He was one of those young boys who appear happiest standing in a puddle of mud holding whatever creepy crawly creature he could find. He was admitted to Grafton because of the repetitive trauma he had endured early in his life and then again when he experienced repetitive sexual abuse. Therapy began along the traditional talk therapy lines, connecting body experiences with thoughts, emotions and behaviors, learning how to establish boundaries and searching for core beliefs that had developed as a result of his experiences. We just couldn’t get the pieces together. At the young man’s request, we ventured outside and that is where he introduced me to the therapeutic value of children at play and the power of the “rolling down the hill” therapeutic intervention. At first, I was hesitant because honestly, watching a little boy tumble down a hill felt more like watching a reenactment of a nursery school rhyme then therapy. But he was laughing, engaged and, over time, he was able to tolerate talking about those awful things that happened without showing aggressive behaviors. We kept working, he kept rolling, and, with time, he rolled himself right into a secure, connected therapeutic relationship, a more regulated state, expanded his ability to tolerate distress, achieved treatment goals and was able to process significant sexual abuse.
This young man’s actions highlights an emerging therapeutic approach, Sensory Motor Arousal Regulation Treatment (SMART), with a team of professionals leading the way that include Elizabeth Warner, PSY.D., Alexandra Cook, Ph.D., Anne Westcott, LICSW, and Jane Koomar, Ph.D.
The SMART approach identifies the proprioceptive and vestibular systems as avenues through which co-regulation and a widening of the Window of Tolerance can occur. To quickly summarize, the proprioceptive system involves tactile input of body movements involving balance and movement. The vestibular system, located in the inner ear, is stimulated through spinning, rocking and jumping.
From this framework, we have expanded the nature of our interventions to incorporate the “therapeutic tools” found on a child’s turf. What takes place is that when provided the space and opportunity, children invite their whole bodies to the therapeutic process and heal trauma experiences (The Body Keeps the Score, Bessel van der Kolk, M.D., http://www.traumacenter.org/products/Amazon_staff_books.php)
For example, an incredibly distressed, aggressive and destructive child was provided the opportunity to go to the playground and spin on the tire swing with his therapist. After a few turns and with the therapist there as a co-regulator, he stopped, burst into tears and shared with the clinician his emotions related to loss and loneliness. These were emotions he had not been able to share up until this point. In another situation, an adolescent male who was addressing the trauma of repeated physical abuse and struggled with managing his assaultive behaviors towards his mother, used weighted balls to shoot baskets, releasing the tension held in his arms and develop coping tools apart from responding with aggression, as he processed the confusion of thoughts and feelings with every shot.
We have been so excited to witness the impact of these interventions play out and are even more energized to see how the children in our care can benefit from the therapeutic progress taking place on the playground.