Dr Claire Plumbly shares strategies for nervous system regulation when dealing with angry patients and difficult colleagues.

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When we're up against a challenging person, a difficult colleague, or

an angry patient, our amygdala gets activated and our nervous system goes into

fight, flight, freeze, or foreign mode.

in our Shapes Toolkit training we describe this as being backed into the corner.

We can find it especially hard to deal with other people's anger, particularly

if it triggers something from our past experiences and our reaction is often

to appease the angry person rather than saying, hang on a minute, I don't

think I should be spoken to like that.

This week, Dr. Claire Plumbly, clinical psychologist and author, is back on

the podcast to talk about how we can regulate our own nervous systems to

avoid those feelings of anger and frustration being transferred onto us.

In our work and our lives, we'll inevitably come across difficult

people or reasonable people who are just in a tricky situation.

But this episode will help you understand what's happening in your own body and

give you tools to work with the other person so you can protect your boundaries

whilst respecting their feelings.

If you're in a high stress, high stakes, still blank medicine, and you're feeling

stressed or overwhelmed, burning out or getting out are not your only options.

I'm Dr. Rachel Morris, and welcome to You Are Not a Frog.

Hello, I'm Dr. Claire Plumbly.

I'm a clinical psychologist specializing in trauma and in burnout, and I'm also

an author on the topic of burnout.

I've written a book called Burnout, how to Manage Your Nerve

System before It Manages You.

And I also run an associate practice of psychologists and therapists

who help people with these issues.

It's wonderful to have you back on the podcast, Claire.

We were trying to work out, you've been three times already, I think.

Yes, and I love it.

I keep coming back for more.

You keep coming back.

You were one of our keynote speakers at our Work Well Live conference, and I just,

I just love your work and I think it's so important for us to hear about it because

we are just starting to understand so much more, aren't we, about our nervous systems

and particularly the, this new, well, it's new to me, this new theory, polyvagal

theory for, for people that haven't heard that before, can you summarize polyvagal

theory for us in like two sentences?

It is a fairly new theory, so it's not your fault that you haven't heard of it.

It's not been around for many years, and it's only really starting to trickle

down into the therapy therapy world in the last, like five to 10 years.

But it's a, it's an updated theory of the autonomic nervous system.

Most people will have heard of the idea that you've got the

parasympathetic and the sympathetic branches of the nervous system.

So we tend to understand the parasympathetic being the the

mode we are in when we are pretty regulated and calm, and then we

go up into the sympathetic nervous system when stresses are coming in.

It just builds on that, to explain that actually the parasympathetic

part of the nervous system is slightly more complicated.

There's two branches within that, the ventral vagal and the dorsal vagal.

The ventral vagal is the bit that tends to be the bit where we are calm

and, and kind of feeling able to think clearly and deal with, um, everyday

stuff in a kind of regulated way.

And then the, um, dorsal is more the kind of place we go to when we are

overwhelmed and completely flooded and the sympathetic nervous system hasn't

enabled us to deal with incoming stresses.

So that's the fight or flight response.

If they have failed us or the, um, there's nowhere to escape, we will go into this

kind of more closed down shutdown place, immobilization for safety essentially.

And so why is it so important that we sort of understand this,

this quite complex neurology?

I think, and where I started using it way more in my work early on

was because it explained the stress response in a more nuanced way.

So rather than just being the kind of fight or flight or freeze, which I used

to kind of use in my psychoeducation and therapy, it helped people to

understand why in sessions, for example, they appear to just shut down.

If we mentioned a word or a phrase or a memory, that was really overwhelming

for them, it, it kind of, they would close down and look like they

weren't really paying attention or connected, they'd be dissociating.

Um, so it helped me to understand this process in the therapy room.

So that's why I learned a little bit more about it.

And of course, whatever happens in the therapy room is happening

outside the therapy room.

So when people go into that more Kind of appease kind of place or unable to, get

moving and motivate themselves, they're very shut down in a physical way and a

kind of cognitive way, you can't really think of imaginative answers or ability

to kind of see far into the future, these are people with when I'm setting goals

with them, doing the smart goal setting just doesn't really work very well because

they can't really see what, what they would like to do other than just not

be in this really rubbish place here.

They just don't wanna be here.

Um, and so it kind of just helped explain, you know, that

level of kind of close downness.

I think understanding ourselves is absolutely key to then being able to

manage ourselves and manage, manage the situations and change what we're doing.

And the reason I think your work is so important is that obviously you

know our listeners a lot of them are doctors, nurses, senior healthcare

professionals, working in these really high stress situations that

are really high stakes as well.

You know, literally people's lives are at stake.

And if we dunno how to manage our nervous systems properly, then we're.

