29. When Science Meets Therapy: the art of co-regulation.

In this episode, we dive into a fascinating discussion about the intersection of scientific research and therapeutic practice. Tracy shares a heartfelt experience of hosting scientists at the Developmental FX clinic, where they observed therapy sessions for individuals with Fragile X syndrome, autism, and other developmental disorders. The conversation highlights the importance of integrated models of care, the subtle yet profound impact of high-quality therapy, and the critical role of co-regulation. We also reflect on the teachings of Dr. Ayers, the challenges and rewards of being a therapist, and the significance of collaborative partnerships in advancing child development.

TIMESTAMPS

00:00 Introduction and Greetings

02:15 A Day at Developmental FX

05:17 The Nuances of Therapy

10:51 Challenges and Reflections

17:24 The Importance of Co-Regulation

22:15 Translating Theory into Practice

34:07 Celebrating the Team's Work

TRANSCRIPT

Cory: So we've just been off mics and now we're hot mics as the really famous podcasters would say. I don't know if I've ever said that, but anyway, here we are. And. Tracy has shared some really fun discussion from her day to day.

[00:00:27] And so serendipitously, or I don't know, we've just decided let's chat about that. Cause who knows, people like to listen. Um, so, and we, wanted to share more, more broadly, and then we'll just see where we go, see where our journey takes us today.

[00:00:49] Um, and shout out to Shivank. I don't know if that's how we say your name. Tracy, have you met Shivank?

[00:00:57] Tracy: I have met Shivank.

[00:00:58] Cory: So am I saying Shivank's name right?

[00:01:00] Tracy: I believe so.

[00:01:02] Cory: I'm pretty sure I've met Shivank too, but I don't know if I've ever said your name out loud, Shivank. So, um, feel free to message me and correct me in whichever way it needs to happen.

[00:01:15] But we, way, way back when we started this podcast, Shivank sent us an email and He was talking about our trialogue instead of dialogue. I don't know if, Shivank, that's an official word, but we really like it and it gave us a good laugh. So thanks so much, mate, for sending that to us and keeping us hooked in. 

[00:01:42] Michelle: Love it.

[00:01:43] Cory: So maybe share Tracy. What happened today in

[00:01:46] Tracy: Yeah, so at Developmental Effects today, we had, um, five, scientist visitors who came to try to learn more about what is therapy. So these are, scientists who are working in the space of creating new treatments that would be medical treatments for individuals with Fragile X syndrome and autism and other disorders. issues that impact how our brains process information. And they're really super dedicated to figuring out how So, if a pharmaceutical agent, let's say that a new medication was made, how does that interact synergistically with really high quality therapy? And that none of us can work alone, that we all always work in partnership, and medication is the same.

[00:02:38] That it shouldn't work alone. kind of in a silo and that we shouldn't think about it as, an agent that is making profound changes for somebody if they don't have the other supports. So in this world, you know, it's hard to describe what is the life of a person like that has a really significant involvement in terms of maybe an intellectual disability,

[00:03:04] perhaps some difficulties with managing arousal that cause a lot of distress, differences in communication access.

[00:03:14] And, um, So, you know, our clinic specializes in Fragile X syndrome as well as lots of other conditions, but we do have a lot of trust with our parents and with our kids that we see. And so these folks were able to come in and observe some therapy. And one of the individuals left end of the day, and it was just so sweet this very professional

[00:03:40] person who said that, in his whole professional career, it was one of the most meaningful days he'd ever had, because he's, he got to see a range of children working with therapists, doing the work that we all talk about in this podcast, but you know, seeing it up close and personal and seeing kind of one session with a child who's a lot more engagable and playful and another session where the child is a lot more stressed and, dysregulated, another child who's working with augmentative communication to let us know what's happening and what their needs are and what their experience is. And none of them had ever seen any kids like this before. And it just brought the work to life in a really beautiful way, but also really showcased when you really provide, you know, the integrated models of care that we know really are necessary for complex kids. How magical it is! And it was a cool day for me to just marvel at my team, see them doing incredible work, nuanced work, and several times these individuals said, it's so nuanced. It's so

[00:05:03] subtle and yet profound what's happening and it's not in the, in the task so much as it is in the whole of the relationship and the attitude and

[00:05:17] the play and the access to capacity. And, you know, we talk about capacity all the time, but when you can see it unfolding, they could see it and they could see it. They saw what was happening and it was so magical. It was just really, I was very proud of our team and proud of the work that we share here on the podcast and the work you both do, um, knowing, you know, how profound it is.

