All episodes
EPISODE 22

Somatosensory foundations of the self

With Tracy Stackhouse, Michelle Maunder and Cory Dundon  ·  57 min

Quick take

This one goes to the heart of why touch matters, not just for babies and attachment, but for the whole of a life. We follow the somatosensory system from the felt sense of safety in our own skin, to empathy and belonging, to the careful, consent-led work of meeting a child’s need for touch without ever crossing a line. It is warm, a little wide-ranging, and it lands somewhere important: boundaries themselves come from the body.

About this episode

We started this one already mid-thought, with Tracy marvelling at how deeply the somatosensory system is wired into our sense of self. From there it opens out: the research on somatosensory amplification when early attachment is shaky, the way a soothing relationship teaches a baby’s body to trust its own signals, and the reminder, via a paper that calls infant body maps a brand new area of study, that Jean Ayres was decades ahead.

We talk about empathy and belonging as somatosensory acts, about relationships robust enough to carry across distance and time, and about the fine clinical line between not forcing a child and not abandoning them either. There are ball pits and penguin eggs and the small, deliberate moments of shared touch that change how a child shows up. And we sit, honestly, with the hardest part: how to meet a teenager’s real need for connection through touch while holding every boundary that keeps everyone safe.

Key topics and highlights

  • Somatosensory amplification when attachment is shaky. When early relationships do not reliably soothe, the system can start over-signalling, feeling every sensation as a negative. The work is not just physical, it is re-establishing a felt sense of safety in the body.
  • Attachment teaches the body to trust its signals. A baby who is soothed when hungry learns that the signal will be met. Tracy connects that synchrony of interoception, physiology and touch to lifelong regulation, and to what happens when it is missing.
  • Empathy and belonging are somatosensory acts. We take on and feel the experience of the other, remapping it in our own bodies. Kids who do not feel I belong often are not using the shared somatosensory experience, which reframes what we are building in play.
  • Stuck or soothed: reading the quality of touch. The same repetitive-looking behaviour can be a child engaging or a child stuck in a loop. Learning to read the quality of the somatosensory approach is what lets us know whether to enhance it or help them get unstuck.
  • Meeting the need for touch while holding every boundary. Touch is a clinical necessity and a safeguarding responsibility at once. The team talks honestly about permission, body-safety rules, consent in rough-and-tumble play, and why the absence of needed touch is its own kind of harm.
Reflection worksheet, Episode 22
Free to download, yours to keep, ready for your CPD record.
Download
Know an OT who needs this episode?
Facebook
Reviews are how new OTs find us. If the show helps your practice, leave a quick review on Apple Podcasts or rate us on Spotify. It takes a minute and it genuinely matters.
Every new episode and worksheet, straight to your inbox.
Join the list

Reflective practice prompts

  1. How do you understand the link between the somatosensory system and the sense of self? Does the idea of somatosensory amplification change how you read a child who finds every sensation aversive?
  2. Think about your own regulating touch experiences. What helps you feel safe in your own skin, and how does that awareness show up in the way you offer touch to the children you work with?
  3. When a child is touching or doing something repetitive, how do you tell the difference between engagement and being stuck in a loop? What in the quality of their approach guides you?
  4. What are your team’s explicit rules and boundaries around touch, permission and body safety? Where could your psychoeducation with families, carers or support staff be clearer?
  5. Pick one child and design a few small, incidental moments of shared, consent-led touch into a familiar activity. What would you watch for to know it is regulating and connecting rather than taxing?

Resources mentioned

  • Dr A. Jean Ayres, whose sensory integration theory underpins the view of touch and the self running through this episode.
  • Andrew Meltzoff’s 2019 work on body maps in the infant brain, referenced by Tracy. The full citation was not named in the episode, so this one needs filling in.
  • Kim Barthel, referenced for playful, incidental ways to offer touch, like letting children place stickers, or using shaving cream.
  • The body-safety framework the clinic follows, described as the 33 rules of body safety, from a Colorado social worker. The exact source was not named, so this needs confirming.
  • The Harvard Center on the Developing Child, referenced on neglect and early development.

