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The Case for Co-treatment

The Case for Co-treatment

At Elmhurst Counseling, we often receive referrals that are best served by combining the expertise of multiple therapists. The most common examples are Occupational Therapy and Speech Pathology. OT and social work are similarly intuitive. The credentials and expertise of these specialists blend naturally on behalf of the child. Let’s consider these two examples.

Many kids fall short of school district thresholds for speech & language and/or occupational therapy services. Yet each of these children displays concerning symptoms, whether that be difficulties with motor planning or self-regulation. What is a parent to do?

You can wait for the kiddo to ‘grow out’ of their symptoms, assuming the lag is within the developmental norm. Or you can engage your own resource network proactively with the understanding that early detection pays dividends.

It is probably no surprise that both speech and motor delays are partnered with most kids. The same goes for sensory processing and social pragmatics. An hour with either the Speech Pathologist or the Occupational Therapist addresses many of the same developmental challenges. When you put them together in the same room with a child, magic happens.

The same magic occurs when you add a Social Worker to the mix. It is the rare ‘OT’ or ‘SLP’ client who doesn’t have a strong social-emotional component to their clinical picture. The ability to address the childhood traumas and family dynamics that impact normal development is, in essence, prevention. Speech/language, social work, and occupational therapy interventions thus all become strengthened in a multidisciplinary approach.

The cost/benefit analysis is clear. Collaborative interventions in co-treatment models have measurable clinical efficacy. It’s just hard to find a practice that offers hybrid services. Most often, parents need to act as project managers and patchwork professionals together on their own. If you can find a clinician that partners in an interdisciplinary practice, sign your kid up!

About the Author

Steve Ritter, LCSW is the Founder and Executive Director of Elmhurst Counseling. He has served as a teacher, author, consultant, human resources director, health care administrator, and licensed clinical social worker since 1977. A fellow of the American College of Healthcare Executives, Steve has provided coaching, therapy and team development services to thriving schools, businesses and organizations.

The Best Medicine for Kids

The Best Medicine for Kids

The human brain evolved outdoors. It was made to notice passing distractions, evaluate priorities, and become fully absorbed in the objects worthiest of our attention. Evolution favored early humans who could successfully scan the landscape and follow sparks of instinct, like reading a compass pointing true north – except the needle pulled them toward a primal understanding of the world.

Likewise, kids’ senses are built for capitalizing on interactions with their environment to bolster their development. Children are natural prodigies of untamed, unstructured experience. When they are given outside play time without an agenda, they transform into their best selves. Exploration begets discovery. As they immerse themselves in the physical world by climbing trees and observing ant hills they gain valuable insight, most of all about themselves.

Anyone who has watched a child indulge their innate curiosity without adult intrusion has seen the beautiful intensity of this phenomenon. You can actually see growth unfolding in real-time. But why does it seem to be so particularly powerful outside in the wilderness of our backyards, parks, and forests? One answer is as mystical as it is simple.

We exist, now and always, as beings made up of the same matter as the rest of the ecosystem. We can only understand ourselves if we’re able to see ourselves reflected in the giant and unfathomably entangled web of other beings. Learning to relate to nature – following animals and insects with our eyes, our hands, and our hearts – allows us, simply, to become ourselves…by becoming one with them.

The most recent results of cognitive research show with scientific authority what we feel in our souls: the growing brain needs this ‘other,’ a partnering incarnate subject that consists of living matter, for healthy cognitive and emotional development. To put it more poetically, children need their gaze to be returned by the surrounding aristocracy of life in order to effectively tap into their own depths.

Unfortunately, our modern society appears determined to pull kids away from both the visceral connection to each other and to the wilderness waiting outside their door. Technology beckons for their attention with ever more seductive hooks to their brains’ reward centers. According to recent Gallop data, by the age of 8, children spend up to a whopping six hours of screentime a day.

The deviation from time spent in our living and breathing outdoor environs to a flat, virtual world is stealing more than just emotional self-awareness from kids. It throws salt in the wound by disabling their capacity for sustained engagement as it becomes constantly punchier and more stimulating, feeding young brains their next addictive fix within milliseconds. The beckoning forest doesn’t stand a chance

Young kids’ neurons are exploding in a million different directions and looking for interrelation. Space to run free in nature actually helps them develop better brain machinery. Juvenile rats who are restricted from play in wide open spaces fail to fully develop their frontal lobes (which control executive function) and have impulse control and social interaction problems. However, rats given just 30-minute unrestricted play sessions released brain growth factors and activated hundreds of genes in the frontal cortex.

