What our Kids Really Need (and us, too): Moments of Healing {EP 53}


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Therapeutic moments can be brief

and ideally are spread throughout your whole week—it’s not just about one hour a week with the therapist.  Dr. Bruce Perry

It’s easy to get discouraged, hopeless, and overwhelmed when your career (mine!) is dedicated to helping kids who have been hurt the worst.  Kids who have some of the biggest, most challenging, and even the most dangerous behaviors.

Their parents and caregivers are understandably run down.  The services that families need literally don’t even exist in the world, let alone are they accessible.

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The Science of Being Human

Maybe this is why I have been so drawn to the science that explains the mind and heart of being human, being hurt, and healing from both.  There is so much hope and I find it hard to argue with science.  At my core, I’m really an optimist and the hope of relational neuroscience helps me stay connected to families when they need it the most.

One Hour a Week

I remember super early in my career wondering how- in a week with 168 hours- my client could get lucky enough to schedule an appointment with me during the hour they were in a mental space for therapy.

I wondered if something magical happened as they walked through the door to the office and just poof- ready for healing?

What if they were having a bad day or a bad hour or simply just not really in the mood?

What if therapy could happen in the moment that the client was open and ready for it?  Instead of at this predetermined time on the calendar that we agreed to because we both happened to have that hour available.

Seemed like we were leaving a lot up to chance.

As I understand more the neurobiological mechanisms in therapy and why therapy works, I’m aware that no, it’s not exactly magic and yes, there is something that happens when clients walk through the door that helps them move into a space where they are open for connection and healing.

Some of the time.

I wonder how much percentage of the week therapy takes up?

Well I guess that’s a quick calculation…. 1/168 = 0.6%

0.6% of someone’s week is supposed to create radical change.

The Current Way We Do Therapy Isn’t Really Working- for too many

Y’all- I’m a therapist and I’ve be a part of therapy that makes unbelievable change in people’s lives.  My own and my clients.  Without question for many, many people the hour-a-week of therapy model works great.

But you know what?

For many many people it doesn’t.

Not to mention the fact that we are smack dab in the middle of a mental health crisis where we don’t have even close to enough therapists for everyone seeking therapy.  Not even close.

When I trained to be a therapist who works with kids, guess how many hours of training I got in working with parents?  Families?

If you’re a child therapist, you know the answer.

Essentially- none.

Bringing Families In

I became a therapist because I love kids. I’m great with them.  I get them.  I told my own therapist once “they just make so much sense to me.”

Luckily, my first good professional mentor was 100% committed to the truth that parents don’t sit in the waiting room.  They are in the office.  With us.

That seemed a bit scary to me but being negatively judged by my new mentor seemed more scary so I started bringing parents into the office.

Want to know what I discovered?

I loooooooove working with parents.

I actually basically adore them.

And they need to be adored. Just like their kids.

Also – it seemed pretty obvious to me that kids would benefit from having all 168 hours of their life be a little different.  Not just the one hour they were with me.

Working with Parents Meant they Learned:

  • New ways of playing with their kids
  • New ways to respond to challenging behavior
  • How important they are in their child’s life
  • I believed they were amazing
  • I was on their team
  • New ways of being with their children (because that’s way more important than the doing)

And if you’re interested in clinical research, it does indeed show that children make faster progress in therapy if their parents and caregivers are involved.

Having parents actively involved in the process meant they learned ways to offer their children moments of healing throughout the week.

What is a Moment of Healing

A moment of healing happens when a child is beginning to get dysregulated and the parent takes a breath, pauses, and looks at their child with new eyes.  Eyes that say “you’re struggling” instead of eyes that say “you’re misbehaving.”

A moment of healing happens when a parent implements an idea of a rhythmic, repetitive, relational, and somatosensory experience that helps the child transition from toothbrushing to PJ time.

A moment of healing happens when a parent sees their child struggling with homework and instead of saying “If you would just concentrate and do your homework this would be over by now” (hey no shame there, I only know that phrase because I’ve said it a lot, to my own kid) they say something like “HEY!  I’ll be you can’t beat me in arm wrestling!” and assumes the ‘let’s arm wrestle!’ position, or they give their kid a double-bubble bubble gum to chew on.

A moment of healing happens when parents feel empowered to meet their child’s needs because I’ve been so clear with them how important they are to their child.

A moment of healing happens because parents get from me from I what I know they want to give their children.  Presence.  Attunement.  Compassion.  Capacity to hold all of their parts.

A moment of healing happens because when parents and kids walk through my door they understand- implicitly because something just feels different in my office and explicitly because I actually have word art that expresses this- that every single part of them is welcome in my office.  That all true selves are loveable.