[00:05:46] yeah.

[00:05:46] Mm

[00:05:47] hmm. Mm

[00:05:50] Cory: What people don't know is that these scientists had spent time with Tracy setting them up. It probably wasn't a significant amount of time, but at least some time just to give them a bit of.

[00:06:00] I guess, preface to some of the theories that sit behind the work before they even got to, that treatment space. so I don't know if that, that had such a meaningful, impact on their ability to then just see it in the work.

[00:06:18] front of them, it did make me think, Oh, maybe everybody should spend an hour with Tracy prior to coming to watch any sessions so that they can understand, uh, some of the tools and therapeutic adjustments that we're really doing in the moment in sessions so anyway,

[00:06:38] Tracy: really highlighted too, I think one of the speech and language pathologists was in a couple of the different sessions just because of happening to be there and um, they really noticed how in one particular session, how, quiet and subtle and just continually, quietly co regulating, offering an augmentative device, continuing to really regard what do you need right now, I see you through moments of frustration, let me help you, let me know what's going on. And then in another session this kind of big, playful attitude, and still always herself, but just being able to have that, meeting the child where they're at and bringing your affect and your attitude and your playfulness to match what is needed to foster that child's adaptive capacity. And they could see it.

[00:07:36] They could see it happening. And they said, you know, when I described to them, what does relationship based therapy mean and how do we make these adjustments? But then when they saw it, it was like, wait, what just happened there? Yeah, it was very

[00:07:50] cool.

[00:07:51] Michelle: was that the same person? You know, often when we're working with families, they will see us match to the child that's in front of us and that family just sees that and they say, Oh, you're so good with them. You know, you're a good match for them. Um, and beautifully, they don't get to see that we're all so different.

[00:08:11] you know, adjusting our therapeutic use of self and all that's involved in that to be the just right match for some other child that's, at the real other end of that. So, um, we know as clinicians, that's what we're doing all the time, dialing up and down, all the different facets of, the interaction.

[00:08:28] But, um, yeah, it's fascinating having an outsider look in, just, and just to acknowledge that, that the work. We do is so critical. Cory, what you were saying made me think about, you know, when you watch, doesn't matter what it is, Olympics or soccer, or, someone do a cartwheel and you're like, yeah, yeah, I can do that, and then you have a go at it. I was seeing the swimmers at the Olympics swim like really smoothly and it was like, Oh, I just have to go a little bit smoother. And I was like, no, Michelle, that is just like precision on precision on precision, but it looks attainable. There's

[00:09:09] a way that it's like, oh yeah. yeah,

[00:09:12] yeah, I got that. I know what you're doing there.

[00:09:14] Do you just point the toes? You try and do it. It's like, that didn't really, you know, doing five breaths a whole lap. It's like, well, that didn't really

[00:09:24] work out for me. Like, oh, it's really hard. Oh, I see how masterful and specialized they are. So I know, anyway, made me think of that. That people go, yeah, yeah, I can do that.

[00:09:36] She's just playing with him, you know, yeah, yeah. He's, she's just got some swings that I don't have. I'd be able to do that. You know, some parents certainly intuitively do, but, um, yeah, there's a whole lot of doing laps at the pool, and it's so lovely that they saw that trace.

[00:09:54] Tracy: Yeah,

[00:09:54] well,

[00:09:55] Cory: props to DFX team, like

[00:09:58] Tracy: Oh my gosh.

[00:10:00] Cory: like it is, uh, and I, I mean, like, to have to do that and to do it in front of

[00:10:08] people, it's pretty epic. Cause you, you really have to, it's a whole other level of, um,

[00:10:15] Michelle: Yeah. And

[00:10:16] Cory: control when you're treating, and I've treated in front of. Crowds, um, not crowds, it felt like

[00:10:24] Michelle: Yeah. You have?

[00:10:25] Cory: of people and, um, and you know, I was a naive new therapist.

