Dr. Ira Glovinsky returns this week to discuss the eight sense: Interoception. He is on the faculty of Arts Education at Brooklyn College in New York and he is an adjunct professor with the PhD program in Infant and Early Childhood Development at Fielding Graduate University. He founded The Glovinsky Center for the Child and Family in West Bloomfield, Michigan where he uses a Developmental, Individual differences, Relationship-based (DIR) framework as a clinical psychologist working with children with severe mood disorders. He recently co-authored two chapters about assessment and what’s missing in a book by Elsevier press called Autism 360.

Interoception: What is your child feeling inside?

by Affect Autism | affectautism.com

What is Interoception?

Occupational therapist, Kelly Mahler, wrote a book entitled, Interoception: The Eight Sensory System. Interoception is the awareness of what’s going on in our bodies: pain, hunger, thirst, emotionality versus what’s stimulation from the outside. Dr. Glovinsky felt for decades like something was missing in his therapeutic work in young children. Then he found Kelly’s book. He by chance happened to be at a conference with her in Atlanta and had the opportunity to talk with her at length and have become good friends. He has now even written a forward to her Interoception curriculum.

Dr. Glovinsky soon realized that he noticed many children in his clinical practice with these difficulties as described in Kelly’s book. As he began to address these difficulties, his therapy changed for the better. Interoception causes you to look at an individual at a totally different level than his training has addressed. 

If you look for the Center for Disease Control statistics for behaviour disorders, anxiety, ADHD, etc. the numbers are rising astronomically along with younger and younger ages are presenting with mood disorders including bipolar disorder. More and more children are having trouble with self control and emotional regulation.

What’s missing in work with young children that’s addressing this pattern of dysregulation could include interoception. His work in therapy is highly verbal. We assume that children understand emotional vocabulary but might not have the visceral experience of feelings. For instance, a 14-year-old client of his was yelling, “I’m angry! I’m so angry!” Dr. Glovinsky asked him how he knows that he is angry. He didn’t know. He asked how he knows when he’s hungry and again, the child didn’t know. The mother said if she didn’t tell him when to eat, he would go through the entire day without eating.

Another child asked what “Calm down” means. Yet another example, a little girl said she was frustrated and when Dr. Glovinsky asked what that meant she said she didn’t know but her parents use the word all the time! I shared that my own 11-year-old autistic son only recently started expressing when he feels stomach pain, for instance. Dr. Glovinsky provided another example of a client who was told to breathe deeply when he’s feeling angry. Like a train coming down the track, you see the light on the train getting bigger and bigger. He said I don’t see anger coming down the track. It just appears. 

I have to help you become a feeling person so you can feel, and then we can work on the strategies. We can’t work on the strategies if you don’t feel it. 

Dr. Ira Glovinsky

Many therapists go straight into the meditative or mindfulness work without assessing if the child feels the feeling and if the feeling gets stronger. I shared that that’s why I don’t like Cognitive Behaviour Therapy. You can’t control your feelings. You feel and then your cortex processes it cognitively. These types of behavioural therapies strictly work with cognition whereas we need more emotional work to get to the root sources.

A Training Program for Parents

What he’s working on now is a training program for parents to really attune to their kids, to be able to develop sensations vocabulary and to put them into clusters, label those clusters, and then help them be able to do the regulating. Will the child feel when they start to get angry? Will they feel their sense of disappointment or shame if a teacher scold them? Dr. Glovinsky believes that we can start this process in infancy. He referred to Daniel Stern’s book The Interpersonal World of the Infant in 1985 that suggested we don’t have the tools yet, but that doesn’t mean the infant isn’t experiencing these feelings.

Dr. Glovinsky gives the example of touch with infants, which starts in utero as the fetus experiences changes in amniotic fluid. Babies will also pick up on mother’s depression or anxiety. If we can figure out how to start parents doing things with infants from birth to get them attuned to their bodies like we already do with words like ‘icky’ and ‘gooey’, we should be able to use feeling words such as ‘rabbit feeling’ (anxious) versus a ‘lion feeling’ (anger). Dr. Glovinsky will use the tools of Attunement (a visceral feeling), Synchrony, Marking, Contingency and Co-Regulation–all of which we discussed in a past podcast with Dr. Glovinsky.

This reminded me of Dr. Stuart Shanker’s concept of interbrain in the Self-reg model where parents attune to their children and co-regulate. Dr. Glovinsky also distinguishes between cognitive and visceral versions of co-regulating. You can look at a green-yellow-red light and memorize emotion labels versus understand the actual visceral experience of feeling happy or angry, etc. Dr. Glovinsky also says that two-dimensional pictures of emotions can also be deceiving. We can also tell our children they’re feeling angry by looking at their face when they might not be feeling angry at all. We have to get it from them.

We often mirror or imitate children which might confuse them, because they might not be sure whose feeling this is. If the mirroring and matching are the same, that could be confusing. We want to mark an experience. If we say “Wow, that’s beautiful!” when a child draws a picture, that’s the parent’s feeling, which might be different than the sense of pride the child feels about the picture. The way they get the concept of an emotion will depend on the intensity of the emotion others respond with. 

The first step is testing out whether the parents are in tune with their bodies. So they spend time working on visceral experiences with the parents. There’s something about the interaction on virtual meetings that allows for longer interactions with the parents, Dr. Glovinsky says. The volume is turned up on the viscera–the body part of it. Parents are saying these are things they never thought about before, which is a major step for Dr. Glovinsky. He wants parents not to use their cortex, but their limbic system, similar to Dr. Shanker’s experience of working on self-reg with teachers first, to help them be able to empathize and then work on self-reg with their students.

We’re getting the adults to perceive the object externally and experience themselves as a subject through someone else’s eyes. Turn your eyeballs inward looking at yourself. This whole movement on embodiment is about turning around and looking inward. So this work is about looking at the child by also looking at ourselves. We are a part of creating a response in the child. We have an impact on our children.

Interoception and Stress

This work adds something to the psychotherapy field, Dr. Glovinsky believes. There is so much pop psychology about mindfulness and meditation but so much of it is so cognitively based and we are aiming for more visceral, experiential, emotional pieces. Someone who is depressed is not just in a person’s brain. They are also experiencing inflammation in their body. If we medicate for depression, that medication affects the entire body, not just the little structure in the brain. There is more holistic work in treating these disorders, Dr. Glovinsky says. 

Dr. Porges talked about our bodies being in defensive states under threat that can lead to many conditions including mental illness. Dr. Glovinsky brought up allostasis versus homeostasis. As you have different experiences, your set point is changing. There are interoceptive changes going on as you deal with more and more stress. You are adapting to higher and higher levels of stress as your body is being damaged by that stress. The strain on the system continues as you continue to function. Allostatic load is the stress on the system.

Many autistics have had so many traumatic experiences with therapies and treatment that have caused post traumatic stress that by the time the reach adulthood, they do have many co-morbidities with mental illnesses. Dr. Glovinsky says that there is very new research that the circuit of the brain in charge of interoception is the insula. The connectivity of the insula to the other parts of the circuit is weaker in autistic adults. Dr. Glovinsky says this finding could lead to promising treatments. I like to think of it proactively instead: Let’s prevent the mistreatment of ourselves, our bodies, and our children before it gets too serious. Dr. Glovinsky agrees.

Thank you to Dr. Glovinsky for doing this podcast with us today and explaining his understanding of the importance of interoception in his clinical work. If you found this interesting and informative, please consider sharing it on Facebook or Twitter, and feel free to comment, share relevant stories, or ask questions in the Comments section below.

Until next time… here’s to affecting autism through playful interactions!

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