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Unveiling the Power of Interoception with Kelly Mahler
401 Plays1 year ago
Welcome to another episode of Growing OT! Today, we have an incredibly insightful guest, Kelly Mahler, joining us to delve into the fascinating world of interoception. In this episode, we're going to uncover the journey of interoception, unlocking its immense power, and navigating the intricate assessment puzzle.
We'll also explore the importance of language in bridging the gap between occupational therapy and interoception, and discover how interoception is the foundation of self-regulation. Kelly will share her expertise on empowering families to embark on this interoceptive journey and how to nurture awareness through fun daily routines.
You won't want to miss this episode! Stick around as we wrap up with some delightful and creative expressions clients have used to describe their sensations during interoception exercises.
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Transcript
Podcast Introduction
00:00:03
Speaker
Welcome to Growing OT, the podcast that's developed and produced by the Society of Alberta Occupational Therapists. SAOT wants to get listeners excited about the wonderful world of OT. I'm your host, Vilmarie Myberg. Please take a moment to subscribe or leave us a review on Apple Podcasts, Spotify, or wherever you're listening to us right now.
Interoception and Dr. Kelly Mahler
00:00:25
Speaker
Today's episode will focus on interoception.
00:00:28
Speaker
the eighth sense, with special guest and OT, Dr. Kelly Mahler. We're so thrilled to have her with us today. Dr. Mahler earned a Doctorate in Occupational Therapy from Mizzicordia University, and she's been an occupational therapist for 20 years, serving school-aged children and adults. Kelly is winner of multiple awards, including the 2020 American Occupational Therapy Association Emerging and Innovative Practice Award,
00:00:58
Speaker
and a mom's choice gold medal. She's an adjunct faculty member at Elizabethtown College as well as Mizzicordia University. Kelly is a co-principal investigator in several research projects pertaining to topics such as interoception, self-regulation, trauma, and autism. Kelly is an international speaker and presents frequently on topics related to the 10 resources she has offered.
Dr. Mahler's Journey to Interoception
00:01:24
Speaker
Well, hi Dr. Mallard, thank you so much for joining us today. To get us started, I'm wondering if you can tell us how you got into this area of practice, or to use your own words, how you became an interoception groupie.
00:01:39
Speaker
Yes, I am a self-proclaimed interception groupie, and honestly, I stumbled across the word interception almost 10 years ago, and at that point in time, I was clueless. I didn't know what interception meant, and through just reading a little bit about it, I got curious. But I really thought originally it was like a toileting thing, something important for toileting.
00:02:02
Speaker
The more I read, the more I realize I think this might be really important for all of our lives, but especially for my clients. So I am like a really, really curious person. My husband actually calls me the interviewer. And so I went right to my clients and I started to ask them lots of questions about
00:02:20
Speaker
their experience and their families, I started asking them lots of questions. And what became very evident was that Intraception was playing a really big deal in their ability to participate in their daily lives.
Understanding Interoception
00:02:35
Speaker
And along those lines, what is interoception and why is it so important? Wow. I think that's a really good place to start. So interoception is a sense, so we call it the eighth sense. And it is our, really our experience of our internal world.
00:02:55
Speaker
So our internal sensations and we all have different inner experiences. So it's how some of us might feel like a certain sensation in our stomach, like maybe an empty feeling or nauseous feeling or gassy, or sometimes even people talk about butterfly sensations. So those are like inner feels that we experience because of interception and it involves our entire body. So we might notice a pounding feeling head or
00:03:18
Speaker
maybe sore ears or tense muscles or I don't know, full bladder and all of those inner sensations we experienced because of interoception. So what interoception science is showing us is that being clearly aware of those internal sensations provides us with really valuable clues about what our body needs for like health and regulation.
00:03:39
Speaker
It provides us with really vital clues about what emotion we're experiencing. So those body sensations, being able to notice them, be able to understand them, help us to know when we're sleepy or hungry or thirsty or frustrated or anxious or calm or excited. These emotions and self-regulation, knowing how our body feels, what it needs, comes from these internal sensations.
