Working 121 with a child I use a range of materials and therapeutic techniques to help the child relax and feel comfortable and safe in my presence.

 

These may be art materials, sand trays, clay, slime, emotion cards, puppets or games. Sometimes I will have resources on the table but the child goes to the cupboards and chooses something else, and that is ok, it is their space and I am child led.

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From the start my priority is making a genuine connection with the child, welcoming them as they are on that day and helping them to feel special. When the child is ready, feels safe, has trust in me and the energy I bring to the room, we can then begin to explore the approach we need to take. For some children, especially older children who have often have big questions they wish to explore with a safe adult and have self awareness of their emotions, they may just wish to talk.  

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Many of the children who come to see me however, have been living in a state of heightened dysregulation for some time, and lack the self awareness of their body and brains reactions to their emotions and experiences. Some children will have had wonderful OT intervention before coming to me, where they may have explored the mind body connections and are ready to explore emotions and experiences. Many are not. So before we can focus on the psychological side of their experiences and worries, we need to spend time developing awareness of what's going on in our body and nervous system and how this is connected to our brain.

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When we look at the bigger picture of healing emotionally, it is helpful if children can notice the signals their bodies are giving them first. Once they have this awareness of their body they need to be able to connect these sensations to emotions. It is helpful to have this understanding, before we weave in focused psychological and cognitive exploration. However, these processes are especially important for children who may have anxiety about bodily functions, such as going to the toilet, paruresis, constipation, bed wetting, incontinence or anxiety about being sick (emetophobia). 

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Initially, I support the child to build awareness of the signals their body is giving them and do this in a very general way at first before gently linking to examples, and then supporting the child to find examples in their own experiences. This is a stage which is very important for all children, but in particular autistic children who can often be very good at sensing body signals, but then find interpreting them and linking to an emotion difficult.

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There is no timeline for this process, each child is different. If they have not had OT intervention, we often need longer on these stages. 

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When the child is showing understanding of their body signals, the emotions they bring and positive strategies to use around different emotions, feels safe and co-regulated with me, we can then begin to identify and explore what has been challenging, or worrying for them. Working within the child's window of tolerance and needs we will slowly explore how their body and brain react to these experiences, using creative resources to support this process and the child's emotional safety. Sometimes they may want to just talk, and not play, be creative or use resources and that is ok too. 

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This process where we focus more on the child's experiences and emotions, and link to their bodies signals needs to be taken slowly, and at the child's pace. It may be that some weeks the child is feeling unwell, not regulated or feeling unsafe. Our focus on those days is to find a sense of safety and co-regulation, where they child can be in the room, feel safe and able to engage with an activity of their choosing. 

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I then use a range of approaches and materials to support the child to begin to identify, express and process life experiences. I follow the approaches advocated by neuro science, research and The Centre for Child Mental Health, which show us that many mental health challenges are the symptoms of deeper core pains. It is though the processing of life experiences that we are able to identify these core pains, express the stories and emotions around them and promote psychological healing.  

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If working with OCD and related behaviours I follow a similar approach to build trust then we may bring in strategies from habit reversal, exposure and ritual therapies depending on the therapeutic focus. Research shows that OCD therapy is most effective when a combination of cognitive, emotional and behavioural interventions are used. 

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