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22. Somatosensory Foundations of the Self

This episode we discuss the importance of the somatosensory system in forming our sense of self through our relationships and how it shapes neurodevelopment. We explore how individuals who have not experienced secure attachment early in life may struggle with somatosensory amplification and somatization later on. We chat about the role of touch in creating a sense of safety and connection, and how sensory integrative processing can impact overall wellness. If you’re curious about the need to balance and respect boundaries while providing positive somatosensory experiences for individuals with neurodiversity this episode is for you. Hopefully, like we did, you get a deeper appreciation of the power of touch in building empathy, shared experiences, and a sense of belonging.


Tracy: I just think it's like fascinating how the somatosensory system is connected to the affective self system.

Cory: Oh,

Tracy: you know, in, in the most constructive, important relationships that we have are attachment relationships.

They, they grow from, from this system, right? So I, I think understanding that so that when you are treating, you have a respect and an admiration for the power of touch and the interpersonal shared touch. And in the little moments and in the big moments and in, in the way that our skin to skin contact, our hand to hand exchanges are brushing into each other's shared spaces or even not touching, but just sharing space and, and what that means in, a shared environmental exchange that invokes the touch receptors even from a distance.

It's really,

Tracy: just like mind boggling to me how important it is not just in the early attachment parts of our world, but forever. Like our whole existence depends on it. Yeah. And then, well, we're just jumping right in.

Cory: Yeah, a hundred

Tracy: because

there's also this kind of, you know, one of the things that I think we're learning about development is that neurodevelopment in some ways is the window into anything that goes awry, whether it be your wellness trajectory or the decline that inevitably happens at the end of life.

Michelle: Hmm.

Tracy: So there's these mirrors, right, of development, and there's this kind of fascinating research about people who, uh, have not experienced strong, connected attachment relationships early in their life. The nervous system so desperately needs that information that then you project forward and maybe you have, let's say you have a college age, university age, young woman who's struggling now with this separation into this adulting life.

And they start to have all of this somatization, this kind of somatosensory amplification is one of the words that's used for it. Where they, they're. not well, they're not feeling well. They feel every sensation as a negative. They're feeling, you know, every time they drink a glass of water, they have a stomach ache.

And, And there's a reality to that. That's not to say that that isn't really happening, but the treatment isn't just the physical treatment. The treatment is to go back and reestablish a felt sense of safety in your body and to reconnect to your touch system.

Because the touch system is amplifying just like it does phantom limb, when somebody has an injury. We have phantom limb basically from a missing out in the relational experiences that we need. So there's this kind of mirror of the sensory defensive profile, that we might see in early development as a neurodevelopmental condition, but then it can have this lingering effect or show up in a different way later.

And sometimes when I read this research, and I'm just sort of like, my mind is blown, you know, on everyone is coming to a different appreciation of sensory integrative processing. Scientists, like, there's a paper that Andy Meltzoff wrote in 2019 and he, he is like a very well established esearcher in developmental psychology.

And he ends one of these papers, um, I'm trying to remember. It's a paper about body maps in the infant brain and how important they are for neurodevelopment and he ends it by saying in 2019 he says, this is a brand new area of study . And, and I just think, oh, oh, gene Ayres, you were so ahead of your world

because it just is like astounding to me that is like a frank statement. I just read it in this paper thinking about what we might talk about today. And it kind of made me chuckle and it made me proud of our work in OT and sensory integration, of course made me think about Dr. Ayers and how far ahead she was and also how in a little micro way and sometimes in a bigger way, it's a little frustrating.

Like, no, this is not new. Um,

Michelle: Yes.

Tracy: right.

Cory: Yeah.

Michelle: but do you know what? We kind of just get on with it, and I'm not in a position to have any influence over Andy, but it, you know, it's like, oh, we are just gonna keep going. In Australia there's a podcast that just launched, a episode, it's called The Imperfects. It's three, clever arty guys getting together, but they're talking about awareness about mental health. They've done an episode with a GP who often can do the GP ness side of, mental health.

Anyway, she did one about accessing, mental health services, mentioned OT, and the guys who host the show do this huge shout out to OTs. And it was really, really, really positive. And one of them's like, oh, what is it? Two of them really knew about it. And then he said, I thought it was just people helping people with occupations, you know, all the things

Cory: The classics

Michelle: referred to as classics. Yeah. So it just started this big train on their profiles about how glorious OTs are. So there's pockets of OT ness. Anyway, we digress. You said too many awesome things Trace to even get caught up in that. Can I just go back? Ugh. Where do we wanna start?

