Trauma Informed Occupational Therapy {EP 52}

Robyn: I'm Robyn Gobbel, the founder and host of the Parenting After Trauma podcast, where I take the science of being relationally, socially, and behaviorally human and translate that for parents who have kids who have experienced trauma. I'm a psychotherapist with over 15 years of experience working with kids who've experienced trauma and their families. I'm also a self diagnosed brain geek and relationship freak. I study the brain kinda obsessively, and even taught the science of interpersonal neurobiology in a certificate program. I started this podcast on a whim with the intention to get you free, accessible support as fast as possible. So the podcast isn't fancy and I do very little editing. It's pretty common to hear cockadoodledoo in the background, and some of you let me know that that's kind of your favorite part. If you love this episode, add Parenting After Trauma to your favorite podcast player and then please share with your friends and colleagues. After you do that, head over to my website and get the free ebook I wrote all about the brilliance of attachment. Readers of the ebook are saying that not only is the book beautifully laid out and easy to read, but it's offering a perspective on attachment that they've never heard before and that that's shifting things for them. You can download the eBook for free at RobynGobbel.com/ebook. 

Robyn: While you're on my website, definitely check out my calendar of upcoming trainings for both parents and professionals at RobynGobbel.com/training and, holy moly y'all, be on the lookout for something pretty epic that I'm about to announce. It's going to start in January, but I'll be announcing it way sooner than that. So you can get all excited about it and decide if you're going to join me. 

Robyn: Today's episode with Marti Smith is sponsored by The Club, my virtual community of connection, coregulation and of course a little education for parents of kids impacted by trauma. Right now The Club is preparing to open our doors again to new members, which we do every three or four months. The Club was an idea I had last year in 2020 that has far exceeded what I ever thought would be possible. And that is only because of the extraordinary parents, and caregivers, and professionals who make up the very fabric of The Club. The way they bravely show up for each other and themselves have exceeded what I even thought was possible. If you need to feel seen, to be gotten, and understood. We would love to have you! In October, we'll be kicking off a three month journey into strengthening the foundation of the brain. We'll be taking some of the ideas you've learned in this podcast series and making them practical and applicable in your everyday life with your kids. And also yourself, because I know I could use a little brain stem strengthening myself. If you head to RobynGobbel.com/TheClub, you'll be able to add yourself to the waiting list and then be the first to know when we open up. The Club will open for a week, and just in time for you to join us on the strengthening the foundation of the brain journey. 

Robyn: Marti was a guest on the podcast many months ago. And just as a side note, how did my podcast get old enough to say many months ago about anything? [laughter] That's so amazing. In this episode, Marti, and I dive deep into her unique approach to providing occupational therapy to kids who have experienced trauma. I won't keep you waiting any longer. Let's just go!

Robyn: Alrighty, welcome back to the podcast, you are my first repeat guest. So, yay!

Marti Smith: What?! [laughter] Thank you! [overlapping conversation]

Robyn: So that's fun. We talked about that, you know, in the first interview we did about how I mean, man, I can have you on like 40 more times, we would never run out of things to talk about. In fact, I told my husband like, well, I'm gonna be talking with Marti. So I’m gonna go for a while. [laughter] But specifically, in the middle of this, like building and strengthening the foundation of the brain series that I'm doing here, you of course, were like, first person I even thought of. Marti, of course has to- has to come on. So with your- you know- your expertise, and obviously, occupational therapy is your job out in the world. But then also, you know, all the other pieces you bring to that as the very unique occupational therapist that you are in your work with a Child Trauma Academy. 

Marti: Yes.

Robyn: Like I said, obvious choice. So tell my listeners, remind them who you are, what you do, and specifically, you know, in regards to strengthening the foundation of the brain, how that fits into your life.

