[JOE SANOK] This is The Practice of the Practice Podcast with Joe Sanok, session number 814. I’m Joe Sanok, your host, and welcome to the Practice of the Practice Podcast. I am so glad you’re here. We are covering everything around starting, growing, scaling, and sometimes exiting your private practice. We’ve been having some amazing issue or issues, yes, we’ve had issues, I have issues, we all have issues. We’ve also had some episodes, like yesterday we had Harry talk about the secret of being more present. Before that, we had Ursula talking about turning uncertainty into an advantage, and Sharon before that about burnout and research behind it, all sorts of amazing episodes lately. Really excited about our show today. Today we have Victoria Albina. Victoria’s, a certified life coach, UCSF-trained Family Nurse Practitioner and breathwork meditation guide, with a passion for helping women realize that they are their own best healers, so they can break free from codependency, perfectionism, and people pleasing and reclaim their joy. She’s the host of the Feminist Wellness Podcast, holds a Master’s Degree in Public Health from Boston University in Public Health, and a BA in Latin American Studies from Oberlin College. Victoria’s been working in health and wellness for over 20 years and lives on occupied territory in New York’s Hudson Valley. Victoria, welcome to the Practice of the Practice Podcast. [VICTORIA ALBINA] Thank you so much for having me, Joe. I’m delighted to be here. [JOE] Yes, I love that you put occupied territory from the tribe that lived there before. [VICTORIA] Yes, they’re still here. Indigenous folks are still here. It’s important to remember that in our land acknowledgements. [JOE] I just read Bury My Heart at Wounded Knee, and it just was like, just to hear the stories of really in-depth that like, we need movies about this American Holocaust and to just see what’s happened. I live, the Anishinabe tribe is up here, and a lot of businesses are putting up signs and saying a lot about reclaiming land or having discussions around that. I think that it’s just an important issue, and I think it’s great that you wove that into your bio. [VICTORIA] Aw, thank you. Agreed, yes, we need to be talking about it more, for sure. [JOE] Well, I mean, you’re highly trained in a number of different areas. I’m sure we could go a billion different ways, but one of the things that you really focus in on is somatic work and the nervous system. I just want to start there. Why does that work matter to you, and how did you get into that work? [VICTORIA] Oh, I love that question. So it matters to me because it, well, it was really one of the most key parts of my own healing. As you shared in the intro, I’m a functional Medicine Nurse Practitioner. I worked in primary care for many years and then had a private practice as an NP in Manhattan. I realized after some years of doing functional gastroenterology that what I was really attempting to treat were nervous system issues, were stress, distress, and trauma held in the body, the somatization of symptoms or of emotions into symptoms and that if the nervous system isn’t regulated, isn’t aligned. If folks don’t know how to hold space through their own nervous system somatically through the body, it is incredibly challenging to find physical healing, let alone healing for our mental health concerns. [JOE] Well, and I’m raising two daughters that are seven and 11, and the idea of doing my best to mitigate the trauma they’re going to experience in the world, and how they identify with their bodies and all of that. I would love to just selfishly start with like, how should a single dad raise two girls to make sure that they’re awesome, bold, badass women. [VICTORIA] Sounds like you’re doing it. Just casual and cool, cool, cool. Right on. Well I will first name that I’m not a parent, but I am woman identified and was socialized as a girl so I can speak from that experience. I mean, first of all, the fact that you’re asking the question would lead me to believe that you’re already doing it. I think having conversations about where our feelings live in our bodies bringing awareness to our emotional state as well as our physical state, really inviting our kids to get present in their own bodies and to make their own decisions around what living in their bodies looks like. For humans of all genders but I’ll speak specifically to those socialized as girls and women, we are taught that our bodies are too big, too much, too loud, too messy, that we are to be contained, that we are to get smaller always. The more we can encourage humans socialize as women and girls to really step into our powerfulness, to really step into our own story, our own narrative around our bodies, and reclaiming the powerfulness that lives within our, within ourselves, within our tissues, I think the bolder, the more bold and brave we can be when we’re living from our authenticity and that somatic connection. [JOE] Now, what if, frame out the problem for us, like, how are women taught to think about their bodies, to think about, like you listed some things at the beginning but dig into that a little bit more, what is the big underlying issue in society that you see. [VICTORIA] Oh my