I kind of wanna start the thing that made me curious. Is around your comments about, the researchers are saying that if you have, attachment that is not secure in your early childhood, so is that, that's just from a relational and that's where there's been no physical, assault or anything really of a physical nature that might trigger that it is the relational piece, which may mean that they didn't get soothing touch and, you know, cuddled rhythmically.

But, so there's a touch component of, secure attachment, but, but it's in the absence of physical, assault?

Tracy: Yeah, so it's not so much in the case of abuse. These are really people who

Michelle: No.

Tracy: grow up in insecure attachment relationships. And what happens as you you know, move forward away from that primary set of relationships is that you often carry that attachment style with you. So as an adult,

 It would really look like kind of, an insecure or anxious kind of attachment you're not avoiding being in relationships, but you're sensitive to relationships and the research, the longitudinal research shows that these individuals are super sensitive. They're like, easily, their feelings hurt.

They often feel that people, they're not paranoid really, but they're really aware that, if somebody looks at them the wrong way, they are sure it's about them. And it's this deep insecurity, this deep sense of social anxiety. I don't quite fit here. I wish these people like me, I don't know how to like them.

They don't know how to like me. I don't know how to like myself. It's this kind of strife happens and not feeling like I accept myself, people like me, or they don't. But it doesn't, you know, when people like me, I can draw resources from them. enjoy them. I can utilize that relationship.

So what you see in this group of people is that they have this relational sense of anxiety, but they also have enhanced, it's actually the phrase that they use is somatosensory amplification. So the somatosensory system is over signaling. It's sort of amplifying and it's doing it in a way that is related back to the way that our nervous system draws resources from the interoceptors, from the somatosensory system to give us a sense of.

Here I am. I get my signals. I know how to use those signals. And that mediation of that, the modulation of signal

comes from the attachment relationship. So when a baby is hungry and you soothe them, or you let them know food is coming, and you cuddle them and you nurture them, and you let them know you're well, you're okay, you're taken care of, you are getting a signal that you're hungry and that need is going to be met.

So in the attachment relationship, the synchronization of the interoceptive experience, the physiological cue, somato sensation is put together. It's, it's like beautifully put together in the relationship. And so when you come to trust through the cues of the other, my body's okay. My needs are met, I'm taken care of when I get hungry, thirsty, tired, when I don't feel good, I'm okay.

And I get that soothing and I get the reassurance that the signal of hunger is going to be met. But when you're in a relationship that is insecure, sometimes I get that need met but sometimes I don't. Then.

Michelle: Hmm,

Tracy: you can have these different profiles where the nervous system says, I need to amplify that signal and then if you keep doing that over your lifetime, you can, this is one of the things that is speculated to cause like Crohn's disease, for instance, where you are over signaling all the time and then you end up in a process where even the nourishment that you need doesn't soothe the need.

That what? Because it's the mix of physiology and relationship that needs to soothe it, if you will. Does that make sense?

Cory: Yeah. So in my mind, this individual, maybe didn't come into the world with diversity around how they processed somatosensory input like they might have come in with perfectly adequate potential for integration around that input. Um, but their life experiences early on may not have optimally organized that system. Because it's all done through our early caregiving experiences and all that input is so intricately organized in that way. So they might not have had the chance to organize or receive soothing somatosensory input through a consistent relationship. Is that what you're sort of saying

Tracy: Mm-hmm. . Mm-hmm.

Cory: Then they didn't have, I guess the, that piece, the ability to get somatosensory input through a positive relational experience has been missing for them, so early on you said that, that our nervous system kind of has this almost like phantom limb experience around that. I have that need for that opportunity to be created or so that my nervous system can reorganize this experience in a way that's helpful and modulatory for physiology. Like you would a baby right?

Tracy: Yeah.

Cory: So, as OTs like, yes, we are aware of the attachment, we are aware of that piece and some of us go and do a lot of extensive extra training around the mental health side of that. But in general, we tend to, have skilled training around the sensory integrative component of it. And we're always doing our interventions through a relationship but I guess in terms of adding to this treatment approach or space, we can advocate for these people to have positive somatosensory experiences in relationships, I guess. Is that right?

Tracy: Yeah, that's a hundred percent. That's a hundred percent right. I think it's also that, in the children that we see, some kids do arrive with, some kind of neurodiversity in the way that they process. And so it might make it harder for them to respond to the caregiving that is provided.

So we don't always know the direction of that. Right? And so then those kids may be, again, without treatment, a lot more vulnerable to lifelong issues. Sometimes people, still have this incorrect idea that kids might just outgrow this, or these issues that identify.

Cory: Hmm.

Tracy: you know, some of this longitudinal research tells us that the

implication for just allowing for sensory processing differences or the, inability to engage in the full range of sensations that typically are expected by the nervous system. That there's actually a long-term implication in our wellness for that.

