Friday, March 13, 2009

Therapy Thoughts

Aidan has come off the waiting list for occupational therapy at the Therapy Unit down in town where he receives PT and regular evaluations. Unfortunately there is a hiatus at present in his physical therapy status due to the budget cuts in California, but yesterday he saw the PT for monitoring and was fitted for Thera-togs. After that he saw the OT, Miss K. There is a bit of ambiguity because if he is regularly seen at the unit he won't be able to see our homebound OT because of "duplication of services." But both agencies seem alright with him being quarterly monitored by the Therapy Unit and seeing the traveling OT weekly in our home.

It was interesting seeing Aidan work with a new therapist. Miss K, the OT, managed a working rapport with Aidan almost right away. She was low-key friendly with a slightly boyish manner -- you know, understated and matter of fact. This worked really well with Aidan's comfort level. He tends to back off from people who see his quietness (a family culture thing) and try to bolster him out of it with effusive cheer. But she got right down to work with him and saved her good energy for interacting with him over the task, "side by side" rather than "face to face" -- which is a better way to handle introverts while you are still developing a relationship with them. Even with extroverts I think it is often better to start off with this kind of lowkey approach at least in therapy because some extroverts start escalating into excitement when they are treated with too much joviality in this kind of situation.

The other thing I liked about her was her watchfulness and "masterly inactivity". When he was doing a task she watched carefully and intelligently. She didn't try to "help" him when he wasn't wanting to be helped. It's odd that I've found that a HUGE temptation for therapists is to jump in and "help" with a task rather than let him finish on his own. This is often because the therapist wants to go on to the next thing on the agenda. But of course, if your goal is that a child learn to do things for himself, you don't want to constantly remove the possibility from him. That's why I'm surprised when I see professionals doing this. I learned it the hard way through homeschooling for several years. I realized I was debilitating the initiative. With Aidan it invariably means a lack of focus results -- he gives up, starts phasing out and becoming distractable. Then of course the therapist's tendency is to remonstrate with him for his spaciness. I've seen several therapy sessions fatally wounded by this.

Now, it's a different thing to help the child have success.... that is, you see defeat and frustration about to take over so you scaffold the child's efforts by a minimal facilitating of your own. Miss K didn't have to do this with him because he was completely focused and calm. She had a bunch of vests with different fastenings -- snaps,zipper, buttons. He was all right with the snaps and zippers but struggled with the buttons. He ended up getting two done though, and was obviously very much into it. I admired her for holding back and letting him finish the second one and furthermore, encircling the task with a kind of calm concentration rather than a "hurry up and be done" type of feeling.

The therapists Aidan has worked with at the unit tend to stand back as much as possible with a task, then help with verbal instruction, and only then do physical guidance. When Aidan was younger this could sometimes backfire. He would quickly lose interest in a challenging task, and words don't enter his consciousness very well -- he has a lot of difficulty translated verbal directions into actions. So by the time physical prompting comes in it is a "rescue" and he is already mentally done with the whole thing. Back then I used to start with gently physically guiding him through things WHILE giving him a verbal formula that summarized the motor movement. Then slowly I'd fade the guidance to a simple touch plus word and finally just the word. But now he seems better motivated to attack the skill and try to master it and only if he has severe difficulty to look around for help.

While Aidan was trying on the Thera-Togs, there was another therapist and a father and teen daughter in the room, along with a translator for the father, who was Oriental. This therapist was talking in a really directive, bracing way. "Walk straight! Come on, you can do it. Straighter!" and I heard her talking about the girl's "lazy, sloppy" gait and things of this kind. I was only incidentally overhearing and had no way of judging fairly what was going on. But I know this approach wouldn't work for Aidan or for me.

I like to see different therapists and the way they use their natural personalities plus their professional skills to build a working relationship with children and their parents. Often I pick up some useful attitudes and strategies. Often, too, I see things to avoid or that I definitely won't follow up on at home because I think they don't have a good effect. In this case, Miss K's style was compatible enough with mine that I can really see trying some of her therapies with Aidan at home. She worked on his writing and showed how to use different colored shoelaces to make the process of shoe-tying visually distinctive. She breaks things down into small pieces and goes carefully forward, not unlike Montessori methods. She used a minimum of words while he was working. She told me she scours the internet and trade journals and consults with other therapists to figure out a range of strategies for any given difficulty. This is basically how I approach things, or try to approach things (at least, at best, when I don't let myself get unfocused and drift). I like to have a range of things to try with a central goal in mind, and a flexible approach that adjusts to the individual, and a sort of matter of fact attention to problems and their solutions. Needless to say I don't always achieve this -- my problem besides lack of focus is a kind of hesitation and second-guessing. But when I'm in my best mode that is usually the territory I'm in.


Stephanie said...

Kevin isn't the only one with the gift of concise clarity.

"if your goal is that a child learn to do things for himself, you don't want to constantly remove the possibility from him."

Some parents should be made to recite that first thing in the morning, over lunch, and last thing at night.

Willa said...

Well, I'm one of them who needs to keep saying it over and over again ;-). It's very hard for me to sit on my hands and not "help" a kid who is working something out, so watching someone else make the mistake sensitizes me towards the mistakes I make. Definitely a process!

Katie said...

Willa, I noticed something similar in my daughter's math class this week. The teacher wanted the kids to do some problems on the board-- they're really struggling with this chapter-- but she was also nervous about time restraints. Instead of quietly letting them work through a problem, she would tell them to do it a different way, or not to be so elaborate in the notes the put to the side to help themselves, etc. She finally realized what she was doing, and later commented that she wants to allow the kids time to do problems on the board, but everyone has their own style, and they just don't have enough time to wait for everyone. (She wanted the class to meet two times per week but agreed to only have one meeting per week, and the lack of time is really hampering them.)

Anyway, sometimes I wonder if I am being lazy just sitting back and observing what the kids do and how they think through their processes. But it is so necessary. They will let us know when they need help, and as long as we are observing and not doing something else, we will be able to watch them think and better understand what the next step needs to be. It's pretty cool.

Katie said...

I get frustrated when I am in some public situation watching my child problem-solve and another adult comes up and "helps" her (read: takes over the process) instead of letting her accomplish it on her own.

One of my kids gets a bit defensive when this happens, because she feels that the product is not 'hers' if someone helped her with it. It loses value to her.