The skillful therapist is like a chameleon – able to shapeshift and turn their hand to any and all presentations; artfully engaging with, weaving and drawing out magical cooperation; making it fun. The art of both assessment and therapy are to make sure whatever we do, it is the “just right challenge”. Whether it’s just the right way of being to connect to a child, preparing a room for the initial visit with a swing or ball pool that’s likely to entice play and engagement, aiming for the “just right challenge” is essential.
Doing parent training in a school recently reminded me again how important it is that we ensure what we do is the “just right challenge” for parents and teachers too. While we are very good at simplifying what we do to make it understandable and accessible for all, sometimes parents need to trust us because we have knowledge and skills beyond what they can read in books and on social media sites.
The “just right challenge” is critical to the therapeutic relationship; too much or too little challenge and too much or too little safety, and we don’t create the right brain chemistry for engagement and participation. Remember last time you were frightened and scared, in an interview – How was your performance, were you able to be who you usually are?
This includes making sure we choose the right assessment tools and therapy activities, the therapist ensuring the ‘just right challenge’ – not too tricky, but also not too easy.
I explained the Sensory Integration and Praxis Test, Clinical Observations and the Sensory Processing Measure to a group of parents, and why we won’t always use the same test for each child, because each child is unique.
Critically, not every child can be assessed with a standardised norm-referenced test like the SIPT or Movement ABC, some assessment can only happen in a different way – with equipment and games, through play – play and assessment served up with artful skill so that the assessment can happen unnoticed by the child.
I was reading a report written by another OT, and her artful use of self to get a thorough clear assessment in a situation just like this. It reminded me about what is special about being an OT. We are trained to problem solve and think outside the box – perfectly placed to creatively choose from the many tools we have in our toolboxes and mix and match them to each person’s unique needs.
Each child is so unique and different – some are clearly children with obvious sensory integration patterns that link to their Autism, just like the research predicts. Some children have had trauma, some have genetic differences, and their patterns are more complex, needing different lenses, and a skillful combination of assessment and therapy approaches. Others need us to wear different hats, combining what we know – Neurodevelopmental Therapy interwoven with Ayres’ Sensory Integration or ASI woven with just the right amount of attachment theory, or just a cognitive behavioural approach coupled with backward chaining to learn a new skill. Skilled experienced therapists know the “just right” combination.