Kim Howard 00:05
Welcome to the Let’s Talk EMDR podcast brought to you by the EMDR International Association or EMDRIA. I’m your host Kim Howard. In this episode we are talking with EMDR certified therapist and consultant, Gary Brothers about EMDR therapy and chronic pain. Gary is located in Austin, Texas. Let’s get started. Today we are speaking with EMDR certified therapist and consultant Gary Brothers about EMDR therapy and chronic pain. Thank you, Gary for being here today. We are so happy that you said yes.

Gary Brothers 00:34
Thank you so much for having me, Kim. It’s an honor and a pleasure. So Gary, tell us about your path to becoming an EMDR therapist. Oh gosh, Kim, it was quite a while ago, when I was living in Hawaii and working for Kaiser Permanente. I think maybe 2122 years ago, it was back when the EMDR basic training, it was split into level one and level two. You know, I didn’t know much about EMDR. At the time, I was working for the child and adolescent department at Kaiser. And also I had a part time practice working with all ages. And I always sought out specialized training for trauma and attachment disruption. You know, usually with a brain and nervous system focus. I was working quite a bit with children and teens with attachment trauma, I was specializing at the time with Dan Hughes model it was dyadic developmental psychotherapy. And then we were pairing Neurofeedback with psychotherapy kind of deprived the brain and nervous system for optimal results. And then this new training EMDR came to Hawaii at least it was new for us. I think it was the first time EMDR was offered in Hawaii, my colleagues and I we jumped at this chance for this new treatment model, as we’re always looking for the cutting edges approaches to working with the kids and teens were treating. But unfortunately, the trainer only came for level one, if something happened, I think it was a death in her family. And the level two training was canceled and never rescheduled. So my colleagues and I, we did the best we could you know, we finished reading the training manual and tried to learn it the best we can. But it was certainly not the ideal situation to say the least. And then in 2006, I moved to Austin, you know where I am here. And not too long after that I started working for a pain clinic. And I just decided to get properly trained in EMDR. That’s when I met Rick Levinson, who is this phenomenal trainer here. And not to mention, he’s become my mentor and a great friend. But that’s when I truly learned EMDR. And it opened up this you know, this whole new world for me and how I began treating my clients and I couldn’t get enough. I started going to all these different trainings on trauma and complex PTSD with that, you know, and because I was working in the plant pain clinics, and I went to mark grants training to learn the pain protocol, and it just blew my mind. And then I went to see the Marcus’s training for the migraine protocol. And he’s training, they made me more and more curious about what was really going on with my clients neurobiologically. Now, as I was saying, I was working with these pain management clinics. We’re seeing, you know, so many clients really not getting much better with the medical interventions, I got a lot of relief, you know, overall, they were just kind of plateauing and sometimes even getting a lot worse over time, they started responding to what I was doing with the therapy, especially with the EMDR protocols. And it just made me more and more intrigued. So I started reading all these different articles article after article, not just on EMDR. But on the physiology of pain, it just took me to so many different rabbit holes, I would find one nugget of information in one article, a book and then say, hey, who wrote that and find the source, and then it will take me into another article or book and then into another nugget and so forth. And this information, you know, along with what I learned from the EMDR trainings and workshops, I was going to, as well as all the other you know, trainings and articles, you know, on the brain and nervous system, things started to come together, you know, slowly, but things started to align piece by piece. And so what I was learning was that chronic pain had so much more to do with the brain and the central nervous system and how these change over time and maladaptive ways, you know, then what was referred to, you know, as the pain generated or what you know, kind of what the clients were seeking at the pain clinics is relief from their lower back, their neck, their knee, their stomach, and so forth. What I was learning is that there’s all sorts of feedback loops, you know, that occur and these other systemic changes in the body that need to be addressed if people are truly going to get better or healthy again.I also notice how many of the chronic pain patients had such terrible trauma histories and so many other coexisting mental health disorders in addition to trauma and PTSD. They had such terrible depressions, you know, all sorts of anxiety disorders and so forth. And what I was reading supported what I was noticing in my practice, but my role in the pain management companies was to treat the mental health issues more as an ancillary or adjunctive service. And also we did all sorts of, you know, risk assessments and evaluations, like when people misuse or abuse or medications, you know, we were tasked to say, hey, are they addicted or are they just you know overusing because their pain was out of control