Tuesday, October 5, 2010

Looking back

Looking back...three and a half years. Do you ever look back? What happens?


These are my notes about John's work in the modality called Body-Mind Centering, with Bonnie Bainbridge Cohen, in February and March of 2007. He first worked with Bonnie in January 2006, and this was our fourth visit to see her and other BMC faculty. When they work together, so many things happen during and between the sessions. It is miraculous. To call it an acceleration of development does not describe it properly. By remembering and writing, I hoped that I might better continue to learn what it is that happened.

John and I attended one-hour, daily therapy sessions. He also received occasional cranio-sacral therapy during these trips. I was given no assignments, but in our free time I worked with John, trying to copy and recall some of what Bonnie did, or just playing with him. The schedule of the trip was as follows: 

Three days travel to Massachusetts

Two days rest

Two days sessions

Two-day weekend break

Five days sessions

Two-day weekend break

Two days sessions

Travel home to Texas

John has a ring stacker toy that we brought with us. Though his OT and I have played with him with it a lot, he still had trouble getting the rings on and attending all the way through putting the five rings on, without throwing them. He did not play with this toy with Bonnie in his first two days; she worked mostly with his feet. In the evening after our second day of therapy, I offered him the ring stacker. He calmly removed the five rings and restacked them in order, three times in a row.

At home, John needed encouragement and physical assistance to pull to standing, and to return to sitting. After the first two sessions, John began using objects to pull to standing without a person physically helping him.

In recent months I have wished that John would begin to approach me to request what he wants. Though I didn't provide Bonnie with specific communication goals, I have seen a great change in John's actions and in the quality of our interactions together in speech and communication.

John began to use more gesture and body language with his sound and/or word communication.

*When grunting to indicate that he wanted me to play his tape, he looked at the tape player.

*By grunting and directly approaching his highchair tray at three different times in three different locations, he indicated that he wished the tray to be returned to the empty chair.

*John oriented his body toward the stairs and said "gay-gay" urgently to tell me he wanted me to open the safety gate and play on the stairs with him.

In all of these instances, John chose to communicate while facing me, when we were sitting close to one another. He was now including both me and the object he was talking about, in his communication.

After five sessions, each evening when I phoned his father, John began having a daily extended phone exchange with him. He had never done this at length before. His dad would say something to John, and John would reply with sounds sounding like one word, or even one or two whole sentences. His dad would come back with either a similar sound or some regular words. They continued to exchange sounds for up to several minutes. John made sounds such as "hii-Yaa," "ooh-Naa," "nuh-nuh-nuh-nuh-nuh-nuh-nuh-nuh-Naa!" and "ja-ja-ja-Jaa." When finished, John would push the phone toward me.

It seemed that John began using a greater variety of sounds to approximate words. He was also initiating (rather than mostly repeating as at home) more single-word utterances when we were together, and would frequently repeat sequences of sounds to approximate a phrase. I could not understand the phrases he was apparently saying, but he would repeat them identically several times directly to me.

One day when we were to go down the stairs, I was holding John's shoes and socks. I wanted my hands free to be with John as he crawled down, so I tossed the shoes to the bottom of the stairs and told him we would put them on downstairs. Using sounds, facial expression and body posture, John communicated to me that he did not want to be separated from his shoes in that way. After his shoes were on we continued to play on the stairs. When we returned to the top, John said "Bo-bo!" (his word for shoe) with a worried look and looked toward the bottom of the stairs, though the shoes were now on his feet. He was telling the story of when I had tossed the shoes down the stairs. I tried to describe what he seemed to be saying, and then said "Now the bo-bos are on your feet" and he brought his feet around in front of him and smiled. We repeated this sequence about three times.

John also showed new and great attention in having learning exchanges of a single word. I had observed him doing this with Bonnie in the summer, seven months ago. One day during our summer sessions, John was playing with bristle blocks. It was a quiet time when Bonnie had finished working with him and was doing something else with me. She used the words yellow, blue, red, and block. Each time John would repeat her, then she would say the word again, emphasizing a different part of its sound or adding the accompanying word, and he would repeat again. In each exchange they would go back and forth three or four times. This went on for over 20 minutes until John was saying "yellow" and "blue block" fairly clearly. In the summer, once we were home, he did not show interest in playing that with me; but after the first few sessions this time, he has played the repeating game with me many times.