And I think that that's

kind of a different aha for all of us to collectively take a breath around and just say, wow, you know, we as OTs know the power and importance of this work, but it in a way it sheds a different light around how critically important it is because, we think about the adaptive responses all the time. We're trying to build the capacity for, skillful motor planning we talked about in the last episode, or we think about, feeling comfortable in the skin that I live in and feeling good about how I navigate the world based on this is who I am in the world.

But there's a deeper level of wellness that can be impacted by altered sensory processing. And whether that sensory, integrative processing difficulty is inherent to the child, or it's comes about because of the lived experience doesn't match what they need in either case, there can be these long-term repercussions that go all the way to the core of how their physiology works.

And I think it's important to, to pause and think about that. But then also just, the somatosensory system, our skin are, you know, the whole surround of us and what we're taking in continually and how it's telling us about ourselves, is critically important.

And we can talk so much about that, but I think it's also connected to, as we become the people that we are, we're exchanging in relationship with other people. And our, somatosensory system is also the primary system that helps us to have empathy that helps us to connect to other people.

Because what we literally do is we take on and feel the experience of the other person. And as we remap, when I notice your, your face gets an aha and then I take in the aha and I feel it my mirror neurons recreate it. And the empathy circuitry allows me to say we're on the same page or not.

And then as we connect and share and grow our shared experience and we co-create. Co occupy moments in time. That's how we become who we are. So if our somatosensory system doesn't allow us to do that, well then we're gonna be at a really significant disadvantage to being able to have shared moments of connection, know that we're building alliances and allyships and friendships and relationships that are meaningful and to feel a part of, and to feel like we're connected and we belong.

And when we work with kids who, don't have that real felt sense of I belong, it often goes back to they aren't mapping and remapping and using the shared somatosensory experience. And so we have to work on that in our work. It's not just let's play in a bin of beans, but let's, let's really join together and have shared experiences where my body and your body are moving in synchrony in meaningful ways where I'm exchanging things with you and having shared tactile moments and that we're connecting. Those are all really real things that kids need and we need. Right.

Cory: And, and that in that process we might amplify certain components so that the somatosensory systems, the interoceptive system, the tactile system, the proprioceptive system can take on that experience I guess we're supporting the process of integration around the relational experience and the somatosensory experience and coming together to support that sense of self and then playing that out in their other relationships so that they can build that capacity through their lifespan and support their wellness. Um, you go Michelle, cause I feel like you had things to say, but this all brought up this whole neurodiversity like talk and movement for me as well.

Michelle: Absolutely Cory. Then when you do that in, um, proximal interchange happening that's relational and tactile and it's backwards and forwards I guess what's coming to mind is this quality of, being able to cross space and time that when you have some robustness in, a relationship that's close, then you can get further away from them and they can still hold that felt sense of you within a relationship. So then when that girl went to uni, or when Cory moves to Brisbane, and you know, trace is in us. We have had time together and we've hugged and we've played and we've

Cory: No doubt

Michelle: cried we've done all the things. we've done all, you know, we've shared emotion, we've shared touch and in, in various contexts. So I feel you, my experience, um, tactile, like I feel you and relate with you across countries and across time. And even when we don't see each other, and Cory and I are chatting, you know, we are chatting on text and that kind of thing, I feel you and I wonder if that girl who went to uni that didn't have that foundationally even at that, very proximal distance or environment when she went away, she couldn't hold onto that felt sense of relationship and, somatosensory experience I guess.

Anyway, wonder if there's something in that Trace that if it's not robust, not transportable across time and

Tracy: absolutely. Absolutely. That's true. And it's a part of, our resilience factors. The way that we transport our resources to put them to use in a variety of situations and circumstances and in different relational contexts. And we have to prime the pump, if you will, in the attachment relationship so that when we show up in a

 uni setting, we can create healthy, strong attachments with other people that are not our family. Maybe we do that with, a pet or we go horseback riding and that becomes our lifeline. I mean, people do a lot of different things to find that connection, they can also quickly fall into kind of maladaptive patterns and not really healthy relationships.

And some of that is that they don't have that ability to transport what were those kernels of richness that allowed me to, to foster those kinds of relationships. And then you can become super vulnerable to feeling lonely and isolated substituting relationships for other kinds of things, like all the things that people do to fill that in.

Michelle: Risky behaviors. Yeah.

Tracy: behaviors, you know, hyper focus on, on anything. Right. Yeah. Mm-hmm.

Cory: I was thinking about, I wanna come back to the fact that it's almost remiss of us not to support this, these functions to come together to a greater capacity for the individuals that we support. Um, I'm just thinking about like, I guess just let them be.

