October 5, 2019 - Michaela Gordon

Progress Through Partnership

By Michaela Gordon, OTR/L

Deciding to start occupational therapy services with your child can feel
overwhelming. It takes a great amount of trust in the therapist and the process.
We are talking about your child’s life and well-being so we must approach their
needs with the upmost of care.

We are living in a time where clients have more access to information and
therefore want more choices and more explanation. Clients will ask me about differing
opinions about certain approaches or perhaps a new gadget or therapy they saw
online. To be honest, I am also being inundated with online information and I’m
often researching what approaches and tools are effective and which are
ineffective. It is very easy to become skeptical, defensive, indecisive, and

sometimes paralyzed in a state of overwhelm with everything coming at us. It is
also very tempting to click on a quick fix or become fixated in our view points
because the algorithms in our social media feeds keep bringing up the same or
similar content. With all this information, it sometimes can distract us from
the most important part of therapy, which is the therapeutic relationship.
Humans really are interdependent. Information is great, but it really isn’t
helpful unless we know how to use it or know how to apply in a way that is
meaningful to your child.

I believe that the relationship I have with my clients is the foundation for
all the good work that is to follow. When entering into any relationship, we
must hold ourselves accountable, have empathy for each other, and work on
developing strong communication with one another. With these aspects in place,
we can effectively work together to help your child learn and grow.

Let’s explore these three aspects a little more. First is taking
responsibility for our actions. As a therapist, I’m upfront with my clients
about my responsibilities and the client’s responsibilities. Some are written
in policies and some are discussed in person. This ensures that we are all in
agreement about how we are going to contribute to the therapy process. If we
get off track, this allows us to have a discussion about the challenges occurring,
assess our plan, and then refocus back to our individual responsibilities.

Empathy is another important aspect in a partnership. As human beings, we
know that life can bring us both joy and challenges. Our goal is to try to be
fully present and on top of our responsibilities so we can make good gains in
therapy. However, there are going to be times where that doesn’t happen and we
must show empathy towards one another. As the therapist, I might make a mistake
in a report or forgot to send out an email out. Perhaps I misunderstood something
you said and took a situation in the wrong direction. These things will happen

from time to time. As the client, maybe you really want to get your home
program going, but you realize you don’t have a strong support system to do
that. Maybe you really want to work on setting a different boundary with your
child, but you are tired from a long day at work and you don’t feel you have
the energy to deal with a meltdown. None of us want to be dealing with
tribulations, but they are indeed part of life. So, whether big or small, we
need to have patience and be understanding with one another. It’s important to
take accountability when we miss the mark, but it’s equally important to know
our strengths and limitations so we can come up with a reasonable plan that we
can all follow.

Lastly, partnership requires good communication. Effective communication
includes accountability. We need to check in with how things are going and make
sure we are working toward our goals. Empathy is also part of good communication.
The words we choose and the tone we use to deliver those words, sets the stage for
how strong our therapeutic relationship will be. Bringing accountability and
empathy into our communication allows us to speak with honesty about our needs
so we can be the best support team for your child.

A partnership is an investment. It is an exchange of effort and belief in
one another. It is a chance to reconfigure life’s challenges into something
fruitful. It is about both you the parent and your child leaving therapy
empowered with skills and confidence. It keeps me motivated to study and learn
new things to bring to the therapeutic experience. A strong partnership leaves
me more experienced, wise, and skilled so I can help the next family with the same
level of passion.

So, let’s be good models for our children. Let us get away from divide and disconnect
and choose connection and collaboration. Let us show them good boundaries and how
to be accountable. Let us show them how we can be empathetic towards each
other. Let us show them how we listen to each other and that we are responsive to each others’ needs through

our actions. These skills can not only be learned in their therapy sessions,
but through our simple interactions.

Michaela E. Gordon, OTR/L

Cleaning up the facts about The Wilbarger Deep Pressure Protocol (Therapressure Protocol)

By Michaela Gordon, OTR/L

At my first job, I remember seeing these white brushes. I knew they were for some sort of tactile stimulation, but I did not use them with students. I moved to CA and here, I would also find the white brushes! I was shown the protocol at an in-service. I didn’t fully understand the neurological underpinnings of the protocol, but I thought this was a great tool, so I started using it with clients.

I later realized after taking the class, it is really important to go to the training because you need to learn about the mechanism of pressure, which is difficult to conceptualize from verbal or written directions. Also, when I trained families in delivering the protocol, I typically had to review the technique with them 2-3 times before they could execute the procedure in an effective way on their own at home.