Timestamps

  • 00:00Introduction: touch and the affective self
  • 02:24When attachment is missing: somatosensory amplification
  • 04:16Jean Ayres was ahead of her time
  • 06:58How attachment modulates the signal
  • 11:45Organising the system through relationship, and the long-term stakes
  • 16:17Empathy, belonging and the shared somatosensory experience
  • 19:11Relationships you can carry across space and time
  • 22:17Not forcing, but not abandoning
  • 25:35Stuck or soothed? Reading the quality of touch
  • 29:08Deep pressure, regulation and GABA
  • 33:19The safety platform: comfort, serotonin and oxytocin
  • 37:25The ball pit: delight before connection
  • 41:03Incidental touch, equipment and the egg pass
  • 46:24Touch, boundaries and body safety
  • 49:20Permission and the rules of body safety
  • 53:40Rough and tumble, consent and boundaries from the body

Related episodes

Full transcript

Read the full transcript

Lightly edited for readability. Speaker labels and chapter markers match the published episode.

[00:00] INTRODUCTION: TOUCH AND THE AFFECTIVE SELF

Tracy: I just think it is fascinating how the somatosensory system is connected to the affective self system. The most constructive, important relationships we have, our attachment relationships, grow from this system. So when you are treating, you have a respect and an admiration for the power of touch and of interpersonal, shared touch, in the little moments and the big moments, in our skin-to-skin contact, our hand-to-hand exchanges, brushing into each other’s shared spaces, or even not touching but just sharing space, which invokes the touch receptors even from a distance. It is mind-boggling to me how important it is, not just in the early attachment parts of our world, but forever. Our whole existence depends on it. And, well, we are jumping right in.

[02:24] WHEN ATTACHMENT IS MISSING: SOMATOSENSORY AMPLIFICATION

Tracy: One of the things we are learning about development is that neurodevelopment is, in some ways, the window into anything that goes awry, whether it is your wellness trajectory or the decline that inevitably happens at the end of life. There are these mirrors of development. There is fascinating research about people who have not experienced strong, connected attachment relationships early in life. The nervous system so desperately needs that information that you can project forward and find, say, a university-age young woman struggling with the separation into adulting life, who starts to have all of this somatisation, what is sometimes called somatosensory amplification. She is not feeling well, she feels every sensation as a negative, every time she drinks a glass of water she has a stomach ache. There is a reality to that, it is really happening, but the treatment is not just physical. The treatment is to go back and re-establish a felt sense of safety in your body, and to reconnect to your touch system. Because the touch system is amplifying, a bit like phantom limb after an injury. We get a kind of phantom limb from missing out on the relational experiences we need. So there is a mirror of the sensory-defensive profile we might see in early development as a neurodevelopmental condition, but it can linger or show up in a different way later.

[04:16] JEAN AYRES WAS AHEAD OF HER TIME

Tracy: Sometimes when I read this research my mind is blown, because everyone is coming to a different appreciation of sensory integrative processing. There is a paper Andy Meltzoff wrote in 2019, and he is a very well established researcher in developmental psychology. It is a paper about body maps in the infant brain and how important they are for neurodevelopment, and he ends it by saying, this is a brand new area of study. And I just think, oh, Jean Ayres, you were so ahead of your world. It is astounding to me that this is a frank statement in 2019. It made me chuckle and made me proud of our work in OT and sensory integration, and of course it made me think about Dr Ayres and how far ahead she was, and also, in a small way and sometimes a bigger way, it is a little frustrating. No, this is not new.

Michelle: But do you know what, we just get on with it. I am not in a position to influence Andy, so we just keep going. In Australia there is a podcast called The Imperfects, three clever, arty guys talking about mental health awareness. They did an episode with a GP who covers the medical side of mental health, about accessing mental health services, and she mentioned OT, and the hosts did this huge shout-out to OTs. It was really positive. One of them said, I thought it was just people helping people with occupations, all the classics.

