Coming back after a long hiatus, we turn to the social realm and the question OTs are uniquely placed to ask: how does the capacity to regulate let us be social at all? It is an episode about co-regulation as the doorway to connection, about reciprocity that does not have to be equal or sparkly to be real, and about the patience of going slow to go fast.
We are back after an unexpected hiatus, a long lockdown and Cory’s wedding, with a baby on the way in February, and COVID has made the topic feel personal: all of us have felt the tax on our social systems. From there we get into why regulation and social connection are so deeply intertwined. Tracy walks the neuroscience, that the vast majority of the brain is engaged in regulation, from blood pressure and posture up through arousal, attention and behaviour, and that all of it expects to be organised through relationship. Co-regulation is the envelope, and relationship is the bookend of regulation.
Then we get clinical. Cory revisits last episode’s breakthrough, where finding a child’s rhythm opened the door to the social, and Michelle shares a child she is still in the fragile early stages with, who uses her as a tool for regulation but is not yet a partner. That leads to the heart of it: reciprocity is not one fully baked thing. It does not have to be equal, or juicy, or even social yet. It is what is available, met at that level, and deepened from there. Go slow to go fast, hold the high expectation lightly, and trust that the science is the compass while the child holds the map.
Lightly edited for readability. Speaker labels and chapter markers match the published episode.
Cory: This is very exciting for us. Welcome back. We apologise for the delay we have had. Hello Michelle, hello Tracy.
Tracy: It is so great to be back with you, and to know you are safe from several months of lockdown in your country from COVID. We have been plugging along in our own way, as all the countries around the world have approached this in unique ways. I am glad you are safe and healthy. The reason we are back and so happy to be together is we have had a bit of an unexpected hiatus, so we are happy to be back to our Spirited Conversations.
Cory: My wedding was not that long, people will be like, how long does it take a person to get married. We are very excited, and it ties nicely into what we are going to talk about today, because we wanted to dive into the social realm. We started to talk about it at the end of the last episode, and we have totally felt the tax on our social systems that COVID has brought around for all of us. So it is a nice segue, even though the break has not been so nice.
Michelle: It helps us understand how tricky it is. Cory has some other news, did you want to show her?
Cory: Yes, I am expecting a baby in February.
Michelle: So not only have we been isolated and unable to see each other and work together to build this podcast, we sit beside each other when we record, so we have not been able to do that, but I also have not seen her baby bump growing in real life. Now we are getting back together, and seeing Tracy after a while too, and I am so excited I want to touch her baby and cuddle her. I do not even know if we are allowed to do that yet. Coming back together, we have both had to look and go, oh, what’s alive, I am so excited to see you in your new baby form, and it has made me impulsively want to do things I might not have, had we not had such a gap.
Tracy: That drive for connection and social contact includes touch contact, which we have been missing. I miss you guys, being far away, but I have the same urge, I wish I could just be in physical connection with you. The warmth and respect we share in our collegiality is full of the depths of connection, and connection is something we value and bring to our therapy, because we know how central it is. This COVID era has brought that front and centre in a different way than any of us have ever known.
Cory: Totally agree, and this will help us talk about it just as human beings. We mentioned reciprocity as something we look for and try to support in sessions, but as a human being going through this experience, we can feel how hard it is to get into relationship and be reciprocal when you have this big overarching experience making all of us quite stressed.
Cory: So that moves us into what we want to talk about: how does our capacity to regulate allow us to be social? That is really interesting to us as occupational therapists, because not many people come at the social realm from that perspective, though it is starting to get more common. It feels a bit unique to our skillset, how we allow people to connect in the world and engage in their occupations, which we have to do in a social way, because we are social beings.
Tracy: These two topics are so deeply neurologically intertwined, because a variety of different scientists all come to a similar conclusion.
Tracy: Regulation is supported by relationship through co-regulation, but it is also what allows us to become most deeply connected to each other. So the bookend of regulation is actually relationship, and the co-regulation envelope we regulate through is very deeply social, and then it lets us weather the hardest parts of life, which end up being social-emotional at the end of the day. It is a full circle. Should we deconstruct that more, or how do you see it in a way that feels alive to you clinically?