Tracy: Mm-hmm.

Cory: Um, and, there's a lot of, and I think it's a really good thing, there's a lot of awareness at the moment around like not forcing compliance and not respecting the individual. And I feel like OTs have been super awesome at those two things for a long time. Right. Well, maybe some of us could have gotten a lot better. Right? But I can only speak to myself, but I've always been super aware of how uncomfortable and yucky it feels when you get into like a we are doing my idea situation or you, you know, like I just, in, in my internal sense, it was like, uh, this isn't helpful.

Like, and it was always trying to find the juice and the sparkle and what creates an, a more adaptive function for them. Because we are occupational therapists, we're looking for

more integrative function, for more possibilities for that individual right. Choice and possibility in their life to engage in meaningful things. So, I like the fact that we are focusing now on let's not, like, not don't force these people to do things that are really uncomfortable for them and to be in experiences that don't match their nervous system very well and to, you know, make them follow the societal expectations of whatever. I think that's a really good thing. But I also think, I worry that at moments we might go too far and not support them at all, um, in a way that's individualized to them and that helps them. Find more adaptive ability in their own nervous system because I don't know, do you know what I mean? I just think we need to get the balance.


Michelle: Cory,

Cory: Um, if you have a little kiddo who has, maybe they have autism and for whatever reason and then not regulated, they might do certain things to help their nervous system feel a bit better.

Like maybe they need to pace back and forth in the room or maybe they need to stand at the window and, flick the chord or whatever it is that they need to do to help the nerve system feel better. And we are worried about people going in and forcing interaction in those moments where a kiddo needs a break. Um, and I think that's a really good thing. But I also don't ever wanna leave that kiddo just to be off completely unan anchored. I want to find the right recipe to help support them in those moments. That's not forcing interaction, but that's also supporting their ability to reorganize their sense of self and then have possibility for alternate ways of experiencing their world, I guess.

Am I being clear? I'm not sure.

Yeah, you are. What I think you're speaking to in so many ways is exactly the foundation of our passion for occupational therapy and the work of Jean Ayres, and that is that we want people to find the ability to have the freedom of adaptation. You know, so

the thing that happens when you have restrictions in processing is that you lose your ability to have the freedom of choice.

So, there are lots of new voices coming out, right? Where we're hearing, especially I think, autistic voices of people who were saying, you know, when I was looking out the window for 45 minutes and couldn't look away, I needed you to help me cuz I was stuck and it feels terrible to be stuck.

And so we are in that situation where we have to deeply attune so that we can even help to discern is this, are you stuck or is this helping you? I think making that discernment can sometimes be very, very, very tricky. It also comes back, I think, to really. understanding how basic sensory integrative processing works, because if you notice that, a child is standing and, repeated repeatedly touching something, and, but when they're doing it, as you watch the motor pattern, you notice that the touch is not really of the quality of, let me actually reach out and engage with this.

But it's more of just a repetitive pattern. And as soon as you notice the difference in the somato sensory processing that allows you to skillfully reach out in order to engage, versus I'm stuck in a loop. it's through understanding how the somatosensory system is guiding the motor function. Once you learn how to look through that lens, then you're gonna be more likely to get it.

You're gonna notice this doesn't look like it's producing a higher level adaptive opportunity. It looks like it's stuck. And as soon as you can get that, then you start to be able to be a conduit that says, oh, you're, you're kind of stuck here. Let's help you get unstuck. Or you're really reaching out and enjoying that.

Let's enhance and augment that and create a different way of even having you have more success with that thing that you're doing.

And so we're really good at that, but I think it's because we know how to. Notice the glimmer, notice the quality of approach in the action pattern. Notice whether it's, organized or disorganized, and really regard that wholly as a part of the, nonverbal communication basically, that the person is generating and really receive that as meaning and not just, looking at the action as a perfunctory, oh, let me just label that as repetitive behavior.

Tracy: Um,

Tracy: instead of understanding what is that, what is that, what is that? the, the understanding of the sensory systems helps us to ask that question in a, in a really deep and meaningful way.​Hmm.

Michelle: I often wonder to Tracy, because I know that somatosensory system. The soothing touch and also deep pressure input, can have a modulating or inhibiting effect on the nervous system that can be down regulating. So I guess in, in addition to the things that you mentioned, I just wanted to point out that sometimes I'm working out is that touch that you are doing or the, somatosensory input that you are, engaging in, is it regulating? Like, is it, it's not just that you're trying to explore the thing, when it doesn't have that quality about it, it is, perhaps it is repetitive, but does it look organizing, not necessarily in terms of a motor function or a discriminative function, but a, a regulation function as well, because I know as we've. Saying that there is this, I think we haven't said it yet, but there's a downregulating quality or a regulating quality to it, um, as well. So that's something I look out for as well. Cuz it, it, it'll have a different quality a again, as if it's looping. Um, yeah. Do we wanna talk about deep pressure and regulation and GABA and things?