[00:10:30] I was like, I don't, it doesn't matter if I get it wrong, like I'm new, no one expects me to be good at this. But once you're in a little bit, there's more pressure, there's pressure to feel like you're doing treatment that's effective

[00:10:43] Tracy: Totally one of my worst moments of my whole career. I think you might have been there. I don't know if you were there. But we were doing a clinical dialogues at a clinic in Australia and so this is like a forum where you're treating a child and there's a crowd, there's a group of people watching and it was maybe my second time in Australia or maybe I don't know, it was early in my coming to Australia And I was supposed to kind of like jump in with this kid, but the kid was, I, I didn't know the child and there were lots of people in the room.

[00:11:20] And for some reason that my stress level sort of got heightened enough that I was like, I don't think I can treat.

[00:11:31] I think I can observe and coach. And there was another therapist there treating the child, but I was going to kind of push in and join. And I kind of

[00:11:41] froze. I mean, literally, like I couldn't move my body. And that, So, on a few fair occasions, I've had this kind of dorsal experience. It's more, it's pretty sympathetically charged, but a bit of dorsal energy.

[00:11:56] So we're, you know, using polyvagal as a lens there to, to describe that, but I got frozen and I couldn't move and I, I, had enough availability that I was thinking through just, you know, take your time, get some breaths, you'll be okay, you'll work through this. But I couldn't work through it very quickly and it was like so kind of horrible.

[00:12:24] I don't know how it was for the audience because everybody was so gracious and I was able to coach enough to be like, try this, but it sort of, I felt like I was like, try...this..., you know, like I felt like I was this disembodied?

[00:12:40] Yes, totally, totally. And it was the weirdest experience.

[00:12:46] Anyway, it happens

[00:12:47] to all of us sometimes, you

[00:12:49] Cory: so much. If I was there, Tracy, I was completely oblivious. I was in love with you. So please don't stress about that. Um, I was never, never been anything but completely gobsmacked every time I've seen you in a treatment space. I'm like, did she know to do that? Oh my gosh, what's happening to this child?

[00:13:10] Like, so it wasn't, Noticeable for me if I was there, um, and so intuitively you knew. In that moment you were the treating therapist,

[00:13:24] you weren't going to go in, like, that wasn't a good match,

[00:13:27] Michelle: no, 

[00:13:28] Interesting

[00:13:29] whether people pick up on that internal disconnect because I might have been watching that, um, Trace, I don't think I was there, and going, Oh, look at her pace, go slow to go fast. Oh, wow. Wow. Look how present she is.

[00:13:50] oh, I would have dived in there. Oh, she's holding back. I'm being cheeky, but you know, it's interesting, but in your mind, I, um, have had similar, I've had to do a few interviews on TV recently, just local issues, but, um, I've actually had kind of out of body experiences, which I knew I was in the flow with what I was saying. I, you know, was in it and embodied, but I also was coming out going, Oh my God, that camera is really big. And that woman, I really want her to ask these other questions and just go for it, Michelle. I think I'm supposed to just, you know, but it was a disconnected, uncomfortable feeling and I watched it back on telly and I don't think you can tell people who know me might of, yeah, it was just this internal sense of I'm not quite right. I'm not wholly present,

[00:14:42] but I wonder Tracy, if your energy whilst internally, was doing back flips and you didn't feel present. But I wonder if you had your intentionality of, I really intend to do my best here, held the space enough, or, portrayed enough that the little kiddo wasn't, more disre regulated from your energy, really?

[00:15:07] Cory: yeah,

[00:15:08] Tracy: it could be, and maybe some of that is connected back to this whole career I've

[00:15:13] had in, in Fragile X syndrome because, you know, these individuals can sometimes be so dis regulated.