Cory: The classics.

Michelle: Yes, referred to as the classics. So it started this big thread on their profiles about how glorious OTs are. There are pockets of OT-ness out there. Anyway, we digress, you said too many awesome things, Trace. Can I go back? I want to start with the thing that made me curious, your comments about insecure attachment in early childhood. So is that purely relational, where there has been no physical assault, and it is the relational piece, which might mean they did not get soothing touch, were not cuddled rhythmically? There is a touch component to secure attachment, but in the absence of physical assault?

[06:58] HOW ATTACHMENT MODULATES THE SIGNAL

Tracy: Yes, it is not so much in the case of abuse. These are people who grow up in insecure attachment relationships, and as you move forward away from that primary set of relationships, you often carry that attachment style with you. As an adult it would look like an insecure or anxious attachment. You are not avoiding relationships, but you are sensitive to them, and the longitudinal research shows these individuals are super sensitive, their feelings are easily hurt. They are not paranoid, but if somebody looks at them the wrong way, they are sure it is about them. It is a deep insecurity, a deep social anxiety, I do not quite fit here, I wish these people liked me, I do not know how to like them, I do not know how to like myself. What you see in this group is a relational sense of anxiety, but also enhanced somatosensory amplification. The somatosensory system is over-signalling, and it relates back to the way our nervous system draws on the interoceptors and the somatosensory system to give us a sense of, here I am, I get my signals, I know how to use them.

Tracy: And that modulation of the signal comes from the attachment relationship. When a baby is hungry and you soothe them, or let them know food is coming, cuddle them and nurture them and let them know they are okay and taken care of, the signal that you are hungry comes with the message that the need is going to be met. So in the attachment relationship the interoceptive experience, the physiological cue, and somatosensation are beautifully put together. You come to trust, through the cues of the other, that my body is okay, my needs are met. But in an insecure relationship, sometimes I get the need met and sometimes I do not. Then you can get profiles where the nervous system decides, I need to amplify that signal. Keep doing that across a lifetime and this is one of the things speculated to contribute to something like Crohn’s disease, where you are over-signalling all the time and eventually even the nourishment you need does not soothe the need, because it is the mix of physiology and relationship that soothes it. Does that make sense?

Cory: Yes. So in my mind, this individual maybe did not come into the world with any diversity in how they process somatosensory input, they might have come in with perfectly adequate potential for integration. But their early life experiences may not have optimally organised that system, because so much of it is done through our early caregiving experiences. So they may not have had the chance to organise, or to receive soothing somatosensory input through a consistent relationship. Is that what you are saying?

Tracy: Yes.

Cory: So they did not have the ability to get somatosensory input through a positive relational experience, and early on, as you said, the nervous system has this almost phantom-limb experience of that. I have the need for that opportunity to be created, so my nervous system can reorganise the experience in a way that is helpful and modulatory for physiology, like you would for a baby?

Tracy: Yes.

Cory: So as OTs, we are aware of attachment, and some of us do a lot of extra training on the mental health side, but in general our skilled training is around the sensory integrative component, and we are always working through a relationship. In terms of adding to this treatment space, we can advocate for these people to have positive somatosensory experiences in relationships. Is that right?

[11:45] ORGANISING THE SYSTEM THROUGH RELATIONSHIP, AND THE LONG-TERM STAKES

Tracy: Yes, a hundred percent. And in the children we see, some do arrive with some kind of neurodiversity in how they process, which can make it harder for them to respond to the caregiving that is provided. So we do not always know the direction of it, and those kids can be more vulnerable to lifelong issues without treatment. Some people still have this incorrect idea that kids might just outgrow these issues. The longitudinal research tells us that allowing for sensory processing differences, or the inability to engage in the full range of sensations the nervous system expects, has a long-term implication for our wellness.

