This is a transcript from our podcast episode published September 5th, 2021. The podcast episode is offered for .1 ASHA CEU (introductory level, related area). This transcript is made available as a course accommodation for and is supplementary to this episode / course. This transcript is not intended to be used in place of the podcast episode with the exception of course accommodation. Please note: This transcript was created by robots. We do our best to proof read but there is always a chance we miss something. Find a typo? Email us anytime.
A special thanks to our Contributing Editor, Caitlin Akier, for reviewing and editing drafts of our transcripts. Her work helps keep our material accessible.
[00:01:40] Ali Arena:
Kate Grandbois: We are so excited to welcome Dr. Ali Arena and Nicole Moore. Welcome guys. um, before we get started in today's topic, do you guys want to tell us a little bit about yourselves?
[00:01:55] Nicole Moore: Sure. You want to sure.
I'm Nicole Moore. I am a licensed marriage [00:02:00] and family therapist. I specialize in the treatment of trauma and trauma related disorders. I'm also the founder of the center method. It's a wellness center in Santa Monica.
[00:02:10] Ali Arena: And I am Ali Arena. I'm a speech language pathologist, and a BCBA. And I specialize in working with neurodiverse and neurodiverse couples.
And I really specialize in social interaction.
Kate Grandbois: And you also have your PhD in special education. I just learned about you.
Ali Arena: I do. I in my imposter syndrome is real
Kate Grandbois: You wear many hats. Um, we are, you guys are going to talk to us today about trauma and communication, which is a topic that. So, so, so excited to dive into, because I think it's so much more relevant to our jobs as clinicians than we realize.
And the two of you as a pair bring such a unique perspective to this topic. And so, you know, we love collaboration. We talk about collaboration a lot. Um, [00:03:00] so the collaboration between the two of you and your different disciplines and all of your degrees is really, really exciting. Um, let's get into our learning objectives for the day.
So there are three of them. I try to read this as quickly as possible also, and I will do my best, um, learning objective number one, define both big T and little T trauma. Learning objective number two, identify signs and symptoms of trauma when working with both kids and adults. And learning objective number three, identify how trauma impacts social interaction and social contracts.
Our financial and nonfinancial disclosures. Another very boring thing that I have to read and I will get through it as quickly as humanly possible. Um, Dr. Ali Arena’s, financial disclosures: Ali is the owner of Ali Arena Communications, Ali Arena’s, non-financial disclosures. Um, Ali is a member of ASHA and is a licensed speech and language pathologist and board certified behavior analyst, Nicole Moore's financial disclosures. Nicole is the owner of The Center Method. [00:04:00] Nicole's nonfinancial disclosures. She is a psychotherapist and licensed marriage and family therapist, trauma specialist, and trauma related disorders.
Um, Kate that's me, my financial disclosures. I'm the owner and founder of Grandbois Therapy and Consulting LLC and co-founder of SLP Nerdcast. My non-financial disclosures. I'm a member of ASHA, 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, Mass ABA, the association for behavior analysis, international and the corresponding speech pathology and applied behavioral health specialist.
[00:04:32] Amy Wonkka: Amy, that's me, financial disclosures. I am an employee of a public school system and co-founder of SLP nerdcast. And my nonfinancial disclosures are that I am a member of ASHA's SIG 12, and I also serve on the AAC advisory group for Massachusetts advocates for children.
[00:04:45] Nicole Moore: All right.
[00:04:47] Ali Arena: We've gotten the,
[00:04:50] Amy Wonkka: the, the, the required components now onto the fun staff. Um, why should we care about learning more about trauma? How, how is trauma related to the [00:05:00] field of speech language pathology?
[00:05:02] Ali Arena: Yeah, I mean, really fair question. It's not like it was talked about in grad school or anything.
Um, but I mean, as humans, most of us have gone through a form of trauma. And it's, to not look at someone with that lens can feel a little unfair. Um, and we'll get into this more, but one of the things that trauma can really impact is your executive functioning and your ability to regulate. And if we're working with our kids, I mean, those are two primary areas that we tend to be looking at.
Right. So I think it's important to think about how these things can be intermingled. Um, and for me personally, the more I've learned about my own trauma and just that journey it's, it's pervasive. And I don't mean that in a scary way. I just need, it's very hard to separate again, a person from their past and where that can be showing up in their life.
[00:05:56] Amy Wonkka: And we don't always know these things, but we do know that we're [00:06:00] all human people,
[00:06:00] Ali Arena: exactly
[00:06:02] Amy Wonkka: who have a diverse range of life experience.
[00:06:05] Nicole Moore: We are all human and we can expect in our lifetime to all have experienced trauma, especially right now with COVID. That is a collective trauma. Whether we're recognizing it right now or feeling it right now or not, it's something that will be affecting us for years to come.
[00:06:23] Ali Arena: Even us as clinicians. We had a stretch this year to do things that we probably never thought we'd be doing. Um, and although we may not label it as traumatic necessarily, it affected us and we're not really going to realize it until we get to slow down and process what our past year was like working with all of our students, adults, whatever.
Right. I mean, it was different. We stretched
Kate Grandbois: and I think, you know, one thing I want to, I guess this is a question and it's maybe leading into our first learning objective. But my impression as someone who knows zero about this [00:07:00] is that the, you know, the lay person may think of trauma as a significant, your house burning down and you're losing a family member or, uh, an extreme moment of physical or emotional abuse. And you think you hear trauma and you think of this significant moments of, of horror, you know, but I I'm, I'm guessing or I'm inferring that that is not necessarily the case. Is that an accurate assumption.
Ali Arena: Yeah, we are going into my first learning objective, Nicole do you want to define big T and little T?