and, or if they had a back surgery or, you know, we would assess them to see whether they’re good candidates are for implant devices like pain pumps, or spinal cord surgery or stimulators. So I wasn’t really directly treating the pain much at the time that was left up to the doctors, you know, in their medicines and interventions, but is the behavioral health department we were just teaching some coping skills came, I realized there was so much more to it, meaning how client’s pain and their health issues were connected to their mental health issues. Of course, I was familiar with the aces. But what I was learning and noticing connected so many more dots to me, I found if I could get the clients to trust me and their therapy process, which was a big task, because they often said, Hey, why am I why do I have to go to behavioral health, you know, the doctors would send them to us and they say, What am I here in therapy for I’m here for my pain, and I’d start to you know, have to engage them that was the first task is to say, hey, you know, it might be something beneficial for the counseling or the therapy. But if I can get them to first engage in therapy, and then get them to be active in their life again, and get them functioning again, because so often, they you know, they had lost all that they were just sitting around, you know, watching TV all day, they had lost their jobs, they had lost their hobbies, they lost all the activities, and if I could get them back moving again, doing some of the activities that they used to like and enjoy, and especially get them functioning and active in their relationships. So often they you know, they weren’t even involved in their, their, their marriages, or with their kids or their grandchildren. Also, if we could get them off those opiates, because what we know about the opiates is that they, you know, were never meant to be for long term pain, sure, short term pain, acute pain, but all the research and this is decades of research. So these, this, you know, is an appropriate treatment for for long term pain. But if we could get them off the opiates, so they can start thinking and feeling again, and stop being just these passive recipients of care that they would get better. And then the other big piece was their trauma, if we could address their trauma, then they if they did, all these things usually got much, much better. And that’s where that the EMDR came. And that was such a huge piece of it integral part of all of this, I left one pain management company and took this position with us other they were they asked me to develop this new behavioral health program for them. And I was really excited, I thought I could really do something cool there. Fortunately, I found the paradigm I was talking here that I’m describing wasn’t really congruent with where I was working. So I kind of found myself at a bit of a crossroads. And that’s where I decided, hey, this might be a good time to go into private practice. And so that’s what I did. You know, somewhere throughout all this, so, you know, that really wonderful trainer here in Austin, Rick Levinson, you know, he was telling me, you know, Gary, you need to start training other therapists and what you’re doing, but, you know, I really didn’t want to, to be honest with you, I was really resistant to that. I was like, no, no, no, that’s not what I do. I’m a therapist, I treat clients. But over time, he kind of wore me down and I eventually gave in, you know, I took what I learned and it took quite a while and I tried to organize it into a structured model of care. And then in 2017, I did launch my first two day workshop, and that workshop is still doing it today, it looks at all the different ways the brain, the nervous system, and entire body changes in maladaptive ways when there’s pain that doesn’t resolve and through understanding this from kind of a more neurobiological and psycho physiological perspective, you know, I help therapists to target the different areas in order to kind of systematically shift the body back into you know, its previous states of how, you know, over time, though, I realized there was a need to share more information as it relates to you know, not just chronic pain, but you know, many chronic health conditions, especially the autoimmune disorders at the root of these so often, but not always, but in so many cases, there’s there’s significant attachment disruption and trauma. So last year, I launched a second workshop that focuses on understanding, you know, how and why this occurs, you know, from a neurobiological lens again, and so I assist therapists to modify EMDR to address these underlying attachment wounds, you know, again, to get the body to shift back to days. It’s a process but the body kind of knows and wants this and craves this, but I would say at the end of the day, I’m go back. I’m just an EMDR therapist, and that’s what I spend most of my time doing.

Kim Howard 09:49
No, good story. That’s very good, very thorough. I appreciate all the work that you do and and you’re not the first therapist on this podcast to talk about how they’ve sort of fell into EMDR therapy, they knew somebody or they heard about it or, you know, somebody came and did a training and they went to it. And so we we like to hear those stories about how it’s the word is sort of spread among professionals about, hey, it’s new therapy is something you should consider. So that leads me to my next question, which is, what is your favorite part of working with EMDR therapy?