All True Selves are Loveable

Candyce Ossefort Russel, LPC-S

When parents begin to believe that about themselves, they begin to stay more regulated for their kids.

They begin to believe that about their kids.  That all of their parts of welcome and their true self is loveable and worthy of love.

They see their kids a little differently.  They respond a little differently.

And they do this in the 167 hours a week that I’m not with them.

Now I have a child (and frankly, grown-ups too and they matter just as much to me!) who is getting thousands of moments of healing throughout the week.  Not a couple of moments that happen in one hour, once a week.

Making Big Change in the World

So I decided to change the way every mental health provider in the whole world does therapy.

Just kidding.  Kind of.

The hour-a-week of therapy model is probably beyond my capacity to change.  But you know what I can change?

I can reach more parents, outside the therapy office, and give them what they need to give their kid moments of healing.

This is my greatest joy of maybe my entire life.

To see how the culmination of all of my experience, trainings, and yes- extreme privilege and good fortune- have allowed me to create the structure for a thriving virtual community of parents all over the world.  Parents who now, because of The Club, have more capacity than they did (because of the connection and co-regulation they are getting!) to give their kids the moments of healing they need.

They also believe that the moments of healing matter.  Parents have learned- because we taught them when we don’t include them in meetings, therapy, and treatment planning- that they don’t really matter.  That me, a stranger, matters more to their child’s healing.  It’s my job to un-teach them that.

Parents.  You matter.  You matter completely.

And you aren’t meant to do it alone. 

You know what else I can do?

Encourage professionals to bring parents closer.   Teach them how.  Empower them.  Inspire confidence.

Help them grow their own window-of-tolerance so they can hold more energy in the room.

Give them the skills to connect with even the hardest-to-connect with families.

The kids who are the hardest to connect with are usually the ones who have been hurt the most by connection and therefore need connection the most.

The same thing is true about the parents.

Parents Need Moments of Healing, Too

I had an AHA moment when I was attending the Rising Tide conference this fall (not to mention basically the best three days of my entire summer).

Parents need moments of healing, too.

One benefit of having parents very involved in their child’s therapy experience is that parents would get what I could call ‘their weekly dose of co-regulation’.  A week is a loooooong time for a parent to go alone, navigating the extremely challenging behaviors of their child in addition to regular every day life stressors.

By the time the next week rolled around, parents needed me to welcome all their frustration, all their overwhelm, even all their anger and hopelessness.

Then they’d get seen and known.  Their cup of co-regulation would get filled.  They’d go back out into the world and be able to give their kids what they needed for a few more days.

Then we’d do it again the next week.

It was lovely.

What if Parents Could Get That More?

What if they could get that more because there are more therapists, coaches, helpers and healers trained to give it??

What if they could get that more because there was a place for them to get that beyond the once-a-week therapy space?

I know there are a lot of you who get that from reading this blog and listening to the podcast.  I know because you write and tell me.  You have literally told me you get your daily dose of co-regulation by popping in your ear buds and listening to an episode.

I know a lot of you listening get those doses of co-regulation in The Club.  Those of you in The Club also get to GIVE those doses of co-regulation and turns out, that’s actually a super important part of this process.

Moments of Healing

Makes so much sense, right?

Of course we all need moments of healing sprinkled all throughout our lives.  Just regular, every day life.

Yes, therapy is awesome.

I’m a big fan 😊

For myself, my family, for everyone who has access to it.

But not everyone does.

And many of the people who do need more than an hour a week, cramming in as many moments as possible- which is hard because we also need many moments of rest in between moments of healing.

Moments of Healing

Moments of healing change kids.  They change parents.  They change the helpers.

Moments of healing change the world.

Robyn

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Trauma Informed Occupational Therapy {EP 52}


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Marti Smith, OTR is an Occupational Therapist, fellow with the Child Trauma Academy, and founding Board Member with A-TROT, the Alliance for Trauma Responsive Occupational Therapists.   Marti is a dear friend and close colleague.  We met what feels like eons ago at a Trust Based Relational Intervention training and became quick friends.  I’ve learned so much from Marti in my own career about chasing the ‘why’ behind a behavior–  and not just the relational and attachment need, but the biological and physiological need behind a behavior.

Keep reading or listen on the podcast

The Brain is Behind Everything We Do

The foundation of my work rests on the idea that the brain is behind every single thing that we do- so let’s get curious about what is going on the brain that is underneath a specific behavior (which is the foundation of the course Parenting after Trauma: Minding the Heart and Brain).  Marti’s work as an occupational therapist beautifully dovetails the work I do as a mental health therapist while also offering a new perspective by looking at the physical body and autonomic nervous system factors that are related to behaviors.

