Welcome back to the Healing Pain Podcast with Ray Chen, PT, PhD(c)
Reviving resilience and healing from trauma means shifting from a mindset of ‘broken’ to ’empowered,’ and finding the strength within to transform pain into growth. For today’s episode, Ray Chen, PT, and PhD candidate dives into integrative physiotherapy and explores the journey of resilience and healing. Tired of conventional pain management models that often leave patients feeling broken and helpless, Ray shares his personal and professional evolution in reimagining healthcare. His profound shift in mindset from pathology to healing has paved the way for a comprehensive and compassionate approach to chronic pain. Intrigued by the concept of meaning and its impact on the pain experience, Ray discusses the significance of helping clients connect with their inner strength, knowledge, and emotional resilience. See how the intersection of physical and emotional health, along with the power of resilience and growth, hold the key to transforming trauma and reviving resilience. Tune in now and start your path to recovery.
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Reviving Resilience And Transforming Trauma With Ray Chen, PT, PhD(c)
Joining us is physiotherapist Ray Chen. Ray is no ordinary physiotherapist. He is an integrative physiotherapist with more than a decade of clinical experience. His journey into the world of healing chronic pain is truly extraordinary. What sets Ray apart is his lived experience, a path that has led him through chronic pain and trauma that ignited his unwavering passion for helping people heal their minds, bodies, and souls. Ray is also a mindfulness practitioner who holds a degree in Psychology and is a PhD candidate studying the effects and mechanisms of mindfulness.
In this episode, we will explore Ray’s remarkable path from pain to purpose, and discuss the importance of building resilience as a foundation for growth after healing. What’s truly amazing about Ray and his work and his perspectives is that he embraces a holistic integration of physical, mental, emotional, and spiritual being for the care of people with chronic pain and other chronic conditions. Without further ado, let’s dive right into this captivating conversation with physiotherapist Ray Chen.
Ray, thanks for joining me.
Joe, it’s great to be here. Thanks for having me.
I’m excited to speak with you. Our paths have crossed. You and I are overlapping in so many amazing, incredible, and meaningful ways as physiotherapists. I love some of the work that you’re doing and the direction that you’ve taken in your career. You and I spoke briefly before this about the thoughtfulness that you’ve put into what is physiotherapy, what are the challenges and barriers, where are the opportunities, and how I now want to shape my career.
We will talk about a lot of that, which is exciting, especially for the physical therapists tuning in. We have people who struggle with pain that tune in. I know they want to hear a little bit about your backstory and some of your chronic pain struggles. Later on, I want to get into the topic that you and I were talking about and things like resiliency and growth even in the midst of pain and suffering. We should start with your personal story about chronic pain.
My personal story first started as a physio over a decade ago. I very quickly realized that the degree I studied did not prepare me well enough to connect with the human or the person in front of me. The course was very much focused on the biomedical model. I loved the little bits of psychology in the course and became interested in the human behind the body. I felt a lot of the technical skills I learned in uni didn’t carry over in the clinician space.
Fast forward to 2017, I was working as a senior physio and working in football as a head physio. I was working long hours and days, 6 to sometimes 7 days a week. I was getting burnt out. It’s partly my doing. I planned to have a lengthy holiday to do some traveling by myself overseas. I was going through a period of growth in the midst of all this. Six weeks into the holiday, I got into a bad bike accident overseas in Thailand. I had numerous injuries but the main injury that was of concern was this brachial plexus injury in my right arm. I lost all function in my right arm. I didn’t know much about brachial plexus injuries because I hadn’t treated it as a physio.
My journey into pain began because of that experience after the accident. My bouts of nerve pain due to my injury, which I go through even now occasionally, took me on this path of mindfulness. I got deeply entrenched in the study of mindfulness, Buddhism, and Eastern philosophy. I loved it and I felt drawn to it in a way. Through that experience, I became a mindfulness teacher.
