Can We Try It Like This? Or, What happened to this school OT when she lost control of a therapy session…
by Stacy M. Turke
on the On the Road with @stacyturke OTR blog
Last year I had a student who helped me grow as a therapist.
Okay…truth be told, all my students do that, daily, because from our interactions I learn what works, what doesn’t, what to repeat, and what to toss into the ‘great idea, poor outcome’ pile. This particular student came to me on this particular day as he always did, full of energy, chatty, and happy to see what was beyond the door in the therapy environment. “What we doing today?” he asked with his usual eagerness. I adore this aspect of his personality.
We entered the room and on the table was a container of the indescribably pinkish-coralish-orangeish material that School OTs know as Therapy Putty, medium resistance. “Oh I know that stuff, you squeeze it!” he exclaimed. Of course because it is my space, and I am not as organized and structured as I wish I were, there was also another set of materials on the table, within reach instead of neatly tucked out of sight ready for our follow up task. We were going to play a game of Perfection. Both of these separate and distinct tasks were carefully planned to prepare the body and the brain for a writing activity that would follow to address the boy’s IEP goals geared toward helping him improve his ability to produce written work in school. He was a hard worker, this young student, so my therapy plan would be able to be completed in the allotted 30 minutes and he would be able to go back to class ready to work. Best Laid Plans of an experienced OT and all…
So we calmly sat down to start with the pre-determined therapy putty exercises that were so neatly and carefully detailed in my therapy plans…and that’s when things quickly devolved. And I mean quickly. Within a 30-second period, this 3rd grader moved from squeezing the smallish therapy putty ball to grabbing the remaining hunk left in the container, collecting it all while rolling it into a fat cylinder, and then reaching for the Perfection pieces innocently and innocuously sitting next to the game box awaiting their turn. “Hey,” he asked, “Can we try it like this?”
“OH NO,” shouted my brain, “We are out of control here!”
“This isn’t on the plans!”
“This will not lead to the outcome I had envisioned!”
“I’m in charge here! He must follow the procedures”…um…
I’m grateful that my brain took a while (if “a while” can be defined as 10 seconds or less) to process what was happening because what evolved from that session was nothing short of magic for me. The kind that you bring home in your heart and think over for days and weeks to come. The kind of magic that reminds you why you do this School OT stuff anyway. It was client-centered therapy (shoot, it was CLIENT CREATED). It was meaningful and fun for the little guy. It addressed the goals for the session and then some. And this young boy, for whom school is not always fun or easy, left a session with his OT feeling valued and appreciated.
So what did we do? What did he guide us to do? Well first, we pushed the Perfection pieces into the cylinder of putty handle-end first, providing great resistance to our strengthening activity while focusing on the fingers used to hold a pencil. Try it. You will see that it takes a lot of strength and joint stability to make this happen! I don’t know what his thought process was as he began pushing the pieces in. I only know his smile lit the room when I told him how cool I thought his putty creature looked! Plan 1 Getting the body ready for writing through hand strengthening: accomplished!
From there, we discovered (okay…HE discovered, and I quickly began to document this for use with other students!) that the pieces could be made to look like facial features. So we searched through the pile of Perfection pieces to find eyes, noses, mouths…and this addressed some of the visual processing skills we were going to work on during this session. Plan 2 Preparing the brain for writing through a visual perception task: check!
It appeared that we were creating feelings on these therapy putty people. So, we then took it a step further and assigned emotions to the feelings. My brain was finally catching up to his so I may have had a role here! Searching through the list of emotions on our favorite self-regulation app from the Zones of Regulation, we decided which “zone” each was in then drew a picture of each emotion, labeling it in the correct “zone” color. In all sincerity, I asked him if it would be okay if I shared the activity he had just created with other kids because it was so much fun and he beamed back at me. “Sure!” was his reply. Plan 3 Writing and drawing: done! We did all of this in 30 minutes!
Did we accomplish all of the therapy goals laid out in my plans for that half hour? Yes. Oh yes. Well, to be fair, we did not write any full sentences during this session. With the emotions as our starting place, we saved that for the next time as we each scurried off to our appointed locations. But he had fun and seemed refreshed. And I learned a valuable lesson. Being a good OT is as much about listening and honoring and guiding as it is about planning and implementing and documenting. In this era of evidence-based work, I had all the evidence I needed to know that this was a good therapy session, even if I wasn’t fully in charge of it. Or maybe that’s precisely the point:)
Stacy M. Turke, OTR/L: “On the Road with @stacyturke OTR blog.” Stacy has been a school OT for 30 years with the same school district in Michigan in what she describes as “my dream job.” Her career has ranged from working in a “center-based” school to working in public and private schools throughout the county, including those in the rural, suburban, and urban areas. She has experience working with students with a wide range of educational needs, to include cognitive impairments, Autism Spectrum Disorder, physical challenges, sensory processing needs, and many other learning challenges. She expresses her enthusiasm when she says “This career has been fulfilling, always presenting new and interesting challenges, and is NEVER boring!” You can connect with Stacy on Pinterest at https://www.pinterest.com/stacyturke/ and on Twitter at @stacyturke.Disclaimer: The information shared on the Go-To-For-OT Blog or affiliated Twitter, Facebook, or Pinterest sites, and shared on social or public media or as links on other sites is for general informational purposes only and should not be relied upon as a substitute for sound professional medical advice or evaluation and care from your physician/medical team or any other qualified health care providers. Therefore, the authors and administrator of these posts take no responsibility for any liability, loss, or risk taken by individuals as a result of applying the ideas or resources. Photos of therapy activities are the property of the author and are not to be used without her explicit permission. Photos that include a link to an originating site are the property of that photographer and their use should include the link provided.