Marti: I- well, I love neuroscience. [laughter] I love the brain. And I love trying to, kind of, be the detective of what is going on here. You know, what is- what is the biologic- biology behind the behavior? You know, and what is the foundation of what's going on- what needs are not being met? I think that's where Dr. Cross said that really good at, you know, seeing the need and meeting the need. And so, you know, not only trying to figure out what's going on, but figuring out well, how do we- how do we remediate that? And I think that's where the occupational therapy comes in, is because we're very activity driven. And as an occupational therapist, we do this thing called activity analysis. Where we look at the whole big picture, and then we break it down by steps, or short term goals, or small increments. And then we say, oh, you know, that's kind of the- the cog in the wheel, or that's the, you know, I don't know if it's the hitch in the gidea. But just sounds good. I don't know if that's correct grammar. But I'll say that sometimes. And then we look back, and we're like, okay, well, then what can we do for that? And an easy example I would give someone is someone can't make toast, right? Like, you know, if they can't make toast? Well, is it because they've got the setting on the toaster too high? Is it because they can't use their fingers to open the bread? Is it because they can't lift their arm over their head to access the bread? Like, just making toast, when we break it down, there's so many components to that. And with anything with a child, you know, they won't drink out of anything but a red cup. Okay, well, why is that? Is that because you always keep the red cup in a certain place that's more accessible for them? Is it your biases to the red cup, you know? So as the OT I'm really good at looking at the whole situation and trying to break down what specific thing is maybe causing everything else to domino. And then, you know, when you talked about the Child Trauma Academy, which is now being switched over to Neurosequential Model of Therapeutics, and- and I think that better describes it too, because it's that neurosequential. It's the things happen in sequence. And again, I'll pull in my OT background in that when we do physical rehab, and I'm working on a traumatic brain injury or I'm working on a stroke. There's a- there's a specific sequence in which neuro- neuro sequential [laughter]. There's a sequence in which the neurons will regenerate or rehab, if you will. So you know, if someone had a stroke, I'm not going to work on finger dexterity before I work on shoulder stability. Because even if you can move your fingers, if you don't have the stability of your shoulder, your arm is still going to be unfunctional. And so that's what we kind of do. And I bring that into that pediatric setting in the trauma setting of we still- the brain still heals in that sequence, and it still functions in that sequence. And that's where I love talking to you. And you and I have become really good personal and professional friends, because we both really understand how the body has structural stability, such as we call it, you know, proximal stability before distal mobility. So that basically means my core has to be strong, before my extremities can be moving. And you know, the experience, right? But the brain is the same way. We have to have the the bottom of the brain, the brainstem, the limbic system, the diencephalon. Those have to be structured in a way that can support the cognitive functioning as we get into the frontal and the prefrontal cortex. And so that's the same thing, you know, the body is set up in a very sequential pattern. And so when you understand that, as someone who deals with rehab, like I do, that's the basis for things. I can't work on these cognitive skills if the child is not comfortable in their body. If they're moving around, you know, and we'll just take an example of like, if I'm so nervous in the room, that I'm constantly scanning with my eyes to make sure that I'm safe, I can't read this little book that you put in front me, because my eyes are already very busy, making sure that I feel safe. And so, you know, kind of what my specialty is through, you know, studying the the TBRI, the trust based relational dimension, as well as the neurosequential model that Dr. Perry has created. It's that, okay, as an OT, how do I go in and say, okay, I need to look at those lower brain structures, and- or more primitive, or more functional and more foundational brain structures. And I have to make those rehabbed before I can help therapists, and people that are doing more cognitive work get into that. And then my- my particular specialty is how do I work with those therapists to teach them how to do that. And that's what I wrote the book for, was, you know, and it's simple things. I was talking with a psychotherapist yesterday. And I said, you know what, why don't you just spin the child, you know, let them get on your office chair, and spin around for maybe 30 seconds before you try and talk to them? And then that would help reorganize that vestibular system? And she's like, can I do that? I'm like, spinning in an office chair? [laughter] There's no, you know, domain, like, what do you call it therapeutic domain? Or like, OTs don't own spinning? Like yes! And jumping, you know, things that you see a toddler do on a couch, you can do in your therapy room without having risk, you know, of like, I'm crossing the line. It's like, no, this kid was doing that in your- in your waiting room, you're just helping them do it in a bit a better specific manner to help them feel better.

Robyn: Yes, yes, yes. I mean, so much of what you've said, I'm like, okay, yes, let’s talk about that. Yes, talk about that. But that in particular, I want every therap- like every mental health therapist to like, go back, press rewind, I know you don't press rewind anymore. But you know what I mean. And hear you say that, again, like nobody owns spinning. Nobody owns the- you know, that the very question implies that as a mental health community, we have, like, dissociated the body, and somehow convinced ourselves that we are skilled, or has- you know, allowed to bring the body into the therapy room. Which I think just goes back to these beliefs that somehow the mind and the body are, are separate. And they're not, 

Marti: They’re not!

