This month we chat with Deena Goodman, PT, WCS, BCB-PMD, the founder of Goodman Physical Therapy. Deena discusses her integrative body psychotherapy approach to treating patients and how PTSD and mental health conditions can add to the complexity of pelvic pain treatment.
Deena Goodman is the Founder and Director of Goodman Physical Therapy in Los Angeles, CA. She is recognized nationally and internationally for her work in pelvic floor rehabilitation and continues to contribute to new areas of development within her field. She is an active member of the American Physical Therapy Association’s Pelvic Health section and California chapter private practice section, and in 2009 became one of the first physical therapists in the country to receive Board Certification as a Women’s Health Clinical Specialist. Goodman is also a graduate of the Integrative Body Psychotherapy Central Institute in Los Angeles, and is on their teaching staff.
SHWI: How did you become interested in sexual health and pelvic floor therapy?
My mother specialized in couples therapy so sexual health conversations at home were always interesting to me growing up.
I realized how underserved women were with their orthopedic and urogynecological needs during pregnancy when I was pregnant with my first child, so I took a special interest in the prenatal and postpartum populations at the beginning of my career. I then expanded my practice to include patients with pelvic floor dysfunction and pelvic and/or sexual pain issues.
SHWI: As a long-time practicing pelvic floor therapist, what are the most common and difficult-to-treat conditions that you see in your practice?
Working with patients who have multiple comorbidities creates a more complex pelvic pain scenario because I can’t just follow a “cookie cutter” version to treatment. High anxiety, PTSD (post-traumatic stress disorder), OCD (obsessive- compulsive disorder), ADHD (attention-deficit/hyperactivity disorder), post recovery from addiction, on top of a medical history of autoimmune disease, can add to the complexity of a chronic pelvic pain patient’s treatment.
With pandemic anxiety and isolation from friends, family, and work environments that many of my patients continue to experience, it is a spiral of events that affect both mind and body and can create a more complex path to healing. I treat many women with endometriosis, pelvic floor muscle high and low tone disorders, abdominal pain including constipation, bladder and genital pain in all genders and vulvar pain related to hormonally mediated and/or neuroproliferative pain.
SHWI: You have a background in psychology and integrative body psychotherapy. How do you integrate this approach into your patient care?
Having tools as an allied healthcare practitioner trained in somatic psychotherapeutic work has given me a different set of skills to help patients. I talk to patients differently, give them more time in the office and space to experience and be reflective in their notice or unawareness of other body responses not just the pain response.
These are key differences from when I was a new graduate following my subjective and objective exam model without using techniques from the psychological arena to complement my musculoskeletal treatment approach. My professional skills to support and not “fix” a patient allows my patients to feel supported and in charge of the course of treatment rather than being a victim to the pain. By being part of a team approach to care , my patients have the added professional care to assist in their healing journey.
SHWI: You often see patients with vulvar pain and endometriosis. Why do you think pelvic floor physical therapy should be included as a multidisciplinary approach to treating these more complex vaginal conditions?
We understand that intraabdominal pressures, other organs, joints and fascial connections affect the pelvic girdle and pelvic floor structures and the need to treat the whole body, and therefore pelvic floor physical therapy is a key component to treating symptoms of pain and dysfunction. Coordinated care in a transdisciplinary approach links disciplines together in a way that forms collaborative care to manage and assist patients’ needs more effectively.
SHWI: What kind of therapies have you found most useful for women with pelvic floor dysfunction and what new therapies do you see on the horizon?
An integrative team approach to treatment can be very useful including physical therapy, acupuncture, sex therapy, somatic based and cognitive behavioral therapies, movement therapies including yoga and other disciplines. We will see more states incorporating dry needling to their physical therapy curriculums and licensures, and new research in the energy science arenas in the future. I think the way each healthcare provider works with a patient is so unique to what the patient presents with at the given moment in each session, what is coming up for the patient in their process may change—it is dynamic, not a static algorithm for how we treat patients.