Cory: You bring up something interesting, Tracy. You see the capacities of the people you work with, and people in your life, in a really holistic way, with this clear connection between regulation and our social capacities, an almost infinite circle, as a standard for you now. If I think back to when I first started learning about this, there is no way I intuitively thought regulation and social went together. We often hear, we need to help them self-regulate, but because it is so complex it is easy to forget the how, through co-regulation, and the why.
Michelle: Why are we regulating kids? Why is that important?
Tracy: I love those questions, and I do not know that I have the answer, but I can offer perspectives informed by the science I never stop reading. I love the question, Michelle, why do we need kids to be regulated, and I almost want to dance around that before we talk about regulation. Generally, the way the brain works, if the circuitry is regulated, if the firing patterns are regulated, then the fine-tuning of those networks, the regularity of their on and off patterns, becomes a possibility, and all the fine-tuning happens. On a very real basis, in a neural circuit, you have to have some regularity, and regularity provides the foundation for comparing on and off, do it again, repeat it, and from patterns you build the circuitry. So on a basic level, regularity is one way of thinking about regulation. But really we are talking about a giant set of neural networks. About 85 per cent of our brain is engaged in regulation: basic physiological regulation of blood pressure, breath and heart, then the postural system, then moving from physiology and sensory motor levels into more advanced systems that let us respond to light and day, organise sleep and wake cycles, organise arousal, and regulate our responses to things that activate or deactivate us, that make us feel engaged, wary, threatened or safe. Then our attention has to be regulated, and our thinking, and our behaviour. There are tiers and tiers of this, and all of it, in human beings and other animals, depends on and expects to be organised through connection, through relationship. So when we talk about regulation being connected to co-regulation, it is a profound circuitry totally dependent on the nurturance, structure and support of another. Whenever the edges of our regulation get pushed, we rely on what we find as the secure base and the holding space, and all of that comes from co-regulation and attachment. It is a huge system.
Cory: You blow my mind all the time, Tracy. I am impressed by how much you can verbalise what feels intuitive for you, all founded on neurology and deep learning, because these concepts are really hard to put into words and explain to other people.
Tracy: You are sweet. Back in the 1990s I was drawn to clinical reasoning in occupational therapy, and one of the phrases Mattingly and Fleming use is that in clinical reasoning you take the tacit knowledge and make it obvious, clear and explicit, something you can talk about. So in the last couple of decades my real passion has been helping clinicians, educators and parents put into words what needs to be understood. When we understand children and our work, we help people come into the fullness of who they are. When we cannot name it, we chase it around. I have a colleague here in Colorado, Shelly Lane, a professor and well-regarded occupational therapist, who says that when therapists are uncertain and cannot name things, their needle gets stuck, like on an old record player, in a particular groove. She and I share a passion for helping therapists unstick their needles, partly by being able to say, what is it we are talking about here? In occupational therapy we always connect everything back to that big human adaptation of engagement and meaningful participation. The more we feel regulated and connected and in meaning, the more we bring that to the individuals we treat. So for me it is full circle, about connecting the dots and seeing the neural networks as alive, connected systems. In the Spirit tool that Spirited Conversations is derived from, we literally connect the dots, we take strings and markers in our hands and minds and tangibly manipulate the connections. That is what we are doing in this conversation, connecting these threads.
Michelle: You are helping us bring it back to the neurology, because what I explained is my personal experience, and I want to make sure that is not just my rave, that I am not imposing my embodied feeling on others. Knowing the neurology, I think, oh okay, there is good reason, Michelle, there is a valid reason for why you are going for what you are going for, and there is soundness in finding it for others and helping them find their own groove with regulation and social and emotional connection.