Tracy: Oh yeah. I think we should,

Cory: I was gonna say given that you were saying receptors and, and Tracy, I think in the last episode you talked about them being very GABAergic. GABAergic, is that right? Where they release a lot of inhibition, I guess Neuromodulators, if you provide, input to the somatosensory system in a deep pressure kind of organizing way, it's very GABAergic and it down, regulates the nervous system in way that's helpful.

Right. you were saying earlier that with that individual that missed the potential for experience that was modulating through the relationship that later they they, it seems like then it's almost their physiology is un, unmodulated. Like it's hasn't had the down-regulating experience of. Relationship based, somatosensory

Tracy: Mm-hmm.

Cory: so it, like you said, Michelle, no wonder we go to that as a strategy because we know neurologically that's a function of that system. if we take the relationship based out of it. You can't, you can't ever do that. But even if you don't even think about that piece, just thinking about somato sensory input, we know that it has that effect.

So we often try enhance that or find ways, that that's, organizing the child in a way.

Tracy: Mm-hmm.

Cory: you said when they're seeking that like movement or touch or whatever experience it is, but it's doesn't seem to be for an exploratory We wonder \ if, we get in there and enhance it in a certain way, or we provide the op for an experience of similar kind of quality, but bigger or more adaptive, however it looks long as we're really finally attuned to their response,

we can tell if what we are doing is just taxing the nervous system further, like is that experience not supporting them? And maybe our relationship is too much and so we just back away, right? We give, we respect that response and we go, okay, that's not the way in.

Let's not do that. Um, or we find something that supports that child to find an alternative response or a different way of organizing the input and then,

Michelle: Hmm.

Cory: F you can see it in their body either softening coming into themself, now there's possibility. And I'm not just doing this activity, I'm now making a choice, and I'm showing intent in a different way. Um, and then it's a different response from us, I guess it's that dance. But I feel like we're always attuned to whether our relationship or our contribution to the interaction is supportive or if it's actually needs to be backed off. And we are doing that function all the time to support adaptive being, I guess.

Michelle: Hmm.

Tracy: Absolutely. Absolutely. And then I think in that, if we identify that, the level of, comfort that this person's experiencing is not wide enough to allow for the range of experiences that might be possible in this moment, then. A lack of comfort, will then restrict the level of engagement and the restriction engagement is gonna restrict participation.

So this is kind of the slippery slope, right? Um, and what we wanna do then is say, well, what is my best opportunity to go back to the source of that slippery slope? And if it is, let me help you find how pressure creates a wider window of comfort for you. So that pressure input then allows for the next higher level of engagement, which then allows for the higher level of participation. So we can unwind it in a positive way by getting to the source and creating that, slate of open comfort and safety that allows for participation. And very often the somatosensory system is a critical element to that, because we have to use these pressure receptors that help us to have the inhibition and create that safety platform so that we can operate from it.

And then when I feel safe in my skin, it's easier for me to decide to reach out and touch a thing that's out in my environment. If I'm not feeling safe in my skin, literally not feeling safe, not feeling comfortable, then the possibility for engagement and participation is so limited. And the somatosensory system, both through the just the pressure inputs themselves that are so down-regulating, um, and invoke gaba. But that then says, now be with me in this social touch space, the social haptic space of the haptic being the touch proprioceptive, visual system and you being here, sharing that with me.

And as we invoke that, then we start to have the possibility of, the information substances like serotonin telling us this feels good and soothing and interesting and curious. And then we start to have the hormonal system like oxytocin saying not only does this feel good, but it feels enriching to me.

It feels nourishing to me. It feels connected and shared to me. And even for a person who comes to the world with neurodiversity, their nervous system is still using the same systems to say, this is what soothes me and every person on the planet. Everyone we treat, I, I would love it if every time we, you know, create a treatment plan, we include the questions, do I know what sooths this child?

Do I know what reassures this child? do I know how to encourage them with gentleness? Do I know how to encourage them with vigor? Do I know how to help them find zest and glimmer? And can I find that whole range? And most of the time, that's gonna include the somatosensory system as a partner because the color of that affect comes from somato sensation.

So it's a sensory affective pairing that allows us to understand the range of comfort to discomfort, and the range of engagement that's possible because of my comfort or my discomfort.