Tracy: That is a different aha for us to take a breath around. We know the power and importance of this work, but this sheds a different light on how critically important it is. We think about adaptive responses all the time, building the capacity for skilful motor planning, like we talked about last episode, or feeling comfortable in the skin I live in and good about how I navigate the world. But there is a deeper level of wellness that can be affected by altered sensory processing. Whether the difficulty is inherent to the child, or comes about because the lived experience did not match what they needed, in either case there can be long-term repercussions that go all the way to the core of how their physiology works. It is important to pause on that. The somatosensory system, our skin, the whole surround of us and what we take in continually, is telling us about ourselves, and that is critically important.

[16:17] EMPATHY, BELONGING AND THE SHARED SOMATOSENSORY EXPERIENCE

Tracy: It is also connected to how, as we become who we are, we are exchanging in relationship with other people. The somatosensory system is the primary system that helps us have empathy and connect to other people, because what we literally do is take on and feel the experience of the other. When I notice your face shift into an aha, I take it in and feel it, my mirror neurons recreate it, and the empathy circuitry lets me know we are on the same page, or not. As we connect, share and grow our shared experience and co-occupy moments in time, that is how we become who we are. So if our somatosensory system does not let us do that well, we are at a real disadvantage for having shared moments of connection, building friendships and relationships that are meaningful, and feeling like we belong. When we work with kids who do not have that felt sense of, I belong, it often goes back to them not mapping and remapping the shared somatosensory experience. So we work on that. It is not just, let’s play in a bin of beans, it is, let’s really join together in shared experiences where my body and your body are moving in synchrony in meaningful ways, exchanging things, having shared tactile moments, connecting. Those are real things kids need, and we need.

Cory: And in that process we might amplify certain components, so that the interoceptive, tactile and proprioceptive systems can take on that experience. We are supporting the integration of the relational and somatosensory experience coming together to support that sense of self, and then playing out in their other relationships, so they can build that capacity across their lifespan and support their wellness. You go, Michelle, because I feel like you had things to say, and this also brought up the whole neurodiversity conversation for me.

[19:11] RELATIONSHIPS YOU CAN CARRY ACROSS SPACE AND TIME

Michelle: Absolutely, Cory. When you do that proximal interchange, relational and tactile and going backwards and forwards, what comes to mind is this quality of being able to cross space and time. When you have some robustness in a close relationship, you can get further away and they can still hold that felt sense of you. So when that young woman went to uni, or when Cory moves to Brisbane, or with Trace in the US, we have had time together, we have hugged and played and cried, we have shared emotion and shared touch in lots of contexts. So I feel you, I relate to you across countries and across time, and even when we are just texting, I feel you. I wonder if that young woman who went to uni, who did not have that foundationally, even at that very close distance, could not hold onto that felt sense of relationship and somatosensory experience when she went away. If it is not robust, it is not transportable across time and distance.

Tracy: Absolutely, that is true. It is part of our resilience factors, the way we transport our resources to use them in different situations and relational contexts. We have to prime the pump in the attachment relationship, so that when we show up in a uni setting we can create healthy, strong attachments with people who are not our family. Maybe we do that with a pet, or we go horseback riding and that becomes our lifeline. People do a lot of different things to find that connection, but they can also fall quickly into maladaptive patterns and unhealthy relationships, partly because they cannot transport the kernels of richness that let them foster those relationships. Then you become vulnerable to feeling lonely and isolated, and to substituting relationships with other things.

Michelle: Risky behaviours, yes.

Tracy: Risky behaviours, hyper-focus on anything.