Cory: When you were talking about all those levels of regulation we need to be in the world, I was drawn back to last episode, the child I was working with and how hard it was for both of us to get into connection and any back-and-forth interaction. He was going about the room doing things to help his own nervous system, but it was not hitting the mark, he was trying to self-regulate but could not quite get there. And then, in finding his rhythm, using the kazoos and breath, getting him inverted, rocking him in time to the rhythm he was singing, we were able to move toward being more social. So for me it is trying to figure out, for each child, what is the recipe to allow the social piece to unfold? And when you do figure out the recipe, what happens?
Michelle: You had a shared experience. Before, you were just two humans in the same space, not really interacting or having a sense of togetherness, and then you facilitated him, by lots of means that are really complicated for him to get easily, into a togetherness he responded to differently and kept coming back for more. That is why we want to keep being interested in this area, so we can let him come back for more and experience it with more ease, which allows his capacities to unfold.
Tracy: Absolutely. When we work with children like this, sometimes their inability to settle into the moment means that, for any of the attuned, loving people around them, those moments do not stick or land enough to be repeatable in a way that builds. The unique skills we bring from our training and theory bases allow for a deeper level of attunement, informed by, how do I just hold this moment, how do I exaggerate that best adaptation the child is showing us, that is peeking at us but hard to grab onto? Once you can identify and see that, the child gets this feeling of, wait, you just got me, that felt interesting, I want you to do that again. As we find the elements that allow that opening of connection, it deepens, and it takes a skilled level of tuning in and really feeling their nervous system. That is what you were doing, Cory, really feeling his attempts that were not successful, which is a frustrating place for any of us to be, trying to regulate but nothing is working. When somebody tunes into us, really feels that with us, and allows the attempt to be more successful, the relief and connection you feel from that is, on a deep level, what co-regulation is all about, because it is co, both partners responding and recovering together, moving on the journey together. That shared embodied experience drives it, but it comes from being able to tune in, literally, in a deep way. Clinicians can often tune in differently than other people in a person’s life. Not that parents do not attune, they often really do, but they are living an experience with the child that is bigger than the moment, and we have this gift of being in the present moment differently. That attunement is very vibratory: we feel the vibration of the child’s system and hold it, showing them the direction toward a different synchrony, a different rhythmicity, a more repeatable pattern, a regularity that starts to feel really good and organising to the nervous system. And when the nervous system is happy, it starts to unfold its capacities instead of shutting off.
Cory: After that initial process, it allowed for some imitation I had never seen before. We were not just two human beings in the same space. My take is that he kind of went, oh, you get my rhythm now. He would join for a time, then take breaks, and that is okay, and doing my own regulatory strategies, just knowing his rhythm in the world was that, and if I could respect it and hold it, he would come back and we would do more. So it was trying to stretch and build that in moments. Just coming back is huge, because I was not getting any of that before, it felt like I was chasing rather than holding, and he was coming in and out as he was able to.
Michelle: I am working with a kiddo now who is just learning to trust that I am a tool with which I can offer some regulation. He will come over and bump into me and invert, knowing I will facilitate him to invert with some pressure through his head, and he looks better and comes to me. But I am not yet getting the glimmers, not yet getting the back-and-forth with a kazoo, no imitation. He knows I am a source of regulation, but we are not, so we are moving toward the social realm, but it is super fragile. If he is pacing and running back and forth and I playfully get in the road, he does not know what to do with it, I am just an object in the road, he does not look at me and think, you are being cheeky, Michelle. So it starts pretty fragile. Your experience showed how quickly, for some, it can unfold, though it took you a while to work out. I have not got there with this kiddo yet, so I am going for a glimmer of him not just looking at me as an object or a tool to help him invert, but that spark in his eye that I am human and we can have this thing together that is not just a transaction.
Cory: The imitation piece is really interesting, because you have talked about it, Tracy, as a foundational piece not just for social engagement but for praxis. Once I had figured out the recipe, it did not actually take that long to start to see really different capacities unfold. So Michelle, in my mind, you are still figuring out the recipe.