Toward the beginning of our trip, someone loaned us a climbing toy. It had an arch with footholds to climb up to a small walled platform about 20" high, then a small slide down. John played with it a little, with help. He did not use it with Bonnie. During our weekend break after seven sessions were completed, John demonstrated that he could climb up, sit safely on the platform to play, then lie on his tummy and slide down, all unassisted. Also during the same time, after a week of practice, John could crawl up a 14-step staircase, crawl around on the landing, back himself over to the top step, and climb down backwards, with me shadowing but not touching him.

John has an incredible capacity to love and appreciate. He is good-natured and curious. He listens carefully and shows signs of being very intelligent. His difficulties seem to be in moving his body and interacting with people and the outside world. There are some areas where he doesn't just watch and pick things up. Then I find myself looking for help. I am often excited about our work at home. But I also worry and find it difficult to communicate what I see in John and what it seems he needs. I find myself not being with him, but thinking about him to consolidate my worries into language that others can understand. Then I try to describe the difficulties I see him having, often feeling as though I am having to convince the other party that these difficulties are real. I rarely feel that the other person has "gotten it." Many times, the discussion, report, or next round of therapy that follows is unsatisfying 

Why does John (after a period of months at home) see Bonnie for one hour, and begin to rapidly unfold and bloom without further skilled intervention, just my love, interest and quiet excitement?

There are things I see and know about this process. I see that Bonnie has knowledge of what is appropriate to input. She looks at him from all her experience and finds the piece that is needed now.  She introduces that piece clearly in an atmosphere uncrowded in space or time. She does not seem to have any expectations, only peace and confidence. She does not struggle or hurry during our sessions–this is not to say that she doesn't ever struggle or hurry, but, in a session, there is input, quiet, and time. I am learning to hold my impulses to question and my many internal reactions. The space and time are too valuable both to me and to John.

Neither one of us has to process the experience during the session. Processing is later, for John when he plays. He spends time quietly going through his familiar books and toys. He tries out his new skills, practices them, and then shows off more new things that the session didn't visibly address. These moments when he does new things out of thin air are the appearance of something that has often been missing for him. Rather than a slow-motion progression of development where each step is made only with guidance, he is popping around in different areas, achieving multiple things in developmentally related clusters. Most of the achievements I have noted here are in this framework. I see the events, but do not yet see how they are related and how they are law-conformable given the work in his sessions.

Along with playing familiar activities and practicing new skills, I think that participating in unrelated activities where there is no attention from me on John or his skills is an important part of processing these sessions. I can't yet prove that it is as important to John as it is to me to be able to return ready for the next time of being with John; I only suspect that being in the background while adults have dinner and conversation, sitting around waiting and watching while Mom does paperwork or errands, and waiting in the shopping cart, looking for friendly people to throw his ball to while I briefly ignore him to pick out grocery items, are crucial to his processing too.

Processing is later for me too. I replay the session in my mind, notice some elements that I was watching but didn't understand. Many of my original questions fall away and I try to know what my questions really are. Sometimes the questions only become clear after I have phoned Bonnie and am sitting listening to her reply. Though some questions are small and factual, being a part of this work stimulates the rapid growth and improvement of whatever my big, lifelong questions are. The features such as clarity, lack of expectations, space and time, and skill that are in Bonnie's work allow the questions and learning about John, and those that are greater, to assist each other in progressing. Even though I am there because of John and for John, I can't help but to develop too.

Without yet knowing why, I know that if I didn't have larger questions and if I wasn't deeply affected by participating in John's sessions, the change in John wouldn't be the same. When we develop, we have the steps inside us and we are constantly interacting with our inner and outer environments to see whether the next step is now possible. As John is newly turned two and I am his mother, I am still a big part of his outer environment. As I see some of his communication behaviors on this trip, for instance, I know that he was trying some similar things at home, but the environment, at least my part of it, was not favorable at that time. The factors I listed just above change me, profoundly when we are on our visits and more slowly at home, and then John's environment is ready for him to go on. I gain information about how to use my body to help his body stabilize and move. I take time to listen to sounds that he probably made at home, and now he is making the sound into a different world. I am present to see a significant movement he probably made at home, and now he is making that movement into a different world. I decide, or at least, I am available, to respond to the same John-produced event in a different way, and then a place that was stopped, now moves. This is not the only way that this work is helping John. Bonnie's knowledge and application is primary. Then, her manner allows her knowledge and application to resonate and multiply multi-directionally with John. Those two things are acting both in the hour of therapy and later inside of John wherever he goes. Last, there is a simultaneous transformation in me that allows a partially new universe for John, outside of himself, as well.

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