Last time, Dr. Stuart Shanker shared that the missing piece in the DIR/Floortime randomized controlled trial study at York University was the mental health professional’s work with the parents about their own stress. This week, that mental health professional, social worker and DIR Expert Training Leader, Eunice Lee, joins us to discuss how we approach supporting parents in the self-regulation process.
Self-Regulation Starts With Us with Eunice Lee
When Eunice was hired for the controlled randomized DIR/Floortime study in Toronto, her goal was to understand the child’s developmental level, to develop appropriate goals, and to deliver the treatment as a multidisciplinary team. She was interested in delivering it as a coaching model. They had to tailor the intervention not only to meet the needs of the child, but also to the needs of the parents.
I wrote about how Dr. Stanley Greenspan discussed on his radio show and in Engaging Autism that the whole dynamics of the family play into the DIR approach. Eunice says that starting with the child makes so much sense and is very logical because there is development that might be delayed and that is the first thing that’s flagged, but the role of the parents is key.
One of the things Eunice likes about the Developmental, Individual differences, Relationship-based (DIR) model so much is how the clinician understands what strengths the parent brings into it and how we individualize the approach for each family. We look at what’s already working and how to build on that which is a parallel process with the child’s program. As clinicians become more experienced working with kids in the model, we start to look at the caregiver and how we can incorporate them into the work.
Eunice says that there are things we can massage or stretch but there are also things about the parents that we have to figure out how to work with rather than change. She likes to think about the common place where the parents and child can meet. So in working with a family, she’s thinking about the child’s profile, the parents’ style, their stress level, etc. She aims to find interactions and things they can connect on that are mutually enjoyable to both of them so the parents can support the child’s climb up the developmental ladder.
In this way, the DIR model is a respectful model by respecting that parents bring different strengths and preferences with the child along with the child’s individual differences and developmental level. She respects that and figures out how to work with it by first building a rapport with the family.
Co-regulation, where the adult is supporting the child with their regulation, is really dependent on the parent’s regulation as well. The adult’s capacity to help the child stay regulated is limited if their own regulation is off because they’re overstressed or feeling physically unwell. That’s where we have to work. In a past podcast here, Dr. Kathy Platzman suggested figuring out what triggers your own dysregulation as a parent as a start.
When it comes to us being triggered by our child’s behaviour, Dr. Glovinsky had told us that it often goes back to the way we, ourselves, were raised as children. Although this could lead into an in-depth psychoanalysis, Eunice said that the main goal in the DIR study in this realm was simply to understand the parent’s regulation to the extent that it affected or impacted the interaction with the child.
It’s helpful to understand your own regulatory style and patterns and to know when it’s becoming a lot for you, and then also figuring out what makes sense in your family. It can be more challenging with other children in the home or in single-parent families. But it’s really like what they say on an airplane: to put on your oxygen mask first before tending to your child. When it’s possible that’s really important because a parent who is regulated will be much more available for the child.
We are always trying to broaden out what’s supportive.
Of course, we want to help our children and not see them upset. It may not even be anything in particular that they want, it might just be they want you. Sticking it out during that really uncomfortable time, because there might literally be nothing you can do, might be the best thing you can do. Just be there with them. In the moment, it takes awhile for the child to calm down but it’s still so important the parent is there.
The regulating piece is knowing someone is there giving you their full attention, being present and attuned to you.
Until next time… here’s to affecting autism through playful interactions!