Michelle: I am still figuring out the recipe, and there is such fragility in that regulation system across all those capacities, attention, autonomic, arousal, action. I am in the really early stages of getting consistent regulation in a consistent, trustworthy way so that will open up.
Cory: In a way it seems like you are trying to get hold of that piece Tracy was talking about, where co-regulation is more powerful, because he is trying to do a similar thing to what my little friend was doing, trying to regulate but missing the mark all the time.
Michelle: And it is not with another, he is using tools, not another, and from the neurobiology Tracy shared, that might get him part of the way, but it is the with-another that is going to stick and hold him. Is that right, Trace?
Tracy: Absolutely. It is reflective of how, for one child, establishing that when you follow my rhythm, when we are in rhythm together, something unfolds, and I am going to stay there with you, and for another child, getting to that level of exchanged, reciprocal rhythmicity is a much harder path. But for both stories, it is the beautiful, intense work of trusting that child’s nervous system, trusting development, and holding it enough that you get to the place where you repeat the pattern. It is so much about repeating.
Michelle: It does not feel social yet. When I was in a swing with him on me, his little legs into flexion, giving a little vibration through the feet into flexion, he was chewing on his chewy, we had Therapeutic Listening on as well, it was lovely. We were together and he was not moving away from that, and that was my point, we were just starting to be together, but it is not juicy and sparkly and reciprocal yet, it is just a being together.
Cory: I resonate with that feeling, because I have been in the exact same situation, where this kid is really enjoying themselves but I do not feel part of it. I can tell the experience is helpful for the child, but I feel like I am just over here, helping them achieve it, moving the swing or providing the input, but there is not a you-and-me-and-this, a being-with-you that helps me feel this way, rather than just the cold delivery of sensation with rhythm. You hit the nail on the head, Michelle, with the fragility, because for your little friend, those pieces Tracy mentioned, being physiologically regulated, then attentionally regulated, if we have not got those together, the individual capacity to manage them is so tricky that it is hard to do both.
Tracy: That is totally right, and there are so many important pieces. The hope and intention we hold for that shared reciprocal exchange feels so good, and we are moving toward it, but what is important, as you hold the space of the fragility, is to not be longing for the connection at that higher level, because it is not quite available to the child yet. It is so much about allowing the regulation they did get to be the actual glimmer. The glimmer does not have to be affective and social initially, it can just be, wow, look what happened, he found his midline, he sustained four repetitions of movement and allowed me to be here with him. That is the first step. The physiological and sensory motor basis of regulation is a precursor to that shared social affect, and the reciprocity that is coming, which are precursors to imitation and higher-level joint attention. Those skills unfold as they do, you cannot force them in, and if you do, it feels like a force to the child, and we are not about force, we are about support, structure, engagement, nurturance and warmth, and unfolding capacity. For each child their individual profile unfolds differently, so we predict, anticipate, support and scaffold, but we cannot force, and if we start to, we give off an energy that contributes to the fragility. One of the hardest things about staying in that developmental space is the patience it takes to hold it.
Michelle: That is a nice reminder, because I am greedy for where I want us to go.
Cory: We all are. Hang in there, you are doing a good job.
Tracy: There is that phrase, go slow to go fast. These kids help us remember to go slow to go fast, and as we take the time to deepen the regulatory framework, it supports more and more complexity when it can. When you get to imitation, so much good stuff happens, it is the gift that keeps on giving. Once your brain discovers imitation, we use it constantly for the rest of our lives. For now, this concept of how co-regulation supports regulation, how one begets the other, this reciprocity within the system, is part of what allows for reciprocity in general.
Michelle: I think that is what is a little uncomfortable for me about reciprocity. I feel like I am facilitating that beautiful regulated state, but I am not feeling in it yet, so it does not feel like a traditional serve and return, an evenness of flow. Can you talk more about that, what is happening for me, and why am I uncomfortable? Therapy for Michelle.
