Speech Therapy Through a Psychosocial and Trauma-Informed Lens
Kizzy Searle
[00:00:00]
Intro
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Kate Grandbois: Welcome everyone. We are so excited for today's episode. We are here with Kizzy Srl. Welcome Kizzy.
Kizzy Searle: Thank you. I'm really happy to be here. Thanks for having me
Amy Wonkka: Now, Kizzy, you [00:02:00] are here to discuss speech therapy using a psychosocial and trauma-informed approach. And before we get started, can you tell
Kizzy Searle: us a little bit about yourself?
Yes, sure. So I am a community-based speech pathologist in Australia. And, um, really just very, very passionate about working in that mental health trauma space, um, because of kind of living, breathing it and just loving it so much and really excited to talk about it today.
Kate Grandbois: And I love that you are in Australia.
This is such a cool experience. You're, we've already discussed this, but I feel like I have to say it for our listeners. It is 5:00 PM here ish in Massachusetts. And you are, what time is it where you are?
Kizzy Searle: It's 7:00 AM The next day. The next day
Kate Grandbois: you're in tomorrow. It blows my mind. This whole time zone thing.
So you are in the future. Yes. And we [00:03:00] are here in Massachusetts one day behind you in the past talking about science and speech pathology. I mean, if this is not the coolest intersection of all my favorite things, time, travel, sci-fi. Anyway, I don't wanna get too off topic.
We're so excited to have this conversation with you today. We've already had a chance to talk with you a little bit before we hit the record button to sort of see the edges of how this topic, this, this topic of trauma-informed a trauma-informed approach to speech therapy intersects with communication.
And we can't wait to get into it with you first. I do need to read our learning objectives as well as our financial and non-financial disclosures. So let's get that over with and then we will hop right into all the good stuff learning. Objective number one, describe the psychosocial and trauma-informed approach to speech therapy learning objective number two, identify at least three psychosocial factors that can make an impact on speech therapy. Learning objective number three, describe how speech therapy [00:04:00] fits into a bottom-up brain-based framework. Disclosures. Izzy's financial disclosures. Kizzy received an honorarium for participating in this course.
Kizzy is the owner of Attuned Speech, which provides speech therapy, work, supervision, and webinars. Kizzy is also a consumer advisor for mental health in the Sydney Local Health District.
Izzy's Non-Financial Disclosures. Kizzy is on the Trauma and Mental Health Advisory Board for Speech Pathology Australia. Kizzy is also a member of Speech Pathology Australia and runs a social media platform called Attuned Speech Kate. That's me, my financial disclosures. I'm the owner and founder of Grand Block Therapy and Consulting, L L c and co-founder of S L P Nerd Cast.
My non-financial disclosures. I'm a member of SIG 12 and serve on the AAC Advisory Group for Massachusetts Advocates for Children. I'm also a member of the Berkshire Association for Behavior Analysis and Therapy. All right, Amy.
Amy Wonkka: That's me. Uh, my financial disclosures are that I'm an employee of a public school [00:05:00] system and co-founder of S L P Nerd Cast.
And my non-financial disclosures are that I'm a member of asha. I'm in special Interest Group 12, and I participate in the a c advisory group for Massachusetts Advocates for Children. All right. We've made it through all the bits, all the mandatory bits. Um, ki why don't you start us off by telling us a little bit about the first learning objective.
And maybe you can start off just sort of helping define. What do we need to think about under that psychosocial lens, um, and trauma?
Kizzy Searle: That sounds good. Yes, because they're a bit of a mouthful. So I, um, I guess the psychosocial component and the trauma-informed component I see as really complimentary elements to the work that I really love doing.
The, the psychosocial part is technically biopsychosocial and basically all it really means is a combination of, you [00:06:00] know, the biological aspects as well as the psycho psychological and social aspects and how they actually impact on everything to do with speech therapy. So for me, it's the way that I understand and think about every single one of my cases or clients and their families, um, And because it's combined with trauma, I'm thinking for example, from the biological perspective, how developmental trauma can actually impact the way the brain grows and also the way the brain is structured and functions and how that impacts on engagement, learning development, the use of social, the use of speech language and communication skills.
Um, and then of course the, in terms of the psychosocial elements we're talking about the social environment, you know, the family, school life. Um, we're talking about culture. All of those things that I think many of us are aware of. But I'm really keeping that in mind all the time. In particular when I'm getting to know a client.
And [00:07:00] that is then basically having an influence on. How I'm then responding. So that how is basically, to me at least the trauma-informed aspect where I'm thinking about really shifting the way I see speech therapy fitting in into a really, a bigger kind of trauma-informed framework. And I'm embedding all of those trauma-informed principles into every part of my work.
So that's a bit of a overview, I guess.
Amy Wonkka: that's really helpful. The zoomed out view. Um, and I think, you know, it,
Kizzy Searle: it
Amy Wonkka: makes me wonder as, as a practitioner who doesn't know a lot about psychosocial and trauma informed approaches, like how, how might that look different?
So I am looking forward to having a conversation with you and learning a bit more about what that means for me as a clinician. Not only about how I think about my clients, like you were saying, but also. How I might change, whether it's my interactions, um, [00:08:00] or, or kind of my clinical approach to be more accommodating of sort of that broader global view.
Kate Grandbois: That's what I was gonna say is as I think as clinicians in, in our field, in in speech pathology, we often think of our role as, we also didn't think of this broader role as part of allied health. So we are fitting into the picture with ot. We're fitting into the picture with pt, special education, respiratory therapist, depending on your setting.
I don't my experience, my professional experience to date, we have not had this component of a mental health alliance or this psychosocial focus. But the way that you're describing it, it makes complete sense that we would be nested in this much broader picture of the individual's biopsychosocial existence.