Robyn: And so- so that's the first thing I want to say. Everyone, pause. Go back. Now that- learn a little bit about the body and know kind of what you're looking at, at least. But, you know, when it was one of the things, you know, I think you and I clicked so instantly, and I think because of that, because both of us have no pretenses about like, who's in whose lane, right? It's like, No

Marti: It’s a really big highway, it’s like a big, eight-lane highway. [laughter]

Robyn: Totally an eight-lane highway. So- okay, so then the other thing I want to- to really highlight what you just said was, okay, let's look all the examples you gave. Like, of a behavior we might see that would lead us to like looking at some sort of, I would call like a physical etiology as opposed to like a mental health etiology. Right? But how quickly they can overlap and to make sure that we're not, you know, looking at everything and those of us in the mental health world and I also think so many parents when they see behavioral problems, the first thing they see is therapist. They think therapist. Like mental health therapists. I need a you know, thera- therapeutic intervention to help this behavior problem. So when I think about the kid that's, you know, hyper vigilant, and they're first constantly scanning the environment and therefore not, you know, doing their schoolwork. And then I think about how could that come up behaviorally? It could come out like opposition. It could come out labeling this child work avoidant, you know. If in the kind of, right but wrong like child/ teacher pair that could look like the child and the teacher fighting with each other. And the teacher punishing. And then the child getting more oppositional or defiant or even aggressive. And so how important it is to, even when we see behaviors that we would class- kind of classically call behavior problems, to just invite ourselves to take a pause, and go, okay. But let's go as deep in the brain as possible and see- lowest in the brain as possible and see if that's related. Because if I'm- start to apply a behavior intervention for an oppositional kid because they're not doing their schoolwork, which I've would never do, but let's just say that's where I go. Behavior intervention, oppositional kid. 

Marti: Right!

Robyn: But we've got something so much lower. We'll never make any progress if we go at it that way. 

Marti: Right. Yeah.

Robyn: Yes. And which, of course, you're like, well, yes, of course. [laughter and overlapping conversation] Yeah, we might not be thinking about eyes when we're looking at a work avoidant kid. 

Marti: Right, right.

Robyn: And so for me, as- I'm not an occupational therapist. Like I'm not trained to treat school- you know, sensory processing disorder, but I can put that in my lens, right? 

Marti: Yeah!

Robyn: It's like, what's going on with this child and all of their senses? And how do I support that? And how do I support like, their lowest- these lowest parts of the brain, just like you said, to build the foundation.

Marti: Yeah, and- and- and one thing, I would just say, you know, to your listeners, too, and- and you've kind of hit it on that a little bit too. We work really well together. And I just would encourage them to reach out and find an OT, you know, that- that will work with them. Because I don't do what you do, you know, we- we have almost a bachelor's in psychology by the time we get out of OT school, but that doesn't equip me to work, you know, especially with the parents and some of the dynamics and I have learned so much working with you. And then Michael Remley is another dear friend of mine, who does a lot of, you know, the mental health, the psychology work and things like that, too. And the cortex, the cortex [laughter] you know, and he has given me amazing things to say to the kids and how to frame things from more of that cognitive, you know, lens. And so, you know, it's that marriage of working with someone and not having, you know, like you said that territorial, you know, like, but being able to be like Robyn, when you're working with this kid put him put him on the swing, because when I was working with him, I noticed this, you know? And then being open to the feedback that you would give me with different things. And so, you know, I love that collaboration. And- and I love that when you work with an OT, you start to absorb some things. 

Robyn: Right. 

Marti: And you learn some things. And so not only will it help you with that one child, but it'll help you view the other kids that you work with differently as well. And- and again, like I- know- I have to be careful because I don't want to let everybody hear this and be like, Oh, you're all certified OTs, go do your thing. But again, jumping on the couch spinning, looking, blowing bubbles, these are all very natural sensory things. It's good to have an OT that you're friends with to say, you know, what direction to blow the bubbles. [laughter] What positions to blow the bubbles and you know, and get a basic understanding of those kinds of things. But don't be afraid to try things, and don't be afraid, like you said, to look at the whole body. You know, learn from what we do. And just take that step back and say okay, what, you know, what is involved. Or maybe call an OT friend. I’d be like there's something going on, I just can't figure it out. And then your OT friend will come in and be like oh, it's all on the left side of his body, the entire left side is weak. And you know you got to strengthen that up and then you'll be like, oh my goodness. Now he sits in this chair now he no longer falls. And- and if we can train other people to- to have that critical lens then it also gives us more information as the OT to make the diagnosis- or not the diagnosis we don't diagnose- but the- the treatment plan quicker, right? Like, if you send me a kid and you're like something's going on with the left side, I'm like, awesome, I can hone in on that. And we can work on that, too. But yeah, I think, you know, I'm kind of derailing on that. And- and the heart of it is, be playful in your- in your sessions. Be playful in your homes! And look beyond the cognitive stuff, beyond the words that they're saying. Look at the movements they're giving, you know. And we talked about the neurosequential. Something that's- a tip for every one of your listeners, is when things are rhythmic, rhythmic things tend to be lower in the brain, right? And so when you have a child that's throwing a tantrum, and everything is rhythmic about it, the hands are waving in a very rhythmic way, the vocal tone tone is, you know, ahhhhhh! If there's rhythm in those tones, and if there's, [rhythmically] ‘I hate you so much’, versus ‘I hate you so much’, you know? Like, there's a different rhythm, in that when a child looks at you, and they're like, you don't understand me, I don't like you. Well, they're- they’re in their cortex. Because those are chosen specific words, but when they're like, [mimics crying] ‘I hate you! You don’t understand me’. If it’s rhythmic like that, then you can be like, ooh, that's- that's lower in the brain. This child needs to be rocked, I need to match them with rhythm. And so when you have a child that's having this fit, and you and I talked about that, you know, match the- um.