Tracy: I love that, because here is what is interesting: there are degrees. Reciprocity is not one fully baked function that is always this rich, fully me, fully you, full exchange back and forth. Where it starts is in the very early stages, even in utero, hello little love. Reciprocity begins in a deeper knowing of, whatever your experience is, is totally okay, and here is how I am showing up in this moment, and as we honour whatever that person brings to the table and let that be reciprocal, that is where reciprocity starts. So it does not always start from a rich trove of fully baked capacity. To flash forward, even in our adult moments, I might come home with 14 things on my mind, and my husband is ready for me to be fully present, and if I cannot let go of the 14 things, or he cannot let me settle in, we will not have a shared reciprocal exchange that is exactly matched. So equity does not mean equal, and reciprocity does not mean we each bring the same fullness every time, it means the me that is available is here for you, and the you that is available is here, and as we exchange, it becomes richer and fuller and bigger, the circumference grows. As I arrive home and connect with my husband, the connection lets me let go of the other agenda and be more available, and my circle grows. So reciprocity is not one shape or one depth, it is mouldable and responsive, that is the whole point. Just like sensory response and recovery, reciprocity is what is available, and then how does that response deepen in the next moment. The deepening may not be all the way to what you bring, but it is what is available, so match it at that level. Cory, when you talked about the little guy last time, your attunement to, I need to just be with him the way he is, shifted it for you, because you realised it is about following where his nervous system is at and going there. So it is holding the fullness of the expectation at a high level, but allowing the moment to be exactly where they are at.
Cory: Let me reword that to check I have the essence. By being with him and, using my therapeutic use of self, adjusting my own nervous system to match what he needed in that moment, using other things to help me do that, I allowed him to come into connection. If I had not held my own nervous system to match where he needed, he could not have returned it. So as I manage myself to do that, he is then able to return more often, instead of it not being a right match and him disengaging?
Michelle: It allows the possibility, and you honour whatever he does, he tunes in, or moves away, or moves on to another capacity. We have to suspend the, I am carrying all this, I want us to go there, and truly put those agendas aside and be with what he is offering, which was staying with me.
Tracy: And then attuning to the quality that allows an interactive, oscillatory, rhythmic exchange to start. Is it physical, vestibular, rhythm, tactile, positional, affective? For each child an opportunity shows itself, and as you attune to it and the child wants to repeat it, you build the repetition, the cycle, and the trust that it will be reliable. From there you offer another curious expansion, maybe do that on a repeated rhythm a little slower or faster, what happens? We play with temporal qualities, spatial qualities, mutuality. For some kids you can do it through affect, for some you stick with sensory or motor. There is not one way, it is the child’s way, what works for them, and that is what you attune to. The invitation is to go slow, tune into the most salient quality for them, and trust that as you repeat it, you can add layers and complexity and move it toward mutuality and reciprocity, in a soft way, not a forceful one.
Cory: You were saying reciprocity is not always equal between people. In my situation, me doing the adjusting of myself, is that the unequal of it, because as the therapist I am more able to move my nervous system to match his?
Tracy: That is exactly right. And when you have a child struggling more with the unfolding of this capacity, like the kiddo Michelle is talking about, the richness of what he is offering does not feel exactly reciprocal to her, but for him it might be really highly reciprocal. So allow it to be, instead of needing it to hit a different benchmark.
Cory: So it is reciprocal but not social, is that what you mean?
Michelle: How I am interpreting it is, I am not bringing the fullness of me to this relationship. In my intention to be with him, I cannot bring the absolute fullness of me, whereas with you, we can handle each other’s fullness and richness and depths.
Tracy: I love the deep, passionate desire for the full richness of whatever it is to be. But not every nervous system has that same need. Every nervous system has a need to be social, but not every nervous system has a need for it to be that juicy.
Cory: That is why this work has been so awesome, because the kids have taught me that in the most exquisite ways. I have to do that dialling up and dialling down, because some children and people revel in that experience of being deeply connected and buzzing, my nervous system buzzing with shared excitement and joy, whereas for others, go slow to go fast feels so much nicer in a different way.