I started studying Psychology. I started doing a PhD in Mindfulness and Pain. I came back around to physio now working as an integrative physio because of a lot of the work I saw from you. I was inspired by that. I saw a lane for myself in the Physiotherapy degree. In the past, I almost felt like physio didn’t allow me the flexibility to do what I’m doing now, which is exciting.
I think about this so much because I run into professionals like you who are creating their version of an integrative physiotherapist or an integrative physical therapist, which I now have on pretty much all of my bio and my social media. It says, “Integrative physical therapist.” I do that specifically because when people come to me, whether it’s patients or people interested in other products and programs I have, I want them to understand that this is not recycled physical therapy. There’s so much of that out there, especially in the orthopedic realm.
We’re learning to look at pain, suffering, physical function, and human capacity because a lot of this involves looking at people in a way where we see that they have the ability to thrive even in the midst of things that might be challenging. A lot of physical therapists become interested in the field because they had an injury first, and then they went through schooling and universities and into the profession. Rarely or less frequently do I come across someone like you who suffered a traumatic injury while they were a licensed physical therapist. I’m wondering how that started to shape how you viewed and experienced pain versus what you learned. We all learned things in a very textbook manner almost in school.
The experience of going through that injury and going through pain gave me a completely different understanding of pain from the perspective of the patient. I felt that this experience allowed me to empathize with those going through chronic pain and continues to allow me to understand the pain in a deep way because I’m someone who has gone through that injury and who is going through pain. I view pain as my greatest teacher now because it’s this experience that I have and I continue to have that informs so much of what I do, my practice, and my ability to connect to the person or the human being behind the symptoms and the diagnosis.
You mentioned empathy. Most pain professionals would say, “I’m an empathetic practitioner. I express empathy, and my patients can feel that.” What did that look like for you as your pain developed and changed? How did you see the way you viewed pain develop and change in your patients or clients? Empathy is a verb to me. It’s something that happens within the container of the therapeutic context, but it’s not something tangible that we can place our fingers on necessarily.
Empathy is a constant process of communication and understanding of yourself and the awareness of yourself to be able to understand others in a deeper way. When it comes to pain and my experience, naturally, I believe I have a resilient and growth-focused mind and personality, which is very helpful. A lot of people going through pain do not have that because of their upbringing, past experiences, genetics, or whatever it is. I’ve been shown a path out of suffering or pain. I believe I can teach people a path that’s specific for them that might not be anywhere near the path I went through. I believe I have the ability to understand a person’s path from suffering to freedom.
Did the mindfulness piece of that come after the injury? Did you seek it out as a way to learn more about yourself through that process?
Mindfulness was something I was interested in even before the injury but it wasn’t something I pursued. Afterward, it became something I was more and more drawn to. I started consuming a lot of material on the subject, tried to get a deeper understanding of what it was, and began my practice, which I didn’t do much of in the past. That journey helped me understand my pain too using mindfulness practice, the qualities of kindness, compassion, non-reactivity, non-judgment, and curiosity. It helped me open my eyes to this experience of pain, take a step back as that observer, and see what was happening.
You started studying that in a more rigorous scientific way through your PhD.
I became so passionate about it. I wanted to dedicate a lot of my time to that. I began studying the effect of mindfulness-based interventions on pain symptoms of musculoskeletal pain. It’s something I’ve suspended for now because life gets in the way, and I had so many other things I wanted to do. I felt that sitting down and doing the rigorous act of writing research papers becomes very difficult and time-consuming.
You have created and developed more of a chronic pain program that has become an embodiment of some of your work where you now have space in a more substantial way to start to take this integrative physiotherapy approach to people who have chronic pain. Can you tell us about that program and how it works?
I run that program at the moment with one of my colleagues. The group education component is a four-day component. It’s about four hours a day, and it’s run virtually. It covers a lot of topics like pain science, psychology, pain management, mindfulness, rehabilitation, sleep, nutrition, and overall well-being. It covers a lot of concepts of ACT or Acceptance and Commitment Therapy. I also use the PERMA model, which I love in positive psychology. It’s something that has been developed by me and a colleague. We both have lived experiences of pain. We draw on it in the program to in a way soften the program and the room, allow our participants to become more vulnerable through the program, and allow that open communication.
