Creativity and Difference Embedded in the Culture of Sensory Integration Practice

Helping their clients to function was the role that the practitioners I spoke to were concerned with. It was evident from the data that in the field of sensory integration, highly creative, often self-engineered tools and practice were being used to modulate sensory, psychological and emotional dysregulation. The inclusive stance and tools

enabled their clients to go from a dysregulated state to a functional, regulated calm state. The therapists I spoke to were all interested in how their clients could function

independent of their interventions. Sally was concerned with how the human body of the primary caregiver could regulate the sensory experience of the infant – with this being deeply personal and particular to each dyad. The practitioners were interested in their client’s own sensory solving strategies. In the UK they were concerned with any

additional tools and interventions they offered being affordable and accessible with many of them talking about kit to give proprioceptive feedback coming from as Lena said “the

Pound Shop”. Many families she explained were not able to afford treatment or the

sensory kit required and she and the other UK therapists enjoyed creating solutions to this problem. The practitioners in the UK were conscious that most of their tools and strategies were not available to the clients they wanted to work with on the NHS. Part of their assessment involved exploring the sensory seeking strategies that their clients already employed. They then worked with their clients, families and teachers to develop these approaches and make them more effective. For some practitioners their thinking seemed to encompass an embracing of seemingly odd client strategies at a very ordinary, daily level, Zoe said: “I once had a parent who said that, every time John

(pseudonym) came home, he (the client) wants to climb under his bed. This was an 11- 12-year-old. The mum thought that that was something wrong. She said “He crawls under his bed and he won’t come out for half-an-hour!” She thought I was mad because I said, “You know, that is absolutely fantastic,” because when he came out, he was all OK. But she was just so focused on that odd behaviour, and I said to her, “That is so amazing because he is self-regulating.” So, actually, to make it more efficient, because she was finding it hard, because then they got home late and then he was under the bed and then

they needed to go somewhere or he needed to come out for dinner, so let’s try and make that time more efficient so that maybe he only needs 20 minutes, or maybe only 15

minutes”. Zoe described this as the amount of time it took for the child to reset his system

so that he could re-engage and begin responding thoughtfully to his environment again. Zoe was concerned with speeding up the time it took for John to settle and ground himself. “So let’s add this and this and this (picking up cushions from around her). Let’s

add some Thera-band that he can put on his legs and just lie under his bed and stretch. That is really nice proprioceptive input.”

Zoe combined education - a top-down strategy - with bottom-up proprioceptive tools to give sensory input to help John regulate his emotion on his return from school. Zoe understood this strategy helped John to attain a calm, alert state in a quicker, more effective manner. The practitioners saw themselves responding to their client’s sensory seeking and avoidant behaviour to create independent interventions. Parents, teachers, other practitioners and clients were almost invited to become sensory detectives

themselves understanding how the environment can create sensory disturbance and consequently effect emotion, behaviour and sensory regulation. Part of the treatment was the narrative and understanding of the difference. Zoe was concerned about the way the interventions were being misunderstood: “I don’t think the College of OT has

been very helpful. In fact they have been quite destructive quite recently with regards to the bottom-up approaches. That has been because, potentially, therapists have been using them in the wrong way, in the sense that, for me, it is a top-down and a bottom-up.”

All of the therapists thought it important that the top-down explanation of strategies was as important as the bottom-up interventions. The people around the client were

encouraged to be less judgmental about the client behaviour and advised to hold an inclusive stance with a creative, open mind. Hayley came up with an innovative solution to help her friend’s child with her concentration: “I've got a pen with a fiddly bit at the

top…also doodling if I'm really finding a meeting hard I doodle. If I can't doodle I can't pay attention I was talking to a friend about this the other day she said my daughter has just got really told off for that at school for doodling in her books and her books are a mess. So I said just give her some post it notes and she can stick them on and doodle and still concentrate because she needs to doodle to concentrate, she can take the post it notes off and put them in the bin and she hasn't ruined her book.”

Hayley’s pragmatic approach tackled affect in a number of ways: the client was helped to feel ok about her behaviour rather than naughty as she was made to feel at school. She was supported to regulate herself with an easy strategy. Her anxiety and potentially shame at getting it wrong and doodling in her school-book had been avoided. Framing behavioural difficulties as a functional response to sensory dysregulation appeared to be an important part of the intervention.