Kizzy Searle: Yes. I, I love that the both of you said that. I think that, um, [00:09:00] at least when I was learning and studying in here in Australia, you know, we were taught, and I understand why, you know, we were taught about each of these speech, language and communication elements in isolation because we really needed to understand what each of them actually were, how to identify, you know, what they were and how to work specifically with them.
Um, but we weren't really taught that in real life they don't actually exist in isolation, which I know you've spoken about in previous podcast episodes, um, and how it's actually a part of a whole human being. And in fact, unfortunately we can't truly, I mean, sometimes we can, you know, it depends, but often we can't actually be working on each of these skills Totally.
In isolation because, They're, they're impacted by the rest of life and the rest of, so, and they also impact on the rest of life. So we do [00:10:00] have to be kind of taking that step back and thinking to ourselves, well, I often find I do anyway is, you know, what else is happening in this person's life? Thinking about their past, you know, thinking about their present, thinking about their future and, and how that is actually impacting on their ability to develop their skills as well as use their skills in real life Well, and I think, you know,
Amy Wonkka: we have, we have talked about this a bit before on the podcast, but when we think about communication, it's an interpersonal experience. It's something, you know, it's something that involves at least two people. Um, and all of us are bringing our own, you know, our own histories, our own present, our own future.
We're, we're coming to that, that interaction with all of those pieces of ourselves, um, whether that's known to our communication partner or not, like that's, that's having an effect on our interaction. And I think, you know, there are some, there are some pieces of like the isolation that's maybe a little bit easier to pull out.
Maybe it's a little bit easier to pull out and [00:11:00] say, I'm looking at articulation through this very narrow lens and, you know, we're thinking about it over here. But I think especially, uh, when we think about. Some areas like pragmatics or you know, any of those areas within our scope of practice, uh, that like you've really, really, you can't separate them out from somebody's psychosocial kind of experience within the world.
I wonder if it would be helpful, I'm gonna jump ahead a little bit. I do this sometimes, but if you can talk to us a little bit about that second learning objective, just thinking about some of what those psychosocial factors actually are. Um, you shared with us some references that we'll put in the show notes too.
Um, but I know, you know, one of the pieces you had referenced and Asha Leader article, uh, that just talked about even the differences between trauma and stress and the idea that some, I wanna think it was 60% of adults or something like that are, are kind of moving through their life, having experienced [00:12:00] some sort of trauma.
So, you know, just what are some of those factors? That, that may be, you know, at play when we're thinking about interacting with our clients and their families and trying to come up with a respectful and meaningful and evidence-based treatment plan
Kizzy Searle: for them. Yes. Um, wonderful question. I, I wanted to first just agree with, with what you were saying about, um, you know, communication and interaction, how it's, it's all one and the same, isn't it?
And it's, it's so deeply psychological and our, our communication is also deeply rooted in our survival. You know, we communicate to survive, that's one of the first things we learn as babies. We have to be able to communicate, we communicate through crying and all those kinds of things. And as we grow, it becomes a little bit more, um, maybe abstract and we add all these different elements into it.
Um, and, and so, so yeah, it, it is all just enmeshed in each other. [00:13:00] Um, in terms of your question about the second learning objective, Yeah, so one of the things that kind of comes to mind to start is, uh, my work that I do with a lot of teenagers and often they come to me wanting to, uh, work on things like, you know, friendships and being able to participate more in group situations.
And they're usually really motivated to work with me. I find at least when they come to me of their own choice. Um, and, you know, I'll start working with them and I'll notice that they kind of fade out a little bit. They don't always seem to be really engaged with me. They may have started the session really alert, and I notice as the session goes on, they're starting to yawn and yawn and they can't keep their eyes open anymore and they don't know why they're doing what they're doing.
Um, and the way I understand, and then perhaps as well, you [00:14:00] know, over a number of sessions, They might go away and come back and nothing's happened. You know, they haven't worked on what they said they would work on, or they're starting to, this doesn't happen to me too much anymore, but they might start not showing up.
And the way I understand this from that bio-psychosocial lens is by looking at the broader context. Yes, they're coming to me. Yes, they have clear goals. Yes, they're motivated, but they've probably had past experiences of going into school environments, of being socially isolated, of being teased and bullied for the way that they speak or the way that they sound, how they might seem different.
And that is incredibly. Distressing for any person to go through. And if they've gone through that, not just in high school, maybe in primary school, maybe even in preschool, perhaps they've had early experiences in their life where they've been really often misunderstood or their needs haven't been met purely because they've been all of these [00:15:00] frequent communication breakdowns and, and it's been no one's fault, you know, not the child's fault, not the parent's fault, but that's just how it's.
All of that accumulation of stress, you know, perhaps there are less protective factors can increase the risk of trauma. And we also know, um, there's lots and lots of research to show that, you know, when there is that long-term exposure to trauma, when we, and we don't have as many protective factors, for example, that really, really securely attached caregiver or were just exposed to lots and lots of different stresses that this can actually change the way the brain actually grows, in particular impacting In terms of the, um, well there are a couple of different impacts.
I'll just mention one for now, but that prefrontal cortex area, which I think also may have been mentioned previously, uh, in another episode, but that prefrontal cortex area, which is where, where we call our, um, our executive functions live. Something that Terra Sumter also mentioned. I [00:16:00] wish I, and I love her work.
I just had to give a shout out. I dunno her, but I had to say it cuz I love her work. Um,
Kate Grandbois: we'll make sure she knows she's, she's wonderful. We'll make sure we pass it on. And anybody who's listening who has not listened to this episode, we highly recommend it. Go back and listen. I can't remember what season is, but we interviewed Tara Sumter, Tara Sumter about executive functioning skills, which is what we're referencing.
