As OTs we also have the challenge of finding ways to bring out the brave! When clients feel safe enough to tackle whatever the next level challenge might be for them in that moment, they find the internal drive to TRY. When clients (specifically children) don’t feel safe or able, they disengage, give up or find ways to avoid. Everyday tasks like eating, talking, using the toilet, getting dressed, going for a walk outside, even playing with toys or other people or on playground equipment aren’t things that many people think of as challenging. Yet, when things like autism or trauma or genetic disorders or sensory processing challenges present themselves, these everyday tasks can feel daunting and truly scary, or near impossible.
Many times it takes bravery AND help to facilitate function. And when we can create an experience for a child that allows them to WANT to engage and to try hard things along with the range of adaptations and/or assistance we provide, some level of success is inevitable. Our unique challenge as OTs (and parents) is to intuit the perception and viewpoint of the child and use skills of task analysis to break down and modify the how AND the what of “doing” and to then use our relationship along with this knowledge base to support growing capacity and that desire to try. HOW we do things and WHAT the activity is, have a direct impact on a child’s “neuroception;” the neural process distinct from perception, that determines the subconscious assessment of threat or safety (Porges & Dana, 2018). Neuroception then influences a child’s perceived demands of a task… ALL leading a child closer to or further away from engagement and interaction and thus function. i.e. what a child sees, hears, feels AND the subconscious and conscious meaning they ascribe to that experience based on their own prior and current experience will determine willingness (and ability) to try.
Success or trying for success can take…
- going slowly and carefully,
- spending many sessions where you aren’t sure you’re getting somewhere,
- being able to see tiny tiny steps of progress,
- good teamwork with families,
- letting go of expectations in the moment (not long term),
- ongoing on the spot creativity,
- avoiding power struggles,
- LOTS of repetition,
- trial and error,
- collaboration with other disciplines,
- trust…in yourself, in your client, and in the other people involved
This list is not exhaustive and these are all things that are difficult to quantify/measure/teach. If you don’t have them, do NOT be discouraged and don’t worry! I don’t have them all the time; none of us do. We are human! I share this list to articulate certain variables that therapists or parents may consider when attempting to understand, interact, or intervene. However, when these variables or aspects of therapy do combine with our unique OT skill set, to create the “just right fit” you might get to see something like the little face above; aka pride, excitement, hope, possibility, JOY!
THIS is what bravery (and trying) looks like! I’ve seen a LOT of brave (and a lot of flushing toilets) lately and I can tell you, it’s inspiring!
Porges, Stephen W. & Dana, Deb A. (2018). Clinical Applications of the Polyvagal Theory: The Emergence of Polyvagal-Informed Therapies (Norton Series on Interpersonal Neurobiology) 1st Edition. W.W. Norton & Company. NY USA.