What parts do you deliver from? There’s a more traditional physical therapy component. There’s a pain education component, a mindfulness component, and a pain psychology component. It sounds like some lifestyle-based skills-building components around sleep and stress management and optimizing nutrition. How much of that are you delivering to the group?
I’m in all of the days, but the day that I am leading at the moment is the psychology, pain management, and mindfulness day. We have a day dedicated to that. That’s where my passion lies. Another day where we do nutrition, sleep, and overall well-being is something I’m passionate about. I run those two days.
Your other colleague is a physiotherapist as well.
He is a physiotherapist who has been working in complex pain for a very long time. He has done a lot of study in pain science. He is a great balance for me because he has the education in pain science that I don’t have. He has done a lot of work with Lorimer Moseley who you would know.
It’s interesting for me to hear. This might be the first time I’ve heard it in such a direct way that a physiotherapist is delivering the pain psychology part of it.
I finished two degrees in Psychology, and I started a PhD in the field of Psychology. It was a process where I thought I was heading in that direction to become a psychologist before an opportunity to work as a physio came back up. I started to mold everything together in a way. It happened organically that way. It’s an area I’m so passionate about and I want to build on as a physio with my psychologically-informed pain care.
I’m assuming that’s where some of the ACT and the mindfulness come in. That’s probably stacked in that pillar of the care. Have you started to take the psychology piece? It’s nice to have something like ACT, which has six processes and a central process of psychological flexibility. You use that, but over time, I’m wondering if you’ve started to mold it, change it a little bit, and start to develop your approach based on your lived experience, your professional experience, and the experience that your clients are sharing with you, which is something that we don’t talk about enough at all.
A huge component of that began through this pain program. It is being vulnerable with the clients in terms of my experience with pain and my experience of having to deal with my physical symptoms, my emotional health, and my mental health. That opened the door to the psychology component in the room and the energy in the room. When I see clients, I’m able to get into the mind and the emotional capacity of my client, and being able to draw out things that a lot of people would not be able to do because, unfortunately, they wouldn’t have had that lived experience. I see my lived experience as a huge benefit. I cherish that experience because it allows me to live out my purpose and my goal of becoming a better pain clinician.
I like that you brought up the emotional capacity. There’s still a bias somewhere that exists in the world of chronic pain management. We’re all now acutely aware that the brain is processing pain. People hear that and they’re like, “If the brain is involved, then the way we get to this problem is through thoughts.” Pain psychology in some way becomes about reframing thoughts. Even pain education is built off that foundation.
Few people have started to venture into it. Let’s talk now about the emotional regulation piece of that and what that means because the emotion regulation piece sits between the brain and the body. It’s raising awareness or bringing awareness to the idea that you may have these thoughts. They may change or not change, depending on who you are, what your life experience is, and what’s happening. You have these emotions that are a product of this brain-body connection. Those emotions are experienced as feelings or feeling states within the body, which are bodily sensations.
I believe the emotion regulation component and the emotional capacity component of clients are some of the biggest parts of managing their pain. Often, a lot of people repress those emotions and those traumas around their pain experience and their past experiences. If they don’t allow themselves to let it come through their bodies and their practice of managing their pain, they will never get to the root of the pain in a way. It’s hard to explain but it’s the component where if you are repressing all these emotions, it’s going to show up in other ways in your physical body in terms of pain and your feelings and sensations.If you're repressing all these emotions, it's going to show up in other ways: in your physical body in terms of pain, in terms of your feelings and sensations as well. Click To Tweet
Being able to process those emotions around your experience is such a critical factor. That’s the area I’m developing more in. The ACT model is amazing but it doesn’t explain how to get that emotional component and that vulnerability out of people. Through this vulnerability through my experience, I’m able to slowly draw that out of people once I can build that therapeutic alliance.
When you look at something like ACT, it’s still a cognitive model, which is still a thinking-based model. Even the idea of diffusion is creating space. If you read all the text, it’s creating space from thoughts. The work has evolved where people are talking about creating a space from different bodily sensations, emotions, feelings, states, and things like that. When you first approach it, it’s still a cognitive model.
