Month: May 2014

Sensory Deprivation and Relaxation: The experience of a Floatation Tank.

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Have you heard of a Floatation Tank or the use of floating for sensory deprivation and/or relaxation?

I’m not going to go into detail about the Floatation Tank and what it is, the rationale for its use and some of the benefits that have been derived from its use.  Instead for all of that information you can follow this link http://en.wikipedia.org/wiki/Isolation_tank and read all about it on Wikepedia.

Suffice to say that I’d not heard much about the floatation tank or the experience of sensory deprivation using this device before.  No I haven’t seen Altered States, although I believe that is now on the must watch list given the number of times I’ve since been asked.  Enough of this chatter, let me tell you about my experience of the Floatation Tank!!

On arrival at Sandhill and during my initial tour, I was presented with the float tank and the offer to go in it.  I was initially quite apprehensive and said no.  However after a wise conversation and keen reminder that there is a difference between theoretically understanding and experientially understanding something, coupled with some self reflection about really learning and understanding neurodevelopmentally informed interventions,  I agreed to give it a go.

Now I get a bit claustrophobic! I do not like enclosed spaces or the sensation that I’m trapped or cornered.  Needless to say my stress response was a somewhat active and my initial heart rate was a little elevated after 1. getting into my bathers and coming out in front of a relative stranger and 2. considering the idea of climbing into the contraption pictured above and knowing the door was going to be closed and there wasn’t going to be much light.  In fact I think from memory my heart rate was somewhere in the high 90s. My blood pressure was also taken, it was pretty normal, if anything a bit on the low side but not clinically low.

So the time had come and in I climbed, laid my body down in the epsom salted water, put my head back and began to float.  The door was closed and the space became dark.  I’d like to tell you that I quickly came to feeling relaxed, but that’d would be a lie.  My first 5 minutes (well it felt like 5 minutes) was spent just trying to calm my heart rate, which upon closing the door had cleared passed the 100 barrier – I could feel it in my chest.  I found myself wondering how the children and young people we see at Take Two, with significant abuse and trauma histories would go in this situation? I’m still not sure I have an answer on this one and I think it could be tricky for some of our kids.

After I’d managed to calm the anxiety about being enclosed, I let myself relax into the water that was holding me afloat and just experience what was going on. Now this is when I started to learn all sorts of things about myself.  Things I probably knew, but because of a world filled with sensory distractions I’d not ever really taken notice of.   You know, every time my body was almost or had just tipped over the edge into a state of relaxation, I found the need to sensory seek.  I’d pull at my togs (bathing suit), scratch an itch (there was a bit of itchiness in the first bit of the float), need to push myself off a wall and move about in the tank and then try and work out where I was positioned or as I do best, have a string of thought processes to keep the mind busy.

This went on for some time, and then out of no where I could hear my heart beating slow and steady, in fact at that moment that was all there was.  I just listened to it and found myself experiencing the beginnings of a deep sense of calm and dare I say it, even relaxation.  I found myself thinking “now if I had one of these at home, I could do 30 mins in one of these and feel relaxed”.  Before I knew it the door was opened and out I climbed, wet and salty but feeling really relaxed (note I’m not someone who relaxes often or really even takes the time to relax). Post heart rate measures saw a 20 beat per minute drop to somewhere in the 70s and a slight (still healthy) increase in blood pressure.  What’s interesting is that my results were consistent with the patterns Sandhill are finding in their children.  I can’t wait for them to do some research on this and get it published.

What blew my mind more however was the fact that I honestly believed I was only in there for 20 minutes, 30 at a push!  I was in the tank a whole hour, 60 minutes and that’s when I realised that I had experienced the state of such relaxation that I’d lost sense of time.

Floating is an interesting experience and I will definitely be doing it again and again.  I highly recommend it, even if you just try it once.  If nothing else, like me you might learn things about yourself you didn’t really know beforehand.

 

 

 

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Sandhill Child Development Center: Authenticity in Relationships

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Del Rio House

I spent the week of May 12 -16 with the staff and residents at Sandhill Child Development Center in Los Lunas New Mexico.  “Sandhill Child Development Center is a residential program for children ages 5 to 13 at admission, who are experiencing significant difficulties functioning in their current home, school or community due to an inability to regulate their emotional states. By repairing a child’s trust in care and adult guidance, Sandhill gives the child the tools necessary to proceed with a healthy and bright future. Sandhill Child Development Center emphasizes a relationally-based clinical approach that is grounded in the Neurosequential Model of Therapeutics (NMT) developed by Bruce Perry, M.D., Ph.D. and The ChildTrauma Academy.” www.sandhillcenter.org  Sandhill takes children from all over the United States.