Gary Brothers 10:22
My favorite part about EMDR is that it’s founded in what I think is called a salutogenic model of care. And that’s why I think it works so well, EMDR. A solutagenic model means to have this orientation, you know, towards health and healing and focusing on the factors that create and perpetuate this. And that’s what I believe the adaptive information processing model is all about, and what Dr. Shapiro was describing when she described how, you know, the information processing system is adaptive when it’s activated, and that’s at the core of EMDR. You know, so much of the healthcare system, you know, it has that more pathogenic focus or a pathogenic model, and it focuses on unhealth or disease and breakdown, think therefore, it gets mired in chasing and treating symptoms and doesn’t really get to the root causes. By doing so it forgets that the body that we’re innately wired in desire to heal and to be in states of hell. But through EMDR, and the ARP model, we assist the brain and the nervous system in the body to get back to these healthy states, you know, sure, we’re addressing the barriers and the blocks to these. But again, the fundamental goal of the IP model is activating that information processing system. And for me to be able to see this happening as it’s happening. I think it’s amazing, at this point in my career, to have a little bit of understanding and knowledge about what is happening neurobiologically as it’s happening, that’s even more exciting.

Kim Howard 11:53
Gary, can you please define chronic pain?

Gary Brothers 11:56
You know, the simple definition of chronic pain is pain that occurs past the point of tissue healing. Chronic pain is generally considered pain that persists despite the fact that their original injury has healed whatever that might have been, or at least it’s healed as much as it’s going to yet the pain signals remain active in the nervous system, many times we get hurt, we get injured, we sprained her ankle, or we get a broken bone, you know, once it’s healed, the pain goes away, but with chronic pain, the pain remains active, you know, all pain is about nerves in his in our nervous system, but you know, so it’s no longer a tissue issue, it’s now an issue of the nervous system. And so chronic pain is now a syndrome state of the nervous system. And this the central nervous system, you know, this doesn’t mean that the pain isn’t real, or even very serious, and it shouldn’t ever be misconstrued or thought of that it’s caused by psychological fact, you know, chronic pain is real, and it has very real neurobiological causes, the causes are just different than you know, those, you know, the normal pain that we think of that acute pain or short term pain, and the causes aren’t going to be the same for everybody. Chronic pain is complex with if it’s caused from an accident or injury, or it could be caused from a degenerative health condition, such as osteoarthritis, or you know, autoimmune disorder, there are different types and different causes, you know, different, you know, perpetuating factors, you know, and so forth. And each person is going to be unique, a unique puzzle, I like to say, and the puzzle pieces are going to be different for each person’s unique situation. So we’re going to have to look at it, you know, from each person’s, you know, perspective. But again, we need to look at it, you know, and understanding from the broader neurobiological perspective, what’s going on with their each person’s, you know, physiology, and not just the physiology, and this moment, we have to look at it through the lens of how the president intersects with the past, you know, I like to say, you know, how the nervous systems developed over the course of a lifetime. So Kim, I think it’s even more than that, you know, we have to understand it from the each person’s unique life situation, you know, not just from the past in the present, but also their relationships, you know, how these are related to their dynamic nervous system states, because all of this has to do with neuro chemistry, that’s going to activate inflammatory cytokines, you know, it’s going to affect our endocrine system. So we have to put all of this and look at all of this together. And all of these factors are so often related to how chronic pain develops from that acute pain states, you know, as well as how these chronic pain states perpetuate and remain. It’s through this understanding that by understanding all these pieces of the puzzle that we figured out how to assist each person’s body get back to his way to you know, to back to health to healing.

Kim Howard 14:41
Thank you, Gary. What successes have you seen using EMDR therapy for chronic pain?