goodness, well, so many, but … [JOE] Specifically around women and their bodies and the way that women think about their bodies that advocates can advocate specifically around that issue. [VICTORIA] Sure. I’ll start by naming that this is of course, a generalization, not all human socialized as women have the same experience. These things are mitigated by things like race, class, ethnicity, culture, religion, social location, socioeconomic status, et cetera. I would say overarchingly within the patriarchy of white settler colonialism and late-stage capitalism, women are taught that our bodies must be smaller. That’s what diet culture teaches us. That our pleasure is not important. Our desire is not a tantamount, it’s not the most important thing. Taking care of others is. So in my practice, I focus on supporting human socialized as women to overcome codependent perfectionists and people pleasing habits, which, if we boil it down, comes to a detachment of from self, living in a false self-outside our authenticity towards the goal of sourcing our wellness worth and validation from everyone and everything outside of ourselves instead of from within. That starts as girls. There’s numerous studies about how early in life girls begin to have thoughts of hatred towards their bodies, how quickly we issue that fundamental connection to the soma, to the body, secondary to, again, the patriarchy and diet culture that tells us our bodies are not good as they are, that fat is a terrible thing, which studies also refute that, that we can’t be healthy and well unless we are contorting our bodies to meet some external standard. Then we bring in the male gaze that starts these days at, which starts in middle school. How we are policing girls’ bodies, women’s bodies and enforcing really outmoded notions of what it means to be a human in a body. Now, when we layer in a family blueprint that brings in codependent habits, we must leave our bodies in order to act in a codependent way. So, intentionality, authenticity, presence, those are contrary to the experience of being codependent because again, our gaze, our view of the world, our lens for everything is what will someone else think? What will they think of me? How will they respond to me? What will they say about me? Will they love me? Will they abandon me? Will they reject me? Will they care for me? Will they validate me? So we’re always seeking to fit into someone else’s story of what it is for us to be good, to be worthy, to be lovable. That starts with negating the body and contorting it. When we layer it, when we layer in stress, distress and trauma, we can see, and I trained at the Sensory Motorpsycotherapy Institute, Pat Ogden’s work as a coach and an NP. We start to look at tension patterns that arise in the body secondary to holding in emotions, not completing the stress activation cycle. What’s immediately coming up once I say that is anger. Girls are taught not to be angry, that that’s a problem if we have anger, if we have rage, if we voice that, act that out, express that. There’s something problematic about us. We’re not fitting the societal roles of what a good girl is. So, again, we learn to hide ourself and our emotions away, and those patterns of tension and stress remain alive in the body. The issues are in the tissues. [JOE] Now, I know that you have taken a lot of time to study the science of the nervous system and all that. Before you start recording, you’re like, if you want to nerd out, and I’m like, I do want to nerd out. Tell us like what’s going on in the body? Nerd out, I give you full nerd out permission. What’s going on in the body? [VICTORIA] When, in what setting? Give me the context [JOE] Let’s take that the rage, you said the issues are in the tissues, the rage, pushing down those emotions. What’s biologically happening when that happens? [VICTORIA] Oh, great question. I will back us up and situate us within polyvagal theory, which is the work of Dr. Steven Porges, Ph.D., and Deb Dana, LCSW, Porges is like, that’s like high nerd, like, get out your safety goggles before you read that and Deb Dana, because social workers are the best, translates it into amazing English. So love me some, Deb Dana. Polyvagal Theory is a way to understand the nervous system vis-a-vis the vagus nerve, which is the 10th cranial nerve, the longest nerve in the human body and it is the connector between our minds and our bodies and controls not just our organs, but our mood, our energy, our emotional capacity, whether we’re present in life or not, whether we’re anxious or chill, checked out or checked in. So the vagus nerve has many different functions in our body, which shift based on so many factors, our individual internal capacity, our environmental and social factors, external stimuli, internal stimuli, what we learned in our family of origin about whether it’s safe to feel our feelings or not and all of that paired with our specific history of stress, distress, and trauma. So the vagus nerve has three main branches or states that impact whether we are at home in ourselves, anchored in ourselves, whether we are jacked up and anxious in what’s called sympathetic activation, or whether we are checked out and unmotivated in what’s called dorsal vegas. How’s