Going With The Flow…

A humanistic approach is central to my practice and I am always trying to find ways to work on the goals that have been set for my clients, but also respond to their needs in the moment. Through my experience, I have found that responding in the moment has evoked more change towards goals then rigid planning. I’ve written about this more before and I call it the Stop, Drop, and Roll strategy.

One of my clients who suffered from significant right side weakness. To compensate, she uses her left side about 95% of the time, and she is STRONG. Mind you this client is under two years old, but she amazes me with her strength. A few weeks ago we began running into some difficulties within our session.

My client was grabbing, hitting, and generally engaging with all of the instruments in a very rough manner for example pulling ukulele strings in an attempt to get them off of the ukulele!  I knew from my assessment that this wasn’t an emotional or sensory response. I found myself limiting the instruments I was bringing out (my poor ukulele!) due to my own fear of them breaking or of her accidentally hurting herself. However, I knew that this wasn’t going to be a permanent “fix”.

I took a step back and thought about the situation and how I could go with the flow. I knew that this behavior wasn’t caused by sensory or emotional needs, so I felt that it could be physical or cognitive. Maybe she didn’t understand the concept of “gentle”? Maybe she couldn’t control her strength yet? Maybe she was so freaking frustrated that her paralyzed side wouldn’t do what she wanted it to that it came out this way? Maybe her core strength affected the use of her arms when engaging with instruments? Maybe it was something else? I decided to take the risk and forge ahead with all of the instruments to see if I could assess where or why this behavior was occurring.

It is so easy to get caught in reacting to a behavior rather than responding. This is something I remind myself daily (especially when I am at my wit’s end!!): Behavior is communication.

So I attempted to go with the “gentle” route first, to determine cognitive functioning and understanding of the concept. My client was very excited when I brought out the ukulele for the greeting song that day and she immediately began to grab and pull the strings. I responded by using hand-over-hand and saying “gentle” in a sing song voice. My client immediately took her hand away and tried again to hit the ukulele (hard!) with an open hand. I repeated the same response using hand-over-hand. This took about four to five attempts before my client began expecting my response and looking towards me. I decided to then model the behavior and strummed the ukulele again singing “gentle”. An then, it happened. 

My client looked at me, looked at the ukulele and gently placed her hand on top of it. She then looked at me for my response. I was so excited that I began clapping and praising her like there was no tomorrow. She responded so well to this and she independently began incorporating it with other instruments.

Now, I knew this was a side-step from my goals to increase her babbling and increase her word approximations. The most amazing thing happened at our next session. She not only remembered to play gently, continuing to look at me for that positive response, she then looked at me and said “ga”.

I knew at this moment that I made the right choice by taking the risk. By thinking about her behavior not as her “being naughty” but as her maybe not understanding or not being able to control it. The best part is that in discussing her progress with mom, she has reported that my client is saying and being gentle like a champ at home.