We have this pain education trend happening. It’s very much brain-based. Some might go as far as to say it’s still a reductionistic model of pain. You have a number of body-based therapies, all the physical therapies, and even some body-based psychotherapies out there. When you look at pain, now that you’ve studied all these different things and you’ve started to integrate it into this integrative physiotherapy approach, where do you see pain sitting? Where do you see the nexus of pain?
That’s such a complex question because pain is so complex and it’s different for everyone. It’s so individualistic. I feel drawn to your PRISM model because it answers a lot of those questions. I believe pain care needs to move more toward resilience, growth, spiritual health, and emotional healing. I believe there’s something in that to guide people along that journey to be able to build resilience in people. I’m someone who has gone through that post-traumatic growth, which is quite common in a lot of people who have gone through trauma. The research suggests that at least 10% of people go through growth after trauma. There’s a component of growth and resilience in there. That’s key in pain care.
I’m focused on the physiotherapy profession. Why do you feel like we need to move toward growth and resilience? You and I spoke about this a little bit before. It’s very different from a pathology-based model. The pathology-based model exists not only in physical therapy but also in psychotherapy. The entire DSM-5 is based on a pathological model of the mind. There’s still a large emphasis on risk factors. If we can identify the key risk factors of the pain experience, we will be able to either prevent pain or treat it more effectively.
I’m not sure if the research has demonstrated that because we now have tons of self-reports. Self-report measures everything. We can measure everything at this point. There are new constructs created every day. Why do you think we, as professionals, need to shift from this pathogenic orientation? The foundation of that model is salutogenic, which is more about health. What’s wrapped up in health is becoming resilient and growing. People skip over this in some way. Why is this needed? If we can’t answer the why, then it’s difficult for people to say, “I want to try this. We do need this.”
It’s very complex. In this pathological model that we’re all under, we’re doing a disservice to people. We’re making them feel like they’re sick and broken when as human beings, we have such an amazing potential to be great, to grow, to be resilient, and to flourish in whatever pursuit speaks to us. Part of my role is helping the client find the spark that drives them.As human beings, we have such amazing potential to be great, to grow, to be resilient, and to really flourish in whatever pursuit speaks to us. Click To Tweet
That’s the most rewarding aspect of being a clinician for me. As an integrative physio, I feel like that’s why I got into this role and why I have developed in this way, to bring out the magic in people and to bring out that innate wisdom, resilience, and growth that we can all touch on and draw on. We just need to be supported by our healthcare practitioners to do so. I don’t know if that answers your question but that’s my view.
There are two things you said there that I put a little tag on. I love the metaphor that we’re all under this pathology model. When you said the word under, I imagined in my mind there’s this weight holding us all down. It holds us back as professionals to engage in care in a certain way. It holds back people with pain. This is where I want to get your input.
Do you think that the pathology-based model keeps people in a state of helplessness? It’s very difficult for them to find the resources and the hope that they need to free themselves from this idea that “I’m broken. There’s something wrong. This needs to be fixed. There must be a high-tech solution that exists outside of me that I now have to somehow insert inside my human body, whether that’s through medication, an injection, or someone getting into my mind and changing my thoughts.” We know that’s not how pain psychology works.
That’s a huge component of what’s keeping a lot of people suffering from chronic pain, sick, and feeling helpless and broken because of this model that we’re under. I work in Australia. When these clients come in, they have been shown throughout that biomedical model. They haven’t even touched on the biosocial side of things, regardless of the integrative stuff that you are doing around the PRISM model. They’re not even touching anywhere near that, unfortunately, by the time they come to me. A huge part of my role is giving them the education to unpick their experience, what’s happened to them in the past, and the things that have been said to them. I’m doing a lot of work to try to get these people in a neutral position to move forward.
It can be very deflating in a way to see people who have been tossed through the system. I believe that’s where we as clinicians, specialists, and doctors need to change that aspect of care. We need to bring in and integrate all these aspects of pain science and pain research. That’s so valuable going forward, but we’re not following it because of this biomedical model that we’re still under.