that? We checking in? We we’re doing good so far, we’re doing well. Oh, you know, I will always, always love an invitation to nerd it on out. So when we are moving through the world, our nervous system is directing our experience of life through interoception, the nervous system scanning of our internal state and exteroception, our scanning of the external state. The body is always, always, always on the lookout, you guessed it for lions, bodies always saying, right, is that a lion? Is doom nigh, is murder upon us? Or, oh wait, that’s just a tabby cat. The body is quickly, constantly scanning through the eyes, through the ears, through the nose, through our senses to look for danger. That said, the primary state of the human animal as a mammal, as a pack animal is something called ventral vagus. So polyvagal is based in a hierarchy of human experience, which is really quite lovely because it gives us a little roadmap. It lets us know what mammals will do when faced with what feels like threat and the feels like is a nod to perception. We’ll, we can come back to that. But speaking to the biology as humans, our steady state, what Deb Dana calls our home state is ventral vegas. So ventral just means front body, so it’s experience and it’s the from the diaphragm up and it is our experience of the world. So ventral Vegas is safe and social, calm and connected. That’s the nervous system state I’m in right now. I love nerding out about this stuff. I think you’re dope. I love our connection. I love talking about this. I love thinking about all these nerds being like, ooh, science, and then going into clinic and applying it and helping people change their lives. I am in ventral vegas. I feel super chill right now. Should a lion roar in the distance, my ears will pick that up and their first response will be sympathetic activation, fight or flight, an adrenalized state. Cortisol eventually enters the picture, it’s what’s called a late stage reactant molecule. Everyone thinks cortisol like happens immediately, but it takes a little hot minute. Anyway, getting into the weeds there [JOE] No, no, keep going. [VICTORIA] Right on. Everyone loves to talk about their cortisol, but anyway, it takes, that takes a hot minute. So if I believe there is a lion coming towards me on this interview, I will go into sympathetic activation. My heart and lungs will start pumping faster, blood will rush away from my non-essential organs, which is rude, but loving, but rude, but loving and will go to my heart and lungs, pump to my hands and my feet so that I can either punch that lion in the snout or book it out of here. When I mention the non-essential organs, I’m talking cognition, I’m talking thyroid heart, liver, spleen, digestion, reproductive cycle. When we are stressed biologically, everything functions sub-optimally within the animal. Let me ask you a question, Joe. If you were being chased by a lion, would you want your body to stop and digest that cheeseburger? You just say it [JOE] No, I would get out of there. [VICTORIA] Yes, for sure because you’re not dumb. That is a lousy choice when we’re thinking about survival. [JOE] Yes, don’t want to have to stop and poop in the middle of being chased by a lion, just going to be honest. [VICTORIA] Yes, for sure. When sympathetic, as your steady state, you’re much more likely to have diarrhea actually because everything is sped up in the body. It’s like, oh my God, get that cheeseburger out of here. I’m going to link it back to gastroenterology at some point, always will. I know, I mean, we can, we’ll link IBS into all of this, give me a hot minute. So we see the lion, we try to outrun it, we try to punch it, should that fail, we go into what’s called dorsal vegas. Dorsal means the back body and a little mnemonic, I like is that your back is against the door of the cave trying to keep the world out. So you are emotionally checked out, depression is likely here as much as anxiety is likely and sympathetic. This is an acetylcholine state. Dorsal is a state in which we are checked out, we are numbed out. We are shut down emotionally to the world. So if you are in session with someone and you see their eyes sort of go blank and they emotionally, energetically withdraw, they may be going into dorsal. So there’s actually a lot of direct clinical applications of polyvagal theory, which of course I think is the dopest thing. [JOE] Now quick question there. So when you’re talking about the sympathetic activation and then the dorsal, can you jump to the dorsal or do you have to go through the sympathetic first? [VICTORIA] So technically we move through sympathetic. Deb Dana talks about how all of us have a home away from home. I will say that mine historically has been dorsal. So in conflict and a challenging conversation with a partner, I will get a little bit of like, no, I didn’t mean it. Then my body just goes, I’m doomed. The doom thoughts start. There’s like a heaviness in my belly, my pelvis feels really like stuck, my breath gets really deep, but not in like a yogic nice way, but in a like, exasperated way. No, it’s not exasperated. It’s hopeless. It’s hopeless, very different from exasperated because that’s more sympathetic. Ugh, I’m exasperated. So the physiology will pass