Challenges of Interoception in Daily Life
00:04:03
Speaker
And that really shifts a lot of how we might support
00:04:07
Speaker
these areas of occupation and our ability just to regulate and maintain the health of our body. It sounds like it's very closely tied to an individual's ability to participate in their day-to-day occupations and activities.
00:04:23
Speaker
Yeah, absolutely. We have to notice that feeling in our body knowing when we need to pee or poop to be an independent toilet or we have to notice those feelings coming from our body knowing when we need sleep and it's really impacting the occupation of sleep. So there's just so many, like I could talk to you all day about how interoception influences so many areas of participation.
00:04:46
Speaker
So as an occupational therapist, when you're working with a client that does have difficulty with interoception, how do you assess for that?
00:04:57
Speaker
Yeah, I think that's a really good question. And I'm just going to say that you're not the only one asking that question, that this is a really highly debated topic in the interception world. What is the best way to assess interception? Nobody can agree upon that right now. And so really what I like to do is look at where the participation strengths and barriers might lie for each client and then think interceptably about that good interception.
00:05:20
Speaker
potentially be at play. So for example, like, toileting is just a really big occupation that people ask us about all the time. And if someone is having difficulty with continents, interception should be one of our curiosities. You know, what is going on there? Are they receiving signals from their body letting them know when their bladder is full, when their colon is stretched and they need to poop? There's a lot going into it.
00:05:41
Speaker
And if I'm supporting a client that I can ask questions to and they can respond, I will ask them lots of questions like tell me about what you notice in your body or how does your body feel when you're sleepy or what do you notice when you have gone for long periods without food or what do you notice when you start to get overwhelmed? So really seeing are they connected to their body? Are they getting reliable?
00:06:03
Speaker
clues coming from their body, helping them to be able to participate. And that being said, I do have a lot of clients that might be non-speaking or maybe they're too young to be able to really answer these insightful questions about themselves.
Framework for Connecting with Internal Signals
00:06:16
Speaker
And so then we're just really looking at clues and making some respectful guesses as to could an interception difference be at play here.
00:06:27
Speaker
Okay. And can you speak a little bit about reliable cues from the body? What would you kind of do as a next step if those cues aren't necessarily happening reliably? Yeah. So our framework right now is really divided into three main parts. And so we always start with what we call section one or part one, which is called body. And those are a bunch of strategies to help a person begin to connect and notice their body signals.
00:06:56
Speaker
And we are always doing this work when someone is regulated and feeling safe in their bodies. That's when any of us would want to pay more attention to our bodies. So we do really fun play-based activities with young kids and also our adult clients. Like we try to make this fun and engaging and we might do something like, I'll just give you an example. Like we break it into one body part at a time and we invite someone to notice like how do your hands feel while you're doing this activity or
00:07:23
Speaker
How does your nose feel when we're doing this? Or how does your mouth feel when you're eating a popsicle? Or how do your feet feel while we're walking across this carpet? We're just really trying to give some play-based experiences for someone to connect and notice how their body is feeling. And then we move into the next step. Now that someone is noticing they're more connected to their bodies,
00:07:45
Speaker
We move on to what we call step two is emotion and helping each person to link their own unique internal body signals to the meaning. What do these body signals mean for me? And that's quite different because I was trained to teach people what does each emotion feel like.
00:08:04
Speaker
What does angry feel like? It's when your fists are tight. It's when your skin is hot. And what reception science has like just completely blown out of the water is that there is no one set footprint of emotion. And we are all so very different in the way our bodies feel. And so this is really a process of self exploration. And it's really cool because we're like the coach on the sidelines, like helping each person to notice
00:08:26
Speaker
and figure out what their unique inner experience means for them. But we don't want to forget about, there's also step three, the final piece, which we call action. And that's like really then working on what can I do in this moment? Now that I'm noticing these signals, I understand what they mean. What can I do to promote comfort, regulation, health in my body?
