Supporting Parents in DIR/Floortime

This week Eunice Lee joins us. She is a Developmental, Individual differences, Relationship-based (DIR) Expert and Training Leader and a social worker in Toronto, Canada. She’s been learning about DIR since 2006. Eunice was my family’s very first DIR coach eight years ago after I saw her featured in the MEHRIT study at York University about DIR/Floortime. We did a podcast two years ago called Self Regulation Starts With Us where we discussed how we, as caregivers, have to understand our own regulation before we can support our children’s. 

Continuing on from our podcast on Interoception where Dr. Glovinsky talked about bringing awareness to parents about what they are feeling inside, Eunice and I discuss caregiver’s self-awareness around the developmental capacities and how essential it is to understanding how we do Floortime with our children. Eunice says that she’s learned a lot from working with parents. As much as she’s aware of the child’s strengths and challenges, she is aware of those of the parents as well because they impact each other.

The Parent and Child Dance

When Eunice was learning about DIR’s roots in infant mental health, they talk a lot about the parent and child dance. If one partner moves quicker, the other partner has to move quicker, and similarly if one slows down, the other must slow down. Practitioners can support both children and parents when they see what they each bring into the interaction. 

On the website of the International Council on Development and Learning (ICDL), the home of DIR/Floortime, under the description of each functional emotional developmental capacity, there is a case description and I recalled an example of a parent being focused on an agenda to get a child to do something specific. When the parent was made aware of this tendency, they were able to step back and go with the child’s flow instead of trying to get their own agenda across.

Parent Goals

When the parent has a different idea than what the child wants to do, Eunice says it’s not necessarily that a parent has to give up what they want to accomplish–it can fit on the list of goals. But she can often see that this may not be the next step of where they child can go at this moment. She reminds the parent about the attunement piece, which is joining the child. This is what we have to do to start with. 

Whether you can do what the parent’s goal was, depends on many things. Eunice wants to hear about the parents’ goals, but she wants to look at it as a timeline, looking at what we can accomplish now and what might be a longer-term goal. This tends to ease the anxiety the parent has of wanting their child to do well, which comes from a good place. 

Eunice wants to help them place that task in an appropriate place and understand what that task or goal means to the parent. Hearing the needs of what the parents are thinking helps Eunice in her DIR work. If a parent says they want the child to appear more like their peers, Eunice can then appreciate what the parent brings to the session and take that into consideration.

Video Reflection with Parents

One of the best ways to develop your practice of Floortime is to video tape yourself playing with your child and reviewing it with a DIR practitioner. This is called self-reflection. Eunice says that when you’re in the interaction you’re thinking about so many things: the environment, the activity, the interaction. It can be hard to be self-aware. But when parents and practitioners have the opportunity to see what was happening from an objective, third-person perspective and can reflect on it after-the-fact, it frees us up to look and think about it more deeply.

It was an eye opener for me to see all of the non-verbal AND verbal cues I missed in my early Floortime videos. Eunice sees even 14, 15 years in that she’s still learning and deepening her practice. It’s like peeling an onion, seeing so many layers underneath. It speaks to the complexity of child development, she says. The opportunity to sit and reflect looking at videos allows us to pause and ask, “What were you thinking in that moment?” 

Whether they are professionals or parents, Eunice wants to pay attention to what was going through their head. She wants to deter them from thinking they missed something, and instead realize there are so many things going on. But it makes us more aware for the next time. If we’re rushing to think we want to move on with the plan, it might help us to pause and check in. Is my child communicating something else to me verbally, or non-verbally through actions? It’s ok if you missed it the first or tenth time because we’re all still learning and we all learn at a different pace.

Understanding the Parent

That’s the great thing about the ‘R’ in the ‘DIR’ model. Daniel Siegel talks about the concept of ‘repair’. We can always go back and repair the relationship. We all do the best we could with all we had. There’s always things we wish we could have done better, but we can start now. Eunice sees her role as the mental health clinician as trying to figure out what the parent was thinking. 99% of the time they’re trying to support the child in another way. Her role is to help the parent support the child using the DIR model, looking at their developmental capacities and individual profile. Within our DIR work, we’re enhancing the parent’s understanding of the child through the DIR lens.