[22:17] NOT FORCING, BUT NOT ABANDONING

Cory: I want to come back to the fact that it is almost remiss of us not to support these functions to come together to a greater capacity for the people we support. There is a lot of awareness at the moment, and I think it is a really good thing, around not forcing compliance and respecting the individual. OTs have been good at those two things for a long time, though some of us could have been better. I have always been aware of how uncomfortable it feels when you get into a, we are doing my idea, situation, my internal sense was always, this is not helpful. It was always about finding the juice and the sparkle, what creates more adaptive function, more possibility and choice for that person. So I like that we are focusing now on not forcing people into experiences that do not match their nervous system, or making them follow societal expectations. But I worry that at moments we might go too far and not support them at all, in a way that is individualised and helps them find more adaptive ability in their own nervous system. We need to get the balance. If you have a kiddo who, say, has autism and is not regulated, they might pace back and forth, or stand at the window and flick the cord, whatever helps their nervous system feel better. We worry about people forcing interaction in those moments when a kiddo needs a break, and rightly so. But I also never want to leave that kiddo completely unanchored. I want to find the right recipe to support them in those moments, not forcing interaction, but supporting their ability to reorganise their sense of self and find alternative ways of experiencing their world. Am I being clear?

[25:35] STUCK OR SOOTHED? READING THE QUALITY OF TOUCH

Tracy: Yes, you are. What you are speaking to is exactly the foundation of our passion for occupational therapy and the work of Jean Ayres, that we want people to have the freedom of adaptation. The thing that happens when you have restrictions in processing is that you lose your freedom of choice. There are lots of new voices, especially autistic voices, saying, when I was looking out the window for 45 minutes and could not look away, I needed you to help me, because I was stuck, and it feels terrible to be stuck. So we have to deeply attune to discern, are you stuck, or is this helping you? That discernment can be very tricky, and it comes back to understanding how basic sensory integrative processing works. If you notice a child repeatedly touching something, and you watch the motor pattern and see that the touch is not really the quality of, let me reach out and engage with this, but more of a repetitive pattern, that difference matters. The somatosensory processing that lets you skilfully reach out to engage looks different from being stuck in a loop. Once you learn to look through that lens, you notice, this does not look like it is producing a higher-level adaptive opportunity, it looks stuck. Then you can be a conduit that says, you are kind of stuck here, let’s help you get unstuck, or, you are really reaching out and enjoying that, let’s enhance and augment it. We are good at that, because we know how to notice the glimmer, the quality of approach in the action pattern, whether it is organised or disorganised, and to regard all of that as nonverbal communication that carries meaning, rather than just labelling it as repetitive behaviour.

[29:08] DEEP PRESSURE, REGULATION AND GABA

Michelle: I often wonder, Tracy, because soothing touch and deep pressure input can have a modulating or inhibiting, down-regulating effect on the nervous system. So in addition to what you mentioned, something I am working out is, is the touch you are doing actually regulating? It is not just that they are exploring the thing. When it does not have that exploratory quality, and perhaps it is repetitive, does it look organising, not necessarily in a motor or discriminative sense, but in a regulation sense? There is a down-regulating quality to it as well, and that is something I look out for, because it has a different quality again, as if it is looping. Do we want to talk about deep pressure and regulation and GABA?

Tracy: Oh yes, I think we should.

Cory: I was going to say, Tracy, last episode you talked about these receptors being very GABAergic, releasing a lot of inhibition. So if you provide input to the somatosensory system in a deep-pressure, organising way, it is very GABAergic and it down-regulates the nervous system in a helpful way. And you were saying earlier that the individual who missed the modulating experience through relationship ends up with an almost unmodulated physiology, because it has not had that down-regulating, relationship-based somatosensory experience. So no wonder we go to that as a strategy, because we know neurologically it is a function of that system. You can never really take the relationship out of it, but even on its own, we know somatosensory input has that effect. So we often try to enhance it or find ways it is organising the child. When they are seeking movement or touch, but it does not seem to be exploratory, we wonder if we can get in there and enhance it, or provide a similar but bigger or more adaptive experience, as long as we are finely attuned to their response. We can tell whether what we are doing is taxing the nervous system further, whether our relationship is too much, and if so we back away, respect the response, and decide that is not the way in. Or we find something that supports the child to find an alternative way of organising the input, and you see it in their body, softening, coming into themselves, and now there is possibility, I am not just doing this activity, I am making a choice, showing intent in a different way. It is that dance, and we are always attuned to whether our contribution is supportive or needs to be backed off.