Michelle: So good. I've got, um, a funny little, story that might illustrate some of that. I see brothers, two brothers, neurodiverse, and they, the family travels a distance to come to see our clinic. so I do them in tandem, 20 sessions with one child, 20 with the other. They, often invite the other brother in.

So I had my sibling session yesterday. have a ball pit. Thank you Cory. And it's filled right up to the brim. so they knew the ball pit was on offer. One of the brothers who's been seeing me, Loves it, has had his fill of it. He, came in ready to play. He saw the ball pit crashed in and then was like, okay, I'll just say, brother, okay brother, I'm ready to play that. They play this hidey go seek and then a Chase's game. So he dived in, had 30 seconds of his thing, and then was like, let's be social. The brother, who I haven't seen for three months, came in, looked at me and was like, oh, he could just see me, who, you know, we love playing together. And then he saw the ball pit and he would often run over and gimme a high five or a hug or something. But then he was like, oh, which one will I go to? So he dived into the ball pit with his brother and got into it and did this starfish swimming on his back thing to nestle into it.

The balls were all over his face. Then he just stayed in there. It was still, he's not a still kind of kiddo. And he, I was just watching him and that whole thing happened. trace, I could see him delight, like anticipate what was coming up, choose a ball bit over me, which is amazing. And then Nestle in and just feel the impact of the balls on him, the light touch, but they are heavy cuz there's a lot of them. Um, and then just stay there. He stayed there, and I just saw this wave go over his face of, oh, is so delicious. Popped his little eyes up brother's saying, Hey, hey, let's go, let's go, let's find the, we had soft toys ready to go, so we're burying them. And older brother was, was ready to go.

He had his stopwatch out and, and younger brother who hadn't had his fill of that input for a while, but just took ages and the process was exactly that. It was like, oh, I just delighted and felt good and had all that somatosensory, imput making him feel good. He eventually kind of poked up and looked at me with these gooey eyes, like, oh, Michelle you know, he was just in love, deep sense of, deliciousness.

And then he, basically to the brothers urging to do the game, but it, it wasn't where he wanted to be, but it was just exactly that. He got adaptive and he played and he used the balls to hide things in, but he, um, didn't want to, he'd be pulled outta that to be, um, in that really social, playful, dynamic, um, game. I just thought I'd share cuz it was like, wow, that is exactly what happened.

Cory: it's, it is funny cuz I guess we're talking about with the balls really enhancing of tactile, like enhance of tactile input right to the whole body. Like a real here you are. Like all the receptors. As many as I can activate as I get into the ball pits, like, oh, here I am Um, but I was thinking about, cuz Tracy was talking about like the incidental moments cuz we're talking about treatment, right? When maybe the ways we can find those moments of incidental positive experiences of tactile input in a really safe space relationally. And um, and in that case, Michelle, it was the equipment right that allowed that. Um, and we so totally used the equipment to do that for sure. That's why we, train, right?

To know the use the equipment to get the responses that we well that we we're hoping for. Um, I've done things with the balls, like from the ball pit where I've had kids climb into the top of the lyra. So we have the layers of the climbing at the top of the Lyra, and then I just them,

cover them with the balls, and then we like shake and move in there in a really rhythmic way or whatever.

And some like, just depends on the kiddo, right? You're just trying to find, what is it? Do I know what soothes that child and what brings the zest or bigger or, um, and, but I was thinking about the kiddos that sometimes if you want it to be like incidental touch, It actually made me think of Kim Bathel because she talks about ways she would do this with kiddos as well.

If she didn't have any equipment or anything, like she would get out like stickers and like play with letting them put stickers on you and then they want you to put them on them and like, where do you want me to put it? And you put the sticker on or, and I guess there's similar things , with like shaving cream or other things that we do with kids, right.

That other people would be like, what? What are you doing?

Tracy: Yeah, for sure. And I feel like sometimes when I'm treating, um, I'm, I'm so aware all the time of those opportunities, I love this little penguin game. It's called Pengaloo. And you hide the little, eggs under the penguins and you have these colors and it's like a memory game. And, but I do a lot of things where we're setting them up and I hold them in my hand and then I really, on purpose, pass them to the child in one egg at a time and compress it with a little pressure in their hand.

And then hold that for just a second. So we have a really meaningful moment. And then I, but we're focused on setting up the game, but we're having these tactile exchanges. And, remember playing that game not too long ago in a therapy session and, the mom was noticing how I was doing this. And I had been talking with her about, you know, really enhancing these opportunities.

So then she went home and they were, Practicing setting the table for dinner. And she did the same process where she would take the spoon and hand it to her daughter and make sure that they had a moment of exchange and then allow for the action to finish. But just infusing it into these little daily moments where now my hands are in contact with you and now we are in synchrony with each other.