[00:15:21] And I had to really learn how to hold a

[00:15:24] very steady, even presence in kind of some of

[00:15:28] the most, you know, challenging of moments and being able to just convey like a sense of ease even when I actually wasn't really

[00:15:39] feeling it. And you know

[00:15:40] in the in the polyvagal world sometimes Deb Dana often says this little phrase and she says you just need a foothold in ventral. You just need like the tiniest little sliver of a hook in there to kind of allow your nervous system to have that referent point. And so it's a funny skill that I think we develop and connected back to this experience today. These folks were watching the session. This one individual with Fragile X gets pretty dysregulated. He's doing so well that, like, I'm, I am gobsmacked right now at my team, but also at the progress of these kids. And this guy has had a tricky journey, but he's doing awesome. But in this moment, when he starts to get a little bit dysregulated, he gets louder and his gestures get bigger. Okay. So it isn't like he's threatening you or that he's going to swipe out at you. Maybe if you let it go too far, but he's really not being aggressive. He's just big in his body and his movements. And he's kind of funny. And he was, he was saying a funny story. They were doing this little rhyme and he was gesturing in this big way and the therapist is sitting next to him and she's just saying so calm and so present and so available and never a flinch. And two of the people were sitting at a table through an observation window, okay, they were right in front of me, and I saw them visibly flinch when he got big. And so I commented to them. tell me about

[00:17:22] that. And they were like, how did they stay so calm in there? And, it was pretty funny. So we were talking about what does co regulation mean and what does it mean, that proverbial thing we say, put your own oxygen mask on first, but we get so practiced at Just being fully present and available and safe in a harbor of safety and, and then that allows this other person's nervous system to hook

[00:17:52] onto that and to stay, Oh, I'm okay, even when I'm getting a little you know, a little silly or a little big or a little bit over responsive perhaps. And anyway, they really noticed that moment and they could feel it in their

[00:18:07] own bodies. They could feel the tension rising as his arousal was going up, but they don't know about what that means. And then they saw the therapist being so masterful at managing that, and that was really something that they got.

[00:18:24] Like, from watching it, they really got it. And, you know, some of these folks had come to a conference I had spoken at in the summertime, in, here in the states, in July , in Florida. And they had come to a couple sessions where I was, you know, you know, talking about these ideas more conceptually than practically because they were short sessions and just whatever. But now they were like they

[00:18:49] got it because they saw it

[00:18:51] and they felt it in

[00:18:52] their own nervous system. And they, and they said several times, how do you do this work? I don't know that I could

[00:19:00] do that work. And you, we hear that feedback all the time, right? That, um, but in this moment, It was one of the times that I didn't take exception at somebody saying it takes a special person to do this work.

[00:19:15] Because, I mean every person is special so we can all honor that. But it is true that there's this beautiful quality in therapists that we then cultivate and enrich and grow and enhance so it was just a really cool experience to see them witnessing that, to feeling that, to noticing it.

[00:19:39] And it was very cool. Yeah. No.

[00:19:47] Cory: I think the reps in the pool thing resonates Michelle because until you do the reps you can't refine it. You know, it's really dynamic in what will come up in front of you in a session.

[00:19:56] And then what you have to build, um, skill around and comes with, an unknowing of how to manage that moment until it arises in a session and being really uncomfortable potentially. in the moment that something comes up that you've never had happen before, or the other thing that I think is really, has been for me, like the

[00:20:19] place where I felt often the most uncomfortable or the most challenged early on was trying to explain concepts to parents.

[00:20:29] And it's in that discomfort that I've continually sought. how do I do that explanation in a different way?

[00:20:36] Cause. It can be a lot to

[00:20:38] Michelle: like what happened with the scientists that they heard Tracy's theory and like, Oh yeah, yeah, yeah, that theory makes sense in neurologically, you know, in our work that we do. Yeah, I

[00:20:50] can get what you're saying versus. Feeling and seeing and having their

[00:20:55] own nervous system co regulated by the child and feel uncomfortable and have their own stress response and then see, I guess they were then co regulated by the therapist as well when they saw how masterfully she was.

[00:21:11] Holding space for that child, having that theory that, you know, which is what our is on the podcast is how do we take these abstract concepts and theories that we cognitively can go, yeah, a tick there makes some sense there and actually. have an embodied sense of that and then put it into practice in the clinic. anyway, I, I think they got to see what, the process of clinical reasoning that we go through, Trace.

[00:21:42] So, oh, you know, lucky them. Wow.

[00:21:45] Cory: And this is the translation of science into practice, it's like, man, you had scientists, who don't spend time in a clinical setting come in to watch what was happening in a clinical setting.

