

Um I heard the IBS, the bowel is crying. The eyes can't cry. Uh, we use the term um from simonides, um, I believe it's simulitis, I'll get the name proper. Alexothymia, no words for feeling. If you don't have words for feeling, then you've got symptoms or behavior or whatever. But when you help people find the words for this year in Slovenia, we're going to do a course on emotion and family medicine. Why do we need to teach and learn so much ourselves, our patients, and our students about emotion? Because finding the words for feelings helps us to move forward.

SPEAKER_03 50:28

Yeah, Adler called it organ jargon. And then you translate the organ jargon in self-expression.

SPEAKER_05 50:36

And Anne says in the chat, although the symptom is awful, it protects against what is intolerable.

SPEAKER_04 50:42

Lovely. Yes, yes, that's wise. Yes, yes.

SPEAKER_05 50:50

So we have a few minutes left. Does anybody have any questions?

SPEAKER_04 50:58

Branny Brown, I see the the name here. Gorgeous action on. I'd love I'm gonna open the chat box myself uh about the vocabulary feeling. Yes, yes, I've seen some of her work, which is very wise. I'm gonna go through this. I hope we can save. Does does um is it Erwin or is it uh Sebastian will save the the chat? I haven't had time uh to save the chat. Yeah, I see John said yes, because I'd love to read these comments and find out who said them and maybe engage with the people who wrote them.

SPEAKER_03 51:27

So on a on a personal note, your own journey, like your trajectory and your growth learning curve. So what has been your challenge in your own soul growth?

SPEAKER_04 51:43

Um, there's only 24 hours in the day, and and I I love learning, I learn so much. I I come to work every day because what am I gonna learn today? Uh for example, this this there's not enough time to do all the things we want to do. That's a challenge.

SPEAKER_03 51:58

So I mean, does the same thing apply like personally, emotionally? That if if there's a conflict, if there's a crossroads impasse, you just want to explore it and with the same enthusiasm.

SPEAKER_04 52:11

It's a gift, yeah. It's it's something it's gonna teach me what's the universe trying to teach me here. And happily I had loving and and and caring parents who who did that with me when I was a child, and sisters who did that with me when we were growing up, and then I had wise mentors when in my professional career, and now I've got a loving wife and daughter who help me who challenge me every day, who don't let me get away with anything. And so, oh wow, and students like the ones who said we want to get home by midnight, speaking your own language, what we understand, but just constantly being challenged means you're being you're learning.

SPEAKER_03 52:46

Yeah. So, by the way, for the audience, the you're you're the most consistent person I know. Basically, you haven't you you've been like this since you were 12 years old. You have more knowledge and wisdom, but it's you're you're the same, unless unless hair.

SPEAKER_04 53:05

Thanks.

SPEAKER_05 53:05

Um I'm putting in the chat the link to the book and the courses. Thanks.

SPEAKER_04 53:10

Yeah. Um, one of the nice things I I learned from like this forum here is that we had a group of 10 therapists, roughly 10, that Deanna was in that group as well. We met every month. Learning in groups is really powerful. And I'm learning from the students for doing the group survision. If someone presents an issue, a case, or an issue that they're dealing with, and you go around the circle, groups of about eight to ten are probably ideal size, maybe 12 is ideal size, and you meet regularly, and there's an intimacy that develops, and you can exchange ideas and share, that's a great way to learn. So I want to again say thank you to John for this opportunity and congratulate him on the work that he's doing. But the people who kind of are becoming regulars, if you have a way of getting together, maybe Cedric can help with that too, and getting um groups to talk about the issues that, or maybe Diana, that people are facing and get supervision in that in that group frame, that's a great way to learn.

SPEAKER_03 54:09

Good. Well, every month we have a different portal to the infinite through the channel of whoever our guests is.

SPEAKER_04 54:16

And yeah, well, that's that's a great way to new people to meet new people, but I'm saying the people who are here who are struggling with either issues themselves like long COVID or COVID vaccine, or a client with so-and-so, and and would like to discuss that in a supportive framework, maybe this could could lead to something else in that direction. The like the the interview guide, the cut we called it the cuddle group. We used to give each other a cuddle uh and and support each other intellectually and emotionally by by presenting cases and supporting the work that we're doing.

SPEAKER_03 54:45

Well, the other the other John John Wilson is what Dr. John's talking about in scope for online events.

SPEAKER_01 54:53

What did he say? Deanna's running a peer supervision group every month. I've just popped the link in there, and there's always room for more adventures, uh online events.

SPEAKER_04 55:04

So yeah. Okay, great. So you're you're you're thinking in that direction, yeah. Because I find that that's the way people really learn when they say, here's where I'm stuck, here's the client who really challenges me. I don't know why I'm stuck, I don't know what to do. What do other people think? And say, Well, this is what I did in that situation, or here's or what would happen if you did this, or what have you thought about that? And that is just such a great supportive way to learn.

SPEAKER_05 55:31

Absolutely. Peer supervision can be very powerful, just yes, you know, meeting peer-to-peer diet.

SPEAKER_04 55:38

Because you're all small people, you're all smart people, and you're all good people, and you put your heads together and there's nothing that will stop you, then nothing will that you can't overcome.

SPEAKER_01 55:49

That's very interesting. Every month is on peer supervision, so it's in the chat. Yeah. Okay, look at a great hour.

SPEAKER_03 56:01

And uh the closing blessing is bless the moment, trust yourself, and expect the best.

SPEAKER_04 56:09

Thank you. Thank you for the opportunity, John, and thank you for all the wise people who asked those good questions. It's really been a pleasure. I look forward to reading the chat uh quietly and my own time afterwards and and maybe getting in touch with some of you.

SPEAKER_05 56:23

Francesca says, Um, did you say you have a podcast?

SPEAKER_04 56:28

No, I don't have a podcast. That's Cedric's trying to get me to do that, but uh I I keep quite busy with my students in live teaching and and uh in the online teaching that I do for a clinic in Canada for upstream counseling.

SPEAKER_03 56:43

Yeah, you're a you're a walking podcast.

SPEAKER_01 56:48

Thank you.

SPEAKER_05 56:49

Yeah, everybody's saying they really enjoyed the conversation. So that's awesome.

SPEAKER_01 56:54

Really lovely feedback in the chat, isn't there? Really nice.

SPEAKER_04 56:58

And Cedric, Deanna, and John, you make it easy.

SPEAKER_05 57:06

The email is in the chat. Um, but I'll see if I can post it again.

SPEAKER_01 57:12

And Erwin, do you have the link to the Soul Portals podcast as well? We could pop that in if in case anybody wants to check out the earlier episodes and then also check out this episode that will be available in the next few days, I guess.

SPEAKER_03 57:27

So Yeah, this episode in itself, the recording, it would be a great teaching vehicle for any kind of student. Absolutely.

SPEAKER_01 57:42

Well, I want to add my thanks to thank you, John, for coming and being part of this um wonderful series, and Cedric and Diana for the way that you've held the hour too. It's been very inspirational, so much energy in this last hour together. It's been wonderful. And thank you to the online events team, Sebastian and Erwin for taking such good care of us and everybody who's been with us. Really appreciated your presence.