I was excited when Pat Wilbarger and her daughter Julia were coming to the area to teach the neurological foundations and the application of their protocol. Pat was one of the first pioneers in the field of sensory integration and she created this protocol to help children with sensory defensiveness. Sensory defensiveness is when the brain perceives non-threatening sensory signals as a threat, causing chronic, undue stress to the individual. During the class, Pat said something that helped me to truly to understand the importance and intent of the protocol. She said, “This sensory defensiveness is serious stuff! This is a matter of quality of life for these people so you really need to understand what you are doing.” It’s a matter of quality of life. I will never forget that. It’s a matter of being able to function in the world and being able to let others close to you. It matters.

There are lots of misconceptions about the Wilbarger Deep Pressure Protocol from its purpose to its details. I am hoping to clear some of these misconceptions up. First, the protocol is often called the “brushing protocol”, which sometime leads both non-trained professionals and non-professionals to miss the objective of the protocol, which is to provide pressure. Some individuals also confuse “brushing” with lymphatic dry brushing, which is surface, light-touch brushing with a different type of brush, which is counter-productive to addressing sensory defensiveness. Pat developed a specific brush where the bristles are a particular shape and texture as well as a rounded handle to ensure good delivery of deep pressure. This pressure is without scratch, tickle or itch.

Second, the purpose of the brush is to apply specific PRESSURE to the skin. It is not light touch or a massage. It is all about specific pressure. The brushing procedure is followed by joint compressions, which is also specific PRESSURE delivered to the proprioceptive (joint/muscles) system. Doing both is important so the brain can properly interpret and integrate the messages from the sensory signals. The tactile stimulation is given with pressure, but even so, can over-arouse the system. The joint compressions that follow are given to provide grounding input without overstimulation so the individual can benefit from both types of stimulation.

I often get complaints about the frequency the Wilbarger Deep Pressure Protocol has to be delivered, which is to be performed every 1.5- 2-hours throughout each day for at least 4-6 weeks or until symptoms resolve. I can assure you that this is not to torture you or your child. If you want to change physiology, the body needs consistent input that is delivered at a specific frequency and duration over time. So the more you can follow the protocol, the more likely your child’s physiology can shift.

Another missing piece is the sensory diet. This is Pat Wilbarger’s coined termed for providing other types of sensory inputs throughout the day along with the therapressure protocol. Again, we are looking to shift sensory input into informative data versus false alarms that puts the individual into distress. The person needs an opportunity to get organized input on their own in conjunction with the therapressure protocol that is delivered by an adult or themselves. Individuals with sensory defensiveness are often avoidant or distressed by daily activities so they do best with predictable, planned sensory activities. Over time, the person will be more likely to seek out and engage in a variety of activities that fulfill their sensory needs. However, until their physiology changes, they will need support and encouragement.

It must be noted that Pat Wilbarger figured out something remarkable. While working with her friend and colleague Jean Ayres, she realized that some of these children were avoidant of treatment versus naturally gravitating towards sensory stimulation that met their needs. Pat was also able to determine that the timing of sensory input was important. Her clinical findings indicated that children generally needed to be engaged in sensory input every few hours in order to keep the integration process going. Due to this discovery, she realized that it wasn’t enough to treat a child just in a clinic, but sensory stimulation needed to be continued in homes and schools. That is why it is important for parents, therapists, schools and other adults in the community working with the child to communicate in order execute the sensory diet and therapressure protocol. As they say, “It takes a village!”

So do the sensory diets and the therapressure protocols require some planning and effort? Yes. Can it feel stressful and at times tedious? Yes. However, I think the missing link is that parents, teachers, therapists etc. may not have gotten the message I received and that is, “This sensory defensiveness is serious stuff! This is a matter of quality of life for these people so you really need to understand what you are doing.” I think when we keep the intent of what we are trying to achieve out in the front, it keeps us on track. We do the best we can to deliver consistency to the defensive/avoidant individual. We do our best to come up with a plan that can be realistically implemented. It doesn’t need to be perfect. The goals just needs to be clear and we have to keep working at it.

Pat Wilbarger has absolutely left her mark on this earth. Both she and her daughter Julia have gone all over the world delivering their knowledge and expertise on sensory defensiveness. I have seen with my own eyes the difference this method can make for individuals with sensory defensiveness. They regain confidence and joy. They begin to understand themselves and connect with others.

A thank you to Pat and Julia Wilbarger for all they have taught me and the rest of the OT community.

“Never doubt, that a small group of thoughtful, committed citizens can change the world; indeed, it is the only thing that ever has.” -Margaret Mead

Michaela E. Gordon, OTR/L