Tracy: Exactly, and that buzzing feels different for each person. For one it is warm, deeply proximal touch, and another gets the same enrichment from a different kind of experience, so we allow for that full range. In this little guy’s developmental story, his burgeoning, I come to you, is as much as he can do right now, and maybe as much as he can handle right now. As we build his window of tolerance and his capacity, it will deepen for him in the way it does for him, and it does not have to be the way it would for another person. Equanimity is an interesting concept to apply to each of our human experiences.
Michelle: It is so useful to make sense of this for myself and other adults, because we are not all cut the same, nor do I want us to be, that is the richness of life. All my friends are vastly different, they rarely get together because they are like, why are you friends? So sometimes I have to come back to me and how I perceive the world, and then go, yes, that makes sense, and think, of course that is appropriate for all the children and families we meet too.
Cory: I have never parcelled out reciprocity as not necessarily needing to be social. You might just roll a ball toward a child and they pick it up, and in a way that is reciprocity, I did something and you responded. There is still a social element, but how complexly social it is varies for each child. For your little one it is not in any way complex, all he is doing is coming proximally toward you, physically reducing the distance, and you are picking up that signal of, I know what you are trying to get out of this. It does not feel deeply social, because it is way back down at a lower developmental level, but we are doing the work of holding in the place we need to be so we can eventually get there. It is hard to do as a therapist, but it is the mark of a good therapist. You see it when you watch other therapists treat, your nervous system almost feels soothed by the connection of the two people.
Tracy: That is right, and it is such a privilege of our work. I remember years ago treating a little boy who had come in from out of town and was struggling a lot, quite young, three and a half. The family had had a really hard time connecting with him, soothing him, organising his daily routines. We ended up spending long moments together just getting into rhythm. I was a younger therapist and felt a little insecure, he was challenging, they had come from out of town, so I felt some pressure, and I had to tell myself, you cannot be pressured, you just have to be present with this child. We were in a pillow together, he was allowing me to be in physical touch and rhythm with him, and in the back of my head I thought, should I be doing something a little harder than this now? Then I caught, out of the corner of my eye, his mum sitting in the corner weeping. I got from her affect that this mattered, and when I processed it with her, she had never really seen him settle into a routine. Trusting that, when you settle in and help the nervous system feel regulated, feel regular, that is where the power comes from. Most of our theories have regulation as the base for other unfolding, for that very reason. So trust the theories, trust yourselves, you are doing the hard, beautiful, profound work.
Tracy: In Spirited Conversations we often talk about things in a theoretical way and then an applied way, and dance between those places. What I love about these conversations, and the feedback we get, is that the science and the development give us a sketched roadmap, but it is not so much the map, it is more like the compass. We have a compass, and the child actually has the map. The child’s map is something we attune to, while we keep making sure the compass is pointing in the right direction. So these conversations are about allowing clinicians and parents to trust the compass and read the map together.
Cory: That is fantastic, Tracy.
Tracy: That is what the work is about, and it is beautiful. We should just pause on how much we feel the privilege and the beauty of it.
Michelle: It is such a privilege, listening to you help unpack and integrate that theory, and knowing we just keep coming back. I clearly raised that kiddo impromptu because there is something in it I am missing yet, which is why it is, ah, let us talk about that. It is such an honour to have you help me understand the theory and improve my practice, so I can better understand that child’s map and not be a speed bump.
Cory: Speed bump, road bump. Fantastic. Good to be back, guys. See you next time.
And that’s a wrap on today’s episode of Spirited Conversations. We hope this sparks something for you, whether it’s a new clinical idea, a fresh perspective, or just the reminder that you are definitely not alone in this work. If this conversation resonated, we would love for you to share it with anyone on their own learning journey. You can find information about the podcast on our website, and you can join us in the courses and communities the Developmental FX team have put together at developmentalfx.org. And if you’re enjoying listening, please subscribe or leave a review, it genuinely helps more people find us. Until next time, keep the conversations spirited!