[33:19] THE SAFETY PLATFORM: COMFORT, SEROTONIN AND OXYTOCIN

Tracy: Absolutely. And if we identify that the level of comfort this person is experiencing is not wide enough for the range of experiences possible in this moment, then a lack of comfort restricts engagement, and restricted engagement restricts participation. That is the slippery slope. So we ask, what is my best opportunity to go back to the source of it? If it is, let me help you find how pressure creates a wider window of comfort, then that pressure input allows the next higher level of engagement, which allows a higher level of participation. We can unwind it in a positive way by getting to the source and creating that slate of open comfort and safety. Very often the somatosensory system is critical to that, because we use the pressure receptors that give us inhibition and create a safety platform to operate from. When I feel safe in my skin, it is easier to decide to reach out and touch something in my environment. If I am literally not feeling safe in my skin, the possibility for engagement and participation is so limited.

Tracy: The somatosensory system does this both through the pressure inputs themselves, which are so down-regulating and invoke GABA, and through the social touch space, the social haptic space, the touch, proprioceptive and visual system, with you here sharing it with me. As we invoke that, we get the possibility of substances like serotonin telling us this feels good and soothing and curious, and then the hormonal system, like oxytocin, saying not only does this feel good, it feels enriching and nourishing, connected and shared. Even for a person who comes to the world with neurodiversity, the nervous system uses the same systems to say, this is what soothes me. For everyone we treat, I would love it if every time we create a treatment plan we included the questions: do I know what soothes this child, do I know what reassures this child, do I know how to encourage them with gentleness, and with vigour, do I know how to help them find zest and glimmer, and can I find that whole range? Most of the time that will include the somatosensory system as a partner, because the colour of that affect comes from somatosensation. It is a sensory-affective pairing that lets us understand the range of comfort to discomfort, and the range of engagement that is possible because of it.

[37:25] THE BALL PIT: DELIGHT BEFORE CONNECTION

Michelle: So good. I have a funny little story that might illustrate some of that. I see two brothers, both neurodiverse, and the family travels a distance to the clinic, so I do them in tandem, 20 sessions with one and 20 with the other, and they often invite the other brother in. I had my sibling session yesterday. We have a ball pit, thank you Cory, filled right to the brim, and they knew it was on offer. One brother, who sees me and has had his fill of it, came in ready to play, saw the ball pit, crashed in, had 30 seconds of his thing, and then was like, okay, let’s be social, and went into their hide-and-seek and chasey game. The other brother, who I had not seen for three months, came in, saw me, and we love playing together, and then saw the ball pit and was torn, which one will I go to? He dived into the ball pit with his brother and did this starfish, swimming on his back to nestle in. The balls were all over his face and he just stayed there, still, and he is not a still kind of kiddo. I could see him delight, anticipate what was coming, choose the ball pit over me, which is amazing, and then nestle in and feel the impact of the balls, the light touch, but heavy because there are so many of them. A wave went over his face of, oh, this is so delicious. His brother was urging, come on, let’s go, we had soft toys ready to bury, and the older brother had his stopwatch out, but the younger one, who had not had his fill of that input for a while, took ages. He eventually poked up and looked at me with these gooey eyes, just in love, a deep sense of deliciousness. Then he got adaptive and played, and used the balls to hide things, but he did not want to be pulled out of that to be in the busy, social game. I just thought I would share, because it was exactly what we have been describing.

[41:03] INCIDENTAL TOUCH, EQUIPMENT AND THE EGG PASS

Cory: It is funny, because the balls really enhance tactile input to the whole body, a real, here you are, as many receptors as I can activate as I get into the ball pit. But I was thinking about the incidental moments, the ways we can find incidental positive experiences of tactile input in a really safe relational space. In that case, Michelle, it was the equipment that allowed it, and we absolutely use equipment that way, that is why we train, to know how to use it to get the responses we are hoping for. I have done things from the ball pit where I have had kids climb into the top of the lycra swing, then covered them with the balls, and we shake and move in there in a really rhythmic way. It depends on the kiddo, you are just trying to find, do I know what soothes that child, what brings the zest? Tracy talking about incidental moments made me think of Kim Barthel, because she talks about ways to do this even without equipment, getting out stickers and letting them put stickers on you, and then they want you to put them on, where do you want me to put it, and you place the sticker. There are similar things with shaving cream and other things we do that other people would look at and go, what are you doing?