Marti’s expertise in the Neurosequential Model of Therapeutics helps keep her focus on the foundation of the brain as a way to support kids with challenging behaviors.  She knows keenly that the foundation of any skill must be strengthened before moving on to more advanced skills.  I mean, if you want to do calculus you’ve got to have addition down-pat!

The Overlap Between Mental Health and the Body

Mental health practitioners!  Listen up!

The body is a part of your domain.

Promise.  We are not occupational therapists and we have different goals and skills—of course!  But the mind and the body are not separate entities.  As mental health practitioners, we are greatly remiss not to being paying attention to the body.  We’ve got support our clients in coming into their body, themselves, and regulation if we want to move on to relational and cognitive skills.  Get the training you need and don’t be afraid to bring the body into the therapy room!

If you need more training, come to my Engaging the Body training on October 15 and 16!

We want to go as foundational as possible, always.  Again- we wouldn’t teach calculus without a strong foundation in addition.

If we want to teach relational and social skills to children, we have to make sure we haven’t skipped over regulation.  If there is a strong foundation, great!  Move right on to relational skills.  If you are good at addition (and a lot of other things, too) go on to calculus.  But if there isn’t a strong foundation, you have to start there- at the bottom.

It’s a Five Lane Freeway

In this episode, Marti and I have a bit of a soapbox on how occupational therapists and mental health practitioners can support one another and how much cross-over there is between these disciplines.  It’s not uncommon to hear practitioners say something to the effect of “Stay in your own lane.” Marti laughingly says to that “It’s a five-lane freeway!” Great occupational therapists have great relational skills.  Great mental health practitioners have great skills at working with the body.

In my therapy room, when kids are demonstrating difficult behaviors and I can see that this is about regulation as opposed to poor character or immature relationship skills, and I support their regulation instead of teach relational skills, the child experiences feeling very seen and known.  Finally.

That’s therapy 😊

As an aside, having a basic knowledge in the body and typical development helps us mental health professionals know when to make an appropriate referral to occupational therapy.

Rhythmic Movements

Here we are talking about rhythm again!  Marti teaches us that when you are with a child whose words, tone, and actions are very rhythmic, you have a good indication that that child is operating out of their lowest parts of their brain.  Rhythmic outbursts of “I. HATE. YOU.” sound different than a moody and perhaps snide “I hate you.”  and can provide clues about where the child is in their brain.

If you can, listen to the podcast because Marti gives great examples that are hard to convey in the written word.

Match with Rhythm

When our kids demonstrate that they are operating out of the lower parts of their brain, match them with rhythm.  Use rhythmic, repetitive, relational, and somatosensory experiences to help co-organize and co-regulate them!  Be a very keen observer.  Notice what the child is already doing and see if you can offer them an experience that will help co-organize and co-regulate their movements.

You have a kid who is flipping upside down?  They are giving us a clue about what their body is craving in order to be OK.

Offer a way to co-regulate the flipping upside down!  Play wheelbarrow or have a handstand contest.  See how many summersaults it takes to get to the other side of the room.

All behavior makes sense.  Lean in and offer support to help co-organize and co-regulate the behavior so the child can come into connection and regulation.

As an aside, this is what I teach to therapists in the Engaging the Body online course.  I’ll be teaching these concepts in The Club October thru December in our series focus on Strengthening the Foundation of the Brain.

The Power of Mirroring

Marti reminds us of the power of mirror neurons.  If you- the adult or the parent- begins to mirror the child’s body you:

  1. Get to feel what the child is feeling and often this gives you great information about what the child is trying to do or what they need
  2. Help the child feel mirrored and increase the possibility that the child will then mirror you and do your movements that are more regulated and organized.

Behaviors and movements make sense- in some way.  They aren’t bad kids.  They are kids who need help.

Changing how we see kids changing kids.  Help them be seen as a child who needs help and whose behaviors make sense given what is happening inside their body, instead of as a child who has bad behaviors who is destructive.

Mirroring our kids’ body movements is a great tool in times of dysregulation but also in times of regulation.  I have a sweet video I show in my Engaging the Body course where I’m dancing with a little one and I spontaneously start to mirror her dance moves.  The delight in her eyes when she realizes I’m doing what she’s doing is powerful to see.

Occupational Therapy versus Psychotherapy

Many parents- and therapists- often ask me which one they should choose if they can’t do both occupational therapy and psychotherapy at the same time.  It’s a huge investment in time, resources, and energy to engage in both therapies at the same time.

I told Marti that I always recommend that families start with occupational therapy if both occupational therapy and psychotherapy assessments recommend treatment and they can only do one at a time.  Marti laughed with relief that she didn’t have to disagree with me on my own podcast.