I also like what you said about helping someone access their inner strength, their inner knowledge, their inner wisdom, or the magic that’s inside of them. No one on this show has used the word magic, but I understand what you’re saying when you use the word magic. There is magic within our DNA, our cells, and our nervous system. There’s also magic even within that space between the therapist and the patient or the person with pain, where that healing starts to happen.There is magic within our DNA. There is magic within ourselves, our nervous system. There's also magic even within that space between the therapists and the patient or the person with pain where that healing starts to happen. Click To Tweet
You’ve made a big mental shift in understanding, “There’s nothing I can do to someone. I can’t intervene. I’m not an interventionalist.” A lot of what happened early in the physical therapy realm was an intervention in some way. PRISM talks about a process. We’re bringing people through a process where they’re under this biomedical model. We want to free them from the idea that they’re broken and that there’s some pathology there. Get them to this neutral position where they’re open and we’re open, and now we can start the work.
A lot of the things that you’ve learned like mindfulness, the pain psychology things that you’re working with, and some of the lifestyle stuff that’s in PRISM are all processes. We take people through this process. They may not need every process but there’s more than one process. How did you arrive at the point where you realized, “I have to help someone change, not that I have to change what they’re experiencing or change what they’re going through in some way.”
That came about through my lived experience and my practice of mindfulness and meditation. I came to the understanding that for myself to grow, I needed to learn. I needed to teach myself. I needed to experience. I needed to be supported. I needed to be guided by teachers, books, or my experience. There’s so much value in the experiences that people go through. These pain sufferers have gone through such a deeply traumatic experience in a lot of ways. To be able to find the strength and resilience in that experience is what I want to bring out of people. That’s going to unlock the healing and unlock so much of their recovery.
Integrating those aspects that you said of psychology, nutrition, and sleep is a part of it. You’re drawing people’s attention toward health and health promotion rather than being stuck in that disease model. That’s so much of what you talk about. I connected with the concept of a sense of coherence, comprehensibility, manageability, and meaningfulness. Meaningfulness for me is one of the biggest parts of pain care that we as clinicians don’t draw on enough. What does it mean for this client to live a meaningful life? That’s huge.
That comprehensibility fits well with pain education. Manageability is where we come in. We can help people access the skills they already have and access their strengths. If they’re ready, we can help them with those new strengths and skills. There’s that meaningfulness part. It’s the thing that people know as potentially the most important, the one thing that can move the needle the most, except they’re not sure, “How do I start talking about this? My back hurts. My back is stiff. My back is painful. I can’t bend over. I can only walk for a certain limit of time. How do I start to have a conversation with someone with pain now about meaning in life?”
That is an incredibly difficult conversation for a lot of clinicians to approach. For someone like me who studied Psychology, Acceptance and Commitment Therapy, and the emotional components of pain, I can bring it up through my experience, especially in this pain program I run. I talk a lot from my experience to give people permission to talk about these things.
In a lot of cases, if I’m unable to explain my experience and be vulnerable with them, it’s hard for them to open up to that conversation. That’s where I come from. With some people, you’re not going to bring up that topic in the first session. It takes time to build that rapport to engage in that way with someone. Often, people going through pain want the pain to end. Those topics are not anywhere near their frame of mind to even broach with them to talk about.
A lot of the emotional resilience piece comes up in those conversations of meaningfulness.
I feel that the emotional resilience piece is so hard to teach. I see the model that you’ve come up with as something that will come with a lot of difficulty and challenges. How can we teach it to clinicians unless they have that self-awareness in themselves, and they have gone through that journey of emotional resilience and emotional healing themselves?
If I look at myself before the accident, I wasn’t ready to treat pain clients the way that I can now. That’s through my personal journey that I’m able to do that. I struggle to see if someone hasn’t gone through not a similar journey but their own emotional and personal growth journey. How can they draw on those tools to help the person in front of them?