Gary Brothers 14:46
I’ve seen a lot of successes, I think vary among individuals. You know, the short answer to your question includes, you know, seeing people who’ve been almost completely non functional in their lives almost entire, you know, their lives almost in entirely revolving around, you know when and how much medications they can take, you know, watching the clock, when’s my next dose, or what types of medical procedures, they might be able to get the surgeries or injections or, you know, nerve ablations, you know, they they kind of going to the one doctor to the other doctor, you know, and see what’s the next thing that they can get that might help and, and so much streaming failures, but going from that kind of position in life to having very low levels of pain, and quite often completely resolved pain without the need of any of those medications, or other procedures, or surgeries or devices. Sometimes clients may still need some types of medications and procedures, but much, much less. You know, I’ve also seen people with very severe chronic health conditions who have been hospitalized for extended periods of time, you know, one client over, you know, 120 days in a year, even, you know, times clients being, you know, critically ill, you know, with very serious infections related to ulcerative colitis, going into remission, or within having very sporadic flare ups, or their symptoms being quite manageable, and their quality of life is much, much improved. So it’s all over the place. But even people with you know, very serious neurodegenerative conditions, things like MS, Parkinson’s or Parkinson’s like disorders, not that we’re going to resolve those, but to slow down the progression of the generation of those diseases, no way to ascertain that it’s the EMDR, the other interventions that we use that are found in the AIP model, you know, that that’s the reason for, you know, prolonged states of health. But when you really look at the neurobiological factors of these conditions, what’s going on with those and, and then also what we’re targeting neurobiologically through, you know, the interventions that are, you know, the EMDR and other interventions, you know, they’re using the AIP model, you know, theoretically, it makes a lot of sense. You know, of course, we need research, lots of research to determine a causal relationship. I think we’re moving in the right direction. There’s a great stories as a great examples, and I’m sure that the people who have been treated and are in less pain than they have been, and are able to function, how they want to function in life, rather than how they’re forced to function in life, are very grateful and relieved and happy that they found EMDR therapy and that it works. And it tells us, I think it’s, you know, it’s for me, it’s about the relief of suffering. And that happens on a daily basis. Sometimes it’s a little, you know, sometimes it’s a lot, you know, sometimes it’s a really a progressive thing. But over time, I think most people get better and better.

Kim Howard 17:38
Great. Gary, are there any myths that you would like to bust about EMDR therapy for chronic pain?

Gary Brothers 17:44
I’m not sure Kim about myths, but I would say more expectations. You know, provide consultation as an approved consultant. And through those workshops, you know, an often therapist, I think they’re they’re seeking this nice concise protocol that works well or gets the job done for everyone with chronic pain, you’re kind of this one size fits all, or fits all protocol. And the closest thing to this for chronic pain is the EMDR pain protocol developed by Mark Grant, which I do teach, and it’s great, it’s actually wonderful. And while the pain protocol is invaluable, and it has, you know, all sorts of applications, many, many applications, you know, but there’s so often this need for an array of interventions beyond the pain protocol if we’re going to truly be effective and get optimal results. And so this includes the use of the EMDR standard therapy protocol. And because there’s so much trauma involved as well, but also other strategies and techniques found in the AIP model. But it also involves bringing theory and information techniques and interventions from many other areas, from neuroscience, attachment theory, somatic psychotherapy, polyvagal, theory and others. So we bring in a more integrated perspective. And it also requires, you know, a bit of learning about the neurobiology of pain in order to know why and when to use all these different interventions. treatment of chronic pain, you know, is most often not this short term treatment, it’s kind of like treating Complex PTSD. You know, there’s a lot of work involved in a lot of repetition involved. In fact, I think therapists who will often realize their clients with chronic pain will often have co occurring Complex PTSD, and there’s no coincidence about that. Again, so many people, you know, with chronic pain, you know, have experienced tons of trauma, we find, you know, sometimes when we work with people, they’ll have, you know, significant reduction in symptoms, you know, with one session, but then the symptoms return or we’ll have multiple sessions, and it’s still there’s not many, much significant relief. It’s a total, you know, you know, both clients and therapists there’s a reason for everything. It’s just a matter of understanding and figuring out what’s going on and what to do about it. And it takes time it takes curiosity and patience, and even perseverance. Again, with all of these things, you know, people eventually get better.

Kim Howard 19:58
That’s good. We like to hear that. Are there any specific complexities or difficulties with using EMDR therapy for chronic pain?