If that’s not convincing enough from a brain-body standpoint, here’s some more compelling evidence for you: kids who spend more time in nature also tend to sleep better, have elevated attention and problem-solving skills, host healthier internal microbiomes, enjoy more robust immune systems, and develop overall stronger and more agile physiques.

So what’s a concerned parent, grandparent, or caregiver to do? The solution need not be complex or intimidating. Simply begin by getting your kids outdoors (and join them when you can – benefits exist for you, too)! Encourage them to take walks, dig holes in your yard, and get dirty. Give them regular opportunities to experience the freedom of being set loose outside. Respond to the “I’m bored’ declaration with the suggestion of a wild adventure. It’s really that easy!

Encouragingly, some societal shifts are also occurring to help out. The number of nature-based preschools and primary schools is growing, and more companies are forming to provide ways for families to reconnect with nature. Traditional summer camp registration has seen huge surges in enrollment since 2021, and many of them offer family stays. Getaway House, a burgeoning business launched in 2015, makes it easy to leverage family vacation time by renting out fully-equipped tiny cabins set up in the woods all around the country, for essentially the same cost as a hotel room.

It’s a worthy cause. The effort to get kids outside has big payoffs. When children are left to their own devices to roam in nature as in generations past, they learn to see themselves as part of a great, magical universe. They shed their self-conceit and experience the fragile interrelatedness of all life. Best of all, they nurture their capacity for empathy, care, and kindness – exactly what this world needs, now more than ever.

 

 

About the Author

Kerry Galarza, MS OTR/L is the Clinical Director and a pediatric occupational therapist at Elmhurst Counseling. She provides specialized assessment and intervention with children of all ages and their families. Kerry engages clients with naturally occurring, meaningful home-based methods to empower autonomy and maximize functioning.

Who Owns the Feeling?

Who Owns the Feeling?

Emotions are contagious. Any of us are capable of shifting the mood of a room by bringing our vibe into the space. We’ve all been altered emotionally by the power of someone else’s mood. Whether excitement, anger, sadness, or fear – one of the ways we manage feelings is to share them. When the other person experiences your emotion, you feel understood.

There are a few psychological defense mechanisms that explain this – projection, identification, and projective identification, to name a few. They are designed to selfishly bring relief to negative emotions and to generously share the wealth of positive feelings. Examples abound.

One guy cuts off another guy on the highway and, before you know it, guy #2 is tailgating guy #1 with elevated blood pressure. Guy #1 gave guy #2 the gift of his aggressiveness.  

A teenage girl arrives at the raucous sleepover party in a glum, tearful state. The girlfriends crowd around her and her emotional weight becomes the theme of the night.

A parent screams at their kid for something minor because the adult endured a stressful day in the workplace. The kid takes responsibility for the parent’s outburst and wonders what they could have done or not done to make the parent less upset.

The high school senior learns of the acceptance to her college-of-choice, and the whole family whoops it up in celebration of her accomplishment.

In clinical circles, we call this ‘parallel process.’ The contagion becomes a window to the world of another person. If you assess what you are feeling in a particular interaction, it is extremely likely that your dance partner feels the same way and shared it with you. This becomes a valuable tool for parents. Consider the chart below as a roadmap for how to manage your child’s emotional reaction:

When the                               

child is:                       I Feel…                         Intervention

angry                           frustrated                    de-escalation

scared                         worried                       reassurance

tired                            depleted                      resources                   

overwhelmed              stressed                       structure

hopeless                      ineffective                    encouragement

withdrawn                   sad                              contact

Of course, this works with two adults in the same way. In the heat of the emotion, step back and get perspective. Become a diagnostician of the macro-level interaction from that wider lens, and then step back into the fray with precisely the most helpful reaction. The emotion you are feeling might not be your own.

About the Author

Steve Ritter, LCSW is the Founder and Executive Director of Elmhurst Counseling. He has served as a teacher, author, consultant, human resources director, health care administrator, and licensed clinical social worker since 1977. A fellow of the American College of Healthcare Executives, Steve has provided coaching, therapy and team development services to thriving schools, businesses and organizations.

Evolving Talents

Evolving Talents

About 100 billion neurons form synaptic connections beginning about 45 days after conception expanding until about three years after birth. That’s enough axons and dendrites to support nearly every future talent. Then, over the next decade and a half, about 50% of those neurological connections shed away leaving behind the uniqueness of each of us as we plow through the end of our teenage years and launch into adulthood. What happens next depends entirely on where we aim our investment of time and resources.