Robyn: Energy.

Marti: Energy! [overlapping conversation] And I would say, match that rhythm as well. So when a child comes at you with a really, you know, high, fast rhythm, then you meet them with that rhythm. And anybody can do that. Any person. Parents can do that, therapists can do that, school bus drivers can do that. Right? 

Robyn: Yes.

Marti: He's got a whole school bus of kids, you know? Get them on the same rhythm, and then  bring them into the calm rhythm that you want. And so, you know, that's just a tip as well of how do we know where in the brain they are? Look at the rhythm and repetition. Yeah, because that's the lower brain stem.

Robyn: Yes. And in my- in the movement training that I teach for therapists, I talk about, like, you'd be really keen observers, and see if you can take what they're already doing, and are co-organized and co-regulate it. So just like you said, like, if- if a kid you know, the psychotherapist who's like spinning? Really, I can spin? It's like, well, if you have a child who's like, all over the place, and like doing like handstands and you know, you're noticing that things are happening vestibularly, but it isn't feeling very organized, like it feels kind of out of control. Like it feels sort of yucky in your body, it feels like the child's got to be kind of uncomfortable to be doing what they're doing. Look- be a keen observer! And look and be like, okay, is there something that I can do that would almost, kind of metaphorically, like lean in to the child's body movements and how they're being, but offer something that could be supportive and co-organizing and co-regulating? Like, they're cluing us about what they need? 

Marti: Yes.

Robyn: We just observe, but I know- I know, a lot of therapists who would look at that kind of dysregulated behavior, like upside down and over the place, and I'm like, here and there, blah, blah, blah, especially because it could make be making a mess in the room. It could be accidentally bumping shelves over, and then toys are falling over. I know, you know, some mental health therapists that are maybe trained in a little bit different way, who would really approach that behavior very differently. Like set limits, and-

Marti: Yeah.

Robyn: -and if the limits were complied with, ultimately, eventually ending the session. Is like, whoa, whoa, whoa. Like, let's look at this, look at what they're doing. See it through the lens of like, our behavior makes sense? Like, how can we lean in, but then offer our support to help just co-organize what their body is already doing? 

Marti: Absolutely. And I'll go along with that, too. You always talk about you know, we're seen a lot of our own self vision is what others see in us, right? And then we'll get into that the whole mirror neuron right in the hole. When you see someone and they're doing what you're doing. That's a way that we connect, and we- and that starts in infancy, right? You know, we make the weird face and the baby makes the weird face. We make the clicking noise, baby makes, you know. It's that- that playful serve and return that you talked about so much. And when we're in the client, when they're in the room, if you can mirror them a little bit, then two things are happening. One, you're doing a really good activity analysis because you're feeling what they feel. 

Robyn: Feeling, yes. 