Gary Brothers 20:07
I wouldn’t necessarily say difficulties, but complexities would be what I would say, you know, I think chronic pain and the brain and the nervous system in the body, you know, as an integrated system, these are all complicated. In short, you know, we’re integrated beings, you know, we always talked about, you know, this mind body connection. But when we consider this, you know, consider that mind body connection, you know, we need to realize that, you know, the mind was never disconnected from the body to begin with, you know, that it’s an extension of the body, you know, it’s a full body experience. And as EMDR therapist, what we’re really doing is integrating experiences, so the body can heal, and that includes the mind and they heal together. And with chronic pain, it’s no different. The therapist has to take what we know about trauma and all the other mental health disorders that may be coexisting and begin to develop this clinical understanding, but the neurobiological and other systemic consequences that occur over time it related to these conditions, as well as we need to develop an understanding of the you know, what happens when we have the chronic pain that consequences, you know, these are the chronic health conditions and see how these are intersecting with the mental health issues and the consequences. So the good news, so as EMDR, therapists were trained to have this dual awareness, you know, and this dual awareness, you know, that type of thinking is in our wheelhouse. We consider all of this and recognize, you know, all these feedback loops that are occurring, and how they perpetuate the problems that you know, that are occurring, and how they lead to the breakdown of the body, you know, over time. But it’s EMDR, we remember that the nervous system in the body, again, is innately inclined to heal and move back to healthy states. And in that is, you know, what EMDR, and the AIP model helps the body to do and we do this as we integrate those other theory and science in this process. So things work well in that.

Kim Howard 22:04
Thank you. Gary, how do you practice cultural humility as an EMDR therapist?

Gary Brothers 22:09
Now that’s such an important question. I think three words come to mind. That would be curiosity, openness and awareness, you know, not necessarily in that order. Because I think these are both, you know, intentions and trade, you know, I constantly try to achieve, it’s a very dynamic process. You know, I think, for me individually, as well, as you know, what I try to demonstrate in sessions with clients. First of all, you know, at the end of the day, I’m a heterosexual cisgender, middle aged white male who is doing okay, financially, you know, it’s hard to have more privileged than that, okay. So it’s important for me to have awareness of my privilege and what and what that means, at least to the best of my ability, but I also need to be aware of the fact that with this privilege is going to come blind spots that are inherent from having it. And that’s my lived experience, and there’s no denying this. And that’s, I think, where the curiosity and openness comes in, you know, I have to be curious about each and every client’s their unique lived experience, and ask them to share it with me. And then I have to reflect it back to them to see if I got it right and be open to when I got it wrong. I also have to be open to how their lived experience manifests in context of me and my privilege. No, both when it’s about me, and something I messed up on, you know, whether it’s a bias, you know, or an area of ignorance that I have a microaggression that somehow snuck out, again, blind spots. And when these occur, you know, I need to take responsibility and make a repair and keep repairing, you know, until it’s repaired. That’s an effort and action. I think that’s required not only to maintain the therapeutic report, but for healing. I don’t think that’s it. That’s not all I also need to be open to when it isn’t specific to me individually, but nonetheless, you know, still requires that empathy, compassion, and a repair, you know, clients, they may perceive it as specific to me, and even if I don’t, maybe they’re right, maybe not, that doesn’t matter at all. It could be a blind spot, and maybe it’s not, it may be a matter of just what I represent, but I still need to be accountable and take responsibility for that repair. Again, keep repairing it until it’s repaired, and say, I perceive myself as the victim, because at the end of the day, you know, clients are in my care, and I owe it to them be the best caregiver, I can. That’s my role. You know, that’s my job. I’m the caregiver and clients are the care receivers.

Kim Howard 24:31
That’s a good answer. Thank you. Do you have a favorite free EMDR related resource he would suggest either for the public or other EMDR therapists?