Really up against it when we're sort of adding to the stress of not just

like the overwhelming demand and the, the, the difficulty of the work, but

we're layering on top things that just completely sort of stymie our

performance, which is why I think your work is so important and so useful.

And so one of the things we wanted to talk about on this podcast was tricky

people, because not only are our listeners working in very often, very technical,

tricky situations, you know, where you can make a practical mistake or a

problem solving mistake, but we're also working with people who are frighten

themselves, who are, who are difficult, who are also overloaded, who are stressed.

And let's face it, no one is at their best when they come to hospital

or go to the doctors, pretty much.

And none of our colleagues are at their best when they are feeling

overloaded, when they haven't got enough resources, when they are

worried about their own performance.

And so we all become tricky people, quite frankly.

But the question I have is, why does some tricky people trigger.

Certain of us more than other people?

And there are other people tricky that other people find really tricky, that

I'm totally fine with, but there are some people that I'm like, oh my God,

that person is, is is really difficult.

Let's just get it all out there.

What are the universal things that people react to badly in

other people all the time anyway?

I mean, being criticized, someone behaving unpredictably, someone

behaving in a kind of gaslighting or passive aggressive way, or being

like attacking, um, putting you down.

Something really pisses me off when people don't listen when they're just

talking the whole time, and it's all about their opinion and they're not,

they're not listening to other people or, or noticing, but I'm thinking all

of those is it, that's very open to interpretation actually, if someone's

being passive aggressive or attacking or.

You are right?

Yeah.

And I think that's something to try and separate out, isn't it?

So I suppose if you were, if you interpret that way, then universally

that would be quite triggering.

But it's possible that our history can make it more likely sometimes that

we will interpret cues in that way.

That definitely is something that happens and we have to unpick.

Sorry, I keep talking about It's cool, comes back to the

history, but it is so relevant.

Well, it does, it does.

You know, I know in my family, you know, my, I grew up in, my grandmother

was Swiss, French Swiss, and she was very expressive, you know, and so my,

my family, we would have these very loud debates at the dinner table,

like pretty much shouting at each other, but they were borderline, but

they, but they were, you know, sort of quite loud talky debates, let's say.

My husband's family didn't have any of that, and so if I, if I raise my voice and

I'm talking like this, he often interprets it as me being very angry and aggressive.

I'm not, I'm just sort of making a point and it's not, I'm not angry at all, but

then he'll say, don't need to shout at me, and that will then really piss me off.

'Cause I'm like, I was having a perfectly nice, natural, normal conversation.

Suddenly I'm accused of shouting me and angry.

I'm not.

I'm just being, I think exercised is the word.

So, yeah.

So there's, there's me, my background, and then there's him interpreting my behavior.

So it, it's all, it's all quite subtle, but there is some

behavior that is just blatantly

Okay, so should we go back to what the blatant ones are?

I think being, having someone being rude.

I dunno what I mean.

It, I think

it's hard because even with culture, right?

Sometimes things that we interpret as rude, it all blunt, rude

actually that in culturally for people, that's, that's fine.

Yeah.

Maybe that, maybe that's a tricky question because I don't think it's

necessarily gonna be, it's, you've gotta think about context and that's what

you're always saying in, in therapy.

What was the context?

And there's observable behavior, isn't it?

If someone's really rude and criticizes you, like in front of everybody

and, and tells you, you're right.

That that is pretty, that is pretty blatant.

If someone ignores you when you are speaking, that is

really blatant, isn't it?

So there are things that if we interpret that as the behavior that will,

that will particularly trigger us.

What are the other categories of things that you see people who have maybe

had certain traumas or wounds or or past experiences tend to get extra

triggered by that other people might not?

I think it's just all of like the interpretation of that, when something's

ambiguous will be misinterpreted as being, yeah, that is being controlling

or that is being passive aggressive and, and it's more likely to jump to

that conclusion than it being neutral.

And to assume you've got a bigger role in the cause for that, rather

than thinking about the external reasons that someone might have had.

And I think it's always interesting when you're watching something play

out that you're not involved in.

If you've ever kind of been in a waiting room, for example, you've seen someone

kind of being passed over several times and then they finally blow a gasket at

somebody who's nothing to do with it, and I think that's always a helpful

observer role, isn't it to take.

Um, but often if you're in the thick of it and you're just on the

attacking end, you find that quite hard to kind of do that, stepping

back and taking in the wider picture.

So we're more likely, if we've had like difficult experiences in the past, we're

more likely to, to personalize somebody else's behavior and the responses rather

say if they're angry and aggravated rather than it's, they're having a bad day.

The patient they've just been with was really difficult.

It's like, oh no, what did I say?

Why don't they like me?

Why did I, why they angry at me?

Rather than just seeing, seeing the whole thing.

So we personalize things more.