She agreed that starting with occupational therapy is starting with the foundation.  Start there. 

Family-Based Occupational Therapy

One of my many favorite things about Marti- besides the fact that clearly she is delightful, creative, and a ton of fun- is her approach to working with families.  When I was practicing in Austin, Marti was frequently involved in my treatment plans for kids and families because Marti takes a very family-focused approach.  Instead of bringing children to the clinic once a week for months of treatment, Marti works closely with families and teaches them how to create ‘moments of healing’ at home.

Marti explains how the hour-a-week therapy model was developed for many reasons but one was because of how the brain heals in physical rehab.

With the type of work that Marti does with kids and families, the brain needs many tiny, frequent doses of healing with frequent breaks in between.  Not once a week of focused therapy, but moments throughout each day, with lots of breaks for rest and integration in between.  Because of this, Marti works closely with parents and teaches them how to integrate her recommendations in their regular, every day lives.  Marti is so great at finding fun, creative ways to make therapeutic experiences just feel like play- not therapy.

A-TROT

Marti is a founding board member of The Alliance of Trauma Responsive OTs – A-TROT–  a new, grass-roots organization whose mission is to provide targeted professional support that equips occupational therapists to deliver trauma-responsive care.  Marti believes that one aspect of being trauma-responsive is to include parents in their child’s treatment, equipping them to provide ‘moments of healing’ for their children in high-frequency but short-duration doses through the week- not just in 45 minutes of OT therapy once a week.

If you are an occupational therapist, check out what’s brewing over at the A-TROT website and join them over the in the Trauma Informed Occupational Therapists Facebook Group (OTs only).

KALMAR

Marti- in all her creativity and genius- is also the developer of an online assessment, KALMAR, a tool to help identify therapeutic activities and approaches that are most likely to have positive outcomes based on observations made by caregivers. The theory for the tool is based on work by Dr. Bruce Perry and his NMT model from ChildTrauma Academy as well as the TBRI method from The Karyn Purvis Institute for Child Development.  Marti’s husband- a software programmer- helped her develop an assessment that lets you put in your child’s behaviors and then offers up specific recommendations.  It’s really amazing.

The Connected Therapist

In June 2021, Marti published her book The Connected Therapist in response to an overwhelming need for parents to have Marti in their back pocket 😊

Like so many of us, Marti has found herself giving similar recommendations over and over again. With the encouragement of mentors, Marti ultimately decided that writing a book was a great way for her to reach more families.  This book is a must-read for all parents but parents of kids with a history of trauma will feel immediately seen by this book.  Marti is exceptionally practical.  She has a talent for making recommendations that are accessible and fun.  The book could certainly be read cover to cover but it could also be used a reference book- just flip to the page you need!

Marti is my first podcast guest to have a repeat appearance on the podcast.  I’m sure it’s obvious why.  Marti is brilliant, delightful, and talented- and she loves you and your kids as much as I do. Go check out all the amazing resources she offers out into the world and if you meet Marti, tell her I introduced y’all!

Connect with Marti

Marti is doing some truly ground-breaking work within his community- go check it out!

https://CreativeTherapies.com

The Connected Therapist

Trauma Tips Video Podcast

KALMAR

More about Rhythmic, Repetitive, Relational, and Somatosensory Experiences

Engaging the Body: Working with Dysregulated Kids is an eight-hour virtual training for professionals (of any kind!) eager to bring movement and body-based experiences intentionally into their work with clients.  I’ve adapted my previously always-sold-out training for play therapists to be applicable to a wider range of professionals and decided to offer it virtually one last time.

The Club– Beginning in October in The Club, we’ll be taking three months to integrate rhythmic, repetitive, relational, and somatosensory experience into moments of healing in the family- strengthening the foundation of the brain.  You can join The Club as a caregiver and/or a professional (I know many of you are both!).

Robyn

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Equine-Assisted Trauma Informed Psychotherapy {EP 51}


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My guest on this week’s podcast is Michael Remole, a mental health therapist in Central Illinois who integrates trauma-informed equine assisted psychotherapy into his work with clients.

A horse-lover since childhood, Michael was working on his master’s degree in counseling when he realized he could integrate his love for horses with his passion for working with people who had experienced trauma.  Michael is now the COO and Director of Clinical Services at Gateway Family Services.  He is trained in Natural Lifemanship as well as Dr. Bruce Perry’s Neurosequential Model of Therapeutics, which is focused on strengthening the foundation of the brain- especially the brainstem and diencephalon.  Michael is also the founder and director of the Rising Tide Conference.