through sympathetic and how long we stay in each state is secondary to our own animal and all the environmental experiences that I talked about earlier. Does that make sense? [JOE] Yes. [HEARD] It’s never too early to start thinking about tax season. Heard is the financial back office built specifically for therapists in private practice. They combine smart software with real humans to help you manage your bookkeeping, taxes and payroll. Regardless of whether you’re a seasoned clinician or are in the first year of private practice, Heard will identify areas of growth and streamline best financial practices for your business. When you sign up with Heard, you’ll connect your bank accounts so your transactions will automatically be pulled in and categorized. My favorite thing about Heard is their allocation guide, what helps you decide how much to pay yourself each month and how much to set aside for taxes. You’ll also receive financial insights such as profit and loss statements and personalized monthly reports. You can say goodbye to pouring over spreadsheets and guessing your tax deductions or quarterly payments. Focus on your clients and Heard will take care of the rest. Heard always has transparent pricing with no hidden fees. Sign up for a free 15-minute consult call today at joinheard.com/partners/joe. Again, that’s joinheard, like I heard it, not like a herd of cattle, joinheard.com/partners/joe. [JOE SANOK] So people move through it, but they may have a direction that they tend to go towards more often than not. [VICTORIA] Totally, and so someone might just stay in sympathetic until they have exhausted that system and then the body, then all of a sudden they need a nap or all of a sudden, so pissed off, so angry, so worked up, so worried, so anxious that their body is like, girl, get yourself on the couch, Netflix, glass of wine immediately. So dorsal is going to look really different on everyone but it is at its extreme, a fainted death response. It’s like a gazelle that got snatched by a lion. The mama lion’s going to go get her cubs so she plays dead till the lion leaves. Humans have, at its extreme, the extreme of dorsal is being catatonic. That’s not what most of us are experiencing every day. It’s more of this frozen, shut down, disconnected experience. Our blood pressure drops because if you’re bit, you don’t want to gusher on your hands. Isn’t that what, think about heart rate slows, your endorphins go bananas so your pain response is mediated, which is again, so cool. I’ll side note here, I promise to come back but when I teach polyvagal, when I think about polyvagal, when I apply it with my clients, one of the key things for me is to use it as a tool to reduce blame, shame, and guilt about our immediate autonomic, automatic reactions to life. Because they’re thinking from an animal that thinks it was bit by a lion. [JOE] How, how, how much of the average person’s life is spent in these non-baseline states? [VICTORIA] Being chased by lions? [JOE] Okay, well, I mean, I’m thinking about how the average person, like when you read studies about sleep or anxiety or depression or things that aren’t actually a lion, but are the perception of a lion. Even just the addiction to like rage in media or any of those things, is the average person living in these heightened states throughout the day unnecessarily, or are they, is that more just like a perception I have or? [VICTORIA] No, I feel like most of us these days are quite dysregulated in our nervous system. We’re not, we don’t know how to map our nervous system. We don’t know what’s going on, and we are living in a low-grade sympathetic anxiety and worry. Or we’re living, think about how much productivity is valued in late stage capitalism. So we’re running around like chickens with our heads cut off from the millisecond we wake up till we collapse in front of Netflix, not connected to our bodies. So that ladder state is called functional freeze. It’s definitely the state I was in for probably the first 30-ish years of my life where I got all the degrees and went to the fancy schools and got the certifications and another board certification and another thing, and was doing the things looked very successful on the outside and was really frozen to my own emotions and my own internal state. [JOE] I want to talk practical application of this for people that they like the nerd stuff, but they’re also like, okay, what do I do in a therapy session? What do I do in my own life to address this? Like, I love that you said if you see a client start to piece out here’s what you can do. So what are some practical ways, maybe like ongoing habits to help build your baseline, but then also like when something pops up for a client or for an individual ways to like reregulate ourselves? [VICTORIA] Love that. So it really starts with mapping our nervous system because you can’t change what you don’t know. So we need to understand where our home away from home is. Like I can name, it is torso. I will go to there if I’m not supporting myself and taking good care of myself. So knowing where our home away from home is and being able from a place of being our own most loving watcher to map our nervous systems throughout the day. Now it’s normal, necessary, vital