All About Praxis: Part 1 of 2

Photo by Mika Baumeister on Unsplash

This Week’s Guest

Occupational Therapist, Joann Fleckenstein, and Licensed Professional Counselor, Mike Fields, both of Individual and Team Therapy Services in Atlanta and Expert Developmental, Individual differences, Relationship-based (DIR) Trainer are here to discuss praxis. Mike was recently a guest at the weekly International Council on Development and Learning (ICDL) weekly parent support meeting and the topic of praxis came up. I did a podcast on the building blocks of motor planning a few years back, so this will be a good refresher. We’ll touch on what praxis is this week and Part 2 in two weeks will be a Question and Answer on praxis!

What is ‘Praxis’?

When we think about the word ‘praxis’, it comes from the Greek word meaning, “to do“, Joann begins, and praxis is how we do everything, she says, from bringing your mug up to your mouth to drink, to thinking through a challenging social scenario and figuring out what to do. When we see individuals who struggle with praxis, it impacts how they do anything novel. For example, if an individual struggles to progress in their capacities, or that adult who just gets stuck and can’t pivot or change plans, when we see rigidity in action, or a need for repetition, praxis might be involved because if we don’t know how we get to our plan B, we’re going to avoid needing one in the first place.   

The first component of praxis is ideation. We get an idea and make a plan, or sequence how we will make something happen. We execute it, then we get feedback on how that planned work. For some of their clients, Joann explains, if the plan they know doesn’t go as they expect, they don’t know how to repair. Praxis is like a vein that runs through the entire developmental pyramid, Joann says. She got interested in praxis and its impact on all of development because she worked with a three-year-old who had a spinal cord injury. It should not have affected his thinking because it was his peripheral nervous system, but he had never had to motor plan because someone had always moved his body.

The way it presented was socially. He wanted his little brother to do something in a very specific way and the little brother didn’t want to. He could not recover if things were not done exactly as he expected. Joann realized if the individual can’t do something in the most basic motor sense, they won’t be able to do the most complex social thing. As a mental health practitioner, Mike deals with the praxis of ideas and emotions. If you think developmentally, Mike explains, regulation and reciprocity come before shared problem-solving, When you’re working in that physical-motor space, you get immediate feedback, but you don’t get that when you’re trying to figure out why someone is mad at you. It’s all abstract.

From a developmental standpoint, we have to be able to have that experience first of the physical-motor space. And you can work on praxis because of neuroplasticity. Joann used to hear that whatever you get after the first six months of a stroke is all you will recover, but when she worked in a nursing home with a stroke client who had had a stroke three years prior, she witnessed a man who began to be able to move again. There are pathways forward, Joann says, and with the kids, if we get them moving and playing, the motor planning and pieces start to fall into place.

Floortime and ‘Praxis’

Mike says that Floortime is about potential. We don’t know what the future holds and that’s what praxis is. Our feelings move us to connect, as Dr. Greenspan posited in his Affect Diathesis Hypothesis. Infants begin motor planning through movement to try and accomplish something due to getting something we want. We are wired to make new connections, Mike says. And Joann likes that praxis has its own set of Individual differences. Limitations in movement limit opportunities to connect and engage. It’s hard to parent a baby who couldn’t be held due to discomfort. As a parent, you have to work so much harder to keep your availability going. If there’s any hiccup in the ‘I‘, Individual differences, Joann continues, it makes it that much harder to get to that next capacity, that is, the Functional Emotional Developmental Capacities (FEDCs).

Assessing ‘Praxis’

All of the evaluations at Individual and Team Therapy Services are play-based, i.e., joyful and fun, so the kids always ask when they can return after their evaluation. If Joann suspects praxis challenges in an older child, she’ll play a game called, The Floor is Lava, where they have a big wooden tower, a trampoline across the room, and a ninja line that spans the ceiling. She’ll give the kids five objects (a folded blanket, a big foam tube that’s wobbly, and stepping stone objects)and say that these 5 things are not lava. She offers them enough things that they barely have to work to get across the room. They make it across the room and back and she gives them accolades.

