What does curiosity have to do with Polyvagal Theory and how does it impact our clinical reasoning? In short, curiosity makes us vulnerable. Vulnerability means reason MIGHT be more difficult or unreachable.

In her new and recently released book, “Atlas of the Heart” Brené Brown writes:

“Choosing to be curious is choosing to be vulnerable because it requires us to surrender to uncertainty. We have to ask questions, admit to not knowing, risk being told that we shouldn’t be asking, and sometimes make discoveries that lead to discomfort.”

As OTs, we encounter uncertainty (and thus vulnerability) all the time! What we do with that uncertainty can mean the difference between “just getting through” a session and “being therapeutic.”  But more than vulnerability, I believe curiosity, when used as a clinical reasoning tool, can also create safety…for us (the clinicians) and therefore, for the client. Curiosity allows us the freedom to wonder, instead of getting everything right in the moment. It affords us the opportunity to hypothesize instead of assume, and it then encourages us to look for evidence in our clients as they respond to our interventions; making it possible to further validate or refine our clinical hypotheses about our clients’ experience(s) and resultant next steps. In this way, curiosity becomes a strategy for managing the unknowns of clinical practice.

When something happens unexpectedly during a session, instead of thinking, uh-oh! I don’t know what to do next, we can lean into the unknown by thinking (or saying out loud sometimes), “That was unexpected! Now what can I try?” Follow it up with, “I wonder what would happen if?” Then try something different (anything assuming physical safety for you and your client) and observe your client’s response.

Very often our first response to unexpected challenging scenarios is to try and explain them. A common scenario is when parents are with us in session, they often ask questions or are looking for explanations of their child’s behavior. When parents (or others) ask us for things, we tend to want to give what’s being requested (many OTs I’ve met are people pleasers…a-hem…it takes one to know one). When asked a question to which we don’t have a confident or clear answer, we feel compelled to give one but are lacking and thus feel inadequate (insert vulnerability) and we fear judgement by the parent when we don’t know something (insert vulnerability) and we project toward possible loss of credibility and thus possible loss of the client (insert vulnerability), which translates to loss of income, loss of reputation etc. etc. (insert vulnerability, vulnerability, vulnerability). Wow! We are hard on ourselves in the moment. And how is it possible to think of so many things that are not clinically relevant, as we try to manage a clinical situation? I hear this kind of vulnerable scenario from OTs over and over.

I surmise that vulnerability increases our sympathetic arousal which, per Polyvagal Theory, makes it harder for us to connect with our frontal lobe (our thinking brain), which means we are less able to reason through clinical scenarios in which we find ourselves. We may be less able to acutely observe our clients, much less make sense of our own observations, and when feeling vulnerable, we are much less likely to be attuned to our clients’ needs and more likely to make the interaction about “us” or at best “net neutral” for our clients (because I trust most OTs are not knowingly ego driven). When we care too much about the fact that we are missing something, instead of getting curious about what we are missing, we miss an opportunity for learning about our client(s) in ways that can actually help to move our client(s) forward. We don’t always have the evidence-based answer top of mind, and that’s ok. When this happens, our client’s response to what we try becomes our “evidence.”

USE CURIOSITY to combat but allow space in your brain, for vulnerability. This is my suggestion for dealing with uncertainty. When you don’t know something, get curious. “The development of genuine expertise requires struggle, sacrifice, and honest, often painful self-assessment. There are no shortcuts … and you will need to invest that time wisely, by engaging in ‘deliberate practice’—practice that focuses on tasks beyond your current level of competence and comfort.” (Ericsson et. al, 2007) “Clinical cognition requires a flexible cast of mind, a power of observation, and a willingness to question, to learn from others, and to compare notes.” (Kassirer et al., 2010)

How do you or have you used curiosity as a parent, an OT, or an outside observer in various personal situations? If you have or if you try it in future, I’d love to hear from you. Let me know! I’m curious (see what I did there?!).

Brown, Brené (2021). Atlas of the Heart. Mapping Meaningful Connection and the Language of Human Experience. Random House: New York, NY.
8 Ericsson KA, Prietula MJ, Cokely ET. The making of an expert. Harv Bus Rev. July–August 2007;85:114–121, 193
Kassirer, Jerome P. MD Teaching Clinical Reasoning: Case-Based and Coached, Academic Medicine: July 2010 – Volume 85 – Issue 7 – p 1118-1124
doi: 10.1097/ACM.0b013e3181d5dd0d

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