And then when, I drop the egg and I say, oh no, the level of empathy and shared problem solving that that child can show in that moment versus 15 minutes before where we weren't in tactile communication with each other is strikingly different. So how we build strong, healthy communities is that we have strong, healthy social cognition and empathy and shared actions where we are in touch with each other, you know, and you guys living in the country in, you know, you have a lot more opportunity to just naturally go pick oranges together or do a thing to, we did the, we talked about oranges many, many, many podcasts ago, but we don't have as many of those opportunities here unless we cultivate them.

Right. But, you know, that's where I just think

Michelle: You've got pickleball.

Tracy: pickleball, we have gardening, we have, you know, playing with animals and playing in nature. But you know, when we're in nature, we aren't just playing in nature. We are looking for opportunities

Michelle: Yeah.

Tracy: for enhanced somatosensory exchanges enhanced, um, movement exchanges. And that's the lens that sensory integration brings to our work that is so vital because it, these are the, the real neuro-vitamins, the, this is what your brain needs to actually put the world together. And, um, so we have to think about it and enhance it and augment it and create opportunities for, what does that lead to? And look at how cool it is when we discover together, that sharing a moment of caregiving for the little penguin egg is the coolest thing that happened to me all week. And connection builds, wellness, mm-hmm.

Michelle: Wow.

 I keep talking, thinking about, through this episode about, kids with neurodiversity and, perhaps, communication challenges where they might misinterpret touch, and this sense of facilitating them to, understand what's appropriate and not appropriate.

And working with some teens actually who are neurodiverse. Um, early childhood trauma, adhd and a s d, so at the moment he's he's 14. He's standing really close to people. He has a tick that's moved into his throat, so he's really now doing like a gut or kind of sound, and he's, touching kids a lot on their arms shoulder or he pops 'em on their head. Really, I'm trying to thoughtfully and respectfully bring attention to the potential impact and the miscuing that people might be, um, staff in particular, but might be feeling with that cluster, I guess, of his behaviours and trying to ensure that everybody's feeling, safe and that he's, connected to him without, him touching.

But I want his needs to be met for, he wants to come in close and be with people. It's just, I'm really aware of having his needs met by someone. He's now in outta home care, so that gets tricky. The staff actually probably legally aren't allowed to hug him or touch him in, know, ways that might typically, be received by young boy. And I just thought when you explained that situation, Trace about the nuance of lingering touch, like we get that younger kids do, but I, I, I don't know, it starts to move in an area where I, I guess I'm thinking about problems and sexualized or that, behavior that's seeking of connection with touch, that can be misinterpreted and that some of the kids we work with are vulnerable to that. from that direction. And, I guess miscuing, also the other way, I really see that some kids have carers, educators, who might be giving them lots of hugs and giving them, you know, kisses on their cheek when they do something well. So the intention is to care and express, joy with them. I worry that they're really vulnerable and it's not too many years that they move into that. You know, that example I just provided where it's like, oh, It's complicated. What, what's okay through touch and relationship is, pretty nuanced across different people,

Tracy: Yeah, no, I think it, I mean, it's a completely critical, part of, the landscape that we enter when we start talking about touch is that it is, my interpersonal space and your interpersonal space, there are boundaries to be regarded there on every single level. And so as, professional deliverers of exchanges that happen in the interpersonal space, we have to deeply regard those boundaries.

Help understand. You know, what's at stake basically. And know that we are working with vulnerable populations and, that we have to follow the rules of that. So, I mean, I think the rules of engagement always are around permission. And so permission starts to be a really complicated topic when you start to talk about somebody who's living, in a situation maybe where their, rights are restricted because they're not being cared for by a family.

 And those individuals are, more vulnerable to lifelong difficulties that are related back to often not having the experiences and relationships that they needed. And so in our context, as long as we know that we have to have the safety of that, there are other people around that we aren't doing private, things in private, ever.

And that we're really talking about body rules and boundaries as a part and parcel of what we're doing. And that we're educating and using really careful psychoeducation with everyone whenever we possibly can and being explicit about the rules that we're following. Those are really, important things in our clinic.

We have adopted the, 33 rules of body safety that we try to follow at all times. And those are from, a social worker here in Colorado who's written extensively about this and has interviewed,

Michelle: Hmm.

Tracy: know, people who are perpetrators of crossing these boundaries and tried to learn about it as deeply as she possibly can.

I think in every culture we have to be aware of all the rules and all the boundaries and all of those thing, and that's incumbent upon us to do so. So, it's not, a topic to be taken lightly. I know that you have to be critically attuned to, these issues and never take them lightly.