00:08:45
Speaker
So what action can I take to help regulate? And that's also quite different than what I was doing previously because I was starting at step three. I was teaching my clients all the coping skills in the world. And I'm like, here, do this. When you're frustrated, take deep breaths. But what I realized was they didn't have this reliable
00:09:03
Speaker
clues coming from their body, letting them know, Hey, now would be a great time to take deep breaths. So I have, I had to rewind my practice a lot because of interception science, but it really has just shifted everything. And my clients are experiencing so many more gains, for sure.
Client's Emotional Footprint and Language in Therapy
00:09:22
Speaker
Great. And in that rewinding process, what was the most surprising thing that you realized? You did mention just now that you kind of switched the steps that you started with, but was there anything else that was eye-opening that happened?
00:09:38
Speaker
Yeah, I know I said this before, but this is what still astonishes me today is just how different each of our bodies are. And I really didn't, maybe I didn't stop to think about it. Maybe I was prescribing to the one size fits all process that we said anger feels the same way for all of us.
00:09:58
Speaker
I was even taught in the 11th grade health class, like stress is when your pupils dilate and your skin is not like that for all of us. I've learned so much about each of my clients and their inner experiences, and it always surprises me what I learn about.
00:10:13
Speaker
how their bodies feel. And I think the other thing that has become really evident and I'm working really hard on this is just how accidentally invalidating I was being to each of my clients' experiences because I was assuming to understand so much about their inner world and I was wrong like 99.5% of the time. So switching to a place of curiosity has really helped me become a better occupational therapist.
00:10:39
Speaker
And along those lines, language matters is a recurrent theme at the heart of your work. So I'm wondering if you can tell us a little bit about how occupational therapists can support clients and their families in this way in language.
00:10:56
Speaker
Yeah, I just think about the way we talk about our clients and what it is we see them doing. And I'm in the pediatric field and there's a lot of talk, especially in the United States about behavior. I'm using air quotes. I know no one can see me, but about challenge behaviors.
00:11:14
Speaker
And talking about kids being defiant or oppositional, those words just shut down curiosity. We're assuming that they are doing this on purpose to be defiant, to be non-compliant. And that just is really dangerous because we never then, like I said, we are assuming to understand what they're doing and we are most of the time wrong.
00:11:37
Speaker
And then when we talk out loud about kids in that way, or this applies to adults too, when we talk about them in that way and that becomes their own inner narrative and their identity many times becomes rooted in the way other people talk about them. And so I think we really have to be careful and really, at least I am, I'm thinking really carefully about
00:12:00
Speaker
the way that I speak with my families and clients and just trying to get better. I still am getting it wrong, I know, but I think it's a work in progress.
00:12:11
Speaker
Thank you for sharing that. And especially that piece about if we're assuming something about a client's inner life or inner experience, then we're really shutting down that aspect of curiosity to be able to explore what's really happening for them. And we've kind of spoken about this, but can you tell us a little bit more about how interoception is related to regulation?
00:12:38
Speaker
Yeah, it's the foundation of regulation. And we talk about co-regulation and self-regulation. I think those are buzzwords out there right now. We're all born into the world needing co-regulation. And throughout our lives, we still rely on co-regulation, where we're relying on someone else to help us to identify and manage.
00:12:58
Speaker
our bodies needs, but for many times, like many times for many people, as we grow and experience the world and life, we start to learn more about our bodies. Like we're born noticing maybe comfort and discomfort in our body. So when we're uncomfortable, many of us are wired to like alert caregivers in some way, whether we're crying or moving in a different way. We don't understand what we're experiencing when we're infants. We just know we're uncomfortable or
00:13:24
Speaker
comfortable. And then as we grow and experience life, we start to get more fine tuned and granular about what's going on in our body. And we might start to realize, oh, this means I'm hungry. This feeling means I'm hungry. And oh, I now realize like when I eat, my body feels better. We start to make those natural connections
00:13:42
Speaker
of noticing body signals, connecting the body signal to the meaning, and then knowing what action to take. And then that's what helps us get over to self-regulation. And so that is the interceptive, interceptive awareness piece, the ability to notice our body signals, connect them to meaning, and know what action uniquely works for our body.