And, and also to say, I think, um, well my experience in therapy has certainly

been that text message con communication can cause a real problem for people who,

you know, are more sensitive to needing the social cues around it, rather than

just like, as the amount of agonizing And what does this mean without the

extra bo d language facial expressions.

I mean, just to say about that, to link it to the nervous system as we started

there, um, humans are social creatures, so we are wired for that social safety.

So our, our nervous system is always on and looking around for cues of

safety, not just in our environment, but in the people around us.

So if someone's got a very still face or a stern looking face, or their eyes,

language doesn't match up with the rest of their facial expressions, we will

interpret that as there's a danger here.

And people who grew up in a house where that danger, you

know, was being played out a lot.

Angry parents, very strict or controlling or critical parents, you know, might,

might have used silence, for example, to be controlling, then we will have that

dialed up sensitivity to all of that.

So does that mean then that if someone silent with them or maybe

doesn't hear them or something, they then interpret that as somebody's

angry or cross or ignoring them?

They'll, they'll read a lot more, reading lots into, it's essentially

what we do over interpreting it?

Exactly, because this meant this growing up, and so that's the

meaning I now take into adulthood.

And I've got all the strategies I need to cope based on that usually,

you know, but it might not be the best strategies in adulthood.

It might have been what kept you safe as a kid?

You know, it might trigger shame.

Shame is an emotion that makes us withdraw so we don't get further harm done to us.

Um, whereas in adulthood, if someone's behaving badly towards

us, ideally we would have a bit of annoyance, anger triggered, because

if that's not okay, we need to then have the anger to tell us it's not

okay so we can uphold the boundary.

But that's another thing that goes a, a bit wonky, I find, is that people

have downregulated anger for so long that they don't feel it in themselves.

Instead, they feel this.

Striving urges to make it better again.

Um, and it's not the anger that's in the driving seat there,

it's, it's fear and it's shame.

That's very interesting.

I've, I've, I've, uh, had a few interactions with a, a couple of

narcissists, which I worked with over the last, um, few years.

And, um, they said some quite outrageous things to me.

And at the time I went into complete, oh gosh, I'm so bad.

I'm so awful mode.

And when I've got home and told my other half, he's been like, excuse me?

What did, what did they say?

But I think because I've had a DHD, I think I've been used to being

a bit impulsive, often being the one in the wrong, a bit of sort

of maybe rejection sensitivity.

When I get some criticism, whether it's right or wrong, I immediately take it

on, like properly take it on board.

Oh my gosh, what have I done?

Rather than have that.

Righteous.

Oh, hang on, hang on a sec. That protective anger.

I, I do, I do go into that anger afterwards, but it's interesting what

the, the, the first reaction is, and I guess vice versa, some, someone might

have that defensive anger straight away to, to any criticism rather

than they're taking it on board.

I guess it's, it's two different extremes depending on how you've been

brought up or what you've experienced?

Yeah, and I definitely have had that sometimes in the therapy

room where someone's felt a bit vulnerable, for example, or put

upon, or just not expected something.

These are, I guess, all the things you could get outside the therapy

room too, and it's gone straight to anger, directed maybe towards me or

to some, you know, you wanna place the anger somewhat somewhere, don't you?

If you're the first person there to be on the receiving end, you might get it.

And that's, yeah, that is really hard because when you're on the receiving

end of that, it triggers your own threat response, and so you can get

this COEs escalation happening, which is the opposite of co-regulation, where

basically your nervous systems are kind of vibing off each other and both

feeling like each other's dangerous.

And so for me, if I'm on the receiving end of anger, I, you know, I get anxious, my

heart starts going and I immediately want to appease, even if it's not my fault.

So I have to make sure, not that I necessarily would get

angry or do something unhelpful.

I've obviously, as a therapist, I do have some strategies, but I would

usually try and ground myself and notice that i'm, I'm really triggered.

I'm finding it hard to think clearly and think of what I want to say.

And so now if I'm in therapy, it's a bit easier maybe for me as a therapist.

'cause I can say, oh, I'm noticing you're quite angry.

I dunno how that would come across in a, in a setting, like in a medical

setting, you can tell me maybe.

Um, but I, I can't, I can't find my words right now because I'm on the

receiving end of, of this anger.

So I just need to take a moment.

Could you just take a moment to, to try and manage your anger?

I might say something like that, for example.

I mean, goodness me, I, I lose count with the amount of times,

yeah, that you are dealing, you are dealing with a patient who.

Is really rude, really angry.

And I think we've been taught that the professional thing to do is respond really

well, respond, you know, calmly, whatever.

But actually I think the professional thing to do is take that pause,

like you've said, it's actually say, I just need a minute now.

I remember I had a patient who, uh, it was when I was quite a young, young GP.

She came and sat in front of me.

I'd never seen her before.