As one of the ChildTrauma Academy’s initial partner certification sites there was no question about visiting Sandhill.  Having been at the implementation of neurodevelopmentally informed interventions in their residential treatment for some time now, I wanted to see for myself where they were up to and what discoveries they had made.

Sandhill have two homes located on two different sites a short drive from each other in Los Lunas, New Mexico.  The home pictured above and it’s surrounding property align the Rio Grande River and both homes look out onto majestic mountain ranges.  Spending time with Sandhill you can’t help but feel relaxed and like you’ve known these people all your life.  The Zimmerman Family who run the service, exemplify nothing short of authenticity in relationships and with that as their template their recruitment of staff seems to follow suit.  It is clear from Management to Direct Child Care staff that relationships are the core of the healing approach at Sandhill.  Wrap that up with all the staff having a thorough grounding in neurodevelopment theory and you have a program applying all sorts of playful, rhythmic, sensory and somatic interventions with the children staying there.

Interventions include:

  • Individual weekly therapy for the child
  • Family therapy – both face to face during visits and via Skype sessions
  • Parent training sessions
  • Modelling sessions/co-parenting on site
  • EMDR
  • Animal Assisted Interventions – Horses, cats, dogs, chickens and peacocks.  Including day to day care of animals, as well as play and working with the animals therapeutically.
  • Nutrition – provision of a “brain friendly” diet which strives to use many organic and whole foods.
  • Exercise and recreation – including sports, team building, martial arts and other exercise based activities.
  • Service Learning via voluntary interaction in the community – litter/trash clean up on roads & volunteering at the local animal shelter.
  • Neurofeedback
  • Floating
  • Wilderness Adventure Therapy.
  • Daily education program through Del Rio Academy whereby the students are closely monitored from skilled and attuned education staff and given “brain breaks” when needed to help re regulate.  This involves taking the children out of the classroom in small groups and having them engage in exercise such as running laps, bilateral stimulation exercises, walking and talking and much more.
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Romero House

All of this provided on site or as part of the one program!

Sandhill has capacity for up to 30 children and adolescents at any given time and their average length of stay is around 18 months.  While the lists of interventions is broad, it is by no means all of what they do and one of the lovely observations I made was in fact the individual consideration given to each child’s sensory or regulatory need in the moment and matching all sorts of movement, sensory, mindful, relaxation and/or exercise based regulatory activity to them.

As I left Sandhill I reflected to their staff, that you know a program is doing a good job when the clients come up and tell you about themselves, why they are there and what they have learnt and how thankful they are for the experience at Sandhill.  Even more so when this happens in a house full of preadolescent and adolescent boys!

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Del Rio Swimming Pool

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Del Rio Academy onsite at Del Rio Property

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The Bath House: Home to the Float Tank and Neurofeedback

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Sports Court @ Romero (note trampolines in background)

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Romero Sports Court

 

 

 

 

Animal Assisted Therapy: Assisted is NO accident!

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Pella: Aurora Police Dept.

I took a lot from the Transforming Trauma: Methods for Animal Assisted Interventions, but like any conference, it’s the message you don’t expect to bring home that stays with you and is most powerful.  My prior blog provided an overview of the conference and some of the key take home messages I had and each of those messages are so very important, thoughtful and thought provoking.  I attended this hoping to learn more about AAT and Child Trauma and oh boy I most certainly did learn.  You know what though, I learnt something so very important for the success of AAT that I hadn’t previously considered and I’m so glad I heard this before venturing into AAT in my own work.

Aubrey Fine stated that first and foremost “animals require very skills therapists alongside them”.  The animal is “not a magic bullet on their own” and that in order to do the work properly, professionally and most ethically the human therapist – must be so very well skilled in their field and able to be attuned to picking up the nuances in the human animal interaction.

