Updated: Sep 9, 2020
As pediatric occupational therapists we have many goals for our clients. We care deeply about their progress and want them to succeed. If only it were a linear path,clients would reach their goals simply with the help of our expertise and support.
Unfortunately, behaviors come up again and again that get in the way of their progress.
How can we work on our goals if the child keeps throwing wrenches into our plan with their interfering behaviors?
Occupational therapists often go straight to self-regulation as the answer. The children should learn tools to self-regulate so that they will no longer need to engage in maladaptive behaviors. Within this framework there is often a heavy emphasis on sensory integration. As a widely encompassing philosophy, there always seems to be a sensory-based answer to every problem.
Instead of going straight to fixing the child involved, is there another way to start the process to bring about behavioral change?
I believe we need to shift our thinking, and make co-regulation the foundation for behavioral change to occur.
Co-regulation is the continuous process of interaction that happens when people are in relationship with each other. This process is easily seen in the adoring gaze of a parent and an infant, each contributing to the interaction. Extensive neurological research has created the understanding that this seemingly simple interaction is actually rich in neurology and important in our understanding of co-regulation. During this exchange, mirror neurons will fire in the same areas of both the child’s and parent’s brains so each is changed by the interaction in similar ways. When we are in a relationship with anyone, our biologies meet. Polyvagal theory tells us that this meeting is unconscious and visceral. Through our presence, we send messages of safety or threat to the other. If there is safety, the vagus nerve will send messages to the parasympathetic nervous system to down regulate, and the individual will be available for learning and developing.
Do we consider safety in our interactions with children?
Stuart Shanker, an expert in self regulation, challenges us to redefine all behaviors as stress behavior. If a child is seen as stressed instead of misbehaved, how can we be part of the solution to lower his or her stress, and meet the child where they are rather than where we think they should be?
Therapy is first and foremost about relationships. In our university programs, occupational therapy students are taught about the therapeutic use of self. For me, this seemed obvious; I wanted checklists and tools to attack the problems, not platitudes. I chose to be in a helping profession, so I already saw myself as kind and empathetic; therefore, therapeutic use of self was a given, and not something that needed further exploration. However, over time, I have noticed a peculiar pattern.
When I am having a great day and feeling emotionally connected, my students’ behaviors seem better and easier to manage.
The opposite has also been true. At times when I have been going through a rough patch in my home life or career, I seemed to have the most behavioral students. Through a decade of serious inner work, including the tools of meditation and yoga, I have come to the realization that if one of my students is having a behavior, perhaps I should start with a mirror and look at myself first. What will come up when we look inward? Perhaps a child’s particular behaviors are triggers for us from our own childhood? Do we become unnerved when a child will not go along with our plan? Can we recognize when we are acting out of our own fears rather than responding to a child in need?
Studies show resiliency can be fostered by just one caring adult who unconditionally accepts a child.
Every one of us has the opportunity to be that person, but this is possible only when we are willing to make relationships, instead of compliance and goal attainment, the center of our work.
Our therapeutic goals mean nothing to a child. Our unconscious intention may be to mold a child into some ideal because we have determined, through our thorough investigation, that they have many broken parts. This expert adult/ imperfect child relationship is about dominance, and our current therapeutic paradigm is heavily influenced by this model. Empathy and dominance cannot co-exist. If we are truly empathetic, we would be able to see and feel as a child, and not wish to dominate. Instead, we have the option of co-creation which requires curiosity and presence, not force. We can work next to a child, and be willing to be changed by them, and, subsequently, they may be willing to be changed by us. From this fertile ground of partnership, we can introduce the tools of self-regulation and sensory integration.
Committing to self-reflection is less to do with finding time, as it is a willingness to alter our view.
We must be curious about how we show up in our work, and we must be open to change. This work is not easy, and I imperfectly go back to a need to control and manipulate others every day. It helps when I start with the premise that children are perfect and whole as they are, and there is no need to fix them. As pediatric therapists we are given enormous privilege and responsibility when we enter into the life of a child. Each day we can start fresh. All relationships hold up a mirror, but we must be willing to look at the reflection if we want to be transformed and to truly be in service to children.