[00:21:59] and could see it. They could see the science that was backing the actions of what the therapist were doing. Your therapist's wonderful and they're attuned and they're working a theory and embedding it into a treatment session. And that, isn't pure science. And so it's backed by that, but it's not like I'm in the session and I'm,

[00:22:27] Michelle: Administering the

[00:22:29] Cory: protocol. Yeah.

[00:22:31] Yeah.

[00:22:31] Cory: And I found this so So. I'm not sure if I'm ready to segue, but I found this quote that I shared with Michelle and Tracy prior to this and it was from Ayers. I don't remember why I was reading about Ayers. I have a fascination with Dr. Ayers, and I was trying my best to get her boxes of notes, whatever I could from the university to read online, and of course you can't get them except

[00:22:58] physically in the library at, I don't know, they were at Texas Women's University, but I think they're probably at Southern California. I don't, I don't know. But in frustration, I read a review by a man and I think a woman, but a man called Michael E. Gorman and Nora, I think they wrote a review of Ayers work after she passed away.

[00:23:22] And so I read that and came across this quote, which is actually just in Ayers blue, sensory integration and learning disorders book on page 265. If anybody has the book and wants to look it up for themselves, I'm just going to read it out. Are you guys ready for me to do that? Yeah. Okay. On page 265, Ayres says, it would be far easier and more impressive to provide treatment through methods that appear more scientific, such as placing a child on a table, attaching some apparatus and turning some knobs to start the apparatus working on the child.

[00:24:06] Such a procedure would avoid most of the disadvantages of using a natural procedure. But that is not the way to further neural integration. The brain must organize itself and must do so through receiving information from self and environment. Integrating that information for use and then using it for adaptive action upon the environment.

[00:24:37] Society may respond more favorably to the spotless, chrome clad treatment office, but sensory motor integration proceeds best with simple, unimpressive, often makeshift equipment, which, furthermore, is often generously sprinkled with dirt, carried in from playground or street, on shoes or Pant cuffs

[00:25:04] and thank you, Dr. Ayers, for being so amazingly ahead of your time.

[00:25:10] Anyway, I just love it. She's full of wonder and knowledge, that woman,

[00:25:19] Tracy: So true. So true. we do. So we're, I want to use the other quote because I

[00:25:25] think that it also totally connects. So with our experience that we've shared with these scientists visiting.

[00:25:31] And in this letter to Sieg in 1988, Dr. Ayers says, Therapists dash in where scientists fear to tread.

[00:25:42] Michelle: da da

[00:25:43] Tracy: we can read the rest of the quote, but I think that part of it was exactly the experience today.

[00:25:49] These scientists said, I, I don't know that I could do this work, and they talked about how centered and present and that, you know, one of them said that if they weren't meditating, they were always multitasking. And we talked about how in a session you have to be. present. And, um, then we're translating theory into lived real moments.

[00:26:18] We're not translating theory just to translate theory. It's very real. And I think the real nature of the work jumped out at them so strong. Um, so I want to, so should I finish reading the quote or do one of you want to read it?

[00:26:36] Cory: No, go for it.

[00:26:38] Tracy: So therapists dash in where scientists

[00:26:42] fear to tread. We should have that on a t shirt.

[00:26:45] Michelle: Ha

[00:26:48] Tracy: A podcast t shirt! Let's do it.

[00:26:50] Okay. Therapists dash in where scientists fear to tread. It's a dangerous thing to do, but it's what builds theory. theory. is not the facts. Theory is putting the facts together so you can use them and in our case to enhance the development of children. This is always my end objective. Ah, thank you Dr. Ayers.

[00:27:23] Cory: And I, I kind of want to circle back to the very start of what you were saying in this, in this, podcast, Tracy, which was like, we're working in a very integrative model. And this is really important because so many of our kids are supported, in their medications, they, they, they are using

[00:27:43] pharmacological supports. Right. So, I'm hoping most therapists out there working in this space have had a similar experience where a child has had the right match in terms of that support for them. And it has, completely changed their presentation and capacity to do any of the therapeutic work or just in, in their life in general. And we've had the opposite experience as well, right? We've had both, sides of that where you can't even explain the change of positive change. And then also we've had the opposite side of that where it's been so, so impactful in reducing their function in almost all areas when it's been a bad match.

[00:28:29] because We are in the trenches of seeing that. play out in the varieties of ways it can play out. And so being able to give that feedback, yeah, it's kind of impressive to. be able to get the scientists in the space of just watching, I don't know, like, seeing the other side of the coin, I guess.