Marti: Yes. And then you could be like, wow, this is- this is the input I'm getting and so then you have a more understanding of where the child is coming from. And you can match that. And then you can say, okay, I'm getting dizzy, what do I do when I'm dizzy, I rock forward and backward, instead of in a spinning motion. And so then you can playfully gain the attention of the child by mirroring them. And there's, you know, there's therapies in the OT world, like floor time, you know? That's really based on mirroring that child and making that connection. And so even if you just kind of mirror what the child is doing, that becomes parallel play, that becomes connection, that becomes relationship. And it gives you insight of, wow, this kid is not thinking about the next thing he's going to destroy. Because when I'm spinning and riding around like this, I have no cognitive thoughts. [laughter] You know, and I'm trying to access my cognition, and I'm having trouble. And so it builds that empathy for you of what is their motivation. And you're like, wow, you know, when they're spinning around like this, you know, my eyes don't see anything. So maybe the child is trying to avoid looking at something. And this is a way, you know, that's too much. Whatever you're trying to get them to sit down and focus on, you know, they're like, that's- that's- that's too painful for me, you know, and again, I don't know, because I'm not a psychologist, but, you know, if I was going to be like, let's draw a picture of your family, and they had to look at this family that was not a pleasant experience for them, you know? And then they start running around the room? Well, they're not looking at anything at that point. And so when you mimic them, you're like, wow, I can't focus on anything. So this is a really good avoidance tactic for them. And so maybe I should just not ask them to look at this photo. And maybe that is the base of this interaction, and maybe I could say, you know, let's build it out of playdough. Or do something more physical. Or, you know, can I change the way that I approach whatever it is, you're trying to- to work with? You know, and does it feel different to me, when I, you know, talk about the family with- with figures, or dolls versus drawing them on paper, you know? And just feeling, you know, kind of where the child is, and again, you know, if you're, and again, I just because I'm trying to educate your listeners a little bit, too. It's that whole look at the rhythmic. You know, is it rhythmic? Is it patterned? When things are patterned and rhythmic, the child's trying to calm down. So you can, you know, you've stressed them, essentially, if they start rocking, if they start humming a rhythm, and they start yelling at you, and rhythm, you know, that's the stress response. But if it's more arithmetic, where, you know, it's things are up, and then they're down, and there's no real direction. Like you can't really predict where they're going next, and they're sporadic all over the room, that's a child that is lacking alertness, you know? Like they're trying to wake themselves up. Maybe they're tired, maybe they didn't sleep well, you know, maybe they don't feel good. You know, those kinds of things, that child is seeking information where the rhythmic child is avoiding information.

Robyn: Right, I also would think that that child that's more erratic, and irregular, that could be a sign of a child who's so stressed that they're moving into a state of collapse. And so the waking up ness is how do I bring my nervous system kind of up and out of collapse, instead of down and out of sympathetic arousal? So it can be kind of tricky, because it's almost a little counterintuitive, right? This super erratic child doesn't necessarily look like they're falling into collapse. But I do- I do. I have found personally that like, in my own work, and then with coaching parents, too, that's like a bet- just the more we do it, the more we use this lens of how we're seeing behaviors, and then feel into it, too. Like I'm always teaching parents and therapists to pay attention to what they're noticing in their own body, to get for clues about maybe what a child is experiencing. The more then we can use what we know about the child and what they need to, again, kind of offer experiences through movement, through play, as opposed to words like calm down, or even even things that are a little less silly.

Marti: Use your words! 

Robyn: Yes, use your words. Or exactly, yeah, use your words or even just to- talk just talking too much or verbalizing too much. You're telling me how you're feeling like these things that are so well intentioned, and we find you know, really trying to pull out our attunement skills by talking about feelings. Or talking about part that's actually being experienced as misattunement, even though we're trying so hard to be- to be attuned. And then the other thing I want to tackle on to what you said about you know, that when we are, you know, really engaging kids this way and how we see them and mirror neurons and all that kind of good stuff. The other thing that I think is so powerful, and being with kids in this way, and like, you know, if you have a child who started to be really dysregulated, and they're moving their bodies a lot, and as you start to kind of do it to to mirror them, not only are like our actual mirror neurons going on, but that child is experiencing you as somebody who's seeing that child, as someone who needs help, as somebody who's- whose behaviors and movements make sense in some way. 

Marti: Yeah. 

Robyn: And that's a new experience for the child, right? Because they're usually being seen by adults as you’re bad, stop that.

Marti: Yeah [unintelligible] then relational. Yes. So relational. And it is a way to feel, you know, that's- that's how we make friends is by doing the same stuff. We start with parallel play, right? You know, that's the whole go around the room and find someone who has your favorite color. We want to be the same with the people that we're connecting with. And so just matching a movement with someone is like, hey, I can do the same things you are. I'm similar to you. I'm trustable, I, you know, like, it's a great way to just get that foundation of the relationship. And often with the most dysregulated kids that I work with, that's where I will start is just trying to, you know, match them in some way, you know, can I match their hand movements? Can I match the way their head is moving? You know, it doesn't have, I don't have to be running around doing the full, you know, they- they crash into my sandpit, I crash into my sandpit. But I can rock and that was, you know, one of the things I talked about was with with an agency I was working with was the child was running around, and they were destroying things, you know. And so she just started to rock her body in the same, you know, kind of movement. Like if you could envision his heartbeat, right? And she just rocked her body back and forth to his heartbeat rhythm. And- and he noticed that in his periphery, you know, and then it was- and then slowly, she was able to rock a little bit slower. And then that brought him down because he matched her, you know, and then they came, and that's something in the office that you can do too, because then they feel seen. They feel connected. You know, it's that connecting, that we're always trying to do, 