But anyway, as you were.
Kizzy Searle: Amazing episode. I totally recommend it as well. Really great episode. But yeah, so those are our thinking, learning, decision making, problem solving skills, and that can often be really significantly impacted in the presence of long-term, chronic, you know, complex, however we wanna call it trauma.
So I'm potentially coming back to the present now with this. Teenage client of mine potentially working not just with a client who has had lots of distressing experiences, um, you know, in the peer kind of world. And therefore having to talk to me about these [00:17:00] kinds of social communication areas is actually really, really hard for him and potentially quite triggering.
So it actually makes sense that his, you know, zoning out in my sessions is starting to yawn. He's shutting down basically, you know, his mind has gone, this is too much. I can't handle this anymore. I'm talking about something that I find really traumatic. I'm gonna numb myself to this situation. So even though he wants to be there, this is what he is fighting internally.
And that's probably also why, you know, part of the reason why he's going away and is forgetting. To work on what we've worked on, but also he may be forgetting because his executive functions may have been impacted by potentially long-term trauma. So, so that's just a really quick, um, yeah, example of how I might actually be thinking about that psychosocial element in real life with my clients.
Kate Grandbois: I may be jumping ahead a little bit, but now I, now you have me wondering about some of the other things that a therapist might look [00:18:00] for or consider. So in terms of, you know, zooming way out, zooming way, in terms of zooming way out and thinking about the broader context, making sure you're considering. An individual's lived experience, what's happening in their lives outside of the classroom, outside of your therapy room or outside of the classroom.
Understanding this connection between brain development trauma and how traumatic experiences can shape our communication skills. What are some of the other components or are there other components besides executive functioning that a therapist maybe who's listening to this who doesn't have a lot of experience in this area might also look out for?
Kizzy Searle: Yes. So, um, the two, I would say that there are, Quite a few different parts of the brain, honestly, that get impacted, but the probably the two other key areas that I like to talk about. Um, so, so I like to talk about three parts of the brain. Basically we've got the bottom [00:19:00] part, the middle part, and the top part.
So we've got our brainstem at the bottom. The middle part is our limbic system, and the top part is our prefrontal cortex. And so we've spoken about the prefrontal cortex, the top bit, the middle bit, um, with the limbic system. I like to think of two areas. So there's the hippocampus and the amygdala, basically that is, I'm summarizing this here, but memory and emotional regulation, and then we've got the bottom part of the brainstem, which is where our actual stress responses live, I guess you could say.
Those fight, flight, freeze, collapse responses. That's kind of where they come from. So, and I hope I've understood your question correctly, but when there is potentially the presence of trauma, we don't always know. You know, sometimes someone will come to us with a clear history or a diagnosis. Other times they won't.
But I might imagine, based on what I understand of their past experiences, that there could have been some kind of traumatic experience. Um, but so basically yes, when, when there is [00:20:00] potentially trauma, what can also happen is the amygdala, which is that kind of emotion place that's also our threat detector can become overactive.
So it can start to be registering potential threats even when they're not maybe there. And, and result in some, I guess, startle responses that, that are perhaps more common or often are come more frequently than other people. They might be constantly on the lookout, you know, for, for potential dangers.
Even when they're fairly feeling fairly safe and regulated, they're still really, you know, constantly, they're observing little changes in facial expression. They're thinking about what's behind them, um, you know, always ready to go. And then of course, just the brainstem is more likely to be activated and they're more likely to go into those stress responses as well.
So that's also just what I'm thinking about when I'm with my clients.
Kate Grandbois: No, that's very helpful. I know that a lot of times we end up in, we're in our workplace situations, we end up in [00:21:00] situations where we're treating individuals where we don't have a complex history profile on them, or the parents are not available to collect more information.
Um, or maybe a therapist might get the sense that something is sensitive and they're not really sure how to move forward. I, I, I love the way that you painted the picture of just things to consider if you do suspect that someone who's sitting across the therapy table from you is having a more difficult time or could even just the idea that they could have experienced trauma, I think is an important thing to consider that often our, in our society we don't necessarily focus on, and a lot of us, were not trained on this in graduate school.
So I think even just acknowledging those things is really helpful. So thank you for, thank you
Kizzy Searle: for sharing that. No problem. Actually, that's a, that's a really good point. So I, I mean, personally also just because I love this area so much, but I do use this trauma-informed approach and psychosocial lens with everyone I work with, regardless of if they're coming to [00:22:00] me with, um, because I'm, you know, a person who loves working in this area.
So it is the approach they use regardless, because you can never know, you know, you, I, I didn't know about my own trauma until 27. Uh, sorry until I was 27. So, you know, I'd been living my whole life with all of this really complex trauma and I could have benefited from that kind of psychosocial trauma-informed approach for so many years before I realized it myself and was able to go, hang on, this is what I now need.
Um, so it, it's really not as obvious, you know, sometimes our stress responses, like those freeze collapse responses, uh, they're not big responses. They can be really subtle and if we're not trained up in it, we can't always pick it up. So you, because the fight flight, they can sometimes be quite big, you know, responses like actually fighting or absconding.
Um, but then other times the signs are really, really subtle. And so I actually think that it's, my [00:23:00] recommendation is often just take the, take that approach. But in particular, like you said, if you have a question like why is something just not working, something just doesn't feel right or there's some kind of weird.
Dissonance, you know, something weird going on. Then maybe there's time to think a little bit about that psychosocial trauma-informed approach.