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Daniel & I

The other take home message for me, was the importance of the welfare of the animal.  This was repeated over and over again during the conference.  As trauma therapists, we all get tired, overwhelmed by the stories we hear and the work that we do.  We seek out supervision, health and wellbeing time and take self care.  It is unfair of us to think that our dog, horse, bird or guinea pig can go back to back in session all day without thought being given to their wellbeing.  As Aubrey Fine said “this work is very demanding on the animals”.  Rise VanFleet said something that will always guide me as I move forward in my exploration of clinical AAT; “the animal must enjoy the majority of interactions and not just tolerate it”.

As I see it, as an animal assisted therapist you need to be a skilled clinician, respect your animal colleagues and be able to manage the multiple relationships that come to exist in the room: you and the client, the client and the animal, you and the animal and the triad relationship.  I suspect a lot of people are drawn to the idea of an animal in the room with them and think it’s easy and just about having the animal there, but you know what? I’ve learnt that this is a very special and demanding style of working that requires unique skill and clinical maturity to really get the best out of the work.

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Transforming Trauma: Methods for Animal Assisted Interventions

Almost a month ago now I had the privilege to attend the Denver University Institute for Human Animal Connection, Transforming Trauma: Methods for Animal Assisted Interventions Conference.  This was a jam packed two days exploring clinical and research approaches to advancing the use of animal assisted interventions in the treatment of trauma.  While there were many fantastic presentations given over the conference, four clinical based presentations really stood out to me: Aubrey Fine reflecting on his many years of using animals in the treatment of child maltreatment, Molly DePrekel who blew me away as she pulled the links between neuroscience, Pat Ogden’s Sensorimotor Psychotherapy work and Animal Assisted Therapy (AAT) together in the treatment of trauma, Rise VanFleet who presented her dynamic work in animal assisted play therapy and Tim & Bettina Jobe presenting on their Trauma Focussed Equine Assisted Psychotherapy model.

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Dr Molly DePrekel

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Dr Aubrey Fine

Each presenter captured and spoke about the human animal connection that allows direct experiential feedback for the child/client.  Treated as a colleague in the therapeutic process the animal (be it horse, dog, lizard or even bird) and the client form a relationship and it is in the context of this relationship that patterns of attachment and relating can be observed.  The animal therapist provides immediate interactional feedback to the client that can then with the assistance of the human therapist can be reflected upon, wondered about and when appropriate redirected with skills development.

So many key messages came from the conference for me and have really led me to the realisation that I need to learn so much more about this work before I bring the new labrador I’m hoping to buy into the therapy room.

Here’s a couple of key messages I took from the conference:

  • In the human-animal interaction look for the reaction of the animal to the client’s presentation, notice it and provide feedback.
  • Notice both human and animal body language and reflect on and wonder about that.
  • Notice your own reactions as a therapist as you watch the interaction.
  • Use the feedback from the relational interactions to adjust behaviour.
  • The importance of wrapping traditional skills development around these observations to change client’s relational and coping styles – for example – relaxation skills, mindfulness, EMDR, self soothing, play therapy etc.
  • Remember that 40% of change in therapeutic treatment has little to do with the technique you are using  – it’s about the relationships and the animal in the room can be a form of social lubricant and initial relational engagement.
  • The importance of rhythm and relationships and the ability to achieve both in equine based mounted interventions using Rhythmic Riding TM and Relationship Logic TM
  • Use the relationship we have as therapists with our therapy animal as a model for healthy relationships for our clients.
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Tim & Bettina Jobe

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Rise VanFleet

 

Want to know more??

Check out:

Rise VanFleet’s Playful Pooch Program (2014)  www.risevanfleet.com

Molly DePrekel:  www.mwtraumacenter.com

Aubrey Fine and his many publications: www.aubreyhfine.com

Tim & Bettina Jobe and their Trauma Focussed Equine Assisted Psychotherapy TM: www.naturallifemanship.com

Therapeutic Preschool: Building Emotional Regulation

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Dr Rick Gaskill: Clinical Director Sumner Mental Health Services

Sumner Mental Health Services provide therapeutic support to the Futures Unlimited Preschools in Wellington KS. Specifically they provide support via the provision of Mental Health Case Management and a role called Individual Psychosocial Rehabilitation workers (IPR), for children classified with Severe Emotional Disturbance (SED). Provision of these services is made available via the USA Medicaid system, and each of the children receiving these services must have met diagnostic classification to receive services.