Robyn: Yes, yes. Okay, so there's two things I definitely want to ask you, for my listeners in this particular season- series, before we wrap up. One is, when it's not uncommon for parents to feel like I can tell that my child would benefit from both occupational therapy and mental health therapy, which one should I do? And I want to tell you what I usually tell parents, and then you tell me if this is good or not. [laughter] I usually will tell them most families, many families can't do both at the same time. Like it's just a lot of stress on finances, and time, and scheduling, and you probably have other children and all this kind of job and all these things, right? Like, if you can't do both at the same time. Start with occupational therapy. Does that feel like the right answer?

Marti: I’m so glad you said that! [laughter] ‘Cause I was like, are we gonna disagree on this? 

Robyn: Wouldn’t that have been fun?

Marti: That would’ve been fun. But yeah, I because if the body's not stable- 

Robyn: Yes! 

Marti: -you can't move forward, of course. But again, you have to understand I am an OT. So I think it's more valid for your listeners to hear you recommend that than me? Because of course, I'm gonna be like, do they have to see me first? But what I would say is get on the waiting list for a good psychologist.

Robyn: No, I mean, I- I do think that in an ideal world, they- and with the right team, ya know, there's so much to be said for- for both, especially if the mental health treatment really involves parents, and parent support, and parent training. Because I think that that is always such an important piece of the equation. But that- the, you know, I just wrote an article and I was like, well, if I'm going to earthquake proof my house, I'm going to go ahead and get real focused on the foundation and worry just a tiny bit less about like, how well the pictures are nailed to the wall. Like both are helpful if an earthquake comes through. [laughter] Our house collapses because the foundation is too weak. It doesn't matter. [overlapping conversation] how well the pictures are nailed to the wall. And so let's start with a very bottom and really strengthen that foundation. And I do think that there are many mental health therapists that are getting more and more trained in body based work and movement based work and we're seeing less of a distinction between like the mind and the brain and there's still limits to what is inside my scope of practice as a mental health therapist, that occupational therapists are so much better equipped at supporting families through really helping to, like, co-organize and co-regulate these lowest parts of the brain.

Marti: Yeah, thank you for that, because- and I agree wholeheartedly, you know, and in a perfect world, you have a team of both, you know, that work together, and, you know, and will be able to communicate with each other. And if you don't, you know, try and open that door for them and see if they're open, you know, to having those conversations. So absolutely. 100% agree.

Robyn: Perfect. Okay, so the other thing I wanted to touch on before we start to wrap up is, aside from just the fact that we clearly were like instant friends, because of our personalities. [laughter] What I loved about your work with families, and why I referred so many families to you when I lived in Austin is because of the approach that you took, which was so family collaborative. And as opposed to this, like, hour a week of occupational therapy, you work so closely with families and parents on how to do what you do, theoretically, in the home. Right? And that, you know, Dr. Perry has, I feel like talking more about, maybe he's always used this language, but I've really heard him say so frequently lately, this idea of moments of healing. Moments of healing, right? Like, as opposed to a 45 minute OT session a week, where- and maybe in addition to how can we equip families to engage in these like moments of healing. Because if we really want to strengthen the foundation of the brain, it takes a lot more than 45 minutes a week. 

Marti: Absolutely, absolutely. 

Robyn: And that, for me, Marti is one, that's what you're- why I love to referring families to you. You're so good at empowering parents to do this, but also like where your book comes in. 

Marti: [laughter] Thank you. 

Robyn: So let's talk a little bit about your book, and how that, you know, if so many families don't have access to someone like you/ They don't have access to an OT who is going to really pull them in to sessions, and really work from a relational standpoint, and really teach them how to create moments of feeling at home. So talk about your book and how that could be supportive for those families.

Marti: Okay, I have three things I have to talk about. One is the 45 minutes and giving a background of when I'm working with a stroke or muscle, or some sort of like a physical thing as an occupational therapist, because we do a large range of things.