00:14:02
Speaker
So if we don't have that clear inner experience, that clear, introceptive awareness, it leaves us back at co-regulation. We're relying 100% of co-regulation for someone else to help us to figure out what's happening in our body, what our body needs.
00:14:18
Speaker
And if we really want to help our clients bridge over to that area of self-regulation, I know that I see so many goals for self-regulation. I think it's a great goal, but we need to have interception. Interreception is the foundation of our ability to move from co-regulation to self-regulation.
Family Engagement and Cultural Shift
00:14:37
Speaker
Sounds like there's a lot going on there then with that co-regulation piece transitioning that to self-regulation. That makes a lot of sense the way that you've put it now. When you're working with caregivers, because I know a lot of times you obviously have your clients, but you're working with the family as a whole,
00:15:02
Speaker
As a therapist, what is, I guess, I wanna say the best way to approach that process, working with the family as a whole, but maybe what's a way that you've found most successful to approach that process?
00:15:16
Speaker
Well, I think just like chatting about interception first, because it is a very new concept for many people, like just the term itself, introception. But once we start talking about what it means, it's usually, oh, yes, that makes like so much sense to me. And so I think just having some discussions first about like even what is interception before we start diving into, okay, how do we assess? How do we figure out how to support?
00:15:42
Speaker
And I'm always thinking and curious in my mind, and it really depends on the family, but I'm thinking about like the caregivers that are involved and what is their introceptive awareness? Do they have a safe relationship with their body? Because if we want to empower them to be doing this work alongside of their child, do they have that capacity? Are they in a regulated and safe place to be able to do that?
00:16:03
Speaker
And I'm always trying to assess and think about that dynamic as well, because I know there's a lot of, I think just culturally, we are raised. I'm just generalizing here, but we are, most of us are raised in a society where we are conditioned to ignore our body. It's weak.
00:16:22
Speaker
to listen to our body. We should push through. No pain, no gain. Work yourself to have a chronic health condition. I think we're getting better at listening to our body than there's messages of self-care out there. But still, I hear from so many people, they're like, okay, no, I should be listening to my body right now. And I am trying to notice. But like,
00:16:40
Speaker
to take a break. That's for weak people, right? So to have the... I think it's just a giant paradigm shift for everyone. Even before getting into practical strategy, I'm trying to think about that dynamic within the family. Where do I think they are at? How slow do I need to be going with this work? How can I help the whole family system feel safe within this work?
00:17:04
Speaker
Yeah, that paradigm shift that you mentioned is really a big, we need to dismantle that a little bit as a society because you want to always be hustling and pushing through and it's really hard to be attentive to what your body is saying if that's kind of your mindset. So that's really interesting.
00:17:24
Speaker
When you are starting out slowly with a family to explore this, what are the first steps that you would go through besides having an open conversation?
00:17:35
Speaker
Yeah, I usually am pulling from something, the resource I wrote called the Interception Curriculum, but I will make it a little bit more informal for families. If we're doing it like in a school or in a clinic, sometimes we're a little bit more formal with its use. And one of my most favorite strategies from the Interception Curriculum is something called Focus Area Experiments. And that is where we pick one body part at a time. Like I mentioned before, we're chunking this into one body part at a time and we're doing fun experiments that are designed to
00:18:05
Speaker
potentially evoke a stronger feeling in that body part to capture attention, to give that child practice noticing how that body part feels. So with a family, we might say, okay, this week, let's just focus on hands. Like I try to make this as easy as possible. So we're all going to notice how our hands feel. So I invite the parents to
00:18:23
Speaker
talk out loud about the way their hands are feeling during different daily occupations. And we talk about a couple things that are going to be occurring in their natural routines. That could be a really good time to invite their child to notice how their body parts are feeling. So what would be a natural focus area experiment for hands that would hopefully be happening in daily routines, like maybe washing your hands?