[00:07:38] Nicole Moore: We'll break it down into big T little T. What you just described as house burning down or being in an accident or war. Yes. Um, childhood abuse, sexual trauma, right? These are considered big Ts. They are pervasive. As [00:08:00] Ali said, a moment ago, they affect every area of our life. Um, and they usually cause PTSD post traumatic stress disorder, small ts are usually the ones that sort of get brushed under the rug. don't get much attention and that could be the death of a pet. It could be switching jobs, it could be moving homes. So these things that still majorly affect our lives. But people sort of minimize the effect that they might have on us overall on our functioning.
[00:08:30] Kate Grandbois: And is that because society sort of expects us to like, oh, it's, you know, your dog died, you can get a new one or you move no big deal or you switch jobs, like get over it.
I mean, you know, is that, is that, is there some interaction there between what's expected of us and that being in direct conflict with what we're emotionally experiencing because of that little t.
[00:08:54] Nicole Moore: Perhaps. Yes, I do actually believe that our society and our [00:09:00] culture puts pressure on us to just move forward to power through it, to pull ourselves up by our bootstraps.
Right. And doesn't give us enough time to stop and process what's happening and what we're experiencing, and it's all relative. Right? So something that's not a big deal to one person might actually affect another person in a major way.
[00:09:22] Ali Arena: Yeah. And I think, you know, one of, one of the big things when I was learning about trauma more is, you know, um, maybe not getting invited to every birthday party when you were little, because maybe you were neuro-diverse and things were difficult for you, right.
Or you had a little bit of bullying. I don't know if you have, I don't know if I have a little bit, but not like, you know, insane amounts. All those little things still count as little t trauma. And if you already have difficulty communicating, which a lot of the people we work with, do, you could see how that can compound because these things are happening to you.
You're really feeling them. You don't have the vocabulary to access, [00:10:00] to talk about what you're feeling. Um, and I think there is a little bit of minimization, like, yeah, everyone gets picked on or maybe not bullied, but like picked on sometimes or like you won't always get invited. Um, I've heard that before from older adults that were saying like, when they were little, people would, um, say like, they're like, yeah, I'm not invited to this birthday party.
And their parents would be like, yeah, don't worry. That happens to everyone. But because they're autistic, they were able to remember, no, I wasn't invited to 15 birthday parties. Like I remember every single one. So think about how heartbreaking that is. Right. Um, and if we don't see that as like, oh, they could be having a real response to that, or that could be really affecting them.
It's hard. It's hard to not have that lens on. If you're going to talk about, um, social skills. Right. And not think about, well, maybe there's another part happening here. They have this like history in their head of why they shouldn't do certain things. Yeah. Yeah.
Kate Grandbois: I'm [00:11:00] going to throw out another vocabulary word here.
Is this related to microaggressions? Something about what you just said, tt felt like, you know, having a lot of, uh, a lot of small, that's what I think of when I hear the word microaggression. And maybe that's just me not knowing what I'm saying.
Ali Arena: Do you mean small instances? Um, like against you in some way
Kate Grandbois: yeah.
And having them build up over time and having to carry that emotional burden as like a, a little trauma.
Ali Arena: Yeah. I mean, I think that's the definitely pretty accurate. Um, and you just, you know, you think about the diversity of clients we see and they're seeing us because something is difficult for them. Right.
So there's some impairment of some kind and that's why they're coming to us. I mean, little stuff, like, I, you know, I can't say my ‘r’, but now kids are making fun of me at school. Like that hurts. But like as speech therapists, we normally don't talk about that part. We're just like, okay, we're going to fix your ‘r’[00:12:00] sound.
Yeah, but there's another component there that can become emotional. Like, you know, the 12 year old that's coming for their ‘r’ still on. They're like, I hate this so much. And it's like, yeah, I got it. Like I can I'm you're still coming through me and it's not getting better. And that's really frustrating. Yeah.
[00:12:19] Nicole Moore: I think with ABA therapy that's what's missing. Oh yeah. Right. It's the consideration that trauma is behind a lot of this behavior. So to try and fix a behavior without taking into consideration the emotions and the events that happened to cause those emotions I think, uh, is, is what is the word I'm looking for?I'm not doing service to the client.
[00:12:50] Ali Arena: And I think Kate, you and I, both being BCBAs are always in conversation about how ABA is evolving. Um, and I think [00:13:00] I took a CEU recently. It was like kindness and ABA and it was pretty cool. They were talking about trauma and just sort of how every person has a history.
So it's just something to think about. Like, you know, we're expressing something in those moments. So trying to maybe navigate what that is a little bit more.
[00:13:22] Amy Wonkka: When you think about big T and little T trauma, or is it important as a clinician to kind of know the difference? Like, oh, this is a big T trauma.
Um, I guess that's question number one. Like, do I need to be able to sort out the difference between those two as, as a speech pathologist, who's just trying to be more informed and provide better quality service. And I guess the other question along with that is, Does sometimes, is that dependent on the individual person?
Like, is it less about the actual event and more about how the person reacts and responds to that?
[00:13:58] Nicole Moore: Yes, I would say it [00:14:00] is more about how the person. Uh, how the person receives the event and how they, how it affects them emotionally. Right. And everybody is different. Like I said before, it's all relative. So when I'm shooting people, I'm not, I'm not thinking like big T little T I'm just saying, how is this affecting you in your life?
Um, but I think the little ts, again, to emphasize they can be overlooked. So to not underestimate the power of a little t.
Ali Arena: And I think also what came up for you when you asked that Amy is, you know, I'll work with kiddos. Sometimes I was saying this to Nicole, like we're speech therapists, so they're not going to come to us and be like, Hey, all these other emotional, right I'm using quotation marks, uh, issues are happening. But if you're going through a divorce, something that's actually traumatic in the home. It'd be nice to know that because I remember working with a kid one time, he was just so shut down. And I, you know, I could've done cartwheels [00:15:00] and he would have been like, all right, whatever Ali, I don't care.
You know, but I think if I had known some of that information, we might've done a different type of session. I might not have tried to drill so much. I might've been like, should we just color? Should we just bond for a second? Like, so just knowing that is helpful,
[00:15:18] Nicole Moore: You bring up a really good point that to have a home that's supportive and safe really enhances the efficacy.