So, and she, in fact, she'd not been to the practice before.

And she sat down and she said well, I just wanna start by saying every

single doctor I've seen has been no effing use, and I think you are

gonna be no effing use to me either.

That was her opening gambit, right?

And you can imagine what happened to my nervous system.

It immediately went into, oh my gosh, I've got to please her.

I've got to make sure that she, she isn't, you know, actually nowadays

I'd be like, uh, right, hang on.

Let's just take away.

Yeah.

Now I know myself a lot more.

I'd be like, how can I possibly now have a neutral rational, uh, consultation with

you where I actually do my best for you when, like you said, my nervous system

is, which is wired for social safety.

I think it's so helpful to think of it like that when my nervous system

will be doing everything it can do to either appease you or to get or or to

be safest, i'll probably end up over diagnosing, over investigating or saying

something I regret or doing something because I'm not, I'm not thinking right.

So it's hard enough for you as a therapist who knows what you're doing.

The rest of us just trying to, like, manage these aggressive

or rude people, um, with no tools in our toolbox to do that.

You know, even knowing that it was okay to say, actually, I'm gonna

pause this consultation and what should come for wasn't urgent.

It really wasn't urgent.

It was some minor investigations.

Actually, I should have said, sorry, I'm not, I can't carry on with this

consultation now because I, I don't think I can think straight having, you've just

said that to me, which is quite triggering for me and I'm really worried now.

Can you rebook?

And that would've also been a very good boundary to say, I am not

prepared to be spoken to that way.

She was incredibly aggressive.

It wasn't just my interpretation.

If someone down and tell you no effing use before they even know you, that

was definitely a her problem, not a me problem, but we're just sort of wide to

go, no, no, you've got to deal with it.

That's part being professional.

But I think a lot of the time we deal with stuff and we shouldn't

be dealing with it, and we get ourselves into trouble because we are.

So mentioned there.

I dunno where to start, but yeah, there was a natural, if there was a

natural consequence, that's helpful.

You know that the, the appointment's been closed down.

I mean, I dunno how reflective somebody would be in that space, but

if there are natural consequences to behaving inappropriately, hopefully

eventually somebody would start to manage their behaviors a little bit.

Um, but I think also, I dunno, I, I, I'm, I've been practicing in mental

health for 20 years now, and I know you've probably been similar time-wise.

I think that does help a little bit because you can kind of, over

time, you've got the experiences of different interactions to hold

in mind, like, I know I'm not a bad therapist, I know this isn't my fault.

So I suppose just leaning on those, remembering this is, this is about this

moment, they, there's something going on for this person I don't know about.

Doesn't mean you need to excuse this behavior, but I can just focus on

regulating myself before I make the first, next step for this interaction.

And it, I think probably everyone listening to this conversation.

Can bring to mind or might already be there with moments where they've

had that torrent of anger at them because that's what, um, memories are

like when we're talking about anger.

Usually angry memories are retriggered, um, because the

nervous system is trying to look after you and trying to go on yeah.

And remember that time you don't want that to happen again.

So I've got an incident incident in my head where someone had a pop at me because

I'd asked if, um, if a trainee could sit in with the appointment and she just.

It was all, and you know, it's quite normal, isn't it, for our profession

to have to have that, but she obviously felt that that was, um, not appropriate.

But the way she handled it was really difficult.

And, uh, this was about 16 years ago, 15 years ago, and I, and I didn't know

how to handle it was my first occasion.

So, you know, just this could be an invitation to think about those times.

Like how could you have done that differently?

Because we take learnings from that, can't we?

At the time, thinking back to it, I think I was in the mindset

that it would've been weak to not carry on with the consultation.

It would've been unprofessional not to carry on with the consultation.

Um, and that was, I would've been open up to complaints, to criticism.

It would've been the wrong thing to do.

Looking back on it, I think it would've been actually the professional thing

to do, to say the reason is not because I'm pissed off, not because

I shouldn't be treated like that.

That's not the reason.

It's because my emotional system, my nervous system, is now dysregulated

and I can't actually make the best decisions for you as a patient

because that has just happened.

And I think if, if we start to understand that that's the

reason, that's the reason why.

I can't have a conversation, you know, maybe if someone's just criticized

me very heavily, I probably can't then have a conversation about

how I can change or whatever.

I probably need to go away, think about it, and, and regulate, and

then I can come back and have it.

So it's the, it's the understanding that it's about the dysregulation and what

that does to our brains, not the fact that we're being rude or weak or unprofessional

that will give us that permission to take that pause and and rearrange stuff.

I think of so many situations that would've been so much better if I'd

have just said, actually, I can't deal with this now because my, owning it.

How, what phrase could you use to own that dysregulation of

your emotional nervous system?