Tracy: Yes, for sure. When I am treating I am so aware of those opportunities all the time. I love this little penguin game called Pengaloo, where you hide eggs under the penguins, with these colours, like a memory game. I do a lot where, as we set up, I hold the eggs in my hand and on purpose pass them to the child one at a time, compressing each into their hand with a little pressure and holding for just a second, so we have a really meaningful moment. We are focused on setting up the game, but we are having these tactile exchanges. I remember playing it in a session where the mum noticed how I was doing it, and I had been talking with her about enhancing these opportunities. She went home, and while they were practising setting the table for dinner she did the same thing, taking the spoon and handing it to her daughter with a moment of exchange, then letting the action finish, infusing it into these little daily moments where now my hands are in contact with you and we are in synchrony. And then when I drop the egg and say, oh no, the level of empathy and shared problem-solving that child shows, compared to 15 minutes earlier when we were not in tactile communication, is strikingly different. How we build strong, healthy communities is by having strong social cognition and empathy and shared actions where we are in touch with each other. You guys living in the country have more chances to just go and pick oranges together, we talked about oranges many podcasts ago, but here we do not have as many of those opportunities unless we cultivate them.

Michelle: You’ve got pickleball.

Tracy: Pickleball, gardening, playing with animals, playing in nature. But when we are in nature, we are not just playing in nature, we are looking for opportunities for enhanced somatosensory and movement exchanges. That is the lens sensory integration brings to our work, and it is so vital, because these are the real neuro-vitamins, what your brain needs to put the world together. So we have to think about it, enhance it, augment it, and create opportunities. Look how cool it is when we discover together that sharing a moment of caring for the little penguin egg is the best thing that happened all week. Connection builds wellness.

[46:24] TOUCH, BOUNDARIES AND BODY SAFETY

Michelle: Through this whole episode I keep thinking about kids with neurodiversity and communication challenges who might misinterpret touch, and about facilitating them to understand what is appropriate and not. I am working with a teen at the moment, neurodiverse, with early childhood trauma, ADHD and autism. He is 14, he stands really close to people, he has a tic that has moved into his throat so he makes a sound, and he touches kids a lot, on the arms, the shoulder, popping them on the head. I am trying to thoughtfully and respectfully bring attention to the potential impact, and the miscuing that staff in particular might be feeling around that cluster of behaviours, and to make sure everyone feels safe and that he stays connected without needing to touch. But I want his needs met, he wants to come in close and be with people. He is in out-of-home care now, which makes it tricky, because the staff legally are not allowed to hug him or touch him in the ways a young boy might typically receive. When you explained the nuance of lingering touch, Trace, that we accept in younger kids, with him it starts to move into an area where I think about sexualised behaviour, or touch-seeking for connection that can be misinterpreted, and some of the kids we work with are vulnerable that way. There is miscuing in the other direction too. Some kids have carers and educators who give them lots of hugs and kisses on the cheek when they do well, with the loving intention to care, but those kids are vulnerable, and it is not too many years before they move into the territory I just described. It is complicated. What is okay through touch and relationship is really nuanced across different people.

