There is so much out there about trauma therapy that addresses the brain and body.  As if the idea is new.  It is only new to you if you thought talking alone solved problems that originate in terror.

Every OT knows that you are more than your mind.  It is integral to our profession.  We NEVER treat you as only a hip fracture or an executive function.  So why would I be concerned with psychotherapists wanting to learn about sensory processing treatments?

Am I jealous?

Am I territorial?

Am I worried?

BINGO!

I am worried that they don’t know enough about physical assessment and treatment to do it safely and effectively, and they don’t have any hands-on supervision to do the skilled administration of physical treatments with fragile patients.  Trauma survivors are more likely to blame themselves as being too damaged than to wonder if their psychotherapist doesn’t have the training to administer a treatment effectively.  These are fragile people who deserve the most skilled care.  They often take a raft of medications for their mental health needs but also for the chronic conditions common to trauma survivors.  In addition, all of us have medical issues unrelated to trauma.  Those can matter a great deal.  Concussions, gut problems, arthritis.  That is the tip of the iceberg when using sensory treatments with adults.

Not all physical treatments create risk.  Anyone can teach skills like progressive relaxation.  When the client dissociates, a trauma therapist doesn’t need to know much about the body to help their client ground in the present time.  They can handle this.  Progressive relaxation doesn’t have the power to harm unless you let a fragile patient do it with such intensity that they ignore pain.

So what do OTs do?  

They effectively evaluate interoceptive deficits.  First, there are assessments for older kids and adults to measure interoceptive ability.  They don’t teach those to psychotherapists.  Second, therapists understand the effects of medications and medical conditions on the physical indicators assessed in this test.  Get it wrong, and you aren’t looking correctly at a client’s responses.  Your treatment depends on accurate evaluation or you are just guessing!

Third, you need to evaluate your patient’s treatment response based on your training in brain science.  Taking a weekend course won’t do it for anyone but the most physically healthy and mentally stable folks.  Brains and bodies after trauma are often …complex.  You need to know which treatments are riskier than others, which are amenable to adaptation, and which are powerful but require preparation.  The most powerful sensory therapies work faster and deeper, and their effects last longer.  The weakest are barely band-aids.  Think squishy balls.  We teach the weaker techniques to parents and teachers BECAUSE we know they are less likely to harm kids, not because they are the best techniques.

What are the most targeted interoception therapies?

This is simple.  Treatment using manual work, therapy ball work in prone or supine, and movements that activate the receptors in the gut build interoceptive awareness.   Activities that combine visual, vestibular, and proprioception together support interoception with enough grounding and orienting to the present to allow tolerance.  Sometimes, these more intensive activities are preceded by proprioceptive and auditory therapy to prepare a patient for intensive vestibular input.  We don’t overwhelm our patients, and we don’t swing them on swings for years, waiting for results.   We craft a targeted program that is efficient and produces results.

The problem is that without knowing enough about assessment of the sensory systems and the conditions that affect interoception, these treatments can overwhelm or even harm patients.  EVERY therapist new to vestibular treatment has caused a patient to vomit.  EVERY therapist who is new to manual work has had a patient tell them they are pressing too hard or they are feeling faint.  Luckily, we are trained to know what to do.  We have worked with fragile medical patients.  I have treated so many non-verbal or partially verbal patients that I know what to assess physically when they cannot speak.

Psychotherapists that aren’t NPs, PA’s, or psychiatrists don’t have that training.  The rest will call 911 or end the sensory activity because they can’t adapt it or determine why things went south.  We don’t usually have this happen… because we are given the training before we touch a single patient, and we get skilled supervision so that we don’t harm anyone.