[00:28:50] Tracy: Yeah, absolutely. And also I think the advent of, um, collaboration that

[00:28:56] is really They're like, like, you know, really pushing that and fostering that, that if a child's going to be on medication to harness attention. I need to know that as a therapist,

[00:29:09] so that I can, think about, let me make sure that that adaptive response is a lot more focal, even though I'm following the child's need and following the child's lead and staying in where is the child in their developmental trajectory right now.

[00:29:25] But we know so much now about adaptive response and neural networks and what can we be harnessing and focusing in on and. focusing our intention and, being able to comfortably in a session know that when I have this child in regulation, I'm or whatever, wherever they happen to be. But it, but now I have this whole slate of adaptive targets that we

[00:29:52] can work on. And what's the most salient to their nervous system? What's the most salient to their developmental story right now? But it isn't, it's often more than one thing, right?

[00:30:05] You can hone in on, posture and attention or, executive functioning skills and social relatedness. And so I think, to tie it back to the spirit, and I shared the spirit with these folks, and they were very excited about it. Because, just seeing the level of thought and detail and knowing that, If they're suggesting to a physician, use this class of medication and the therapist can be a partner to you in harnessing that adaptation. You know, advancing our practice to the level where we can talk like that amongst each other, to each other, and collaborate in treatment planning feels to me like, Very important progress that Dr.

[00:30:53] Ayers sort of hinted at, when she talked about, the work that we're doing to advance development. That's what this is about. And, and it's about, making sure the child is organizing their own brain, but for the purpose of a higher level integration. Those are all real things, and I think we're advancing the science a lot, and it's exciting.

[00:31:17] Michelle: And also, hopefully, the collaborative partnerships, because we certainly could have that place if we know, which, you know, sometimes we do when we're involved, um, in a strong multidisciplinary clinical team. We know there's a pediatrician appointment coming and there's been a trial of intervention, for example, um, that we haven't. perhaps has achieved the shifts that we're hoping to get, you know, functional gains in school or across context. And there's going to be, um, carers want to have a discussion about trialing medication. I just love being part of that early stage so you can do all the baseline clinical assessments. Okay. What's your primary thing you want to change? You know, that you'd like to look different. after medication, attention. So it's like, right, well, let's do some measures of that. When he, how long can he, um, stay attended on a task that he's really motivated by? How long can he, um, pay attention and stay connected to a task that he's not motivated by?

[00:32:20] And then using the spirit model, we can assess the other as well. So it's like, okay, attention definitely increased, from medication. However, social connectedness decreased, for example, or whatever. You can just start to go, okay, well, this, this happened, but this was the outcome, a knock effect or a side effect or a, so can we tweak that a little bit? Is this, is this working okay? So, um,

 Cory: it was useful in the other it wasn't, or across the day, like being the occupational therapist, looking at broader timelines, looking at in context and environment, and with who and with what, and being able to, just feed that back a little bit yeah. So anyway, it can be tricky to get your foot in the door. It's useful to have, Discussions with parents, and whoever's working with the child so that I can make sure I'm as precise as I can be and I'm as useful in progressing their development as possible.

[00:33:20] Tracy: That's right. Do you think you would say something like, Mom and Dad, I think if you and I and your physician could have a trialog, it would be really helpful.

[00:33:33] Cory: Yes! Oh dear.

[00:33:37] Tracy: And it's also really good to take moments like we're sharing now where there's little moments of celebration like the bringing my team into this forum and then being able to celebrate the magnificent work they're doing and Ah, what a, what a beautiful kind of cup filler for all of us. And I think sometimes we, when we are intrepid therapists, you know, and marching forward where scientists would never go, sometimes you pause at the end of the day and you realize, wow, there was some incredible thinking going on today, some incredible, you know, gains happening, some incredible hurdles that we ran smack into. And all of that is the work and we have to figure out ways to share it. And I love that we've created this forum for talking with each other about it. I know that folks who listen then talk to their friends and colleagues and it kind You know, allows us to all foster a community of practice that I think is so rich and beautiful.

And, um, yeah, it's just, it's so fun. I love doing this with you guys. Ha ha