Kate Grandbois: I just love that so much, Amy, I'm so sorry. I can see that you wanna talk and I just jumped right in. I'm so sorry. I just love that so, so much. And I think it speaks to what we can bring to our therapy rooms to create safer spaces that are focused on trust and compassion and person-centered care, regardless of the history that you know.
So thank you so much for saying that. Amy, take it away. I am sorry that I interrupted you.
Amy Wonkka: No, it's fine. I was just going to thank you, Kizzy, for answering the question that I didn't ask, which was this seems like it, like there's absolutely [00:24:00] no harm in utilizing this approach with everybody and potential harm in only utilizing it with the clients or family systems who, you know, have a certain history.
Um, I think connected with that. I guess a question that I have is, As a clinician who's looking to change my approach a little bit, to be more trauma informed, to be more psychosocially oriented. What are some things, like, how, I guess if we can go back to your example of your high school student, um, how might you change the way you interact with him or change, like, I'm just thinking perhaps if you weren't using a trauma-informed approach, you might think, all right, well he's not doing his homework.
Maybe I'm going to set up some type of incentive plan to get him to do his homework. Um, that might be what you would do, but I'm wondering if it might look a little bit different when you're approaching it from this [00:25:00] broader framework. Um, and if you could just talk us through some, some sort of examples or like what that process, how that process might look a little different.
Um, so we can, we can try that on in our therapy.
Kizzy Searle: Yeah. Great. That sounds good. Um, I, yeah, so I guess this brings me into that trauma-informed section where, you know, I think of that as the actual doing bit. The, so we know the kind of, you know, I, I guess we know the why maybe. And this is like the, how, how do we actually change our approach?
What do we actually do? Because of course it's kind of like, it's great to know all these things, but you know, now what do we do? So, um, so basically the, there are a few things. Um, maybe the first one I will cover is Dr. Bruce Perry's neuros sequential model. So he, he has this one aspect of, uh, part of the model.
So I haven't kind of done all the learnings and courses in depth cause it's quite, quite intense. [00:26:00] But he has this one approach that's called the three Rs, um, which is basically, Uh, regulate, relate and reason. So I think of it as like a framework or a bit of a, um, a reverse pyramid with regulate at the bottom, relate in the middle, and then reason at the top.
And it's basically in line with the three parts of the brain that I spoke about before. We've got the brain sim at the bottom, the limbic system in the middle, and then the prefrontal cortex at the top. And I like to think of a lot of that, those really in-depth speechy things that we do as living in that top part, that reason section.
And actually, no, it's not an upside down pyramid. Sorry. Got it the wrong way to, it's a normal way pyramid, if you know what I mean. So, um, yeah, so was recent at the top. So, um, Naturally we've got our regulate section, which is all about the window of tolerance, which is, [00:27:00] which means, you know, how we remain regulated.
You know, for any of you who are maybe a little bit confused about what regulation actually is, naturally includes when we're in that calm state. But it's actually, you know, when we can be in a whole range of different emotions, from happy to sad, to angry, but we're still able to reason, problem solve, make decisions, and be responsive.
When we move into our, we're reactive. Now we've gone, you know, mind blank. We're just, we've got all this, you know, the pumping heart rate. We're just ready to fight and go. That's when we've gone into a stress response. We're now dysregulated, you know, we're in that fight, flight, freeze collapse, which we all go through regardless of if we have, you know, history of mental health and trauma or not.
It's just that it's much more common, um, and much more difficult to perhaps get a handle on. If you do have that, if you are impacted by trauma, basically, So, so there's that, that first element is what I think about with my clients is how are they doing regulation [00:28:00] wise, because what we know, um, from, so now I'm just gonna introduce something else.
Uh, there's this hand model of the brain by Dr. Dan Siegel, which is a really, really simple model where he basically shows what happens in the presence of a stress response. So usually you can think of the brain as like a fist, basically a closed fist. And what happens is when you have a stress response, what he says is, we flip our lid.
And that means that that top part of the brain, which is our prefrontal cortex, actually turns off. And, and now what I've done is I've like lifted up my. My fingers, so they're no longer connected to the rest. So I'm kind of like a palm now, no longer connected to the rest of the brain. So now what we've got exposed is the limbic brain, which is the middle part limbic system, the middle part of the brain and the brain stem.
And they're now completely in control. So our, our ability to think, problem solve, reason, you know, communicate, [00:29:00] all of those things are actually offline during a stress response. We can't access them and we need all of those things to engage properly, to learn, to actually to grow. And so we're potentially working with people in our sessions who don't actually have access to that learning, thinking, decision making part of their brain when they.
When they're dysregulated. So that's why it's so important for us to first be thinking what is their regulation like, how are they doing? Do I see signs of fight, flight, freeze collapse? What do I know about them? Do they seem to be, you know, a bit zoned out? Are they obviously really fidgety and they need to move around?
Cuz these could be signs that it doesn't. I can't actually say to them, uh, communicate with them verbally at the moment. It's just not going to work. So that's that, that bottom bit. And then of course the next part is the relating section, which is where we're really focusing on connecting. It's that trust [00:30:00] that that, um, so the bottom bit is the safety, the middle bit is that trust, the connection, the, and, and I really, really focus a lot of time on this section.
Naturally, I know, you know, the states, it's a very different environment, funding environment. So I can't, I, I don't know how much time, you know, you guys have to do this kind of stuff too. Sometimes that's the case too, where restricted by funding, but wherever possible, I'm actually spending a lot of time on the relationship because we also know, based on the brain, That the more they feel connected to us, the more they actually trust us, the more they're going to learn.
So the more time I spend on those two bottom sections, the more likely speech therapy is to be extremely effective and actually happen really, really quickly. Rather than me kind of feeling like I'm just like, what's that term? Um, I dunno, I, it's a bit early for me, so I can't think of the term, but kinda like, I'm like just really chipping away and I'm not getting [00:31:00] anywhere.