to have some sympathetic activation during the day, or you would stay in bed all day, you wouldn’t put on pants. You’d have no get up and go. But really noticing when you leave that level of sympathetic that is supportive, that is loving, that helps you be an animal in the world doing stuff. When you cross over into worry, anxiety, stress, compare, and despair, all those thought patterns that come from the nervous system experience of sympathetic, what does it feel like in your body when you go into sympathetic? What do you think there? What do you do there? What do you say there? Who are you there? What is your perception of self from sympathetic? What is your perception of the world? What are the stories you’re telling around the guy driving next to you, the person in line at the coffee shop ahead of you, about your boss, about your partner, about your kid, about your dog? What are the stories that you are inhabiting about others from self-concept? So a sentence stem from Deb Dana again, one more time, social workers are goddesses and god’s. They’re the most amazing animals. I love you. Nurses love social work. Come on. Right, come on. Anyway, Deb, Dana shares this practice where she asks us to write, I am blank and the world is blank. When I’m in this state, it’s a tool that I teach from Deb to help map the nervous system. So when I am sympathetic, the world is, I am angry and the world is unforgiving, I am alone, and the world is harsh. What are the stories we tell from sympathetic? Of course, please, we start in ventral, we end in ventral. We always angulate, we go to the resource for our nervous system, the kind, loving, grounded, safe place, then we go to where it’s scary, we come back to the resource, go back where it’s scary, come back to the resource, always, always, always. That means starting in ventral vagal, the safe and social, calm and collected, connected part of the nervous system, which can really just be the therapeutic relationship. That can be a good starting ground. From there, checking out sympathetic and from there, coming back to Ventra and from there, checking out dorsal and asking those same questions. Who am I? Who is the world? What is the world? What are my stories about self and the world? What do I do? How do I show up? Most importantly, for me in that so much of my work is somatic about coming back to the body. What does this feel like in my physiology? What is this energetic like for me? Does it have a color? Does it have a temperature? Does it have a weight? Is it limitless? Is it limited? Does it expand in my physiology? Does it make me want to curl up? Does it make me want to expand? What does this energy need? Does it need me to run around the block or do some pushups to get out that’s stuck sympathetic? Does it need me to do, I teach a various somatic movement practices. Does it need me to do figure eights with my arms or figure eights with my hips? Does this movement or does this energy want stillness? Does it want quiet? Does it want a good cry, a good scream? So really starting to map our nervous system so we can understand what that felt experience is for us as individuals in our soma so then we can move through our day with more awareness. When we get a text from our mom and we’re like, ugh, and we go right into sympathetic, like, ugh, why is she texting you right now? It’s probably full of criticism, whatever. We can understand. I’m having this thought because my nervous system went to there. So let me bring my nervous system back to ventral vagal or stay with the sympathetic, stay with the dorsal. Give it what it needs, and then do mindset work. Then bring CBT based protocols in, then start to change the thinking but we have to regulate the nervous system first and that starts with mapping it. [JOE] I love that you start with just a general awareness of what the body is feeling and experiencing instead of here’s the 10 tools, do some meditation, do some deep breathing, do some movement. It’s like, well, what if your body doesn’t need that tool? So to start with, okay, here we’re going to just focus on what’s going on in your body. Even just thinking about my daughters when they, every kid, every adult has times they get worked up but to just say, okay, just go figure out, what’s going on and if you need help, let me know. Then to know, okay, here’s some tools. Once you figure that out, does your body need to run? Does your body need to do figure eights? I love the list that you just gave there of letting the body lead and letting you know that awareness lead. Now the last question I always, oh no, go ahead. [VICTORIA] Well, I was going to say because we can inadvertently emotionally bypass without realizing it when we feel a challenging emotion, those that are often referred to as negative, I don’t believe in negative emotions, those some are really, really challenging. But when we feel one of those challenging emotions so many of us have become trained, particularly in the wellness world, to take a deep breath, to make that feeling go away and like, sure, if you are in a busy airport and you need to not freak out at the person at the counter, if you, right, there are times when that’s a great choice and I love what you spoke to of really asking the