Interoception and the Non-Speaking Client

Hi everyone, Kelly Mahler, occupational therapist. I want to talk about a topic that’s based on one of our frequently asked questions that we hear very, very often. The question is, “How do you effectively provide interoception-based supports for non-speaking clients?” This month, I am joined in this topic by one of my friends and colleagues, Judy Endow. If you would like to see Judy’s website, have a look here: http://www.judyendow.com. Judy and I have been collaborating together and developing a live course on this topic, and we also wanted to offer a blog post with a few free tips. Hope you find them helpful!

 

I must mention that as we were developing these tips, it really occurred to me that these tips are essential for our non-speaking clients, but you know what? They are also really, really important and helpful for most of my clients, regardless of their form of communication. So, these tips apply to non-speaking clients and speaking clients alike.

Tip #1: Internal and External Stabilization and Co-Regulation

Tip number one is all about internal and external stabilization and co-regulation. How do we help our clients’ bodies to feel as regulated as possible, and why is this important? Think about a time when you’ve been super stressed or super dysregulated. How did your body feeling in that moment? Comfortable? Uncomfortable? I don’t know about you, but my body feels really uncomfortable when I am dysregulated, and that’s not very a good or motivating time in which I want to be invited to pay attention to how my body is feeling. The same holds true for many of our clients. We want their bodies to feel regulated and safe for many reasons—but when it comes to nurturing interoceptive awareness we want that regulation so that their body is a motivating place to invite attention–to notice how their body is feeling.

That regulation is so important, and many times our clients require something called co-regulation to help their bodies get to that regulated spot. What do we mean by co-regulation? This means that we, as the supporters, are helping our clients to regulate. We’re offering the sensory based supports that we know are a match for their neurology while considering those internal factors. We are helping to reduce that dysregulation, and to stabilize their nervous system and reduce their stress response. We also have to consider external factors. We need to think about the environment and ask ourselves; how do we modify that environment to promote as much regulation and felt safety as possible? We want our clients to feel safe in their bodies and in their worlds, in their external environments, in order to start our interoception-based supports. So step number one, before you even start interoception-based supports, is to consider that co-regulation, that stabilization through internal factors, as well as external factors such as the environment.

Tip #2: Predictability, Sameness, and Routine

Tip number two is all about predictability, sameness, and routine. Judy has taught me so much, and one of the biggest lessons I’ve learned from her is just how important these three factors are for most autistic learners. When we begin to consider how we will implement interoception-based supports, these are three factors we must consider. How do we make interoception supports very predictable? How do we incorporate elements of sameness across every single time that we’re implementing these supports? And our routines surrounding interoception supports are so incredibly important.

Consider things like visual supports. What kind of visual supports can you offer? Maybe it’s a visual schedule, and that visual schedule incorporates the client’s interests, and it is presented exact the same way in each of your sessions or times that you are inviting interoception-based play. Also consider the use of routine. Maybe you are using our Focus Area Experiments strategy from The Interoception Curriculum. How are you going to present these experiments in a way that is based on routine? Can you present the experiments what the same way each and every time, and maybe the only thing that changes is the experiment themselves? How can you present that work in a predictable way?

Tip #3: Communication Supports

Tip number three is all about communication supports. Every single person deserves the right to have access to communication supports that are a match for their personal neurology and experience in the world. We really need to think carefully when we are implementing interoception-based supports. Do we match each client and their communication style? How do we embed things like, perhaps, visual supports, or different methods of communication that will allow them to express what their unique inner experience is all about? If you remember, we’ve talked in past blogs about how important it is that we validate and we honor every single person’s unique inner experience. This work is not about us labeling someone else’s experience or telling them how we think their experience should be. This is all about helping each person discover their own experience, and that is no different when we’re talking about communication supports. So how do we foster a process where we are empowering each client to be able to express in their own way how their body is feeling?

Tip #4: Presuming Competence

The next tip is all about presuming competence and really thinking about how we are presenting the interoception-based work. It is so important that our clients always experience full body autonomy, both within interoception-based work and outside of it, and they always have choice. We talk a lot about how interoception supports are always an invitation to participate, they are never a demand. A person has full choice over whether they want to participate or not. If something doesn’t go well (and, guess what, I’m going to admit it, I have sessions that do not go well) we need to be really careful about not placing the blame on the client. I get very reflective with myself and challenge myself to think about what I need to do differently to help support the success of my client.

There’s literature from the 1980s, so it’s pretty old but I love it, about a concept by Donnellan called instructional inadequacy. It’s all about  assuming that if a learner is not doing well with the supports we provide, then we, as supporters, need to consider how the instructional process we are offering is inadequate. Maybe, it’s not a match for that learner’s neurology, and we need to continually reflect and challenge ourselves to find more meaningful ways of supporting each client. Judy brings another piece of this and that’s called environmental inadequacy, and that’s all about considering if the environment supports the success of the client, or perhaps the not-success of our client. Again, not putting blame on the client, but thinking about how the environment perhaps contributed to a barrier in performance or participation. It is important to shift that focus. If something doesn’t go well, shift the focus away from the client and onto the environment and/or how we presented the supports, and figure out how we can make changes to support their interoceptive success.

Tip #5: Learn from Non-Speaking Individuals

The final tip, the most important tip in my mind, is that we need to learn from non-speaking individuals. There are amazing Facebook groups, websites, books, blogs, etc., all written by non-speaking people. There’s a lot of information that we have in today’s world at our fingertips and we need to be taking advantage of this access and learning from non-speaking people. Again, challenging ourselves. How can we continue to get better at providing interoception-based supports? I’m so grateful to many non-speaking self advocates that are willing to share their story and to share the approaches and different strategies that have been successful for them.

So, after reading this blog, if you want to learn more, my best suggestion is to go right to the experts of lived experience, and we’ll provide a couple links in this blog below. Until next time.

Link to Facebook Group, Ask Me, I’m an AAC User!: https://www.facebook.com/groups/456220758119314

Link to Blog, Not Too Trapped in My Head Anymore (English + Spanish): https://nottootrapped.wordpress.com/

Link to Blog, Ashish Speaks: Revelations of an Autistic Mind: https://insidetheautisticmindblog.wordpress.com/

For more practical tips to implement interoception with all clients, check out these resources!

On-Demand Course: Providing Interoception-Based Supports in Various School Settings