The parent comes to practitioners as the expert of the child. We’re laying down the DIR framework to help them understand the child, Eunice says. Clinicians rely on the insight of parents to understand what else might be happening in that moment. If the parent-child interaction appears to be mismatched, you have to get inside that parent’s head and then look inside the child’s head at that moment and figure out a place where they can meet, from an interaction perspective.

The importance is to clarify misunderstandings. The parent might think the child really likes a toy, but in the moment the child was eyeing something else. Parent are so used to it and so well-versed in what their child likes. So it might be easy to miss when the child looks at something else. Eunice might ask, “Is it possible that the child might be interested in this other thing?” when pausing the video and seeing the child’s eye gaze, for example.

At times, a child might offer something new and we want to see how to expand that. As parents, we might be so panicked about when the melt down might come so we don’t want to rock the boat. Thus, we may continue doing things the same way. But, we also want our children to grow and must watch for the cues when they’re ready for something new. We want to keep the peace when our children’s dysregulation also dysregulates us. It makes sense that we want to be careful and cautious. 

It’s natural, Eunice says. This might be the benefit of having the professional working with you, because the professional can be the guinea pig that tries new things or tries something out of the box because they can support the parent if the child doesn’t like it and has that meltdown that the parent was scared of. It takes a certain amount of confidence to try something new or not to have the ‘favourite’ toy available and seeing how that goes in a session. Eunice says you have to try things out to see. It can also work beautifully today, then tank next time you try it! It’s important as a clinician to validate the parent’s concerns. 

Meeting the parent where they’re at

Eunice doesn’t want to change it up just for the sake of changing it up. She wants to discuss it. “It sounds like there were some moments in the past where it didn’t work out when you changed it up. Would you be ok if I changed it up a bit today?” Oftentimes, the parents are ok with it. It might have occurred to the parents, too, but they may not have had the confidence to follow through. 

I gave the example of the marble track run that my son loved at the occupational therapist session. If one day it wasn’t there, we might make the Floortime session figuring out where it is. Eunice says she would check with the parent first and let them know that the toy is not available that day, or it’s hiding up on a shelf. Also it gives the parent the opportunity to give feedback about whether the child is already having a bad day, in which case it might not be the day to try something that is a surprise.

Rather than to push her agenda, Eunice wants to build the relationship she has with the caregivers before trying something that is her agenda. It’s important to her to always have the parent on board. So if the parent says they are too nervous about the marble run not being available, Eunice might try to play with the marble run in a different way, or start with that toy but then try to move to another toy once the child is calm and relaxed. Her approach would be different if the child wanted to play with only that marble run for the entire session.

She wants to discuss with the parent what they think might happen if the toy isn’t there. That might lead to the discussion of whether the child has ever surprised the parent by not wanting it, and how would the parent know if that toy is always available. It helps Eunice understand the parent’s anxieties and then figure out how to work with them. They are all valid and based on past experiences. It’s her job to take that all in and understand that.

We are looking at the Why behind the behaviour of the parent as well. It’s like doing Floortime with the parents as a practitioner. Coaching really is in parallel. You have to think about the adult as well as the child. Whether you’re coaching a therapist or a parent, you have to take into account where the adult is coming from and what is driving their ideas and how they’re contributing to the interaction.

The focus isn’t moved to the parent alone. The focus is still on the child, but if Eunice is trying to encourage the interaction between them, she must consider the parent as well and what they are bringing to the table. Some parents might require more support than what she can provide, and she would encourage them to access those supports.

She wants to look at their profile and what supports them. Otherwise it’s like working with a box that you don’t know what’s inside. In DIR we don’t just say “This is what your child needs“. We build on what’s already working. Sometimes parents are very humble and they say they don’t know, but there’s always a place to start, so Eunice will observe it and find it versus instructing them to both play in a certain way.