But also to know that the cost of not delivering touch is damaging.

And, um, I wouldn't ever say I would, I almost the word equal came out, but I stopped myself because you know, there's no qualitative way to, to know what is the deepest, hardest impact to our lifelong journey.

But we know that abuse is terrible and also the absence of the experience that we need is terrible and there all damaging.

So we have to be aware of all of those levels. Yeah.

Cory: I just read on the Harvard Center for the developing Child. They have like eight key things for development to keep in mind. And one of them is that neglect can be, as impactful as, other negative experience and like you're saying, in not providing the opportunity can feel maybe like it's a neglect to their nervous system.

And so I, I was thinking about your kiddo, Michelle,

that boy. I guess it's like a, a whole process as a team of being like, okay, there's an unmet need here, what are our boundaries? Like, we don't want him to stand too close. We feel really uncomfortable with that.

Okay. We need to figure out how to get the need met and respect our boundaries and keep him safe. And I guess it's just like this conversation, right? Um, and it's like you would be doing that, I'm sure. And I, and I, I know, like you said, you're trying to respectfully help him to the fact that he's miscuing people, because you can see the need. And that's, that's a huge thing because he, you are on his team

Michelle: It's not

it's not



Cory: you are restoring that for the people around him, right? Yeah.

Michelle: And I hope I'm doing it in terms of breaking that down cuz I think it, in part he really wants some rough and tumble play. So we're doing that. For multiple reasons, but in part for that, that we can start to do ball wrestle and soccer wrestle and I'm, you know, really going back developmentally I guess, but there's a physicality in that.

And so he's like, we are like doing the check-in. So we pause and in, you know, in addition to all the other kind of things that you do with, baller wrestle where it's like, oh, I just kind of half squished your leg. Is that

So we, we are doing this, you know. Oh, I pushed you over. Was that ball too hard? It fe it felt really, um, not. automatic and a bit weird, but it's a way to be like, oh, are you okay to that? Yeah. Squishing a leg. That's fine. Oh, your hand on

What? Nah, move your hand away. So where through this ball play, I guess wrestling. Having fun doing rough and tumble, having a physical kind of game that has us in close proximity, that doing this consent, is that all right with you? Is that all right with you? And he started to say, I had a coffee breath. He's a reveal had coffee breathing.

It was like, Ugh, that's too close. And so, you know, it's not just that

Cory: Yeah.

Michelle: say no,

like your hand of my hand. He's like, Ooh, I don't want your mouth to breathing on me. Yeah. But I'm also really working with, his support workers in the home to see how he can get some moments of intimacy, I guess tactile intimacy, because I think the rough and tumble and, you know, um, cuddling mates sideways were allowed, you know, we are talking about sideways cuddles and fist pumps and all that kind of stuff. So I think the more playful, ways to get connection and tactile input. Somato sensory input together are easier, particularly for a teen but I want the softer flavors too cuz he's, you know, he needs that as well. So it's like, oh, how can we have handshake that might involve, a squeeze and a pat in the back or a rub on the, head that are laden with emotion and, and relationship, but an intimate, but less construed. you know, Hopefully less able to be misconstrued into intimate touch. Really that sort a, you know, intimate, interpersonal, nature. So anyway, it just has been interesting to listen to this. Cause I think. We get it. And there was a little boy yesterday, three year old, was getting so excited and in the session it was time to say goodbye. He came up and he put his hands kind of about to be on my face and I thought, oh, he's gonna touch my either side of my face. And I didn't know what was gonna happen next, whether he might just touch me or come in for a kiss or I dunno what. But he didn't, he stopped his hands about 10 centimeters away from my face.

And then just was like, oh, like, oh you are, you know, whatever. I just felt so, oh, I'm gonna miss

Cory: Oh, that's,

Michelle: well

Cory: that's so cute.

Michelle: see you next week. But it was, it crossed touch. We didn't touch, I did it to

know, back to him. We didn't touch

but yeah, it was that really deeply tactile infused.

And you said that at the start Trace

Tracy: yeah, that's right. And what's also, I love what you just, you know that story because boundaries come from a somatic sensory receptors. They tell, that's the signal he got. Like, I, I love you so much that they want to touch you, but now this is as far as I'm gonna go because that's what feels right and safe.

And he felt all of that through his somatosensory system, through his polyvagal circuitry. And he felt it. And he honored it. You honored it. You reinforced it. And so boundaries aren't always like I. , you know, we must follow these rigid rules, which sometimes we need, but they, it's about respecting the signals and, living by them and, and learning to trust them and that's beautiful.

I love that.




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