So to know if someone is going to a home where they don't feel safe is really, really important information.
[00:15:35] Ali Arena: Right.
[00:15:36] Amy Wonkka: They asked that at the doctor now.
Kate Grandbois:I know it makes me so happy that they do,
[00:15:37] Ali Arena: what are they asking.
[00:15:44] Amy Wonkka: Oh, do you feel safe at home? And I'm always like, yes, but thank you for asking.
Kate Grandbois: I know every doctor's appointment I've been to, maybe it's a Massachusetts law.I don't know, but they doctoral questions related to physical and physical and emotional safety in the home. [00:16:00] Um, but it's slightly tangential. We're really glad that medicine is moving in, moving in the direction of creating, monitoring for home safe environments. A couple of the things that you guys were saying earlier.
I just want to emphasize a point of how sort of bringing it back to the, how this is relevant to speech pathology. If you have a communication disorder, or like you said, Ali, you're coming to a speech pathologist because there is something that you are seeking help for. You are there for a reason, right.
And that would imply that in some capacity you have a communication, you are seeking assistance to improve your communication skills, right. Which is a key component of human connectedness in some way, shape or form. So I am just sort of dropping the breadcrumbs here and seeing how this all relates to potential trauma in so many ways. Um, I know I threw the word microaggression in there earlier, which is maybe not the [00:17:00] right word, but just, you know, it comes up a lot in the autistic community that, you know, in the fluency community, uh, you know, and, and how those things, you know, in other words, to reframe it ,communication is, or trauma is incredibly relevant to communication disorders. As, as I'm, as I'm learning, as I'm sitting here talking to you, how do we not talk about this as part of our field, as part of these critical components of counseling? Because, oh my goodness. That's so they're so related
Ali Arena: and I think especially for speechies it's important because we're, for whatever reason, I'm going to say it because we're great. But we're typically the first member of a lot of teams, right? Like they tend to refer to speech pretty early because the speech problem, quotation marks, right. It's pretty obvious to people. So we might be the first people realizing like a larger umbrella, like, oh, actually there's a huge anxiety component [00:18:00] going on here.
We should be referring to a therapist. Right. But if we only look at this isolated, like I'm just looking at this speech thing. That kind of does a disservice to the environment and the autistic community is really why I am my own trauma, but why I got so passionate about trauma because yeah, it's inseparable.
I mean, they all have experienced trauma and it's literally, you can't pull it apart at this point. Um, and then it compounds, right? So it’s like, Are you actually having difficulty communicating socially because you don't have the language or are you so anxious because you've gotten rejected so much, right? Like it just sort of keeps compounding and then you're trying to pull those layers apart.
Um, and so if you don't have someone like Nicole also on a team with you, it can get difficult.
Kate Grandbois: Um, I'm making very aggressive gestures with my hands, for people who can't stand, because, because Nicole, we need you everywhere. I mean, the fact that we don't have a, you know, as a [00:19:00] field, the component of counseling and social work and, you know, people with your credentials being consistently involved on our teams is it's an oversight.
Ali Arena: Yeah. And I think. We're in LA where I feel like I'm pretty into what they're feeling. But when I was back on the east coast, like you would not say a child had anxiety. That was like, if I was going to say that I really had to feel extremely informed, but I feel like just having conversations around. Yeah, I have noticed, um, that this kid really tenses up when we talk about a certain topic.
And I just wanted you to know that, like, just giving that parents that feedback. I think sometimes we think we shouldn't, or like, that's not our lane, but again, you're with these kids for an hour at a time, you know? And, and they tend to get pretty close with us. We play awesome games, like we're fun. So they tend to show us more of themselves than maybe worrying about.
Kate Grandbois: Yeah. And as you were saying that I was, you know, and this is the [00:20:00] last thing I'll say about it. And then, and then I have more questions about how do I identify it. Um, what you said resonated with me in terms of, you know, discussing trauma or, you know, referring for anxiety because a lot of times. As this as a speech pathologist, making those referrals or bringing those things up, I might get a little bit of pushback, particularly from a behaviorally oriented professional about how that can't be measured or you can't see it.
And I just want to say for anybody who is listening. That that is not true. And there are private internal events that we all talk. You know, we all have thoughts. We all have feelings and the behavioral community does acknowledge that. And it's, you know, cognitive behavioral therapy and all these other kinds of things that is a whole.
Other topic that we are not going to talk about, but if anybody's listening and they've had that experience, there is a little bit of ammo to throw into the conversation. So I'm off my soap box. I can stay focused. Now.
Ali Arena: I also [00:21:00] love doing commitment therapy. That's fun too.
Kate Grandbois: Yes. So acceptance commitment therapy is a thing that is embraced by the behavioral community that is related to internal, private thoughts and events that are related to in a lot of ways, anxiety and all the other thoughts and feelings that we have.
Okay. Really now the soapbox, soapbox is over. I'm thinking more now about, you know, the clinicians out there. Who are thinking about other students thinking about their clients with, you know, who, you know, are part of the, um, autistic community or fluency community, or can't say their ‘r’s and they're 15.
I mean, whatever it is, whatever communication issue they're having and now thinking, oh my gosh, are they experiencing trauma? What are some of the signs and symptoms? How can a therapist really engage more deeply with their clients if they are concerned about.
[00:21:56] Nicole Moore: So as Ali just mentioned about the [00:22:00] kid who tenses up when they touch a certain topic, right?
So you might see a shift in their body language. They might be really relaxed and laughing one second and then they might freeze. Um, you might notice their breath changing. They might have more rapid inhales and exhalations, right? It'll be more shallow. Um, they might, all of a sudden have an outburst and behavior.They might start acting out. Um, they might want to curl up into a little ball and hide and disappear.