Claire, what would you tell your clients to say?

I mean, that phrase that you used.

I think, I mean, I've, I've definitely had a few sessions where people have come

in angry, , and it's been directed at me.

I think the way I phrased it is something like, well, I can see you're really

angry and this is coming at me, and this has triggered my threat response.

So I'm finding it really hard to think clearly right now.

And I have on one occasion ended a session early because I, I

couldn't think what I could do.

So I had to say, I, I don't know how to proceed with this appointment

because I can't think now, so we are gonna have to rebuke.

I like that.

I like saying this, what's just happened, this behavior, this thing has triggered

my threat response because what you're saying, and we talk a lot in our training

about going over the net, which is this concept that if I say to you, Claire,

you've undermined me, you've been really rude, well, that's over the net because

I may have received it as rude, but I dunno that that's what you intended.

Actually, what might have happened was that you told me I was effing useless.

Now that that's the baby you can observe or, but you might have, You

might have said something in a, in a loud voice, and I've interpreted

it as, you are angry with me.

Maybe you're just like excited or something.

So I'm over the net.

If I assume that you were intending harm to, uh, to be difficult, that you

are being really angry or whatever.

So saying like.

I feel threatened here because what you've just said to me, or the way

that you've just said it has triggered my threat response, whether you

meant to or not, like I don't know that, but I'm feeling threatened.

I'm feeling because I'm feeling threatened now.

And it could be to do with all my, my previous shit that's gone on, you know.

In, in A&E you know, if, if somebody is really drunk or whatever, um, and

a nurse is thinking actually, i'm feeling threatened because the last

patient that was in here in your state thumped one of my colleagues.

You know, you're owning it.

You're saying this is why I'm feeling threatened and now I can't think straight.

So you're not saying you've done anything wrong.

'cause the minute I think, the minute you start to imply that someone else has

done something wrong, then that's where you get that COEs escalation, isn't it?

Um, I mean, they might be annoyed anyway with you saying that.

but at least you've tried to, not to trigger them too much.

Yeah, it's really hard.

I think acknowledging someone's anger and emotion is really important.

It, I mean, it is the key part of any emotion regulation work

in therapy, helping someone name it so you can name it for them.

You know, it looks like you're really angry.

I mean, it might be really obvious, but that's an intervention.

And you could, you know, it might be coming from somewhere else, but I'm

experiencing it that as threatening.

And so either I need to take a moment and come back and then please don't

talk, continue talking to me like that if you'd like me to carry on doing my job,

but I can't carry on right now without a moment to manage myself, regulate

myself back into feeling okay again.

So I think recognizing that using tools like slower, regular breathing, for

example, and with my clients I make little, um, soothing kind of packs.

so, or kits maybe in a little spectacle case or a pencil case, like

a little travel one, just a few bits.

So if you know you get triggered a lot, you can take out a certain smell or a

little thing to kind of squeeze or, just something that's grounding, you can come

back to and feel a sense of safety in.

I guess there's a, there's a different level, isn't it?

There's that time where, you know, the patient's so angry with you

that you, you just can't think straight that, that patient being

really, you know, rude to me.

I can't think straight, but there are just the, the subtle little things where

it would be escalating it a lot to say, right, that's it, i've been triggered.

I can't, I can't do anything.

And that, that's the nuance stuff that is really difficult to deal with.

And I love that thought of getting a nice thing outta your pencil case,

but, but you can't, you can't do that say in the middle of a meeting or, you

know, in a professional consultation.

So what else can you do?

I mean, I, I, I like the idea of having affirmations or,

and embodied affirmations.

I know I've spoken to you about them before, but some, some

wording that, you know, you need to hear in a moment like that.

Like I've got two or three phrases that I know I've got my sleeve.

One is, for example, I'm doing my best.

And, you know, if you aren't right in front of someone, I might

put my hands on my heart just to kind of reinforce that message.

This job is really hard, like it's just little reminders or I've got

this, I I don't need to prove myself to anyone, i've already got this.

Um, I deserve to be here.

You know, some of those things I might say to myself.

I like that.

I, well, I'm, I'm thinking of some mantras that various different people

on the podcast have, have talked about.

Annaline Weston, who's their dental legal advisor dentist in Australia, she's got

this mantra that she makes all her dental students say, and that is, I'm gonna make

mistakes and some of them will be serious.

She makes them like their first day of, their first year of their dental training.

She sits with lecture this and makes them say that.

But, you know, saying, I'm gonna make mistakes.

Some of them will be serious.

Like she know, okay, you've just told me I've made a mistake.

I'm gonna make mistakes.

It's just like normalizing some of that.

Some other stuff I guess I found useful was, I try and do this

sometimes, like, this does sound like a you problem, not a me problem.

