I arrived at a client’s home today ready to start a session, and as I walked up the front steps I could hear what sounded like crying or an upset child. Sigh. It was my client, no doubt. Poor thing. Poor mom.
I rang the doorbell, hoping that might incite some calming; No answer but continued crying and yelling.
I knocked on the door in case the doorbell didn’t ring, using a “da da da-da da” pattern, hoping the playfulness might create some calm; the crying got closer and still no opening of the door.
My searching “Hello?!” was met with a louder yell, “NO!!! It’s not time. NO!! NO!!!” and more crying. “DON’T COME INSIDE!! I DON’T WANT YOU INSIDE!” Followed by more yelling.
I reassured him I wouldn’t come in. “I will wait,” I told him.
After what seemed like a few more minutes of me standing alone out on their front steps, but was likely only 30 seconds or so, I called through the door…”Did something happen? I hear you crying and I don’t know what’s wrong!” I received a muffled reply in a very calm voice (cue the realization that was wa-a-a-y too easy to calm from what sounded like an awfully upset state), “I wasn’t ready when you came. I want to do OT in the field.” He said through the door. There is a field across the street from my client’s house.
Given 1) my realization that he calmed immediately when he thought he was getting what he wanted, 2) my desire to move things along so we didn’t “waste any more time” in our session, 3) my empathy for his mom who had likely been dealing with this “kind of behavior” for a chunk of time (and does so on many other days as well), and 4) one of our OT goal areas is self-regulation, my instinct was to challenge him. In my head I was formulating how to hold a limit and not escalate him further; how to find a compromise so he wasn’t getting his full way, and how to use this as a teachable moment. I went through all the behavioral strategies and felt my own frustration with being “controlled by a 5 year old” rising. Then…I paused…and realized I need to practice what I preach. This is not about me and not about controlling the situation or him. As far as “teaching him a lesson” goes…he’s not going to learn if he’s escalated. Repeat escalations don’t teach him anything but give his brain and body a chance to practice being escalated.
So I agreed. I told him that as long as his mom was ok with it and she came with him to make sure he’s safe crossing the parking lot, that we could do OT outside. “Outside is fine with me. I’ll meet you in the field!” I stated through the door. What do I care where we do it? He can learn skills in any environment and if outside was being requested by an upset little boy, then something about outside was what he needed AND he voiced it. Isn’t that a skill we want to foster and reinforce?
So to the field I went. I told him I’d meet him there and a few minutes later he and his mom showed up with a blanket. We did our tactile play at the bottom of a hill and while he somewhat contentedly made pretend Legos, I tried to incorporate discussion about “unexpected things” and I told him that the same situation might happen again. He wanted to know exactly when but I told him we don’t know. That’s why it stays unexpected. I pointed to the box that the “mad matter dough” was in and asked if he knew what was inside before we opened the lid. Mad matter was “unexpected.” I asked him if he knew the “fake snow” would be dry when he touched it. The fake snow was “unexpected.” We talked about how long it might take the builders to finish the roof on the house outside across from us. That amount of time was “unexpected.” Some unexpected things are things we like and some are things we don’t like. In between Legos we practiced some rounds of nose/mouth breathing (with visual cues from my hands to extend the breath) and before the session ended I had him sit on his mom’s lap and we tried a rhythmic side-to-side round of “If you’re happy and you know it”…because sitting on mom’s lap when the time turns on the hour is one of his favorite things, and hugs slow down his heart rate (we know this from prior sessions). He specified, “No singing,” (likely because he’s heard me sing in prior sessions) and at one point he specified, “No talking,” so we let him do the talking. Before leaving, I told him I’d wave and say good-bye 2x and then stuck to that plan and as I left he was waving and smiling.
Did he get out of the session what I hoped he would? Probably not. Was the session helpful at moving him toward long term functional goals? I’m not sure. Did he get to practice a few calming strategies and contemplate “unexpected” situations, sure. BUT most importantly, did he end the session happier than when he started, did he feel respected, calm himself down without running away, without hurting himself, and without hurting his parent, like he’s done before? Yes. 100%.
Sometimes sessions are unexpected. And many times we can’t use any of the strategies we say or think “should work” (offering vestibular or proprioceptive input or choosing from a calming tools menu as I stood on the outside of a closed door, was completely impossible). But the one strategy that didn’t fail today was connecting and respecting what my client said and was showing me he needed. It may not be practical or reasonable for parents to use this strategy every time. But, therapy isn’t always real life and doesn’t have to be. I believe our session today helped him regroup enough to transition through to the next part of his day and to feel somewhat calm for the half hour I was with him. His brain and body didn’t spiral and sometimes staying in one state vs. fluctuating up and down is a win for the nervous system. Having fewer vs. no meltdowns is also a win. Sometimes we just don’t know the impact or gains we are making and that’s ok. We keep going. Because just like life and the message I gave to my client, sometimes things just stay “unexpected.”