[00:22:34] Ali Arena: Um, one of the things I was going to say is, you know, you're in your speech room and you have your investigative hat on. You're like maybe there is stuff. I think one of the easiest ways to even start to have a more safe place for your adults and kiddos is to normalize a lot.
So like we, I started a lot of my sessions with improv, which I know we're going to talk about in another CEU, but [00:23:00] I am so awkward during it. And like, I own it. You know what I mean? Like I'm like, yeah, I mess up too. And I'm awkward at this. Or. You know, I, I talk a lot with dating with clients and I'm super open.
I'm like I met my fiance online and let me tell you, there were a lot of other things that were really hard and we're not going to do that with kids, but just that normalization and the lack of judgment. And it just being an open place. Makes a big difference. Um, and you can do that little ways, right? So like you can mess up coloring and not make it a big -.
So, um, sometimes when another assignment be like intense perfectionism, like just getting so frustrated, if something goes wrong, that could be another sign. I'm trying to think of more. Yeah.
[00:23:43] Nicole Moore: To your point, I think what you're describing is shame. There's a lot of shame involved in trauma it's, um, shame, meaning that individuals allowing themselves to the shame informs who they are. So they might think in their minds, like I'm a bad kid, [00:24:00] nobody loves me. So there's a lot of shame that goes along with it. I have to hide what happened to me because nobody loves me because I'm bad because I deserve this.
[00:24:08] Ali Arena: So breaking my heart. I love hearing these. I know.
[00:24:12] Nicole Moore: Yeah. It's, it's sad.
[00:24:14] Ali Arena: You know, like we were saying, and you can, you can do all the neurology with this. Cause you're still gonna have, but like trauma really affects executive functioning. That's where it's going to like latch on kind of. You, if you start to notice certain executive functioning difficulties that maybe don't correspond with the diagnosis, you would've thought, right.
Someone's coming for fluency. And you're like, oh wow. This is really, this seems odd that this, this is feeling like an issue. That's another thing to think about as well. Like why is there difficulties with like planning and organizing your thoughts if we're just kinda talking about the weekend and it's not the fluency part, you know, it's the, um, organizing of the thoughts.
Go ahead Amy.
[00:24:56] Amy Wonkka: If, if you're, if you're working with a client [00:25:00] and you notice that and you notice, okay, I'm seeing this, this thing that would be unexpected. I'm seeing some unexpected challenges with executive functioning.
How would your treatment change or would your treatment change if you suspect that that might be connected to some type of trauma compared with somebody who kind of just has baseline challenges with executive functioning, does it look different? Should it look different?
[00:25:26] Nicole Moore: Okay. It actually looks very similar.
Um, and, and that's okay. I'll, I'll explain why. So the neurology behind it is the same, um, Dr. Stephen Porges. Created something called the polyvagal theory. And are you familiar with that? Because,
Amy Wonkka: you know, I just like brain stuff.
Nicole Moore: Okay. Um, I'm going to simplify this so much so that it, anyway, I'm going to simplify it.
[00:25:54] Ali Arena: Please do. Okay.
[00:25:59] Nicole Moore: is [00:26:00] There is a nerve called the vagus nerve and it goes from our brainstem down our spine and it connects to all of our organs. So we also have, uh, a mechanism within us, uh, that triggers the fight flight freeze response. It's within our limbic system, in our brain and the amygdala within the limbic system, you can think of it as a smoke detector.
So some smoke detectors are really, really sensitive. Like if you're taking a shower and the steam goes out and it sets off the smoke detector and you're like, that's not smoke. It's steam stopped going off. But you can think of that as, as trauma really sensitizes our system. So when that's activated it, then sends the direct signal from the brain to our body to get into that fight flight freeze response.
And that's when you'll start seeing the behavior changes. Right. And so that's, that's your cue to. And change what you're doing because that person is, it cuts off our, [00:27:00] our access to the prefrontal cortex, which is the executive functioning part of the brain. So with individuals who have autism, they're often caught in that fight flight freeze response, maybe because they don't understand they're, they're interpreting things differently and they just don't understand.
And also same thing with somebody who has had trauma. Like I said, that that faulty smoke detector. So they're constantly in that state, that hypervigilant state and a very, one of the very basic, uh, strategies of trauma treatment is emotion, regulation and stress tolerance. So you want to help the person calm their system down.
And eventually be able to have a greater stress tolerance to sort of train that smoke detector that they don't need to go off. It's just. That makes sense.
[00:27:55] Kate Grandbois: Now it makes so much sense just to normalize this a little bit. I need that. Can I get, [00:28:00] can I get, I mean, I think, you know, I, I, I am a lot of us have some history or something that's happened to us where we realize, oh God, I really have a hard time handling X.
And for me. Conflict. No, thanks. I'm just going to like sit here and be quiet, smile and then freeze. And then my heart's pacing and I'm sweating. I have had conflicts with parents on the job and I'm like sweating, pitting through all my clothes and I look like, you know, it's a disaster. And so it's okay. I think it's important to just acknowledge that this is something that we all experience and as you were talking, I was like, yes, all of those things.
Yes.
[00:28:37] Nicole Moore: Everybody could benefit from understanding this.
[00:28:39] Ali Arena: And that's kind of, Amy to your point. I don't think we're saying like, let's go around speechies and like diagnose trauma, but if we see it and we can recognize it in the moment we can bring in mindfulness, right? We can, we can have them get up. We can maybe switch the activity.
I think that's the big piece here is to [00:29:00] just look at the individual more holisticly. And just be like, okay, maybe there's something else going on. That's not, it's not just because they don't feel like doing speech today. You know, go ahead Amy.
[00:29:12] Amy Wonkka: I wonder sort of to Kate's point, and this is where I'll, I'll pretend to be a BCBA, but I'm not one, but like don't you guys talk a lot about antecedent strategies?
Like, is that something that we could just be doing in general kind of for everybody? Is that like, could we, could we all just work a little bit on.