Supporting the Parents Forward

I hear DIR clinicians ask all the time what parents like to do with their child to have fun. It’s a good starting place. Eunice says it doesn’t need to be a structured thing. It gives them a place to start and then expand and broaden it. We gave some examples in the last podcast with Eunice of mismatches of parents trying to play with their children in environments that didn’t work for them.

What do you do when something jumps out to you as so obvious but the parent just isn’t getting it. Do you pause and watch the video and comment on what’s happening and then wonder what the child was thinking in that moment? Dr. Glovinsky said a lot depends on how we were raised ourselves. When Eunice reviews videos, she usually starts with the really broad questions such as an open-ended question. Then she might ask more specific questions such as “What were you looking at?” or “What was the child looking at?” Maybe the parent is seeing something else, so she’ll acknowledge that. 

Then she might get more directed with the question, “Do you think he was engaged with you in that moment?” and there might still be some parents who say “No” when Eunice points out a moment where they looked engaged. So Eunice would then ask for examples of when the parent thought they were engaged with a child in the past. She needs to understand what the focus is and what their definition of engagement is. Parents can be respectful of professionals and just agree, so she wants to focus the discussion on the child.

A parent might say, “I think my child is only engaged when they do x, y, z…,” so then Eunice might need to help them understand what engagement is. In DIR there are more abstract concepts. Engagement is not a checkbox. It might also lead to understanding what the parent’s goals are. If Eunice is celebrating engaging moments and the parent doesn’t see it, she’s not helping them if the parent is aiming for something completely different. It helps her identify where the parents are at.

Supporting Self-Reflection

What about the parents who won’t film themselves? It’s hard for some parents to film themselves because they feel put on the spot or judged. Eunice says it is a normal reaction. It can be nerve-racking and embarrassing. She might start by asking the parents if they will film her playing with the child first. They can then review those videos first. She would then ease into filming the parent by having them talk about moments in between sessions where they felt stuck.

It’s hard for a clinician to see everything when they only see the child for an hour per week. Especially when the parent says the child is totally different at home, she will use that as a springboard to filming as well. She’ll suggest filming just the child first and in happy moments, or the child with siblings. It’s something gradual that can build over time. As parents are more comfortable with what this work will look like, the relationship builds and the parents get more comfortable. Then Eunice might suggest that she films them in clinic before she asks them to film them at home.

Parents always inevitably say, “I wasn’t sure what to film. I don’t know if it was good enough to film.” Eunice says that’s why filming herself with the child first models the process for the parent. She’ll point out how she missed cues, or she was too fast, or too slow. It’s good discussion material, but it also gives them an awareness of what they might be discussing if it’s the parent’s video.

Another hurdle is that parents might be hesitant to film long videos. Even if it’s a short clip of 3 to 5 minutes, there are still so many opportunities for Eunice to learn about the child and the relationship. Parents will also film themselves and showcase what their child can do and discouraged if they feel like they’re pointing out their child’s deficits. Eunice says she has seen that. She would understand that as it gives her information about what type of structured activity they do at home.

She might ask if there are ever more unstructured things that they do at home. Eunice might then start with, “Let’s talk about some of the ways we can give the child the ‘just right’ challenge” and start with more unstructured things in clinic and discuss some ideas for unstructured activities they can do at home. The parent could be worried about things going awry if the activities are unstructured. The parent might also be too aware of their home not resembling the clinic where there are so many toys or equipment.

Wrapping it Up

When the parent is seen, heard, and felt, it’s much easier for them to then see, hear and feel the child, and that’s what we’re fostering with Floortime coaching. It’s where we get more self-awareness as well when their thoughts and feelings are acknowledged. It’s part of the DIR work. 

Thank you to Eunice Lee for joining us today and discussing this important topic for caregivers to think about. If you found it helpful and informative, please consider sharing it on Facebook or Twitter, and feel free to comment or ask questions in the Comments section below. Next week, psychologist Kathy Platzman joins us.

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