Keep reading or listen on the podcast

A Roadmap of the Brain

Michael kicks of the conversation by talking about how the Neurosequential Model of Therapeutics provides a roadmap of brain development.  According to the NMT, if we to help strengthen the brain (ourselves, our clients, or our children’s brain), we have to connect with the part of the brain that’s online in that moment.   Michael stated that if he wants to connect to a horse – or human!- who is operating from the lowest part of it’s brain in a fight or flight response, Michael has to “speak the language of the brainstem”, which is rhythmic, patterned, and repetitive sensory input.  While he’s working with horses, that could translate into how is swinging a rope or patting his legs- in a rhythmic, patterned, repetitive, sensory input.

When horses are in survival-mode, they have a very difficult time accessing their ‘thinking’ parts of the brain.  They need humans to be predictable as a way to communicate safety!

This, of course, is true of humans, too.

The Beauty of Equine Assisted Therapy

The beauty of equine assisted therapy is that if the client (the human) wants to connect with the horse, they must convey their safety to the horse, allowing the horse to feel regulated and safe.  This means the client must learn to pay attention to their own internal state and to the non-verbal cues that they are offering the horse.  At the same time, they must learn how to accurately interpret and respect the non-verbal cues that the horse is offering.

Helping clients develop internal awareness, honor it, and have their inner state become congruent with their outer state is a foundational aspect of working with people who have a history of trauma.

Insides and Outsides Matching

I loved this part of the interview!  In my own work with clients, especially parents, I regularly talk about how important it is to have their “insides and outsides match.”  Meaning- it’s crucial for parents to honor their true emotional state and not fake being calm.

Pretending not to be mad on the outside when you’re fuming on the inside is a good strategy if it means that nobody gets physically hurt, but it isn’t a good long-term strategy because it sends DANGER DANGER cues to the other person.  Since a core aspect of my work involves helping children move into the ‘connected’ part of their brain instead of the ‘protected’ part of their brain by inviting them into felt-safety, it’s important that parents practice having their ‘insides and outsides’ match.

A Predator

Michael offered a new layer to this concept when he described how horses interpret this incongruence to mean that the person is a predator.  Something about Michael’s use of the word ‘predator’ really hit home in a new way how this incongruence is experience by the other individual (or horse!) as a cue of danger.

We must find ways to come into congruence and connection with ourselves if we want to create an environment of safe for our children or our clients.  Working the horses provides a great laboratory to practice this inner attunement and self-knowing.

If you’re a long-time listen to the blog, you are recognizing this conversation of congruence from the podcast episode with Lisa Dion- check that episode out (Regulated Doesn’t Mean Calm) when you’re done with this one!

Dr. Perry reminds us how important predictability is in establishing safety and helping dysregulated people become more regulated.  Being in relationship with someone who has a mismatch in their ‘insides and outsides’ contributes to a lack of predictability because it becomes very difficult to make a guess about what is going to happen next.

The same is true about our kids!

With horses, the motivation to practice this authenticity is high because horses, frankly, are big and dangerous.  This high motivation gives us great opportunities to practice these important skills of authenticity.  We can say to our kids, or friends, anyway “Hey, I just want to let you know- I just had a distressing experience.  I’m feeling it in my body.  I’m OK but you’re probably noticing I’m a little off and I want you to know it isn’t about you.”

The reality is that it is very hard to show up this authentically in relationship.  It’s hard, but it’s important.  Working with horses, where it’s non-negotiable that we show up this authentically, gives us wonderful opportunities to practice this very important relationship skill.

What’s the Magic of Equine Therapy

Most of us don’t have a lot of experience being in close relationship with horses.  This means we don’t have a lot of previous neural pathways about what horse behavior means. In our relationships with other humans, it’s easy to interpret their behavior as personal because we have a lot of history having relationship with humans.  There are a lot of neural pathways!  And we quickly and easily assume that other people’s behavior has something to do with us.  With horses, we don’t get our personal feelings involved and we can interpret the horses’ cues more ‘cleanly’ and accurately.

So much of parenting- parenting in general but especially kids with a history of trauma- is about accurately interpreting their behaviors simply as manifestations of the child’s autonomic state.  All of us parents have our own ‘stuff’ that gets in the way and we instead of being able to cleanly see behavior as simply information about their autonomic state, we interpret behaviors as rude or disrespectful or many other negative connotations.

In my Parenting after Trauma: Minding the Heart and Brain course there is significant emphasis on what I call “X-Ray vision goggles”- helping parents see underneath the behavior to what is driving the behavior.

Working with horses provides an opportunity to practice viewing behavior without interpreting it relationally or personally.  Horses aren’t rude or disrespectful; they are behaving in a way that is congruent with their autonomic state.  To help the horse behave more relationally, we have to change their autonomic state to be experiencing safety and regulation.