[00:29:33] Ali Arena: Yeah. I mean, yes. Like I, I fully know that if I'm like, you know, whatever, just being a crazy person, my energy has been crazy and all of my clients feel my crazy energy.
So like just me being self-regulated helps. And then when Nicole and I run groups, we always, mindfulness is just in there. So they don't even, you know, it's not like, oh, I'm taking out my mindfulness cards. Like it's just in the [00:30:00] program. That's just what we’re doing.
[00:30:02] Nicole Moore: Also, I just want to say Amy, that I think one of the tricky things about trauma is that the antecedent is not always clear.
It's sometimes it's seemingly disconnected. And so I use the analogy, I say, imagine there's, um, you throw some dots on the wall and it's like a connect the dots without any numbers and you have to figure out how it makes a picture. So it's not always clear and the person doesn't always know why,
[00:30:32] Amy Wonkka: and if they don't know, how on earth do you have any chance of knowing you're not going to know?
Not that we necessarily need to know, I guess is that, is that part of the point is that we don't need to know the specific. To be of help to our clients.
[00:30:44] Nicole Moore: Exactly. But just to understand that they're going through something to have some empathy for whatever it is. And even if it's seemingly it's, it's small, if you think, well, that was nothing.
I just dropped a pencil. You know, it may have been a really big impact on them for whatever reason.
[00:30:55] Kate Grandbois: [00:31:00] I just want to review really quickly something that you said earlier. So it's fight and flight, which we're, I think most of us are familiar with. So run from the bear. Fight the bear, right. Or freeze and pretend that you're a tree so that the bear doesn't see you.
Right. These are the analogies that I've come up with in my head. I've recently heard another one, which was fawn.
Nicole Moore: Interesting. I have not heard of that.
Ali Arena:I've been told I fawn so I can give you a little bit, um, yeah.
Kate Grandbois: It's basically like a pleaser, right?
Ali Arena: Yeah, yeah. Yeah. Like inherent people just constantly.
Pleasing. I also can check out though. So that was something, um, oh, this is actually so important and I think it's so, so I do have ADHD, so I'm sure this is in here too. When I was little teachers used to always be like, Ali does not listen. She's not paying attention, but I actually now as a grownup, I'm like, I was just checked out.
Like I did really well in school. Obviously I was listening enough. [00:32:00] Right. But because I went to a Catholic school, they were like pay attention to me. Um, but I think that's really important too, to just be aware of what kids are like, if they're responding to you, but they're just checked out for a second.
Let them just check out for a second. Like, I don't think it always has to be this perfect. I love whole body listening on a Disney, whole body listening, but like, I need to be whole body listening in every moment, like, I think it's just knowing that. Maybe, maybe stuff is going on at home. They need to check out for a second.
And I think it's also, um, like I worked with one client. I took out a red pen not to be punitive, but because I have a million colors, I have those jelly pens that we had, you know, in grade school. Um, and he was really like, he liked tensed up like that. Hey, what's going on. He's in his thirties. And I was like, Hey, what's going on?
And he was like, I just lost so much red that like, I know you're going to tell me I'm doing things wrong. And I was like, whoa. So something that little, and that wasn't where I was going at all. I think I was writing myself a note to like, make an appointment. I haven't read, but like, so it's just something that little, and he had the words to tell him, [00:33:00] Right, right.
Kate Grandbois: That's that's another, like, it's such a huge point. If you're working with someone, I mean, this is a podcast for speech pathologists. Again, working with people who presumably have a communication disorder who may not be able to articulate or communicate what they're experiencing and that that's where you see a lot of commun- , nonverbal communication.
So changes in behavior, you know, changes in physical, you know, appearance or, you know, the tensing that you've described. I'm wondering if from a counseling perspective, what can a speech pathologists do in that moment? I mean, what did, what would you recommend? You know, so you see the tensing or you see something that cues you into, okay, something's happening.
There's a, they've been triggered. What, what is it that the speech pathologists do? I mean, obviously the answer is don't go forward with the rest of your ‘r’ drills, but what, what else can you do?
Ali Arena: Go ahead Nicole. And then I'll say, when I [00:34:00] attempt to do,
[00:34:01] Nicole Moore: as Ali mentioned, mindfulness is really, really helpful, but there are some specific tools to use when you noticed that your client is true? Right. Um, there are three things that I use. One that I use right off the bat is I call it present moment. So bringing the person back into the present moment, because when they're triggered, their brain is somewhere else. They're right back to where they were, whenever that event happened. So they're not in the present moment. You can turn it into a game with kids. So what I do is I say name five things as fast as you can in the room. I quickly. Um, microphone, glass mug thump, right? Or you can say something like I spy something blue, what is it? So you can make it into a game and make it fun, but just make sure that they're, um, engaged with you. So get them to be engaged. Another thing that I do, so breathing actually deeper than calms the heart [00:35:00] rate and then sends a direct signal to our brain that we are safe and turns off the activation.
They're right back to where they were, whenever that event happened. So they're not in the present moment. You can turn it into a game with kids. So what I do is I say name five things as fast as you can in the room. I quickly. Um, microphone, glass mug thump, right? Or you can say something like I spy something blue, what is it? So it seems simple, but it's a really, really powerful tool.
And with kids, you can sing a song. So a lot of them might have a favorite song. And, um, one of my kids likes to sing, “It's raining tacos”
Amy Wonkka: that is awesome. It's so cute.
Nicole Moore: So yeah, you can make up a song or sing a song we might know, but just. Taking big breaths and you can do it in super slow motion. So make it kind of fun and silly. And the third tool that's really helpful is I call it sacred place. But as we discussed before, sometimes people don't have a safe place to go to.
So we offer them one in their imagination. And with kids, you can have them draw it out. And be really [00:36:00] specific with it. So, and I call it sacred place because safe might be a trigger for them. So sacred place means it's a space where that person has total control. They can invite their cat in or dog and whatever they like and anything they don't want in, stays out and they use their imagination.