I observed the absolute value of the IPR role in the preschool setting as I watched an IPR with a 6 year old child with significant emotional disturbance.  From the outset of allocated time, the IPR provided this child with one to one, undivided attention, co-regulation and supported emotionally and developmentally respectful redirection when necessary.  Enacting her role, the IPR was regularly in physical contact with the child in the classroom.  During circle time the child placed herself in the lap of the IPR, leaning back and cuddling into the worker, while the worker provided gentle touch, stroking and running her fingers through the child’s hair.

The IPR worker scaffolded the child from activity to activity in transitions, keeping distractions to a minimum and providing nothing short of opportunities for success for the child, all of this done through largely relational based interaction and regulation.  At the outset of their time, I watched the IPR prepare the child for her impending departure and watched her regulate the rhythm of the hour for the child, so that in the 10 minutes before the IPR’s departure, they moved to a corner and engaged in a quiet activity, drawing together so that their separation provided drawings that could be swapped as transitional objects.  The IPR giving the girl the drawing she had done and vice versa – the child then able to take and keep a piece of her precious IPR worker.  In the two minutes prior to the IPR leaving – the teacher joined the dyad and a process of “handover” occurred and here again while the IPR made her exit, the teacher provided hugs and relational interaction to enable the child to succeed in the moment emotionally.

What really stood out to me was the fact that this child, in the hour supported by the IPR was able to experience success and a baseline level of emotional regulation, contrary to descriptions that had been given of her.  Her IPR remained attuned to her emotional state and danced the dance of catching early signs of emotional dysregulation, such that the child was able to be redirected, be that via comfort, movement, touch or scaffolding to another activity.

Imagine the long term benefits we could achieve if our kindergarten/preschool children who struggle emotionally, received opportunities like this at the time when their brains are still actively organising neural networks.  Could we start to create early changes in neural templates from over active stress response systems and emotional dysregulation to enable younger children a better platform for self regulation?

Therapeutic Preschool: The Safe Place

Sumner Mental Health Services provide therapeutic support to the Futures Unlimited Preschools in Wellington KS.  Specifically they provide support via the provision of Mental Health Case Management and a role called Individual Psychosocial Rehabilitation workers (IPR), for children classified with Severe Emotional Disturbance (SED).  Provision of these services is made available via the USA Medicaid system, and each of the children receiving these services must have met diagnostic classification to receive services.

I really want to spend time reflecting on the role of these IPR workers and the amazing early intervention and skill development they provide to kids between the ages of 0 – 6 years with respect to emotional regulation.  However before I do, one feature of the classrooms really stood out to me and I think there’s some direct application others may be able to use.

Firstly the therapeutic preschool enviornment, like our Kindergartens in Australia, are a wonderful sensory environment, with lots of different activity stations, bright and lively colour, lots of structured, predictable schedules and developmentally appropriate activities for children .  One of the things that Sumner Mental Health and Futures Unlimited have incorporated into their preschool classrooms, which really interested me was the SAFE PLACE.

In each room there is a corner where a little wall juts out and in this space are a variety of sensory toys.  The idea behind this space is that at any point during the day, when the students become dysregulated, upset or need some “emotional space”  they can take themselves to the “Safe Place” and chill out, calm down and then when ready rejoin the group.

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During my visit, I had opportunity to witness the “Safe Place” in action.  After lunch the preschool children had some outside exercise time in the playground.  One of the male students struggled with the transition from exercise to circle time on the mat when they came back into class.  This boy was not a child allocated an IPR who could sit with him, rock him, hug him or co-regulate him, so when his teacher attempted to move him into the next class activity he became upset and tearful.  Instead of creating a scene however or requiring the teacher to stop the class activity and attend to his emotional needs, I witnessed this child get up, take himself to the “Safe Space” corner and cuddle a big green frog.  He kept himself there for a couple of minutes, huddled in the little alcove, cuddling the frog and when he seemed to have calmed down, taking the frog from the safe space, he rejoined his classmates and was able to participate in the classroom activity.