Attunement

For me to attune to you, I must attune to myself first.

Dr. Stephen Porges (Polyvagal Theory) teaches that the foundation of therapeutic change is the therapist’s attunement to themselves.

Does that feel surprising? It’s common to believe that the foundation for therapeutic change is how much we know or what protocols we practice.

But the foundation for change is attunement and for attunement to someone else to truly happen we have to first attune to ourselves.

Working with horses is a great way to develop the skill of attunement to self. 

Celebrate those wins!

One of my favorite parts of this interview is when Michael reminds us that when a horse finally does what we are asking it to do (for example, wear a saddle), the humans are quick to celebrate. We easily give the horse a lot of praise and allow both of us- the horse and ourselves- moments to enjoy the success.

We definitely don’t say to a horse “Now wouldn’t that have been easier if you’d just done it this way in the first place?”

But with our kids?!  When my son finally does the dishes or finally does his homework, it’s so easy for me to resist celebrating that and instead to say something like “Now wouldn’t that have been easier if you had just done it that way in the first place?”

The challenge with that response is that it eliminates the feel-good chemicals and experience of “YAY!  You did it!”

If we skip over those feel-good chemicals, we skip over an important piece of how the brain changes.

Our kids don’t always have to love the requests we give them- like doing the dishes.  Neither does the horse.

We our kids express their unhappy feelings in our request, it often feels like we only have two options for how to respond: either we relinquish our request or we plow forward without any compassion.

We can be with our kids while they have a valid protest.

I mean, who really wants to do the dishes? It’s OK to be unhappy about that. But the protest doesn’t mean we skip doing the dishes.  It just means that there’s a valid feeling that the adults can offer co-regulation through.

Then, return to the request.  It’s time to do the dishes. 

Rhythm, Horses, and Co-Regulation

Being on a horse offers an immediate rhythmic, repetitive, relational, and somatosensory experience.  It is an experience that implicitly lends itself to strengthening the foundation of the brain.

But what about when our kids are dysregulated over doing the dishes?  There is no horse we can mount in most of our kitchens!  Definitely not mine.

Equine Therapy in Real Life

Michael helps us take the concepts of equine therapy and bring it into real life.

First, he reminds us of the importance of the rhythm of our heartbeats.  As parents, if our kids are starting to get dysregulated, we want to try to keep our heartbeat and our breath regulated and rhythmic.  Humans can feel the rhythm of one another’s heartbeats, so let’s always start by paying attention to our own.

This is especially true if your child is reluctant to engage in any more active rhythmic, repetitive, relational, somatosensory experiences such as going for a walk.

Parents can slowly sway back and forth, or tap on their own legs, or focus on keep their voice rhythmic.

These experiences not only can help to regulate our children- even without them directly participating, but they keep us as parents regulated!!!

Focus on Self First

I love how Michael is so encouraging of parents focusing on their own regulation.  He’s clear that it’s OK – more than OK, it’s necessary! – for a parent to call a pause when they are starting to feel dysregulated.

“Hey, I’m starting to feel dysregulated.  I’m going to walk to the mailbox and when I return, we’ll chat again.”

I love this example because it’s rhythmic, repetitive, relational, and somatosensory but also because it’s exactly what I do at my house.  We have a long driveway and are fortunate to live in a beautiful, wooded area.  The walk up and down my driveway is gorgeous.  During the pandemic, I’ve created a ritual for myself of having a few minutes of regulation every afternoon while I simply walk to the mailbox.

More Ideas to Bring in Rhythm

Rocking chairs can be a great way to experience rhythm.  Sitting on exercise balls can resemble being mounted on a horse.  Michael said that gliders are an excellent thing to have in the house- maybe even more than a rocking chair because gliders don’t get as out-of-control as rocking chairs can.

Active versus Passive Co-Regulation

The examples that Michael gives about parents focusing on their own regulation, breathing rhythmically, swaying in a patterned way, is about providing passive co-regulation to their child (though it’s actively regulating themselves as parents!).  The child doesn’t have to actively participate or engage with their caregiver to experience the benefits of passive co-regulation.

Inviting our children to get involved in a rhythmic, repetitive, relational, and somatosensory experience like taking a walk or tossing a ball back and forth can be a great experience of active co-regulation.

But if they won’t participate, don’t give up!  We can offer passive rhythmic, repetitive, relational, and somatosensory experiences and it matters.

Why Good Times can Suddenly Go Bad

Toward the end of the interview, Michael touches on how even positive and fun experiences can create dysregulation.  Unfortunately, we didn’t have enough time to dive deeply into this topic, but I’m sure some of you are very interested in understanding why fun can cause dysregulation.  I’ll bring Michael back to the podcast in the future for sure, but in the meantime, check out a blog post and podcast episode I did previously on Why Good Times Can Suddenly Go Bad.