Some of us ride the wave of our strengths, whether athletic, artistic, or academic. Others devote themselves to rigorous practice to maximize the potential of an interest. When that effort is directed at a natural strength, the wind is at our backs in a downhill ride. When we work on one of the abilities that was shed away before the age of sixteen, it’s an uphill battle with the wind in our face.

Either way, growth happens. Sometimes it’s frustrating and seems to take forever to see progress. Other times, time and space get suspended as we flow effortlessly forward. The point is to keep practicing.

Whether a budding cyclist, bricklayer, or cellist, you get to choose how good at your craft you become. The cyclist can coast or pedal. The mason can eyeball the project or learn to use a level, plumb bob, and string line. The cellist can play Frere Jacques forever or tackle the Bach preludes.

It begins with a mindset that predicts whether you can or can’t grow. If you believe you’ve reached your ceiling, you most likely have. If, on the other hand, you believe the sky is the limit, the sky is the limit – even if it takes a lifetime to get there.

 

About the Author

Steve Ritter, LCSW is the Founder and Executive Director of Elmhurst Counseling. He has served as a teacher, author, consultant, human resources director, health care administrator, and licensed clinical social worker since 1977. A fellow of the American College of Healthcare Executives, Steve has provided coaching, therapy and team development services to thriving schools, businesses and organizations.

Let Your Children Be the Bosses of You

Let Your Children Be the Bosses of You

We’re still in the time of year when many of us (in spite of ourselves) feel the temptation to make resolutions. If you’re like me, you’ve been pondering ways to become a better all-around person. In my case: more patient, attentive, and affectionate.

But I always grapple with the question of whether to broadcast my goals to anyone else. What if I fail? Better to keep my resolve quiet. On the other hand, if I tell someone I’ll probably feel obligated to try harder.

It might be better to go public, after all.

Common wisdom tells us that once you make your goals known, you’ll become more motivated to accomplish them. Aside from a couple of exceptions (including a 2009 study that found students acted less on their goals once they were shared because announcement gave them a false sense of completion), social scientists agree that external accountability helps.

And here’s something you may not know: it’s been proven that sharing your goal with a person whose opinion you value gives you a huge boost. Not only are you giving bigger life to your resolve, but you’re also now receiving implicit support and approval from someone who really matters to you. It’s almost like you’re doing it for them – like following through with your resolve is a gift.

So if your goals include being a better parent, like mine, I propose going straight to the source – your kids. Who better to share the gift of your resolve?

Let them know what you’re hoping to change, and why. Invite them into your heart and soul. They’ll feel the love conveyed in the message and probably be more than willing to hop on board to support you. You can be sure they’ll hold you accountable!

Little successes will become self-reinforcing – and you will have already taken the first step in your goal to become a better parent by simply telling your kids how much they matter to you.

About the Author

Kerry Galarza, MS OTR/L is the Clinical Director and a pediatric occupational therapist at Elmhurst Counseling. She provides specialized assessment and intervention with children of all ages and their families. Kerry engages clients with naturally occurring, meaningful home-based methods to empower autonomy and maximize functioning.

Take a Breath for Clarity

Take a Breath for Clarity

It takes very little to spark anxiety. Our internal worlds anticipate worst-case-scenarios while our external environment throws continual curveballs that require all our skills to catch. Every day is an exercise in adaptability. We imagine ourselves managing crisis situations with poise, only to be humbled.

Physiology is not on our side. The path to a fight/flight/freeze response is fast. Once the brain starts cycling that quickly, the ability to decipher communication diminishes. Lessons from past experiences get blocked in the same way students go blank on exams under pressure.

Give yourself a break. A minute or so of breathing done right effectively resets your body, and repairs your temporarily disabled coping skills. Inhale slowly into your belly. Hold that breath for a moment and then let the exhale leak out slowly. Before you know it, your heartrate and blood pressure decrease, muscles relax, brain speed slows down, and the immune system produces more T-cells.

Life’s challenges are constant. Under normal circumstances, we adjust and move forward. Under stressful conditions, some of our strengths disappear temporarily and we’re not always our best selves. Managing the stress effectively awakens maturity. Clarity is only a few deep breaths away.

About the Author

Steve Ritter, LCSW is the Founder and Executive Director of Elmhurst Counseling. He has served as a teacher, author, consultant, human resources director, health care administrator, and licensed clinical social worker since 1977. A fellow of the American College of Healthcare Executives, Steve has provided coaching, therapy and team development services to thriving schools, businesses and organizations.