Robyn: Yes! 

Marti: That I can do in 45 minutes. And I can stretch the muscle and then the muscle takes that 24 hours to 48 hours to heal and to correct. So the model of occupational therapy was kind of built on that. Where we're working with muscles, and we're working with the spine, and we're working with, you know, those types of things. And like cooking and the ADLs, or activities of daily living. So the model was made for a very great, functional thing, 

Robyn: Absolutely. 

Marti: But when we're looking at more- but when we look at trauma, and we look at relational things, and we're looking at the sensory system. The sensory system, it cannot attend for more than three to five minutes, right? So when you have to dissociate- and Dr. Perry talks about this too, like you do a little bit, you know- dosing is what he calls it as well. So you get a little bit of a dose. And then you have to step away. You've got to dissociate for the brain to reorganize and know where it's going to put that therapeutic input. So it's not like the physical rehab when we start talking about neurology. So that is why, if I'm doing a 45 minute session, the brain is taking breaks every two, three, five minutes. And I'm only getting two or three doses in. And repetition cannot happen in two to three times. The baby doesn't take three steps, and start running, the baby toddles for months. And every step that they're taking, they're building those neural connections. And then they fall, and they rest, and they take a break, and then they get back up. And so when we're building neural connections, you have to have the breaks in between. And that's key to the carryover. So if I want to get 1000 repetitions, and I'm only seeing you for 45 minutes, and I'm not talking to the parents, I'm going to get four repetitions a week. You're going to be in my therapy session, you're going to be seeing me till you're 16. 

Robyn: Right. 

Marti: That is not functional. And so that's why in my practice, it is so important for me to bring the parents in. And you know, I encourage therapists to find- or, parents to find someone that allows them, you know, to understand what the carryover is going to be. And, you know, if I'm like, Hey, have them use their left hand more, you know, or, you know, play this peekaboo game or whatever sensory thing I'm trying to get into. I'm wanting to do that 1000 times. So that's the one thing is absolutely, it's the dosing, you know? And there has to be smaller doses, but more frequent than what most typical therapy sessions are. 

The second thing I will say is exciting news. It is out in the public now, the National Association- or National Alliance of Trauma Responsive OTs, and the Trauma Informed OT group on Facebook. We- there's several therapists, now. I think we're up to several 1000. We are trying to do just that. We're trying of let's stop doing these 45 minute sessions. Let's bring the families in. How can we actually consider that neurosequential model? How can we consider how trauma has derailed some? How can we change the way we interact and have a less behavior based approach and more compassion based approach and, and we're trying to equip therapists and so like, I'm actually part of the movement of we're trying to, you know, create resources for people and connect people. And, you know, we're hoping to launch in October. And so that's another exciting development. 

Robyn: So exciting. [overlapping conversation]

Marti: Find me. I don't want to take on everybody in the world. But I want to equip other therapists to be able to be ready to- to take them on. So that's very exciting. Darn, And then what was the third? It was actually addressing? Oh, my book. Yeah. [laughter and overlapping conversation]

Robyn: We're gonna talk about. So that's when you're like, I'm forgetting about my book. 

Marti: [laughter] This is why I'm not good at marketing. [laughter] I get excited about helping the people and then forget the resource. My website, you know, you go to CreativeTherapies.com. I always forget that I have KALMAR as well, which is an online tool that you can just enter in the behaviors, and it'll give you some activities. Everybody talks about that. And they're like, oh, there's this really cool website, and one time I was like, Oh, that's my website! 

Robyn: My website! Okay, so everybody listening, you even sort of just really glossed over that. So I will, Marti is talking about this really amazing asses- would you call it an assessment? Is that the right word for it?

Marti: Yeah, let’s call it an assessment.

Robyn: It's online, it's free. It's- I will link to in the- in the show notes so everybody can just go right to it and look at filling out an online assessment of like, what is your kid doing? And then here are like these recommended, body based essentially, mostly all body based, interventions. 

Marti: Yeah, yeah. Pretty crazy. But that- that's what happens. You know, I developed that because I was doing training. And then people were like, how do we know these activities if you're no longer in our pocket? And I was like, well, I'll have my husband write you an algorithm. And then Dr. Krause, I kept getting upset with him- not upset, like in a very playful way. But you know, they give me an hour, they give me an hour and a half, you know? You're you're having me on this podcast for 40 minutes, like I can't do things in 40 minutes. There's so much I want to say. And so Dr. Krause was like well, write a book, and put all the things that you don't have time in an hour, an hour and a half, put it in a book. And so I was like, I could do that. I've never written a book before, I don't even read books. But of course, I could do that, like [laughter] so. So that's what the Connected Therapist is. Basically, if someone were to allow me to have eight hours of your time, to really go specific into the different systems. And this way, you don't have to listen to me for eight hours, if your child is having primarily vestibular issues, you can just fast forward to that chapter.

