A treatment session lasts anywhere between 45 and 60 minutes and, when possible, I prefer for you to be present and involved on an ongoing basis. This involvement may be direct, in the treatment space, watching through an observation window, or watching and listening remotely via live feed from a camera to a tablet. There is a space nearby if you need to take care of personal or work business during the treatment session from time to time, but I prefer for families to be as involved as possible. The treatment session typically begins with me assessing a child’s nervous system state upon arrival and, if dysregulated, working toward helping to bring the child into a regulated state, or what some refer to as their window of tolerance. Many children that I treat are frequently dysregulated and outside their window of tolerance, and some have never experienced a truly regulated state, which is necessary and optimal for learning and making changes. For these children, there is no window of tolerance, or the window has been slammed shut. They are either stuck in fight or flight responses, or in some form of freeze or collapse. These stress responses are happening automatically and once primed, become harder and harder for a child to break out of. Essentially, my job is to first help them feel safe enough to move out of those responses into a more calm and relaxed state, which is necessary to bring the thinking brain online and to make new neural connections. This is where all the good stuff happens. It can take a long time to help a child get to this state, especially the longer they have been stuck in a dysregulated state. It also takes a large paradigm shift to view behavior and development through a different lens, but once that happens and children can get to a regulated state, we can start to peel back the layers of what we are truly dealing with, and begin to make progress in a gentler, easier, and longer-lasting way. It takes significantly more time, energy, effort, and financial investment to try to push skills in, rather than helping them to occur in the natural way they are meant to, and WILL, when given the time and appropriate intervention to allow that to happen. As I am building trust and relational safety with your child in the context of playful interactions, I am teaching you to do the same with them at home. I place a high emphasis on caregiver education and utilize visual aids, videos, books, websites, etc., to help make the treatment concepts more concrete, accessible, and relevant. While helping to provide education to you as the caregiver, and building relational trust and safety with your child, I am also creating physical safety in the space in which we are working so that your child feels free to move in new and different ways and therefore, willing to take risks. Risk-taking is necessary for resiliency to occur. As I am making sure your child feels safe, I am not leaving them there. I am coaxing them toward higher levels of development and challenge, but trying to be careful not to lose them along the way. I will “back the train up,” so to speak, when inadvertent overwhelm and disengagement or shutdown occur and they fall “off the track”. This may happen frequently and is all part of me getting to know your child and working towards resiliency. As an OT, I am highly trained and skilled in modifying and grading activities and challenges to meet the child where they are at. This is called providing the “just right” challenge. Many therapists are working too high for the children they are treating, and the challenges are too great or the child is too dysregulated to make any significant changes. This leads to frustration for all involved and a perception of the child not trying hard enough, the parent not putting forth enough effort, or the therapy being ineffective. I work hard to avoid all of those scenarios, especially the first two because they are most often inaccurate, and can be incredibly damaging for the child and parent alike. I believe children do well if they can. My job is to figure out how to help them be successful. As a body-up or bottom-up practitioner, I start at the bottom of the developmental pyramid and move upward from there. Every child is unique, so the specific progression and time it takes to move up the levels will vary, and they aren’t concrete divisions, so we are frequently working in more than one level at a time. However, my emphasis is to make sure we close any gaps and fill any gaping holes in the lower levels that are so often missed.