What was clear to me was the expectation and permission that self regulatory self-removal from the activity was acceptable and in fact preferred.  There was little to no disruption to the preschool activity, the teaching or the other students and the time away from task for this child was minimal.  The materials provided in the “Safe Space” were highly sensory and what’s more,  just outside the wall of the “Safe Spaces” were mini trampoline’s for indoor physical movment & activity.  I also really liked that the children could bring items from the “Safe Space” as transitional items to help them rejoin the class, without any comment, restriction or intervention on part of the teacher.

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“Heartwaves”

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“I need to be able to keep myself calm, if I can’t do that then how can I send her the heartwaves she needs to regulate, she needs and relies on my calm heartwaves”.
Tammy: Mental Health Liaison for Head Start part of Futures Unlimited , Wellington KS.

In the days of rest and jetlag recovery before my visit with Sumner Mental Health Services and the therapeutic preschool they provide services to at a Futures Unlimited, I had time to think and reflect on the last couple of months, the many consultations I do with our Take Two staff, but also the direct clinical work I do in my own private practice. With time on my hands and minimal demands on me, some of the struggles we have in our work became clearer.

A large part of the initial work in trauma recovery for children isn’t in treating the child themselves, but rather supporting and educating their carers/parents, workers, and teachers. Essentially it has to be about getting these significant relationships in the lives of children, armed and ready to provide the wrap around support and developmental guidance necessary for the child to heal from trauma.

This is often no easy task. Many of the direct care staff, parents, teachers and workers are at the coalface of the worst emotions and behaviours of traumatised children. Carers, teachers, parents sometimes can’t see beyond the behaviour, others less trauma informed may reinforce notions of the issues being purely behavioural. Often by the time these children get to a trauma informed therapeutic service, carers, teachers and workers are tired, worn out, at their wits end in how to manage these kids – some of them even ready to give up, if they haven’t already.

As therapeutic intervention staff, we can often get so child focussed that we charge on in, giving information and education about why the child behaves the way we do – All of it great and accurate information. Then we find ourselves perplexed that these significant adults in the lives of children continue to engage with the child as they did before, or retreat to explaining the behaviours of the child as naughty.

It occurred to me that we often approach this work with the best of intentions and assumptions that we are working with alert and rational adults. I want to be clear here, on a good day that’s exactly what most, if not all, of these adults are – rational, alert and thoughtful about the children they care for. But when you are under the pump, dealing with difficult, challenging and even aggressive and violent behaviour day in and day out, then maintaining a state of alert and rationality is challenging. In fact, these carers, parents and/or teachers may be stressed, angry or reactive in response to their child’s behaviour.

We know that many of the traumatised children we work with have overactive stress responses, these young people due to infant or early childhood exposure to threat, chaos and danger are ‘wired’ for stress. (Remember the brain organises as a function of our experience.) We know that when we move up the arousal continuum, the more stressed, fearful, aroused we become, or in other words as our state changes we have correspondending changes in our behavior. We become increasingly reactive and more likely to engage in fight/flight/freeze responses. We also know that there are changes in our cognitions or more simply, our ability to use the thinking part of our brains. In fact the more we move into a state of arousal, the less likely we are able to problem solve, recall memory, rationalise, reflect and in fact learn.

This arousal continuum is a universal human experience and with this in mind we can be more clearly directed in our treatment planning. Yes we need to get the direct care staff, parents, teachers and the like to a place of understanding their traumatised children, understanding the child’s self regulatory abilities and the reasons for this and then in turn help them in the support of enhanced coping and regulation for the children.

BUT

If we are going to be truly sequential and systemic in our intervention then we have to notice and respect the state of the carers, parents and teachers of the children we work with. Often time the struggle we have in getting these individuals to be able to learn and hold a trauma informed understanding of their kids is because we are less attuned to their state. Like Tammy said, the client she was working with the day I observed her at Sumner Mental Health and Futures Unlimited, needed her to have calm heartwaves to share for co-regulation. In the same way we need our carers, parents and teachers to have more regulated heartwaves and state regulation to hear, learn and hold the messages we have to give.

I came on this fellowship to explore regulatory activities and interventions for infants, children and adolescents, but many of the things I’m going to observe are going to be equally relevant in the wholistic and systemic work in the therapeutic web of a child. What’s more they are essential in order to ensure those caring for and teaching our clients are really able to internalise and reflect on our psychoeducation.

In essence, when necessary, state regulation of those caring for or teaching our infant, child & adolescent clients, in my mind must be one of the primary treatment goals.