Next, Joann says that the lava is rising. She’ll take away an object at a time. Usually she’ll leave the blanket for last. She’s looking to see if they’ll use the bolster (foam tube) in more than one way, if they adjust their plan at all, or look at it and give up. If they get to just the blanket, and they haven’t yet opened up the blanket, she will pick it up, shake it out, and fold it back up to see if they took that as a cue. Typically she sees that by the time she’s taken away two things, the kids are done with the game because they don’t think they can do it. 

With her younger kids, they’ll play a round of hide-and-seek. She wants to see what happens when she gives them plenty of places to hide. What’s their planning like? What’s their sequencing like? What’s their perspective-taking like? Can they anticipate that she’ll probably look in the exact same place where they hid last time? Do they know where their body begins and ends so they know if they’re completely hidden? Can they anticipate how much time they have left? All of these components are praxis. 

These games give Joann a lot of information, including the opportunity to check how robust their capacity is to tolerate different affect states, such as if the lava is really scary because there’s monsters that will come up, ramping up the intensity in her voice. With hide-and-seek, she can wait and sit in that hiding spot, waiting to be discovered. She can see, in real time, how a child does everything they need to do, from walking across the room to get into a hiding place, to turning ideas around in their mind. This helps her determine where she can offer some more growth, stability, and brain development so that when she looks at the fourth capacity of shared problem-solving (FEDC 4), the child will have some nice foundational skills.

How Do You ‘Teach’ Praxis?

What makes something praxis is that it’s unique, Mike says. When you show them the idea, it’s no longer praxis. Now it’s working from memory, which is a whole different part of the brain. Praxis is the thinking part, not the memory part, he explains. We don’t help someone with praxis by giving them the idea, Joann continues. We can facilitate praxis development. We offer opportunities where we scaffold for low muscle tone, sensory differences, or things outside of praxis, so that the child is able to engage in these activities and develop those inklings of that thinking.

Praxis Across the FEDCs

At the first Functional Emotional Developmental Capacities (FEDCs), Self-regulation and interest in the world, the only praxis that’s involved is only that which is required to explore the world and access sensations, so there’s very minimal praxis there. At capacity two, Engaging and Relating, we need sufficient praxis to participate in an activity with another person, to connect with them, to be available, to find them in the room, to copy what they’re doing, and to sit with them in an activity.

At capacity three, Intentionality and Two-Way Communication, it really starts to ramp up, Joann continues, because you have to anticipate the pattern and implement the motor planning, head turning, and everything at a specific time and pace to keep that reciprocity going. At capacity four, Shared Problem Solving, it’s possible without praxis, but it sure is hard and requires so much scaffolding and support to occur. Joann has a video of her with a young child who really wanted a swing hung in her therapy room but who had no idea how to do it. But he was able to connect through gestures and words what the problem was, and that he wanted her help.

So, she offered an opportunity for a facilitation of praxis by not fixing the problem. He had to be comfortable sitting in the distress of the problem not being solved, and Joann was there supporting him, sitting beside him in distress. He was able to continue to try to figure out another way and get help from the assistant in the room to try to hang that swing, and he got it up there, and he was so happy. Joann says he would have deprived him of that had she just hung it up for him.  

Facilitating Praxis Development

A lot of what she does in facilitating praxis development is to make sure the child is ready to sit in discomfort. If they can’t, it limits the options. And second, they wait: wait, watch, wonder. Can she sit in that discomfort as he tries to come up with a new plan? It’s such a tricky jump from the early three capacities where there’s lots of action, and we’re doing a lot of work to maintain regulation, engagement, and circles of communication, to the higher capacities where we sit and wait and let the child bring the ideas to us.

You can’t do capacity four by yourself, Mike continues, so it becomes more of an equal connection and relationship, which is why Floortime is so natural to facilitate this. You can’t teach praxis, but you can harness curiosity and anticipation. But, you can’t make someone be curious either, so that’s why Floortime is child-led (or adolescent or adult-led). We want to join them in their interests and what they’re good at, because those are things they’ll be more curious about, especially when they’re frustrated, and especially if they’re connected in a Relationship with us. When you feel connected, it helps you to be a little more resilient, Mike shares.