Connect with Michael

Michael is doing some truly ground-breaking work within his community- go check it out!

Gateway Family Services

Gateway Family Services on Facebook

Rising Tide Conference

More about about Rhythmic, Repetitive, Relational, and Somatosensory Experiences

Engaging the Body: Working with Dysregulated Kids is an eight-hour virtual training for professionals (of any kind!) eager to bring movement and body-based experiences intentionally into their work with clients.  I’ve adapted my previously always-sold-out training for play therapists to be applicable to a wider range of professionals and decided to offer it virtually one last time.

The Club– Beginning in October in The Club, we’ll be taking three months to integrate rhythmic, repetitive, relational, and somatosensory experience into moments of healing in the family- strengthening the foundation of the brain.  You can join The Club as a caregiver and/or a professional (I know many of you are both!).

Robyn

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Theraplay: Strengthening the Foundation of the Brain {EP 50}


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Theraplay is a dyadic (parent/child) treatment modality for supporting children and families that focuses on harnessing the power of the relationship between the child and their caregiver as path toward change and healing.

Theraplay places a priority on strengthening the parent/child relationship as the way to create change for a child or within a family- even in diagnoses or symptoms that don’t seem obviously related to the parent/child relationship, such as ADHD or Autism.  Theraplay believes that strengthening the parent/child relationship will always contribute positively to a child’s mental health, regardless of the specific symptoms or mental health diagnosis.

My guest today on today’s podcast episode is Mandy Jones, Program Director of The Theraplay Institute in Chicago, IL. Mandy is a Theraplay trainer, practitioner, and supervisor, a Registered Play Therapist, and an attorney.  In addition to her administrative and training responsibilities at The Theraplay Institute, Mandy also provides therapy to children and families.

Keep Reading or Listen on the Podcast

Four Theraplay Dimensions

Theraplay is based on four, equally important dimensions: Structure, Engagement, Nurture, and Challenge.

Structure

Humans– both children and adults– do better when we have some structure in our lives and we know what is happening next.  We feel safer and more secure, both in ourselves and in our environment.  Theraplay provides more structure for the therapy hour than many other child therapy modalities, such as child-centered play therapy.  This structure is viewed by Theraplay as a crucial element in creating felt-safety for children, especially ones who have had a history of unpredictability, trauma, or toxic stress.

Theraplay is a therapist-led yet extremely child-centered modality.  It is an advanced skill for a therapist to be able to balance the level of structure in Theraplay while maintaining the level attunement necessary for healing.

It can be a common misperception that Theraplay is not child-centered! Child-Centered Play Therapy is a very specific modality of play therapy that is different than Theraplay, but that does not mean Theraplay is not child or client-centered.  As a Theraplay practitioner myself, I find the high-level of presence and attunement needed to stay so child-centered while being therapist led to be one of the most powerful- and challenging- elements of the model.  I have always considered Theraplay to be an advanced modality for therapists to learn and effectively integrate into their practice.

Engagement

Attunement, as mentioned above, is a core element of Theraplay.  This level of attunement intended to create an experience where the child feels as though they are the center of the adult’s world.  The therapist, and ultimately the parent, are focused on reading the child’s non-verbal cues to stay in attunement- does the child like this activity? Or not?  Are they becoming more regulated?  Or less?

Theraplay therapists use very few toys and the therapy experience is largely focused on the experience between the child and the therapist, and ultimately the child and their caregiver while the therapist provides support.

Nurture

Nurture is all the things we do to keep babies alive!  They’re fed, rocked, swayed, and soothed. Nurturing activities and experiences are a central aspect of Theraplay treatment.  Theraplay therapists usually have oodles of band-aids in their office and the therapist and caregivers pay a lot of attention to caring for kids’ hurts.

Touch is also a big piece of Theraplay.  Theraplay practitioners are trained on the ethical use of touch and to lean into touch as an important component of healing of our regulatory circuits.  It’s not uncommon for Theraplay therapists to have to re-work their ideas about touch in the therapy room.  If this makes you feel a little uneasy, it might help to remember that the child’s parents or caregivers are heavily involved in the therapy.

Challenge

The challenge dimension of Theraplay recognizes that parents and caregivers are the first to lay the foundation for the child’s sense of self and competency.  Some of this comes from engagement but some of this comes with challenge!

In the interview, Mandy gave them example of tummy time.  Parents and caregivers can find playful ways to challenge children right at the edge of their window of tolerance.  When challenge is too much, it becomes overwhelmingly frustrating and erodes connection.  When challenge is too low, our children don’t grow and discover their capabilities.