00:18:46
Speaker
or like putting on hand sanitizer or if they're going to a playground and hanging from like different playground equipment or if they're catching balls or if they're doing the dishes together during bath time. So there's so many different times that are occurring that are these natural focus air experiments that someone
00:19:02
Speaker
can invite their child to notice like, hey, I wonder how your hands are feeling right now. And so we try to find a couple of those different times during the daily routine each day to give that practice, connecting and noticing how their bodies are feeling. But like I said in the beginning, like I tried to invite the parents to do so as well, which can be a big shift for, it was a big shift for me to talk out loud about the way my body was feeling. It's a big shift for a lot of families, but
00:19:29
Speaker
Um, it just demonstrates a lot of things. It demonstrates that we all have different experiences and that's great. There's not a right way to feel here. Like my hands might feel cold when I put my hands in this water, but your hands might be feeling like slippery or warm or whatever their experience. And we celebrate those differences. And it also just shows the child listening to your body is good for every, everyone. It's not just something you're doing because Miss Kelly's here as your occupational therapist. This is an important skill for all of us.
Connect with Dr. Mahler
00:20:00
Speaker
Sounds like there's a lot of opportunity to grade that experience to as everyone gets more comfortable talking about how things are feeling. So yeah, that's really great. Now, besides attending your virtual workshop through SAOT, which is coming up on October 12th, 13th, 19th, and 20th, what is the best way for listeners to connect with you online or to learn more about you and Interoception?
00:20:27
Speaker
Wow, well first I am so excited for that workshop and we're going to have so much fun hopefully, but they can connect with me on my website is probably the best way to find me. It's kelly-mauler.com. My last name is spelled M-A-H-L-E-R.
00:20:43
Speaker
So you can find my website. We have tons of free resources on there. I'll be talking about a lot of our resources in the workshop. And then with your social media person, I'm on all the social media platforms. Probably our most active is on Facebook, where we have a closed group, Interception, the 8th sensory system. And then we also have more of an open page. And that's just under my name, Kelly Mahler.
00:21:07
Speaker
Great. Thank you. We usually do like to end with a fun question. And I'm thinking that you've probably been exposed to a lot of descriptive language about feelings and body experiences. So I'm wondering what's the funniest word that a client has come up with to describe how they're feeling.
00:21:28
Speaker
Oh my goodness, I've heard so many amazing ways of describing the body and how I can feel. And I talk about this a lot in my workshops. There was one client that stood out so much, and every time he was trying one of those experiments that we were talking about, the Focus Air experiments, he was labeling his body parts as feeling like different fruits and vegetables.
00:21:50
Speaker
And yeah, like he would say, like, my hands feel like a tomato right now. And one of our rules is that we honor and validate every single answer we hear because that is such a big part of this work is validating another person's
Unique Client Stories
00:22:02
Speaker
experience. And so we were like, oh, that's great. But in the back of our minds, we're like, what does this mean? You know, like we're trying to figure it out. And his mom eventually put it together that he was coding his sensation. So if he was trying to experiment and he liked the way that it felt on his hands,
00:22:18
Speaker
He was labeling it with a fruit or vegetable that he liked. And then if he didn't like the way his hands felt during a certain experiment, he was labeling it with a fruit or vegetable he didn't like. So it was a genius system, right? And we wouldn't have discovered that if we weren't validating it. And we were like, no, your hands can't feel like a tomato. But because we kept that curiosity, we were able to really get insight into his inner world and it was really incredible.
00:22:47
Speaker
Wow, that is so cool. Well, thank you so much for sharing your time and your energy with us today. I know our listeners will get so much value from listening to this episode, especially just that whole idea of staying curious when we're working with our clients. I think that's so important. Yeah, thank you so much. Thank you.