The DIR model gives us a unique position to understand, support, and foster natural curiosity, and then let it happen, so our kids can be thinkers and not just doers, Mike explains. This part gets into the mental health part: getting into the emotions and solving abstract problems. But even our feelings have sensory components, he says, which an Occupational Therapist helps with. Mike gives the example of a thirty-year-old who had a relationship that ended and now they only want a person who looks just like that person and is exactly like that person. They can’t reason out of that, especially when they’re emotional.

Mike had another example of a young adult involved in an accident. The person was scared the police would get involve, he’s lose his job, and go to jail. A few days later, he got into a rumination spiral about how horrible everything is and then began acting out and having meltdowns. The parents didn’t know why and thought it came out of nowhere. With a child who has trouble connecting ideas at capacity six, Mike explains that the individual had physical sensations due to his anxiety, but didn’t understand where they came from. It just made him feel bad, and he just started thinking of the big, bad things in his life.

Everything Builds on the Foundation

Everything builds on the foundation, Mike continues. As Dr. Barbara Dunbar, his colleague, used to say, “Linger longer at lower levels” where you feel safe and get the sensory input you need, so your baseline is less anxious. Joann likes to consider what capacity an individual has when they’re having a bad day. All you can offer yourself in that instance is to go back to capacity one and get yourself back on track before you can engage, be reciprocal, and problem solve together.

Keep your expectations at capacities one, two, and three. When you see glimmers of capacity four, then you can keep going. It is hard for parents when the age and grade level keeps going up and we’re still in the early capacities for so long. Social-emotionally and developmentally hang at the lower capacities, Joann insists. Only then, capacities five through twelve can start to fall into place like that old Windows game of solitaire when the last card falls into place. It’s hard when the other kids are all doing so much more than yours.

Create Opportunities

We want to figure out how to create opportunities for them to be curious because we can’t teach this directly, Mike says. They have to be interested. He gave the example that he gave in this podcast of knocking on the door when the child was expecting Mom and how he kept closing the door on himself then knocking again until the child eventually let him into the house. It wasn’t reasoning on the kid, Mike said. There was a violation of expectations. The kid had an idea, and it didn’t work out. Not understanding what went wrong is terrifying, Mike says! What if your world is just chaos?

Mike wanted to show this kid that he could be trusted and was predictable so he responded to any sign the kid gave; the kid understood that Mike wasn’t making him do something he didn’t want to do. Oh, so it’s not scary! He realized he could make a sound or look and it stopped. He had control! Mike created that opportunity just by being. He focused on the Relationship so the child would feel safe, rather than working on the capacities. I paraphrased that Mike gave discomfort in small doses so he could built up the kid’s curiosity.

For a lot of our kids there’s ‘now’ and ‘not now’, Mike says, and ‘not now’ is scary; a minute from now might as well be a million years from now. A minute is abstract, he says. You can’t touch one or see one. It’s in capacity six. Attach it to the emotional idea of being safe such as saying that five minutes, for instance, is their favourite YouTube video: “Mike’s gonna be here for one more Blues Clues video“. Joann says to allow for unstructured time and allow the opportunity to fail then try it another way. When Mike works at the adventure camps he described in this podcast with Aerie Experiences, his colleague will often yell out to him: “Thief! You just stole an opportunity!” when he solves something for a youth.

I expressed how challenging this is for parents to do because of how we feel when our child ‘fails’. It’s our anxiety that makes us the opportunity thief when we solve things for them! I can’t wait to continue this discussion next time with questions and answers and more examples!

Thank you to Joann and Mike for taking the time to describe the aspects of praxis through a DIR/Floortime lens. I hope that you learned something valuable and will share it on Facebook or Twitter and feel free to share relevant experiences, questions, or comments in the Comments section below. Please stay tuned for the next podcast in two weeks where we’ll have Part 2 with Questions and Answers about praxis.

Until next time, here’s to choosing play and experiencing joy everyday!