But I find when I focus a lot on the regulate relate, the, the reason bit, the goal setting speechy bit just happens so quickly.
Amy Wonkka: I, I love everything that you just said. I'm gonna jump in, in front of Kate. Sorry. Same, same, same, same,
Kate Grandbois: same, same buddy. But I, I
Amy Wonkka: think, you know, we, we talk a lot on this, but Kate and I both work in AAC and I feel like we talk a lot in this podcast about the set framework.
I love the set framework, which is a framework for thinking about assistive technology. But one of the pieces I love about it the most is that it gives us the ability to identify the environment and analyze variables in the environment. And when you were speaking, I was like, regulation is part of the environment, right?
Like so, so this regulation piece, the environment is not
Kizzy Searle: just how
Amy Wonkka: noisy is it and how much movement is there in the background, and is it like a distracting visual environment? It is also, As much as we can tell and we can't be inside somebody else's body. [00:32:00] Um, but, you know, what is your internal environment as a client and your availability for being there?
And I think,
Kizzy Searle: you know, I thinking
Amy Wonkka: about having that in the back of your mind as you're working with a client, I think is a, is a really, it's a really important layer I think that perhaps many of us are, are not like giving those discrete thoughts to, um, because I would imagine if you're in that, you know, like your, your lid is up, your fingers are up and you're not able to access sort of that ability to learn and be present in a learning exchange that also could potentially escalate things and make the whole experience even more negative.
So then the next time the client comes back, that was their previous experience was this escalated negative experience. Um,
Kizzy Searle: so. Thank you. I guess
Kate Grandbois: I was, was just gonna second all those comments [00:33:00] because the, the image of the fist and then the fingers going up, you can just see how parts of the brain are just not available.
I don't know. Something about that visual was incredibly helpful for me, so thank you so much for sharing that. The other piece that it made me, that, that came to my mind as you were talking was, I know as therapists we're taught to build rapport to make it fun, right? I mean, everybody knows that if you're in pediatrics, you're on the floor.
You might play a session, spend a session or two playing. If you're working in a hospital, you might spend a session or two having a conversation and get, make, you know, being friendly and making the person feel at ease. But that is so much more important than just. Having fun when you were talking about this, it is a critical, it made me realize that this is a critical piece of someone making progress.
This is a critical piece of their [00:34:00] neurology. This is a critical piece of, um, you know, making sure that we do no harm by accident, unintentionally. And I think that there is something fundamental in that. Again, just do this all the time. Don't wait for the red flag. Um, you know, don't wait for the explicit in the, go ahead.
The green light. Well, this person has trauma, so you should use a trauma informed Glen's now. No, I mean, this are, these are cornerstones of learning. It's just my, my brain's going off here. It was just so, so helpful.
I
Amy Wonkka: Have a question. I have, I have a question about kind of piggybacking on Kate's comment about fun.
And I think fun is important too. Like, I mean, I, I'm more engaged when things are fun. Um, but the idea of co-regulation and
Kizzy Searle: so as, as a speech pathologist who doesn't
Amy Wonkka: have a lot of background in this area, like not this, the same approach is not going to help regulate our every client, [00:35:00] right? So I don't know if you can talk a little bit about that and just, you know, not that everybody's gonna listen to this podcast and be an expert, but, you know, I think there are different things that we might do in the interaction with the client, depending upon what signs the client is giving us to help make that a more comfortable and accommodating space.
And I don't know if there are any tips you have, um, for listeners for me and Kate.
Kizzy Searle: Yeah, I, I, um, I love the concept of co-regulation and it is, again, one of those really jargony words that can just seem like, oh, you know what even is that? Um, so yeah, I would love to speak a bit about it. It, it's basically, I, I mean, I guess yes, if I, if I were to summarize it, it's occurs at the nervous system level and it's basically when you can help soothe another person's.
Nervous system through your nervous system. So that's [00:36:00] kind of at that kind of nervous system level. And we can think about it when we, we, I guess we can better understand when we think about maybe a mom and the baby, you know, when a baby becomes distressed or dysregulated and they start crying, you know, the mom usually comes over, identifies they're upset, picks them up, soothes them, uses all of that beautiful, you know, like, sure.
Whatever it is, you know, all of that beautiful tone and volume and, and the baby can naturally be soothed sometimes the mom also recognizes that there's a need that needs to be met. Perhaps the baby's hungry, she meets that need soothes the baby, and the baby's okay. During that process at the nervous system level, you know, when the mum connects with the distressed baby, her nervous system also becomes dysregulated.
She feels this baby's pain. She's distressed by the baby's distress, and as she's soothing the baby, she's actually also soothing herself. They're coming back into a state of regulation together. And what's happening is because [00:37:00] self-regulation is heavily reliant on executive functions, in fact, it is an executive function skill and a baby's brain executive functions are not developed.
We know that that prefrontal cortex is the very last thing to develop. In fact, I think it only fully develops, and please don't quote me on this, was it 25 or something like that? You know something much, much later. Yeah.
The baby doesn't have skills of self-regulation. We, we naturally learn these skills through doing it together with an adult who already has those skills. So that is a really, really natural, normal thing that moms or parents will do for their children. And something that we can also be doing as adults for our clients too.
In fact, adults co-regulate other adults too. My dog helps me co-regulate, you know, he co regulates with me. So it doesn't have to be human to human like is, but it's, it's a very, very natural, [00:38:00] normal thing that a lot of us do intuitively we're not even aware that we're doing. But because of trauma, you know, our ability to self-regulate can be greatly impacted.