So, for example, my place is a garden and it has a fountain in the middle of my dog and cat are there. Right. And once, once they're calm, you can actually have them do something called the butterfly, cross the thumbs over and place the hands over the chest and slowly tap one hand. And then the other, that sort of solidifies in the body, the calm.
[00:36:47] Ali Arena: That was really helpful watching you dothat. So I know she has a very calming presence for sure. I try to [00:37:00] bring that with me and just say.
Kate Grandbois: So, so you're the SLP, you've paused your ‘r’ drills you've acknowledged and noticed the trauma or the trigger. And you've gone through these exercises of, you know, deep breathing, you know, tailoring them to the age and preferences of the client, obviously.
And then, and then what, so you've, you've brought them back. You, you know, obviously want to finish your session. Maybe you, you know, pare back some of your demands. Are there. if you're working with a younger student, would you talk to the family? Would you make a referral? Like what, what else? You can't just leave that poor little human being going out into the world, knowing that they're suffering because you brought out a red pen.
I mean, you know, what are you going to do?
Ali Arena: Yeah. So I think for me, what I've done is always. Like kind of looked at like how large of a reaction was this. Right. Like if it was like, I brought out a red pen and they're like freezing and shaking, I'm like, okay, parents, I mean, parents have to know that. I think [00:38:00] though, if it's smaller, like I see a little bit of a shutdown and then I can sort of redirect through the activities Nicole mentioned, I might wait and see if that's like a pattern that's occurring a lot because the thing I, I think, um, I. I don't want to make it seem like is that we're supposed to be like trauma police, like out there labeling and, and telling. And that's really important too. Like if a kid is in trauma, you don't need to like, tell them they're in trauma.
Right? Like you just into the breathing. And like,
Kate Grandbois:it sounds like it would be a bad thing to do
[00:38:32] Ali Arena: and you're not supposed to be like, oh, I'm seeing, it looks really tense and it's probably because you're having such a bad memory, like you don't want it. So I just think, um, I'm joking about that because I think actually that's the opposite of what we're told.
Not always, we're told to label the crap out of things because we want the kids to learn the language. Right. So that's why I'm sort of making it such a joke, but it's not actually, you don't actually want to highlight it because I actually feel more triggering like, oh wow. Now they see even [00:39:00] more than I'm having a reaction.
Um, and to Nicole's point, traumas sneaky. So like they might not even know they're having a reaction like Kate, when you were giving your example of, um,
Kate Grandbois: when I sweat through my clothes
Ali Arena:you might have been sweating for good tenants where you noticed your sweat, and I'm not trying to say that to scare you, but like your body might be showing something before you even cognitively are like, oh, this is happening.
So by highlighting it, you might make it a little weirder for the person. Um, so again, I think just using those strategies, if it's a very large reaction, I mean, I think we all know we have to tell parents, right. Their kid is having a really difficult time. Um, and if it's, uh, an adult like, so that, that, um, man with the red pen, I really clarified, like that pen was a random choice.
Like I, I will now take out a green pen. Um, but I was like, There's going to be red pens at the office. So we got to talk like this needs to be addressed in some way. So in that instance, I think you can honor, like [00:40:00] I just saw what happened, you labeled it, this needs to be addressed. I don't think it's me.
That's addressing it. And he gets your therapist or whatever, because what I find what happens a lot with, again, with, um, I work the most with the autistic community. So I swear I'm not trying to make it, like, I'm not saying that it only happens in them. Um, because they're autistic, there tends to be a lot of black and white thinking.
So I am seeing Ali for social stuff. I would not talk to Ali about anything else, but like I was saying all these things layer. So if I see a moment where I'm like, Hey, I don't think that's just because you have autism. I think there's something else happening here. I'll definitely help to identify and refer.
Kate Grandbois: That all makes a lot of sense and is incredibly helpful. And it's making me think of, again, this is a very natural segue into our third learning objective. Just to how, how trauma does impact these social interactions. So you're having a social interaction with your client, right? I [00:41:00] mean, and you've, you know, there is a huge impact there.
So just to refresh our listeners' memory, the third learning objective was identify how trauma impacts social interactions and social contracts. Um, I think we've already illustrated a lot of ways that trauma can impact social interaction, but what is a social contract? Just for, I think I might have like a very loose definition.
That's probably wrong. So I'm going to let, I'm going to let you tell everybody
[00:41:27] Nicole Moore: Examples of a social contract might be, you know, Ali and I are sitting next to each other right now, but a year ago we couldn't do this. Right. So the way we interact out in public, do we hug? Do we shake hands? Can we even touch?
Right. So, so, so social contracts in the way we behave has been significantly altered with COVID
[00:41:50] Ali Arena: and I think like a precursor to this point is we all experienced trauma. Maybe it was big T [00:42:00] maybe it was a little T, but COVID was not normal. And we all went through something pretty intense. And I I've been talking to a lot of clinician friends that just ended like their school years or stuff is starting to lighten up and they're like, I'm so burnt out.
But I didn't know it because I was just trying to get through this year. And I think we were all doing the thing of like, okay, this will end by October. This will be over by the holidays. No way this is still happening in March. So our bodies were just being like, we're good. We're good. This is all good.
And now we're kind of good. I don't want to say we're, you know, whatever. I didn't want to get into it, that politics, but like it's a little bit safer, let's say. And I think now that people have that moment. Okay, I'm safe, but like, do I keep my mask on? Like I joke, I feel like I'm always wearing like a chin diaper.
Ali Arena: Like I just have the mask on because
Kate Grandbois: you don't know whether or not to take it off or put it on
Ali Arena: near me at all times.
Kate Grandbois: I think that's a good example of a social [00:43:00] contract, right. Because it's the social expectation of how you're going to behave with another person. Is that right? I mean, I know we've used a lot of examples with like COVID and, and greeting people and hugging and all those kinds of things.
But in general, a social contract is the ex - is the social expectation from that interaction. Is that right?
