By Amy Lewis, OTR/L
As pediatric therapists we have many tools in our toolbox. Many of us take course after course, adding to the things we know, in hopes that when a child walks through our door we will have the right answers and know the best thing to do.
It took many years for me to realize that the most important thing I can do is meet the child where they are and be with them in exactly the way they are showing up at that moment, supporting their sense of “felt safety”.
A pivotal experience in learning that lesson came from attending Camp Avanti:
Being a therapist at Camp Avanti, a camp for kids with sensory integration challenges, is demanding. During my second year of being a staff therapist I was 5 months pregnant and since supporting kids with diverse needs all day for 5 days requires stamina, I was assigned to the “easy cabin”.
I had the 10-year-old boys, and they were indeed easy. So easy, in fact, that at the end of the week when it was time to write up the report about their progress, I got worried.
That group of 10-year-old boys had done every camp activity available. They’d played games, built campfires, sung songs, cheered each other on, wrestled, chased, worked together, and had a ton of fun. They were friends. They were inclusive. And it felt like we’d done minimal intervention to make that happen.
Sure, Camp Avanti sets things up in a way that supports the kids in so many ways. The expectations, sensory diets, even the rhythms of the day…they are all thought out carefully for every child, and they make it possible for these kids to have a successful sleep away camp experience. But in this cabin, it felt like we’d had to do very little extra work.
I was struggling to think of what we had done that was “therapeutic”.
In preparing to write their exit paperwork I pulled out their intake paperwork and read the goals that their parents had set for them at the beginning of the week. I sat, stunned, as I read the things their parents had hoped for: I hope he finds one friend; I want him to tolerate group activities; I want him to participate in a campfire; I just want him to make it through the week.
These boys looked nothing like the kids their parents described on paper.
Their parents described them as boys who went to school and spoke to no one; kids who wore their hoods up all day every day, had no friends, and struggled at home. Kids who avoided group activities and struggled with emotional regulation. I had read those descriptions before the boys arrived but had forgotten very quickly because the kids in front of me were absolutely thriving.
I’ve shared that story at camp many times, encouraging new staff to believe that what we do matters, even if it feels like we are just “being with” these kids in a way that supports them, without trying to change them.
I am a person that really likes understanding why things work and that has led me to reflect on my camp experience many times over the last 12 years.
I’ve found my answer in the science of “felt safety”.
Felt safety is based on an individuals’ perception of what is happening inside their body, around them in the environment, and between them and people they are with. Deb Dana, psychotherapist, uses the phrase “Inside, outside, and in between”. Our brain is always taking in millions of bits of that information and comparing it to what has happened to us in the past to predict what might happen next, to keep us safe.
We have a valence-based tipping point mechanism that is always judging what is happening, in that precise moment, as being “safe or unsafe”. You are either tipped one way or the other. This judgement is not yet a thought or an emotion, just an unconscious valence-based judgement of: “this is good; or this is bad” or “this is something I want to move towards; or this is something I want to move away from”. It doesn’t actually have words to it, just a feeling, a sensory perception.
The experience we are having gets tagged as positive or negative, safe or unsafe depending on the valence-based tipping point.
This is happening on a cellular level, but it underlies all observable behavior. For example: even very young infants will move towards the smell of their mother, and away from a noxious smell. We lean in when we are interested in what someone is saying and shift back if we perceive someone as threatening. We don’t think about these behaviors, they are automatic because of the valence and our perceived sense of felt safety.
Felt safety is a survival mechanism. The #1 job of our brain and body is to protect itself. So, these processes are wired in and happen very quickly at a non-conscious level.
Neuroscience researcher Lisa Barrett explains that our body operates like we have a body budget. Using energy efficiently is our priority. Anything that feels like a threat, whether physical or emotional, takes a lot of energy from our body budget. This means that our automatic response is always going to be getting ourselves out of danger. Even if that danger is just perceived.
What we are talking about happens on a cellular and brain circuit level. What that looks like on the level of behavior is a child wearing their hood up all day at school because it is too noisy and too visually stimulating, so they reduce and control the input as much as they can. Or avoiding eye contact because it protects them from sideways looks and judgment from their peers. They might lash out aggressively when they are accidentally bumped in the hall because the low route danger signals in their brain move much faster than the signals that come from the cortex, the part of the brain that would help us reason out that the person wasn’t meaning to be hurtful.
Remember my boys from camp? They were often operating in a state of protection. They lacked felt safety.
When we perceive felt safety, things are coded as “safe, good, and something I want to move towards”, the state of the brain is receptive, and all the parts of the brain can work together. When things are coded as “unsafe, bad, something I want to move away from or need to protect myself from”, the state of my brain changes and protective responses are prioritized.
This is called state dependent functioning. Bruce Perry explains “all humans process, store, retrieve and respond to the world in a state-dependent fashion”.
When we are in a state of safety, our whole brain can work together, we can be logical, use language, and engage in reasoning using our higher cortical functions. When we are in a state of protection our brain moves energy resources towards the lower parts of our brain that are responsible for survival.
Why is this important in our therapy sessions?
In therapy we are trying to help kids reach their potential by challenging them. Even a little bit of challenge can be perceived as a threat. And when they are in a state of threat, their nervous system is poised for protection, not engagement and learning.
Often the most important thing we can do is back up and provide a sense of felt safety.
But that can feel like we are not doing much.
It can feel like coming alongside, engaging in parallel play, following their lead, sticking with an activity that feels too easy for their development, or just helping them to feel comfortable in their body. It can look like us just controlling our own breath because our breath influences their breath. It might look like giving them time and space to recover; more time and space than feels comfortable to our nervous system. We might judge ourselves for not providing enough therapeutic intervention. We might wonder what parents are thinking of our treatment sessions when it looks like we are “just playing” and not providing a huge challenge.
But, as Stephen Porges says, sometimes “safety is the treatment”.
When we provide felt safety, we give the child an opportunity for their highest level of functioning to emerge. We allow their brain to function as a whole and open up the possibility of them gaining new skills.
For my 10-year-old boys at camp the routines and supports, along with an attitude of compassion and acceptance, provided them the foundation of felt safety they needed for the skills of friendship and autonomy to emerge.
Felt safety built a foundation for belonging.
For some kids, felt safety might just be the starting place. They may need more intervention for skills and mastery to emerge, but…
It always starts with felt safety.
A few things we can do to create felt safety are:
Facilitate breath and the suck swallow breathe synchrony
Facilitate alignment
Match the energy of the child
Use rhythm and build rhythmicity
Attune and coregulate
Lead with compassion
Value the child exactly as they are
Learn to regulate ourselves
Felt safety is the foundation of learning and behavior, and affects everything we do as therapists. Providing felt safety is the most important and therapeutic thing I have learned to do.
I’m looking forward to learning more about creating felt safety and moving towards mastery in the upcoming Integrative Ed offering: From Safety to Mastery: Variables of Successful Intervention. This one-day course is the 2022 Avanti Pre-Camp Conference, a fundraiser for this very special organization. I hope you’ll join me as I learn from my amazing mentors Patti Oetter, Irene Ingram, and Kim Barthel.