The challenge dimension supports the parent to attune to their child, in the moment, and set the bar for their child just high enough.  When the caregiver sets that bar at the right height, the child feels a sense of competency and “I’m good!”  When the caregiver sets the bar too high or too low, it’s simply a rupture!  Ruptures in relationship mean they have the opportunity to repair- to try again.  This persistent pursuit of “I want to know you and get it right” is healing and strengthening in the parent/child relationship.

Parenting the Theraplay Way

Theraplay happens in the office (or in the home with a Theraplay therapist) but one of the more important elements of Theraplay treatment is that the therapist helps parents and caregivers take the concepts they are learning in the Theraplay therapy into their everyday life.  There are so many ways that the concepts of Structure, Engagement, Nurture, and Challenge can be woven into moments of parent/child relationship in their home and life outside the therapy room.  Theraplay places a priority on supporting the caregiver’s relationship with the child so ultimately the child can experience these moments of healing and attunement far beyond therapy.

Theraplay activities are almost all grounded in rhythmic, repetitive, relational, somatosensory experiences (and at this point in the series, we all know that those are experiences that strengthen the foundation of the brain!). I’ve spent many sessions blowing cotton balls and feathers back and forth with children (and grown-ups- yes, pre COVID when we got a little more cautious about blowing spit around the office)!

But more than the specific activities, Theraplay is all about discovering a fluid dance of serve-and-return between a caregiver and a child.

I do this and you do that. 

This back-and-forth continual attunement becomes moments of rhythmic, repetitive, relational, and somatosensory experiences.

Caring for Parents

Theraplay therapists hold at their core that if parents aren’t OK, kids aren’t OK.  Theraplay therapists wrap the parents up in their care and work to empower the parent to really own that they are their child’s expert.  When I work with families, I want parents to know that they are who their child needs, and that I will help them feel confident in that role.

This is one of my favorite aspects of Theraplay and unfortunately, it’s a unique aspect of children’s mental health treatment.

Therapists can – and should! – take concepts from how Theraplay prioritizes the parent/child relationship and weave those tenets into other modalities.

Moments of Healing

Dr. Bruce Perry speaks so emphatically about the important of creating moments of healing for kids.  Theraplay is the perfect modality for supporting the parent/child relationship during the therapy appointment while also providing the caregiver with new ways to provide their child with moments of healing throughout the week.

Brains (and relationships!) don’t heal in one hour a week.  But the one hour a week (or less) of Theraplay can provide a great touchstone for the moments of healing that can emerge throughout the rest of the week.

Theraplay is Exhausting

And so is parenting the Theraplay way.

Parenting with this level of attunement, structure, challenge, nurture, and engagement is exhausting.

It’s a challenging way to do therapy and it’s a challenging way to parent.

Mandy considers the possibility that one of the reasons why parenting the Theraplay way is so exhausting- and doing therapy that way!- is because it’s a new way of being in relationship.  As a parent (or therapist), your brain has a lot of new neural connections to make in order to parent with this level of attunement.  Changing brains is hard work!

The level of intimacy in Theraplay requires that parents (and therapists) do a lot of internal work and self-exploration.  To show up in a relationship with that level of depth and resonance can be hard and, yup, exhausting.

You Need Support!

It’s so important to find the level of support and self-care needed to keep showing up for yourself in this way.

Which, for so many parents and families, is almost impossible to find.

There aren’t enough resources or time.  The supports simply don’t exist.

Where can parents find the connection and co-regulation they need in order to give to their children what they need?

This is one of the reasons I love Theraplay because yes, it’s exhausting, but a great Theraplay therapist is pouring in to the parents and caregivers as much (or even more) than they are pouring into the child.

The Club

This is also why I created The Club.  Parenting kids with special needs, especially behavioral special needs and then on top of that, kids who struggle to be in close, connected relationships is exhausting and can be traumatic.

It’s lonely.

It’s confusing.

Finding ways to be seen and known and not judged can make a tremendous impact in growing resilience and decreasing burn-out, hopelessness, and overwhelm.

This is challenging even in a community that is bursting with resources (where is that community? I need to know!).

Feeling less alone is the most common piece of feedback I get from Club members.  And not only are they less alone but they are surprised at how much it matters to feel less alone.

Find Theraplay

Head to the Theraplay website to discover all their resources and training opportunities.  If you live in the greater Chicago area, The Theraplay Institute offers therapy services for kids and families.  If you don’t live in the greater Chicago area, you can contact The Theraplay Institute to see if traveling to Chicago for an intensive therapy experience could be a good option for your family.

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