And this is the case for me, you know, so I had a lot of challenges self-regulating into my adulthood, and I had to, I had to actively learn that as an adult. So, you know, so the first thing that I actually like to think about as speech therapists is, you know, what is your own ability to self-regulate? You know, checking in with yourself.
What do you do when something stressful happens? How do you respond? Do you find hard to think? You know, do things kind of just become a mess? And how do you bring yourself back into that state of regulation? Are you able to do it yourself? Do you rely on someone else? You know, what do you do? How do you go through that process?
Because first we need to become more aware of how we self-regulate before we can then go, okay, now that I know how I do it, [00:39:00] I can now think about how I can be co-regulating with my client who hasn't learned to do it themselves yet. So, yes, co-regulation.
Kate Grandbois: I love this idea. I think, um, you had said something earlier in the podcast that made me think of this too, this idea that, We are providing person-centered care.
We are looking at the broader context of our students, clients, and patients. But we are also people in a therapy room, right? We are bringing humanity into our therapy room when we bring ourselves into a therapy room. And I think we have to give ourselves the, the head nod, the acknowledgement that there is a possibility that we're stressed or overworked or hungry or tired.
Um, we have another podcast episode where we interviewed Dr. David Luterman on counseling, and he says that the best thing we can do for our patients is eat lunch. The best thing we can do is, you know, engage in some of that self-care so that [00:40:00] we are bringing our regulated selves into the therapy room. Um, and there, there's something really, really whole about that, that I, I really appreciate in, in.
Just acknowledging that there are two people in the therapy room together. Mm-hmm.
Kizzy Searle: We're only human, you know, and we have our own traumas. We have our own stressful lives. Uh, and so we're not perfect and that's okay. Um, and we are going to need help and that's okay. We are going to need a bit of co-regulation ourselves and emotional support ourselves, and that is totally okay.
And there are gonna be days where we can't provide that co-regulation, and that's okay too. Um, so, and, and I also realized I didn't actually say much about how you actually co-regulate, so I thought I'd. Briefly just touch a bit on that. Um, and, and that is through those kind of like with the mom and the child, you know, a lot of that soothing connection, um, bringing in that safety, bringing in that, um, that regulation component.
It could be through movement, it [00:41:00] could be through gentle, you know, it, it could be through your tone of voice. But I definitely find that, um, you are much more likely to be successful in co-regulating another person if you've already developed that relationship with them. So hopefully your very first session or very first interaction with them won't be, sometimes it is, won't be at this incredibly, you know, dysregulated place.
But, and, and you do get a bit of that opportunity to first really focus on that connection because, you know, we do all get taught about the importance of rapport, but sometimes we don't really get taught about why, why it's so important. And like you were saying before, Kate, it is from that neuro.
Neurobiological level, it is just crucial. We can't do without it, you know, we need that connection to feel safe. We need that connection to learn more effectively, and we need that connection if we want to be able to regulate as well with another person. [00:42:00]
Amy Wonkka: I really liked the question that you had us all ask ourselves in terms of how do we regulate, how do we do those pieces for ourselves?
Um, because it makes me think about, you know, professional development in a much broader sense, right? I think that when we think about professional development, we often think through this really narrow lens about those really narrow areas of the field that you talked about earlier. I'm gonna learn more about phonology, I'm gonna learn what, and all of those pieces are super important and we need to continue learning in those areas.
But I think it also, you know, the questions that you're raising, I. Broaden that view a little bit further to where, you know, we are going to be better able to be there for our clients when we better understand ourselves and our ability to navigate these things ourselves and how that might look in the context of a therapy session.
Um, so it's also interesting to [00:43:00] broaden that scope a little bit when we think about professional development and recognize that that's also has to do with us as the other person in, in the communication dynamic.
Kate Grandbois: I love that so much, and I wanna piggyback on it quickly to talk about the intersection between professional development and personal development and how you develop as a person will influence how you show up in your therapy room.
Just as a quick example that I thought of while you were talking a personal example, I am a very different clinician now that I am also a parent. I am a parent of two school-aged children. I have a deeper understanding of what it means to be a parent, to have a busy household, to experience parental stress because it's real.
And if anybody tells you it's not real, they're lying to you. So, and I can, I reflect on myself as a clinician before becoming a parent and the things I would say to parents not really having an understanding of what their, what their lives were like. So my personal development [00:44:00] has really had a big impact on what I bring to the therapy room.
And I just love this idea of reflecting on your own personal development and whatever that is, you know, whatever that is for you as a person, but just considering how that influences how you show up in your therapy room. I just love this. A brain's exploding all over the place. It's amazing.
um, I wonder if you could tell us a little bit about the bottom up brain-based framework. What, what is that? I'm imagining now another pyramid somehow maybe flipped upside down, but, but can you tell us a little bit about
Kizzy Searle: that? Yes. So I, I, um, that, that was the, the framework actually.
Um, so it is because there are, I guess, Lots of different frameworks out there. I, I thought I'd use that term. But basically the three Rs from the neuro [00:45:00] sequential model is that bottom up base. Yes, whatever I call it, bottom up brain-based framework. So basically, yes, it's because it's about all about the brain, um, based in how the brain works and it's bottom up because we start with that regulation part of it.
That doesn't mean to say that it's, it's not a like a step one, step two, step three formula that we have to follow. It's really individual. So it really depends on who we're working with at the time, what the current situation is. You know, I will always do the relating section, so that connection part I will always, um, work on regardless.
But I don't always have to be really working on the regulation. You know, sometimes I'm working really closely with the occupational therapists and psychologists if they're available to figure out some really good sensory processing strategies or. Practicing some of those regulation things that I'm aware of that, and that the client understands how to do them with me [00:46:00] so that I can basically prompt them a bit if they're needed.