Like, but I wouldn't actually say, wouldn't say that, but you know, in

your head thinking, oh, this is a, this is really a you problem not, not

a me problem, which again, I think a lot of doctors do, and I'm sure

psychotherapists as well, you know, take on their, their clients' problems,

like they've got to solve them, that they, and often I think we can be

triggered by the fact that someone dumping a. Unsolvable problem on you.

And even if the patient hasn't said, you've gotta sort this, you know, we

think to ourselves, oh, I've gotta sort this, what we're gonna do.

And if I don't do that, then they're gonna be rude and I know

what they were like last time.

So we sort of trigger ourselves.

So this whole, well, that's a you problem.

I can't do anything about that.

And I think one of the things I like to say to myself, although I often on

my own, is, you know, again, hand on heart, of course you reacted like that.

Look at what you're coping with.

Because one of the things I've learned recently that has really helped me is

the fact that every behavior makes sense to the person that's behaving like that.

So if that person is like outside waving a, I don't know, sword around

that, that makes sense to them.

Whatever's going on in their head, they're not just doing it, there's

something that's triggered that, that's a bit of an extreme example.

But if someone, yeah.

Is being really rude in a meeting, that behavior's making sense to them.

It's not making sense to anybody else.

But what is it in their past that means that they think that is an

okay way to put they being modeled.

What are they scared about?

Like what, what that, that sort of thing about their really

wide sensing social threat.

Are they feeling really insecure that they just have to dominate everybody?

I mean, it's fricking annoying, but I think it's starting to

have a little bit of compassion.

To the other person, yeah.

I mean, it's not fun to be in that place and that the, what you are getting at

sounds to me like the essence of trauma informed care, where instead of asking

like, well, what's wrong with you?

You're asking, well, what's gone on for you?

What's happened to you in the past that you are in this

space, behaving in this way?

And you know, often when I'm in therapy and I'm hearing people's

experiences in health settings, You know, the, the system is so squeezed

and busy that the ability to be trauma-informed is really compromised.

But they are things like showing that you're listening.

It's like you said earlier, slowing questions down and, and allowing a bit

more pause, which I know is really hard.

But some of that might be within someone's control.

Um, if you are slowing the pace down, that slows them down and it buys you a bit

of time if you feel a bit dysregulated.

If you kind of thinking about just that as an action, it communicates, I'm listening,

but it also communicates, and we can take this a bit more slowly, and I think

that can be really valuable for someone who's stressed or upset or nervous.

'Cause often that's, that's gonna be underneath, isn't it?

This.

This anger or frustration that's coming at you, um, feeling of not being in control.

Um, this, this has moved into mostly focusing on anger, isn't it?

I dunno if that was your intention.

Well, I think anger, interestingly, and I heard this, tell me if I'm right.

I've been told that anger is a secondary emotion, that there's

always something underneath anger.

So there might be fear which comes out as anger or there's distress or sadness

or, and often stuff come out, comes out as anger and, and I suffer with this

affliction that when I'm really scared about something, there's a sort of

bearing my soul here, there's a famous incident in our family and the, the family

of our best mates where we went for a lovely pub walk lunch when the kids were

quite little, and my daughter cycled home with the, the son they were about.

Seven, six or seven.

The son thought he knew the way home and we were going across

the meadows and stuff like that.

And so we lost these two kids on a bike and some quite, you know,

difficult roads for about half an hour.

And they had just cycled to the local Sainsburys and would

sort of sat waiting for them.

And when we found them, my best friend was like, oh, darlings, you're here.

Whatever.

I just let rip.

I was like, I cannot believe you did that.

I yelled at my daughter and, and this other little boy, it sort

of gone down in history as Mum yelled at someone else's kid.

I was so scared and worried about it.

It came out as absolute rage.

And often I think when we are scared, it comes out as anger.

Sometimes when we're upset it comes out as anger.

When we're worried, frustrated, often it, it, it, for some

of us it comes out as anger.

I dunno if you've experienced that with clients.

Yeah, yeah, definitely.

I would say that that can be the case.

Uh, I mean, I've not heard it phrased as it's only a secondary emotion.

I feel like it can be a primary emotion too, if, if a boundary's

been crossed and there's justified anger because that's not okay.

Um, but I think helping people identify what's happened there can be helpful.

And I do think, like you say, it can be a secondary emotion.

And then of course you get.

Another layer of that, which is then shame for feeling younger and for

reacting and, and then there's that whole weight and burden of those emotions.

So therapy, a lot of therapy is spent talking about are poor

down regulating these emotions.

It's actually harder to upregulate anger, believe it or not, than it is to

downregulate if someone has never been able to be connected with anger, to get

'em to start feeling anger, um, in an appropriate way is actually really hard.

What are they feeling instead then

Um, shame or it's directed inwards so it's not directed outwards

to where it should be directed.