Ali Arena: And now imagine, you know, you are young kid and you have had some significant trauma, it might alter the social contracts that you think you're supposed to have. With other people. So I think that's really interesting to just think about, I think our field is moving away from just teaching like blanket social skills.
Right. We're really just trying to look like in the moment, what works and looking at kids, different communication styles, but to also consider. Do they have a contract that they aren't verbalizing because something had happened at some point or, um, do I have a contract I'm putting on like, just to really [00:44:00] examine that.
And I think, you know, the social interaction piece, like you said, you could go into a fight, right? Oh my goodness. Fight flight freeze or fawn, I guess the four F's. Um, obviously that
Kate Grandbois: What kind of Freudian slip was that there's something interesting, just kidding.
Ali Arena: Um, but that could be happening and that person's being perceived as. Or inattentive or whatever. Right. And I think we even could do that to ourselves a little bit, like clinician on clinician, shame on the little like, well that person didn't speak up or this person didn't do this.
Right. And like, I think the whole point of this conversation is to just give people grace, like have a little empathy, realize that like, just because I'm standing here today doesn't mean that [00:45:00] there's not like a, history there, or like we talk about this a lot. It doesn't mean that like I hit a ton of traffic coming over here, so I could come in with that energy and it has nothing to do with Nicole.
Right. So I just think. Keeping that perspective, always of just giving people grace is like our big, our big message.
Kate Grandbois:I love that. And I want to expand on it for like one hot second. This is only the second soap box and I'm going to get, I'm wondering if Amy knows what I'm going to say? Cause I talked about this a lot, but this is also related to competition, ego and collaboration. Oh gosh. So, you know, giving people grace, when you, you know, we're talking about social interaction and how trauma may, may impact that, but you also have to really make sure that you're monitoring yourself for any competitive feelings, especially when we're talking about other decision-makers and other professionals on a team or other [00:46:00] collab, people that we're collaborating with and not get into the well I'm right. You're wrong. Um, and, and give each other a little bit of space and empathy to, you know, help the student with trauma or. You know, now I'm talking about like five different things, but I just think it's really important unrelated. No one, I mean, starting to fall at one point,
Ali Arena: I think again, what we keep talking about it, to really just be looking at a kid holistically. Right. So, and, and another, I love OTs. I probably should have been in an OT like, I just think it's so cool.
Kate Grandbois: add it to one of your other degrees.
Ali Arena: I'll just keep going.
So I like there, you know, there is a certain point I'm like, okay, wait, you're having a lot of difficulty just like integrating an OT should be on this team. And I should listen to what they're saying, like an OT and trauma you're certified in safe and sound protocol. Right. OTs can also be certified in that because it's, it's an integration of the [00:47:00] systems and your vestibular system.
I butchered that a little. that a little, but yeah, I mean, so also just recruiting, I'm listening to other people on the team and think of a kid holistically, not just as they can't say ‘r’, or maybe they really can't just say ‘r’, but you know, I'm just saying always think of them holistically.
[00:47:17] Nicole Moore: I was calling to comment, Kate, that you brought up a good point about, um, people with their conflicting views.
And I think a lot of the small t’s and big Ts, but often small teas challenge a person's ego, How they feel about themselves, then it goes back to the shame. Right? So shame is a huge driver for a lot of our behaviors and our social interactions.
[00:47:38] Ali Arena: Well, yeah. And I'll be, I'll be super vulnerable. I think I have so many stupid letters after me because I was probably trying to prove worth in a lot of ways. Like I had a lot of shame around stuff, but I didn't know, you know, so just again, like just let people be people and just be kind like, I don't, [00:48:00] I just, there is, there's a lot of clinician bullying and competition and I don't know, it's just, it's not, you know, our, our field. And like I was saying, I think anyone who was in a helping profession during the pandemic has experienced little t because we just had a do things that we never thought we'd do doing.
Kate Grandbois: Hmm. So in terms of our clients and our students, And their social interactions. And you know, this connectedness is so we've already just as like a, to reframe this. So I'm on, is coming to see you, presumably because they have a communication issue or they're looking for some support in some area.
Um, communication is a fundamental component of social connectedness and social interaction. If they have experienced trauma, I have to, I have to assume that there is a double impact there that this is like a, you've used the word compounded, you know, it [00:49:00] compounds itself, which is I think a really great word.
Can you talk a little bit about that.
Ali Arena: Yeah. I mean, like I was saying, it's kind of like the chicken before the egg, and again, I'm going to use the autistic community again, just because I know it the best, not that this doesn't apply to other communities, but yeah, like, like I was saying this thing, it was difficult for me to access my words for whatever reason, or it was difficult for me to enter the group because I didn't get the dynamics of how to enter it.
Or, um, you know, a lot of autistics talk about how they, they genuinely communicate differently. And they probably tried to communicate with a neuro-typical person who just didn't it didn't jive. So then you try to keep doing that over and over, and it's still not working and you, you get strategies and it kind of works.
And then you, but think about how you're going to feel after years of being like, okay, I'm just not going to do what feels natural to me. Cause that doesn't work. So I'm going to try to cover that up. I mean, That can really add to some trauma. Like if the, world's saying to you, the way you [00:50:00] do things, don't really, that doesn't work.
So you should put on a mask and try to make sure that you're, you know, I'm using quotation marks, like okay in the world, that's gonna affect someone. So I think again, It would be naive to think that these individuals haven't experienced some form of trauma and also naive to think that they necessarily have the vocabulary to tell you that.
Like, I think just, we sometimes think if someone's not talking about it, that like, it's not a big deal to them, but I wonder for a lot of them, and I've spoken with a lot of autistics, that's so murky. Like that just feels like, well, this is who I am at this point. I am asking. I am constantly scanning the environment for what's socially appropriate again, using quotation marks so that you can under, you can see how that could feel traumatic.