body, do you need to shift or do you need my presence? Do you need my awareness? Because presence is love. So often these parts we can bring a little ifs in, the protector parts, the exiled parts, the firemen, the managers, they feel exiled. They are not befriended. They are deep breathed away. So of course they scream louder. It’s like, if I yell at my dog, like, Frankie, stop barking, she looks at me and she’s like, you have sympathetic activation. I will bark louder. She’s no fool. So when we turn towards the energy in our body, and thank it, first of all, because it loves us. It’s trying to keep us from being murdered by lions and from thanking it, we then befriend it, build intimacy with it, and ask it what it needs. So thank you for saying that so succinctly. [JOE] If every private practitioner in the world were listening right now, what would you want them to know? [VICTORIA] Come back to presence, come back to presence. I think one of the greatest gifts that we can give ourselves, the people we love, our clients, our patients, is to have a regulated nervous system for ourselves and to stay in presence and to find the ways to come back and to honestly, indirectly name and I’ll do it in session. I’ll be like, oh, hold on, my brain just sent me sympathetic. Let me take a breath with you and let me come back. But being able to be in honest, radically honest presence is the greatest gift in the world, that and chocolate, that’s the other greatest gift. [JOE] Ooh, I have some friends, they own Grocer’s Daughter Bean to Bar, and it’s been ranked top chocolate in the world four years in a row. Google Grocer’s Daughter for sure. [VICTORIA] Woo, alright, I will. [JOE] Got to give a shout out to DC and Jodi. Awesome. Well if people want to follow your work, if they want to connect with you, what’s the best way? [VICTORIA] If you head on over to victoriaalbina.com/thepracticeofthepractice, I have a special gift just for your listeners. Isn’t that fun? [JOE] That’s awesome. What are they going to get over there? [VICTORIA] They’re going to get a set of meditations, an orienting exercise, which is a beautiful and important nervous system practice both for us to do and to share with our clients and patients. They’re just really lovely meditations and they’re there for free, just for your listeners which is a delight. You can follow me on the gram. I give good gram at Victoria Albino Wellness. My podcast, as you shared previously is called Feminist Wellness. It’s for humans of all genders. It’s free in all of the places. You can work with me or learn more about working with me through my six-month program, Anchored Overcoming Co-Dependency, which is a nervous system and somatics-based program that includes thought work and breath work at victoriaalbena.com/anchored. [JOE] Oh, so awesome. We’ll have links to all that in the show notes as well. Victoria, thank you so much for being on the Practice of the Practice Podcast. [VICTORIA] Thank you so much for having me. This was an absolute delight. [JOE] I love having shows like this where we really dig into a topic. I mean, this is what podcasting’s all about. It’s the longest form of media that’s out there right now. You don’t see a half hour show on Instagram. Even on YouTube, I think the average video watch length is like three minutes. So good on you to listen to this podcast. If you want help starting a podcast, we do have Podcast Launch School. There’s a free tutorial over there for you. If you are in our membership communities, don’t forget that we’re doing a monthly breath work session that Dana is leading to get back in touch with your body, to be able to just feel the feelings. The work we do is really difficult and that’s just included in our memberships. If you’re not in one of our memberships, reach out to us. Probably the easiest ways to just go to our website, practiceofthepractice.com/apply. Then just put in some information, we can point you in the right direction. We couldn’t do this show without our amazing sponsors and Heard is just insane. They’re so awesome. As a therapist, the last thing you want to do is to think about your bookkeeping and your taxes. Whether you’re a seasoned clinician or it’s your first year of practice, Heard really can help you streamline the best financial practices for your business. You don’t have to pour over all those spreadsheets and guess your tax deductions at the end of the year. You’re starting to probably think about some of these things. Prices begin at $149 a month for solo practitioners. You can just meet with them for 15 minutes, totally for free. Head on over to joinheard.com. Again, that’s joinheard, and that’s herd, like I heard it, not like a herd of elk or dear, so joinheard.com. Thank you so much for letting me into your ears and into your brain. Have a great day. I’ll talk to you soon. Special thanks to the band Silence is Sexy for your intro music. This podcast is designed to provide accurate and authoritative information in regard to the subject matter covered. This is given with the understanding that neither the host, the producers, the publishers, or the guests are rendering legal, accounting, clinical, or other professional information. If you want a professional, you should find one.