You’re a step ahead of me because my next question was going to be this. This is not just physiotherapists. There are a lot of professionals out there who treat pain. Do you think we are preparing people to treat pain in a way that is comprehensive and effective? It’s a little bit of a leading question because you and I have spoken about this. I wrote that model on pain pretty much saying that in a lot of ways, these skills are not embedded within us as professionals. How can we ask people to cultivate these skills if we can’t model them ourselves?
It’s extremely difficult. I believe we need to get clinicians to understand the perspective of the client first. Get them to put themselves in the client’s shoes, imagine that they are the client, create case studies where they take off that clinician cap, put on their client cap, and get in the mind of the sufferer. If you don’t do that, it’s very difficult to be able to show that kindness, compassion, and empathy for that experience. You need to feel what someone is going through. A lot of clinicians are scared of that and it is scary. It’s not comfortable trying to imagine someone’s experience of pain. It’s not meant to be comfortable. It’s meant to be dark, uncomfortable, and painful.
I was working with someone. There was a moment during the session when I noticed that I was uncomfortable. Are they uncomfortable too? Am I uncomfortable because they’re uncomfortable? Am I uncomfortable with something else that’s happening at the moment of this exchange? I’m still thinking about that patient and starting to unpack that. When I was done, I was wondering, “Is this where the work is happening? We’re becoming physically, emotionally, psychologically, and spiritually resilient by interfacing with the relational exchanges between two people that are very uncomfortable at times.”
I have an article on my website about finding comfort in that discomfort. That’s such a key area that I am constantly improving on because I still get very uncomfortable in some sessions with clients. My ability to sit with that and find that level of being able to meet the client where they are is key. Offering that guiding hand and that hand of support, and allowing space for them to communicate those uncomfortable truths and those experiences is such a huge part of what we do.
Mindfulness comes in handy there.
I integrate mindfulness by using guided meditation in my sessions to allow people to sit in that feeling, the emotions, and the sensations, and gain some freedom from them through that experience or therapy.
In that PRISM model, I struggled with putting mindfulness in as a process or psychological flexibility. They’re very similar concepts. Some would say they’re the same in some way. If people would say, “They’re different,” that’s fine. You can substitute one process for the next. At the core, there’s this idea of being present with whatever is in the moment in your mind, your body, and your nervous system, and still being able to move forward in a way that’s effective. That’s mindfulness. That’s psychological flexibility. That’s all of the resilience-building skills that we have been talking about.
People who are in insurmountable amounts of pain struggle with being present with that experience. They want to push away, avoid, and distract rather than feel. At the end of the day, it’s through the process of feeling your emotions, your sensations, and your physical body, and being present with them that we gain freedom from them. It’s a hard thing for people to reconcile with.
It’s the paradox of being present with painful sensations.
That’s the key area that I had to learn through my journey and I’m trying to teach in a way. It can be very difficult for many people.
It has been great chatting with you about integrative physiotherapy, both your personal and professional journey, and seeing how those have braided and come together into this pain program you have now, and some of the great things you’re working on both within the more science evidence-based realm and still bringing these tools and techniques to help people build pain resilience and growth. Let people know how they can learn more about you and follow your work.
Ray has a great Instagram handle. He may not post frequently but the things he does post are high-quality, evidence-based, and very useful with regard to the topics we’re talking about, which sit within pain resiliency and growth. Ray is a good example of the physiotherapist of the future. You don’t have these boundaries of how you practice, but through both your personal and professional growth, you create this new version of physical therapy. Make sure to share this with your physiotherapy colleagues and any health professional who may be stuck in what they’re doing, and they’re looking for different ways to approach and help people with chronic pain. It has been great being here with you. We will see you next time.
About Ray Chen
Ray Chen is an Integrative Physiotherapist with over a decade of experience as a Physiotherapist. Ray also has a lived experience of trauma and chronic pain that has led to a passion for healing pain. Apart from being a physio, Ray is also a mindfulness practitioner, PhD candidate, and psychology graduate. Ray is a practitioner who believes in the importance of integrating physical, mental, emotional, and spiritual well-being.