But other times, you know, I'm really just realizing that I can, through my, um, through thinking about safety with them. So thinking about the way I'm presenting myself, my facial expressions, my volume, you know, how distant I am or close to them. I am physically thinking about the actual sensory environments of space around me, how private it is, how it's set up that I can already pro be providing them with enough for them to feel regulated so that we can focus more on that relating aspect, which I, where I do a lot of creative like play.
Yeah, it, it's fun. It's a, it's about being creative. There's no right or wrong. It's really flexible. It's obviously really person led. And then when we can, we're building in all of those really, really, um, Skill focused elements of speech therapy.
Kate Grandbois: Thank you for clarifying that. That was really helpful. [00:47:00] Um, in reading some of the notes that you submitted before we recorded the podcast, you list some psychosocial and you, you list some other factors that are, that can be related to trauma.
I know we've reviewed a lot of them. One of the notes that you have here is cultural influences, and I wonder if you could take a second to talk about the intersection between, um, cultural influences and a trauma informed lens in therapy.
Kizzy Searle: Mm, yeah. Great question. Um, so I, I guess. Because a trauma-informed approach is really about, you know, it's, it's a strengths-based approach.
It's about following the person's lead, you know, meeting them where they're at. Sometimes I just, this is just the example that I can currently think of, but sometimes I'll engage with a client and their family where they're, they really want a medical model from me. [00:48:00] You know, they, they really want me to be the expert and to tell them what they're supposed to do, what their goals are, and how I'm, I'm, you know, I'm telling them what to do, basically.
And I find that sometimes it's not appropriate for me to, to jump into my, well actually, you know, I use a strength based client, you know, I client led approach and, and all of these sorts of things because they're not ready for that. You know, their, their culture and their understanding of the d the relationship between professionals and clients is totally different to the way that I like to work.
And if I like, push them to try to work in the way that I want to work, what I'm instead doing is I, I'm no longer being respectful of their diversity. I'm no longer, um, giving them that choice and control. That is another. Those are some aspects of a, of trauma-informed practice principles. Um, and, and therefore I'm kind of leaving them behind.
I'm dropping them a little bit. And this is also the case when I come across families who [00:49:00] sometimes think very differently to me about the presence of trauma, about the impact of trauma, and also about neurodiversity. You know, sometimes we can have very, very, very different opinions and I might really, really disagree and in fact might even be angry internally.
But I will still. Respect them, their, their opinions and meet them where they are at, and slowly walk to work towards a bit more of a balanced approach between the two of us. And that's because of two reasons. One, of course, as I mentioned, that respect of diversity and different belief systems, but also because what we know about trauma and, and you know, again, you never know who's been through trauma and who hasn't, but there are strong defense mechanisms that we have as a result of trauma, and they are there to protect ourselves from what we cannot basically handle.
You know, all of those intense emotional thoughts, perhaps as guilt, you know, perhaps as fear. And we can't handle them. We basically develop these [00:50:00] defenses like beliefs, um, like behaviors and, and different things that help protect our mind from what we can't handle. So I don't want to be shaking a person up and trying to remove them of their beliefs and what they're clinging to, because I don't know what I'm potentially doing to them by taking it away from them.
So, I hope that answered your question.
Kate Grandbois: It did, and it, it brought to mind something that I, I learned on this podcast in the last 18 months or so, which was the word, uh, cultural humility and bringing, again, this intersection of personal development, professional development, taking a moment to enter a. An interaction with humility, with cultural humility to center someone else's culture.
Um, and I think that's, that's also a very personal journey in terms of how you consume information about different cultures, reflecting on your own culture or your own privilege. Um, and [00:51:00] so I, I, I really appreciated the way you described, making sure that you're centering the other person throughout the entire interaction.
That was really helpful. Thank you.
Kizzy Searle: Actually that, that made me think of something else that, um, I've been on my own learning journey about, , you know, just because I believe something to be true or to be right doesn't actually mean that it's, you know, there's nothing wrong with me totally believing in something and totally believing it to be the truth and, and the, and, right.
But that, that doesn't mean I have to enforce it on anyone else. And that doesn't mean that anyone else has to believe that either. And I find that, you know, even though we get taught to, to identify our biases and think about how they might be influencing on others, it's not always so simple because our biases are unconscious.
We're not aware of them until we're made aware of them. And often that happens through. Just coincidence, you know, just through, uh, maybe a massive conflict that we suddenly realize, oh, hang on, the rest of the world doesn't think the way that I think. [00:52:00] Um, and so something that I like to share with others is when you are trying to become a bit more aware of what some of your biases might be and how they might be influencing on your interactions with your clients and how you're potentially responding to them, to, to basically try to notice whenever you are, you are getting that weird feeling of, um, sometimes it's like a disdain or it's like a bit of an anger or a hatred or a, or a, just a weird feeling of rejection for something that someone has said and you're not really sure why.
You know, if you can happen to catch latch onto that, that weird feeling that you get when someone says something that might be your body hinting to you that you have a bit of a bias in this area. And it could be something to explore if you feel your, it's safe enough for you to explore, because sometimes those feelings can be a bit intense.
Thank you.
Amy Wonkka: I love that. I also really appreciated, um, in your previous example that it incorporated, you know, uh, a [00:53:00] family system, right? Because depending upon the age group who you're working with, you may have a client who's coming with their care caregivers or their spouse. Um, and I think being aware to have this expanded perspective in this expanded model, not just for our client, but for the people who are part of their communication circle, um, is also really helpful.