A large part of Zoe’s intervention was to help John’s mother understand that what he was doing was less odd than perhaps the mother had first thought. By climbing under the bed the child was finding a small, dark space with minimal exteroceptive sensory feedback. In the small space he could squeeze himself therefore giving himself proprioceptive feedback, regulate sound and ground himself. The therapist’s role in this example was to

give meaning to the parent and child as to what the behaviour – hiding under the bed - could mean. She also gave permission to the child to carry on with his strategy and to find ways to improve the child’s own method of regulation by introducing other ways to give the proprioceptive feedback. Hayley acknowledged: “you are giving it the OK.

You've got a license to do it.” This is seen in sensory integration terms as introducing

effective strategies as “OK” to self-regulate using proprioceptive feedback. The

consequence of this self-containment and proprioceptive feedback was that the child was able to think and get on with the rest of his evening without mental or emotional collapse or ‘meltdowns’.

8.2.3 “Meltdown” – Sensory Dysregulation

John and his mother were representative of a number of clients that the practitioners mentioned. Many of the therapists were called upon to help manage what their clients termed ‘meltdown’. Zoe told me that she: “ was talking to a parent yesterday, with a child

with sensory processing difficulties, and it is resulting in very poor regulation. So she will have complete meltdowns and actually hold her breath and pass out”. Zoe’s view of this

vignette came form a sensory regulation perspective.

What were viewed as behavioural difficulties by some professionals, therapists and parents for instance – hanging upside down on chairs, swinging on chairs, rolling around, sitting in corners, laying under beds - were viewed by these practitioners, from an

interoceptive, sensory perspective as a response to sensory context and sensory

overload to self-regulate. Hayley thought: “that's definitely what people don't understand

that this is really painful and extremely uncomfortable. If you think about light touch from a sort of neuro-physical point of view, light touch travels to the brain on the same

pathway as pain so if you are have a sensitivity to light touch there is no gate that stops that going to the pain sensors in the brain which is why we use deep touch as that travels in a different direction. I'm not surprised that if you brush past someone and they give you a kind of a whack well that is your fault. In my mind ninety nine per cent of the incidents we have still in this school - which is very good - are caused by us.” Hayley

explained that some people who could be described as tactile defensive experience soft touch as painful. Hayley used her empathy to understand the experience of the child in this example. Instead of imposing a typical social view about the behaviour she used a sensory integration stance to interpret the presentation. This sensory empathy helped the child to be understood rather than punished. It also helped the staff working with the child to understand how their behaviour may impact the child – not everyone enjoys being touched softly. Hayley felt that sensory regulation issues within the environment needed to be addressed in order to avoid meltdown: “So you can't have children’s

arousal levels sort of up here and say so I'm just going to start Math’s now and then wonder why they have a complete meltdown because they get tipped over the top - so we start the day with resetting their systems really getting them ready to learn. They will also have individual therapy programmes throughout the day and they will also have strategies in lots of their classrooms.”

Lena told me more about one of her clients who she described as regularly being in ‘meltdown’ due to his sensory context: “so he would run off, he would kick, he would

or feeling…that pain threshold is very real to them, when your sensory processing is out of kilter, you will feel it as pain”.

Katy described her client’s meltdown: “She was a teacher in a special needs school and

she was finding it very difficult. Certain sounds really upset her to the point that she would have meltdowns and loose it with her team of staff to the point that it had become a big issue and there were disciplinary issues - they knew she had issues and so were trying to support her but it had come a real difficulty in the workplace and also she had become a social recluse. Her life was her work and then she had time for nothing else so she really wanted to get better. One of her goals was to go out and feel like she could cope with going on a social event … she was somebody that I felt there was just so much anxiety for her. That was one of the things that we used music (Therapeutic Listening

Sound Tracks – Frick, 2017) just to reduce her anxiety before we really even got going

on the programme that she wanted me to use because I just felt that her anxiety was so much we sort of had four weeks of music that we just used to shift her anxiety and even in that time she was sleeping seven or eight hours a night …”. Hayley’s client had not

slept for more than four hours before she was introduced to the music from the

therapeutic listening programme (Frick, 2017). She explained how the music enabled this client to sleep and reduced her anxiety so that there were no longer functional issues in her home-life and work. Hayley explained that she would have liked to work alongside a psychotherapist with this client so that the client’s historic trauma could be addressed. Hayley felt “she was just the best she had ever been in her body - amazing organization

– but I really didn’t know what to do with that. Actually, it was definitely linked to her history, but that was just in the session and we didn’t send that one [Therapeutic

Listening music – Peach Jams] home because, in my gut, I felt that that was where she

needed to be, but I didn’t know what to do with that”. Hayley thought that different types

of therapeutic listening music possibly elicited traumatic memory.