Um, so hatred, self hatred.

And that's hard, isn't it?

Because with, we are told, I think in our society that showing anger is,

is really bad and is really wrong.

Actually, sometimes it's the healthiest thing to do and particularly if someone

is being tricky and overstepping up, and actually I think a correct response with

that patient that I talked about earlier should have been a bit of controlled anger

rather than, oh gosh, I'm such a bad doc.

Actually that is not okay.

I don't feel, I now feel threatened and unsafe, and I'm feeling

quite angry that you said that.

You know, I think that would've been much healthier reaction than, oh gosh,

I've got to make you, better and make you love me, and all that, all that sort

of weird stuff that went on in instead.

And, and I think it's difficult for women.

Women aren't allowed to show anger as much as men perhaps.

And so at work, if a woman is, if there's a tricky dynamic with people, if a

woman shows that they are angry because that boundary's being crossed and that

person has been tricky and they've done something rude, then it immediately

becomes the woman's fault for reacting.

Whereas I think men probably get away with a little bit

more, hang on, that's not okay.

And they can say, and it doesn't get taken as this, this dreadful, toxic anger.

Now that's just my thoughts.

I could be totally wrong.

I don't know what your experience are.

when I looked at this, um, for another podcast actually about the different

stress response to men and women, women are more like to show their

anger in a passive aggressive way where they gossip after the event, rather

than setting or saying it upfront.

And in, and they're also more likely to go to the kind of appeasement, fawning

kind of behavior because in terms of, you know, our ancestors being kind of

the ones in charge of the young we, that would've been a better survival

strategy to kind of appease the kind of the threat so that, 'cause you can't

run with all your young, very fast.

And actually, yeah, that's exactly what women do.

They, they don't say anything, then they go and bitch about it afterwards.

And not, not all the time, but you know.

I always think it is healthier to say something at the time,

but it's this co-escalation and co-regulation that's the key, isn't it?

What else can you do to co-regulate?

So you can, you've already talked about slowing the pace of your speaking.

You know, you're talking slowly, you are maybe showing some em empathy.

Yeah.

I, I mean, I, I try and soften my facial expression.

I think about, you know, lots of, kind of gentle language without being

patronizing, using eye statements like, oh, I noticed this and I need this.

And, um, you know, just, uh, this is a pain in the neck, this form, isn't it?

But, um, this is something we have to just try and at least do the basics of.

Like, I dunno, I just use phraseology like that, that kind of tries to come alongside

someone without patronizing, without, you know, making the situation worse.

Is there any ever place for saying to somebody, actually, I think

you need to take a break and step out and, you know, take a quilt.

It it, the problem, this is really annoying.

Someone telling you to take a chill pill, it's bad.

It's as bad as someone telling you you're really angry when you're not.

Then sometimes you take a chill pill when you're, when you're quite chill.

Just, that really annoys me.

But what can we do about these, these tricky people because okay, we, we've

looked at people, you know, we've looked at our own response and what is triggered

in us, and maybe stuff from the past.

But if, if someone genuinely is difficult, everyone knows they're difficult,

they're stressing everybody out.

You kind of want to know your team is there for you, but not in a ver

like a visual we are now gowning up on this person kind of way.

Do you know what I mean?

I think there's a bit of a subtle, kind of like a kind of little, I dunno ha like

at home for example, if my husband's a bit annoyed, I might just put a hand on my his

shoulder and just go so I'm there for him.

It's like something like that being a team format that doesn't then involve

other people coming in to kind of rescue you or like get involved, 'cause I

think that can escalate it all as well.

And I'm, I mean, this is a really boring response.

I feel like I'm in a job interview now, but what, what policies,

what do the policies say as well?

Because I think it is helpful just to be aware of that, like, as well, just to

have a sense of what, um, your managers might be think, uh, like aligned with.

But I think it's gonna be uncomfortable.

Expect it to be uncomfortable, and expect that sometimes when you are dealing with

human distress, this is gonna be the result in a system that's chronically

underfunded and um, stressed, and there's gonna be knee-jerk reactions

that have happened somewhere in the system that may be, has been unhelpful.

People's history of helping professions isn't always sunny and delightful.

So the reaction to you might be colored by previous experience

of helping professions.

Um, actually that's something else I always, um, find out about in therapy

with people, you know, tell me about what has happened in other scenarios

where you've been in a therapy setting or with other doctors and, you know,

helping professions, because that does often give some seeds of idea, like

obviously you weren't listened to, so I wonder how that's gonna make you

feel about how I might listen to you.

I mean as a therapist, Claire, you did mention to me earlier that you've

got a an EMDR type template that you use sometimes, which is quite helpful.

This particularly works well if you know you're going into something that's

gonna be tricky and you kind of have a rough idea of what that might look like.