Um, And there must be, I mean, not that you're having the same depth of relationship with those caregivers in broader circle, uh, but I think in your interactions with those people, are you also sort of applying the same
Kizzy Searle: approach? Yes, I am. That's a great question. I apply it to absolutely everyone I work with as a speech pathologist, so including, you know, other professionals as well.
I'm also thinking, you know, sometimes, so parents, other professionals can sometimes also be really dysregulated. It's just that because they're adults, they're better at masking [00:54:00] it. So sometimes when I find I'm trying to have a conversation with them and for some reason we're just really not on the same page, or I've said something a few times already and I don't know why they, there seems to be a bit of anger or something like that, you know, I'm thinking, hmm, maybe they don't feel too safe at the ma moment.
Maybe they're not. Feeling very regulated at the moment. Maybe they've had a past experience with another speech pathologist who has been really quite rude to them and or, or they've just for some reason had some major misunderstanding and I'm now coming in without that information and that context, and so I need to take a step back and be like, hang on a minute.
Can they maybe also benefit from a bit of co-regulation? I'm also checking with myself, you know, is my heart a bit elevated right now? My also son to engage in a bit of a conflict, so maybe I need to take a step back and have a bit of a breather. And then really just focusing on the connection as well.
Sometimes I'm actually spending way more time with the parents than I am with the client because I realize that in quotation marks, you know, the, the real client [00:55:00] is kind of the parent and not, not the child because the child's already doing as much as they can and, and perhaps it's more about me really getting a better understanding of what's happening with the parents and what supports they need so that we can then be working through them with the client.
I love all
Kate Grandbois: of this. This has been so incredibly helpful. We've covered so much material today. One thing that we did forget to mention is that you've provided a free resource for all of our listeners, um, and it's, we'll be available for download on our website. There will be a link to the course in the show notes.
This is a material that you've created to help put some of these things into the therapy room to help a clinician bring some of this material with them into therapy. So thank you so much for creating that for us. I know you have a lot of other additional resources on your site. We will put some links in our show notes to that as well in our last few minutes, do you have any parting words [00:56:00] of wisdom for our, for any speech pathologist or special educator who might be interested in learning more about this or is just beginning their journey with trauma informed care?
I would say
Kizzy Searle: that the. Only thing, um, that I wanted to perhaps emphasize is kindness towards yourself. You know, because we live in a day and age where we are constantly bombarded with information. There are all of these movements happening around us, and we are only human. We can only learn what we're able to learn at the time that we're learning.
And we've just got, we've got the rest of life to deal with too. So, you know, there is no pressure to be walking away from this podcast episode thinking, right? Oh my gosh, I've gotta suddenly completely change the way I'm working. Or I've gotta rethink, you know, how I'm thinking about the client and think about the regulation and the relating, and then all [00:57:00] this kind of stuff.
It's, it's a lot to take on in particular, if this is maybe one of your first interactions with this way of thinking and working. Um, and so I totally understand, you know, just, just taking on one thing, which is too, To reevaluate how, how much time you spend just for yourself, because to do this work long term sustainably in the way that I've been describing, you do really need to be thinking about how much time you are allocating to yourself, which I know is incredibly difficult to do.
But the more that we can try to find some regular time to ourselves just for ourselves, you know, whether it be on our own or with an emotional connection where we can receive some of that co-regulation, the more space we're gonna have to actually be able to think about some of these things that we've been talking about and therefore implement them.
So I guess that's the only thing that I would say. I really don't want anyone to walk away [00:58:00] feeling horrible about the way that they work and guilty that they haven't done this or thought about this already. Because, I mean, I went through a massive wake up call myself before I was able to change and, and think about these ways of working.
And I, yeah, I just really don't want anyone feeling. Bad. That was
Kate Grandbois: such wonderful advice. I appreciated that so much as a human. Thank you so much for sharing that. Thank you. You've been just such a wonderful guest.
Kizzy Searle: Thank you. Um, and, and also, so just one thing I thought of, um, you are very welcome to get in touch with me.
By the way, anyone listening to this, I love questions. Please feel free. You know, um, Kate's already mentioned my, um, my Instagram, so I'm assuming they'll be in the show notes. So you'll be able to go take a look, send me a message, or of course I have my website too, where you can just, you know, fill in the form and, and reach out to me there as well.
Um, and hopefully I'll be able to come out with some additional, you know, webinars or [00:59:00] resources and maybe an online course, fingers crossed, um, that you'll be able to access. Thank you. That you'll be able to access in the future to further the learning. Fantastic. Thank
Amy Wonkka: you so much, Kizzy.
Kizzy Searle: Thank you. No problem.
Thank you for having me. I, I was a little bit starstruck honestly, when I got the email that I would be on this podcast. Oh man.
Kate Grandbois: Don't know how much of a mess I am. That's, that's,
Amy Wonkka: that's what that means. We're all a mess and it's
Kizzy Searle: okay. Exactly, yes. Now
Kate Grandbois: there's um, there's modeling, compassion and kindness.
There you go. Bringing in full circle. Kizzy, it was so great to have you. Thank you so much for being here.
Kizzy Searle: Thank, thank you so much. Honestly, I've really enjoyed this conversation. I really appreciate you having me on your show.
Sponsor Outro
Kate Grandbois: Thank you so much for joining us in today's episode, as always, you can use this [01:00:00] episode for ASHA CEUs. You can also potentially use this episode for other credits, depending on the regulations of your governing body. To determine if this episode will count towards professional development in your area of study.
Please check in with your governing bodies or you can go to our website, www.slpnerdcast.com all of the references and information listed throughout the course of the episode will be listed in the show notes. And as always, if you have any questions, please email us at info@slpnerdcast.com
thank you so much for joining us and we hope to welcome you back here again soon.
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