Like, I don't know for, for me, one of my CFs was so dramatic. My supervisor hated me, so I like faked it entire six months, you know, [00:51:00] like I tried to go,
Kate Grandbois: it's exhausting. That's emotional. That is emotional work. That is a drain. That is, unless you have experienced it. It is real. Yeah. Not the CF, the emotional masking, no hangover.
Ali Arena: Yeah. I mean, well, just us. It's not that I'm ever faking it with my clients, but we all put on a mask when we're like hanging out with client. Right? Like I'm not sitting there drinking wine, like lounging you can't just be me. So imagine doing that all the time. Like it's gonna affect your system. You're it's, you know, I just think
it's exhausting. That's emotional. That is emotional work. your neurology it's going to affect your, I mean, that's another really big takeaway here is that this is a physiological thing that people are experiencing.
It is not, it is not like a, it's not something to be shoved under the rug. This is a physical change.
[00:51:52] Amy Wonkka: So I've got a question for you guys. Um, just thinking about how this is something that is kind of pervasive in our society. [00:52:00] It's a lot of people have had these traumatic experiences. This is something that's challenging, probably a lot of our clients.
Um, there's the linguistic impact of, you know, you may not have the vocabulary. So I, so I don't even know what's happening with that in terms of neurologically or just does that make it even that much more challenging to process these experiences? Um, but if that is a piece of the profiling. Does it make sense to kind of incorporate some of those examples that Nicole gave us into just you're like, this is just part of how we start our session. This is part of how we get ready to be part of this group and kind of set the stage for this to hopefully feel like a better space for everybody to be like us included. I get, you know, as the clinician, what are your thoughts on that?
[00:52:52] Ali Arena: I mean, yeah, like definitely. To your point everyone's [00:53:00] experiencing something.
So just integrating that into your sessions is just really being a, it's being a trauma informed clinician. Right. And just being kind and thinking about the people that you work with.
[00:53:12] Nicole Moore: I agree with that wholly. And, um, we use it in our groups. We use it and it seems to work really well. We get a good response from it.
[00:53:24] Amy Wonkka: We're worrying about who gets asked the last point, um, when you're, when you're running it in your group, just, just for me. So I can get a picture in my mind of what that looks like. Like, are you like, is that an activity in your group? Like, is that how you start maybe? Or is that a part where, okay, now we're going to play the, you know, be in, be in the moment game, or now we're all going to, you know, take deep breaths to get like, is it, is it something that you kind of call attention to it. It is a recurring event. Like how does, how does that look?
[00:53:56] Nicole Moore: Yes. Our groups are very structured. So the first part of the [00:54:00] group, we do a check in and then we immediately go into mindfulness. We do breathing and a little bit of a meditation and then continue on with.
[00:54:07] Amy Wonkka: Thank you that helped me like picture it.
[00:54:10] Kate Grandbois:And just for the sake of saying it, if anyone isn't familiar with mindfulness strategies, we can list a couple of links in the show notes. Um, one of my favorite books is related to acceptance commitment therapy called the Happiness Trap. They make an illustrated version.
I made Amy read it. Yeah. You, she loved it. It's so good. You can read it in like a half an hour, 45 minutes. Well, if you're Amy, you can read it in like three minutes, but I'm just teasing you just for the sake of it. But it's, it's, it's, there's a lot of really great information out there about mindfulness and there is literature and research that it physically changes you.
So it's not, it's not wishy-washy. Also rooted in behavior analysis and accepted by the behavioral community. So another good thing to bring up if you're ever in a difficult conversation with someone, um, but we'll, [00:55:00] we'll list a bunch of those mindfulness resources in our show notes, in case anyone listening would like to do a little bit of a deeper dive or learn a little bit more.
Um, in our last couple of minutes, do you have any parting words of wisdom or anything that you would like to share that we have not covered?
[00:55:17] Nicole Moore: Good question.
Kate Grandbois: No pressure
[00:55:18] Ali Arena:. I mean, I think I'm bizarre speech therapist in a lot of ways, because I feel like I'm so into drama and all these other modalities and stuff, but I just think to remember like you, yes, you're a speechie, a speech therapist, but you're working with humans again. So just always think about.
Um, and, and you're working with not just the little human, the family, like just the always think again holistically. Um, and one of the best things that you can do for the people you work with is listen, you know, like I, I feel like when I first started as a clinician, oh my God, it was so planned and I probably overtalked so much.
[00:56:00] Um, but that's, you know, you don't really have, you don't always have to be that way. You can just kind of hold space, be calm. And bring in more and more calming activity as to what you're doing
[00:56:11] Nicole Moore: and to play off of that as well. Um, with trauma connection and attachment can be really difficult. So just to notice that, so sometimes simply just the connection between you and the student or you and the client can be so helpful.
[00:56:30] Kate Grandbois: Here here. Like, I wanna, I want to put that on a loop. That was, yes. All of, all of that. And, and I, I want to add one more thing to it is that, you know, if you, as a clinician have these really wonderful goals of making connection and holding space and being calm to create a welcoming, and I guess the word safe environment for your client, you also need to do some self care.
Oh, I also need [00:57:00] to practice self care, make space for yourself because you cannot pour from an empty cup. And that is something that I think in a helping profession, we don't talk enough about it is not selfish to engage in self-care. It is a gift to other people around you. It's an act of altruism and you do it.
You take care of yourself so that you can better serve your clients. And that as the third and final soap box that I will get on to close out our episode. Right. Um, you guys, this was so informative. It was, this was really just really, really wonderful. Thank you so much for joining us. Um, to anyone who was listening, who wants to learn more, we will list a bunch of resources. And links, um, in the episode, in the show notes, um, if you'd like to use this episode for ASHA CEUS, you can do so by cruising on over to our website, www.slpnerdcast.com. You can email us anytime info@slpnerdcast.com. If you have any questions and yeah, [00:58:00] thanks again so much for joining us and hope everybody learned something.
[00:58:03] Nicole Moore: This was so fun. Thank you so much.
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