But you know, if you are in scenarios a lot, say that the A&E example, I

imagine people do get a lot of, stuff thrown at them that's quite intense

that tends to be quite similar, to just to run through in your mind's eye

how you could handle it, maybe using some of the things we've talked about

here, and just say that to yourself.

I can cope with this, I can handle it.

And picture yourself handling it.

You know, it might be something like, I'm gonna just take a moment, or I'm

gonna say one of the phrases that we've spoken to today, spoken about

today, and then like picturing yourself getting to the end of that interaction.

Um, and then you could just rehearse that.

So in, in the mdr r we would pair that up with, with tapping.

So obviously if you choose to tap, that's kind of at your own risk 'cause you're not

in an MDR kind of setting in a therapy.

But certainly visually practicing and rehearsing something and how you

can handle it can be really valuable as a tool, even without the tapping.

That sounds like a really useful, um, thing.

I mean, you know, visualization of anything's good, isn't it?

You're starting to lay down those mental pathways before it's even happened and

you're sort of predicting behavior, which probably will never exactly happen,

but at least you're sort of got some strategies that you've already thought

of, like, well, if I find myself getting really, really triggered, this is the

phrase I'm gonna use to get myself out of it, or I'm gonna make sure I,

like you said, I use the eye phrase, it's like, I'm feeling this and I'm

feeling that, so let's, let's just, rather than going, you are attacking me,

therefore I'm gonna do this or whatever.

But, um, it's a work in progress.

And it sounds like the main thing is sort of understanding

where people are coming from.

I think sometimes just context is everything.

If you know that a colleague.

Is tricky yet you understand the experiences that they've had in the

past, you'll forgive them anything really, you know, um, if you know that

they've had a, a bad reaction with a dog, for example, when a dog comes and

you can see them like thing and being a bit snappy with you around a dog, well

you go, yeah, of course you like that.

So the more you get to know people, the the better it is.

'cause you just understand the context.

Although I think there's that caveat of don't assume just 'cause you

know somebody well, that you really know what's gone on in the past.

You might not right.

So Claire, can you give us your three top tips for sort of regulating

yourself, co-regulating other people in, in a situation where

someone is being a tricky person?

Three top tips.

So it would be just notice your own physiology, that you're

struggling to think straight.

Give yourself permission to step back and just tend to that.

And try and if you can just try and communicate that.

I'm just taking a moment, you know, because there's a lot that's just

come at me and I can't do my job.

I think those would probably be, I know I'm just rehashing what we've already

said, but I think those feel like if it's anger, um, like don't expect

yourself to be able to perform, like you were saying, at the same level you

would if you were, had all your frontal lobes online because you were calm.

I love that.

Is that sort of like, that's my main takeaway from this is like communicate

my frontal lobe's just gone offline, so I can't, I, I can't deal with this in

the way that I really want to deal with it, so I'm gonna, I'm gonna need to step

out or whether, but Claire, that's so, that's so helpful that every time we

speak to you, there's, there's, there's more stuff and, um, gosh, there's so

much more we can, we can talk about.

So we'll get you back if that's okay.

In the meantime, if people wanna find out more about you and your wonderful book,

which a colleague of mine, a consultant urologist, just has described as the best

explanation of the sort of polyvagal, dorsal ventral, vagal, or whatever

it's called, system he's ever read.

So high praise Claire.

Honestly, it's a really, really good book.

Um, you, we'll put a link in the show notes, but where else

can people find, find you?

Yeah, and just say it's also available as an audio book, for

people who listen to this, probably consume a lot of audio books.

So it's Burnout, How to Manage Your Nervous System before it manages You.

Um, yeah, I'm on the social medias.

I'm on uh, LinkedIn and Instagram and Facebook.

and I've got a website, drclaireplumbly.com where you can find

me and my associates if you want therapy.

We also do EMDR, like you said, as as an intensive format.

If people kind of feel like I've got a bit of leave coming up and I've got something

I really wanna go deep on, um, it's good for people to know that that is an option.

Yeah, an EMDR is a treatment for post-traumatic stress, isn't it?

or trauma?

Yeah, you're right, it's a trauma treatment, but now we apply it to

lots of different things, not just PTSD, because often there's some

sort of trauma, at least little Ty trauma, um, that's coming from that,

so we'll, we'll put links to past podcast talks about little T trauma,

but do to check it out and, and really if you are struggling with this stuff,

therapy is genuinely eye-opening and changes, changes, everything.

It's about that understanding.

So, um, yeah, I would seek out a good therapist and Claire and the gang

are a, a really good, a really good bunch and I'd recommend them highly.

So thank you so much for being on the podcast.

We'll speak again soon.

Thank you.

Bye.

Thanks for listening.

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