[49:20] PERMISSION AND THE RULES OF BODY SAFETY

Tracy: Yes, it is completely critical. Part of the landscape we enter when we talk about touch is that my interpersonal space and your interpersonal space have boundaries to be regarded on every level. As professional deliverers of exchanges in the interpersonal space, we have to deeply regard those boundaries and understand what is at stake. We are working with vulnerable populations, and we have to follow the rules of that. The rules of engagement are always around permission, and permission gets really complicated when someone is living in a situation where their rights are restricted because they are not being cared for by a family. Those individuals are more vulnerable to lifelong difficulties related back to not having the experiences and relationships they needed. So in our context, we make sure there is safety, that there are other people around, that we never do private things in private, that we talk about body rules and boundaries as part and parcel of what we do, and that we use really careful psychoeducation with everyone and are explicit about the rules we follow. We have adopted what are called the 33 rules of body safety, from a social worker in Colorado who has written extensively about this and has interviewed people who perpetrate these boundary crossings, to learn about it as deeply as she can. In every culture we have to be aware of all the rules and boundaries, it is incumbent on us, and it is not a topic to take lightly. But we also have to know that the cost of not delivering touch is damaging. I almost said it is equal, but I stopped myself, because there is no qualitative way to know the deepest impact on a lifelong journey. We know that abuse is terrible, and that the absence of the experience we need is also terrible, and both are damaging. So we have to be aware of all of those levels.

Cory: I just read on the Harvard Center on the Developing Child that they have eight key things for development to keep in mind, and one is that neglect can be as impactful as other negative experiences. Like you are saying, not providing the opportunity can feel, to the nervous system, like a kind of neglect. I was thinking about your kiddo, Michelle. It is a whole process as a team: okay, there is an unmet need here, what are our boundaries, we do not want him to stand too close, we feel uncomfortable with that, so how do we get the need met, respect our boundaries, and keep him safe? It is just like this conversation, and I am sure you are doing exactly that. You are respectfully helping him understand that he is miscuing people, because you can see the need, and you are restoring that for the people around him.

[53:40] ROUGH AND TUMBLE, CONSENT AND BOUNDARIES FROM THE BODY

Michelle: And I hope I am doing it in a way that breaks it down, because in part he really wants rough-and-tumble play. So we do ball wrestle and soccer wrestle, going right back developmentally, but there is a physicality in it, and we do the check-in. We pause, and alongside all the other things you do in a ball wrestle, it is, oh, I just half-squished your leg, is that okay? Oh, I pushed you over, was that ball too hard? It felt a bit un-automatic and weird at first, but it is a way to ask, are you okay with that. Squishing a leg, that is fine. Your hand there, no, move your hand away. So through the ball play and the rough and tumble, a physical game that has us in close proximity, we do this consent, is that all right with you, is that all right with you. And he started to say things back, like, you have coffee breath, that is too close. So it is not just me saying no, your hand off my hand, it is him saying, I do not want your mouth breathing on me. I am also working with his support workers at home to see how he can get moments of tactile intimacy, because the rough and tumble and sideways cuddles and fist pumps are allowed, and the more playful ways to get connection and tactile input are easier, particularly for a teen. But I want the softer flavours too, because he needs that as well. So how can we build a handshake that involves a squeeze and a pat on the back, or a rub on the head, laden with emotion and relationship, but less likely to be misconstrued as intimate touch? It has been interesting listening to this, because I think we get it. There was a little boy yesterday, three years old, getting so excited at the end of the session, and when it was time to say goodbye he came up and put his hands as if about to touch either side of my face. I did not know what would happen next, whether he would touch me or come in for a kiss, but he stopped his hands about 10 centimetres from my face, and just went, oh, you, and I felt, oh, I am going to miss you, see you next week. It was crossed touch, we did not actually touch, I did it back to him, but it was so deeply tactile-infused. And you said that at the start, Trace.

Tracy: Yes, that is right, and I love that story, because boundaries come from the somatosensory receptors. That was the signal he got: I love you so much that I want to touch you, but this is as far as I am going to go, because that is what feels right and safe. He felt all of that through his somatosensory system, through his polyvagal circuitry, and he honoured it, and you honoured it and reinforced it. So boundaries are not always about following rigid rules, which we sometimes need, they are about respecting the signals, living by them, and learning to trust them. That is beautiful. I love that.

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!