Gary Brothers 24:40
You know, there’s so many wonderful resources out there, but I’m going to keep it specific to our topic here. I’m going to shamelessly plug myself here. I’m sorry about that. You know, the EMDR pain protocol, and a number of different techniques that I use and teach they use auditory bilateral stimulation, you know, versus the eye movements or tactile BLS. And in the past, you know, I could never find a form of audio BLS that I really liked. And so as a lifelong drummer, about four years ago, I went into a recording studio, I have a buddy here in Austin, he has his own studio written set. And I asked him to help me with this. And I figured out a resonance that I think works pretty well. And I created my own auditory BLS. And it actually vibrates the eardrum, so you get a bit of a tactile response, in addition to the audio, bilateral stimulation, and I’ve been offering these recordings for free on my website and on YouTube ever since. And I’ve had so many therapists and clients and even inquiries from the public, and they asked for a downloadable version of these. So last year, I started offering for a small cost, but I have the free versions, and they’re available on my website and on YouTube, keep them there, you know, forever and ever. You know, one of them is a BLS recording for EMDR therapists who use with their clients for EMDR treatment. There’s another one for clients and public to use on their own that releases what’s called gamma amino butyric acid commonly referred to as GABA, this is our most abundant inhibitory neurotransmitter. You know, the body produces this for a lot of things, but it’s really helpful for pain relief and to calm the nervous system. So it says to soothe anxiety, activation from trauma and PTSD, along with the pain relief response that it provides. There’s also a third recording that reinforces nerves when they’re calm and at rest. So it reinforces decreased pain states and a calm nervous system. And it’s really helpful. You know, if you think about neuroplasticity, and the neuro tuning aspect of neuroplasticity, you know, so you know, to make those, you know, calm and pain free connections more bushy when you think of how neurons connect to each other through dendrites and their dendritic connection. That’s great. I will include a link in the description of the podcast so people can go to your website and find that information.

Kim Howard 26:53
What would you like people outside of the EMDR community to know about EMDR and chronic pain?

Gary Brothers 26:59
Simply stated, I think for most people, living with chronic pain isn’t a requirement. It’s not for everybody, but for most people, it can be effectively treated. But it’s an active process. You know, clients can’t be passive recipients of care. being passive doesn’t work. It involves effort and action, you know, to be able to change and heal and to get better involves clients to look at and address areas of one’s life beyond what one typically is focusing on with their medical providers. They have to, to be involved in they have to really work at it, I really look at myself as kind of more a guide and a coach, you know, in addition to you know, just being the therapist here, and when again, emphasize that pain is not a psychological manifestation, the pain is, you know, what I call a psycho physiological experience. Again, it’s complicated. It’s just the way the body works. You know, it’s true that the mind comes from the brain and the nervous system, but the nervous, the nervous system extends throughout the entire body, and the nervous system is constantly interacting with all our other body systems. And creating, you know, creates so many different networks, pathways and feedback loops. You know, like I said earlier, the mind is this full body experience. And you know, I’m not at all suggesting that pain is all in the mind. But I am suggesting now there’s not this mind body separation, the mind is part of the body, the brain is part of the body. Pain involves a brain and nervous system greatly. But it also involves other systems in the body. It involves tissues, of course, but it further involves chemicals, all sorts of chemicals throughout the body. And as I said earlier, pain involves what’s going on in the present, but it also involves the past and how the body has come to be in the present because of the past. It’s way too complicated for us to cover, you know, everything here, but it’s just how things work. And this is what we treat with EMDR for chronic pain. And not acknowledging in understanding or treating pain in this context is very often why people don’t get better. And I’m not suggesting at all that working with medical providers is unhealthy or unnecessary. But there’s this need for an integrated approach for cure that considers all of this and this is lacking in most contemporary chronic pain treatment approaches at this time.

Kim Howard 29:11
Great. If you’re an EMDR therapist, what would you be here?

Gary Brothers 29:15
That’s a funny question for me, because I always tell people, if I wasn’t a therapist, my dream job would be working at a barista as a barista somewhere maybe Starbucks. And I say that because I love my morning coffee. I love people and giving people coffee makes them happy. So what better job than that? But, you know, all kidding aside, I really can’t see myself doing anything different. This is such a large part of why I’ve been a therapist about 30 years now I know I’m dating myself, but that’s kind of a long time and I’ve been around the block maybe a few times. But if I really had to choose something different. I think there’s this whole new field about to open up and there’s some really cool research and exploration the field of environmental neuroscience and neuro conservation. And, you know, as we’re facing, you know, all the challenges ahead of us with the climate crisis. And as we’re learning more and more about the intricacies of how we’re we’re not only neurobiologically interconnected as a species, but with all living organisms, and even as their Earth at large, there’s such a