Robyn: Yeah!

Marti: And so yeah, that's what the book was written. Because I really wanted to inspire people to understand not only do we all have different ways of viewing things, and a little bit of the neuro foundation and- and the familial foundation of that. And it's kind of a little bit of my journey as well, because I used to be very behavior based therapist. I was an occupational therapist, that was very, you know, first then, if then. You know, very mechanical, and when I discovered TPRI, I and you know, Dr. Perry, you know, kind of took me under his wing. I was like, oh, oh, ohhh, people have emotions. [laughter] Wow. That did not occur to me, and just how it changed my own life and my own parenting as well and just the lens that I looked through. And so I wanted to write about that both kind of chronologically- chronicled my journey into being more compassionate and empathetic, as well as if I had eight hours of unlimited time and could teach parents, and therapists, and other OTs about the sensory systems and how trauma will impact them, then that's what I want to write, because that's what I wrote.

Robyn: Yes. That's what you wrote and it's amazing. And one of your top gifts, you have many, one of your top gifts is practical, right? Like you so quickly, so quickly, have- can take this like big concept and go like, Oh, well just go take this thing that everybody has in their house and do this with it. You make everything accessible, practical, and fun. 

Marti: Thank you. 

Robyn: It's just exactly what parents- especially, you know, I think all parents see that stuff. But especially if you've got a kid with big behavioral problems, you know, practical and fun, are extremely important. So y'all, if you haven't grabbed Marti's book, The Connected Therapist, it is a mum I mean, I really think it's a must have for people in their kind of parent book library. And really, you can like flip to the chapter and be like, Oh, X, Y, and Z fun activity would probably help my kid. I mean, it would take you 20 seconds.

Marti: Yeah, that’s the goal. You know, I look at it. I've been training. I've been doing trainings around the world for 20 years. And for 20 years, I've always been like, I need more time. So this is what if I have more time, and it's also the what things am I asked the most, you know? When I'm doing these trainings, what are the questions that they asked me? And so I've tried to be like, okay, if I'm doing a training, this is what people want to know. So I'm gonna write it. And then my friend Holly edited it. And she made it actually sound like a book, which was pretty exciting.

Robyn: It is just perfect. It's truly is perfect. So Marti, thank you so much. And of course, y'all listening who love Marti: Don't worry, she'll be back. Because I plan to podcast for a long time. And, Marti, there's like, a million things we could keep talking about. And I just love being with you. So,

Marti: Likewise. Absolutely. Likewise, I always enjoy time with you, whether it's in person, online, virtual podcast. Because, yeah, like, yeah, it's we think alike. And we have the same heart and compassion. And yeah, I just love working. And I love the people that you work for, too. 

Robyn: Yes.

Marti: They’re our people.

Robyn: Yes! They are our people, we both love them. And that's the other part of my podcast is like I've been trying to be so deliberate about like I want- I want to introduce my audience to people who love them as much as I do. Because it's really easy for parents of kids with really big, challenging, baffling behaviors to only interface with professionals who don't really like them very much because they experience their family is difficult. [laughter] You know? And so if I can help remind these families that like, no, there are people out in the world who love you, because you're lovable. And you're, you know, perfect and wonderful. You just happen to have a kid who really struggles and that's very stressful. So.

Marti: It is! And- and we do the best we can with we have.

Robyn: Absolutely, yeah. And you know what, when I'm super stressed out, I'm not always behaving my absolute very best. And I don't expect the parents of the kids that I work with to always be behaving their very best. And I adore them anyway. And I know you do, too. So thank you for being on this journey with me and for these families. And I can't wait till we think of the next thing we're going to talk about.

Marti: That sounds great. Thanks for having me, Robyn. Take care.

Robyn: It's hard to even know what to say now. I mean, Marti is just one of those people that I sit back and wonder, how did I ever get so lucky to come to know you? She has a wealth of resources and knowledge. And I've put live links to all the things we talked about in this episode into the show notes. And over on my blog at RobynGobbel.com/OccupationalTherapy. Thanks for joining me today on the podcast. I really, really grateful for you. Thank you for your commitment to kids and families and to making the world a better place by embodying the science of relationships. See you next week.