EP37 Building Underdeveloped Sensory Systems an interview with Sarah Lloyd

In this episode of Pondering Play and Therapy, our host welcomes Sarah Lloyd, a consultant occupational therapist and play therapist, who introduces her innovative BUSS model, focusing on Building Underdeveloped Sensory Systems (BUSS). Sarah shares her journey from traditional therapy to integrating sensory motor systems with therapeutic relationships, particularly for children with disrupted early development. She describes the critical role of the body in emotional and social development, and how parents and caregivers can become key agents of change using playful, engaging activities designed to rebuild foundational sensory motor skills.

Website: https://bussmodel.org/

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Transcript

Building Underdeveloped Sensory Systems an interview with Sarah Lloyd

Julie: [00:00:00] welcome to this episode of Pondering Play and Therapy and today I'm absolutely delighted to have with us Sarah Lloyd. Sarah, I think you're up in Leeds. 

Sarah: I'm indeed. Up in Leeds, yes. Lovely to be here. Thank you so much for asking me.

Julie: And you're in an old mill. 

Sarah: We're at Springfield Mills in Farsley. In Farsley there are two mills. There's a very smart mill that's been redone and it's galleries and we are in the other mill above a lat and opposite a school provision. And so we think of ourselves as the scruffy mill in fire, the scruffy mill.

Thank you for joining us from your scruffy mill. And Sarah, you're a consultant occupational therapist. I'm indeed A-B-A-P-T play therapist. And you and I have that in common. So it's lovely to meet another batch play therapist. And more recently, the creator of the BUSS model and that's buss spelled with two S's, BUSS.[00:01:00] 

And I understand it stands for, see if I've got this right, building Underdeveloped Sensory Motor Systems. Doesn't exactly roll off your tongue, does it? But yes, that's I've got, it written down just in case. And you are particularly looking at the sensory motor system for children who've experienced some disruption of any sort in their early development and how that's impacted that.

For the listeners in a little while, Sarah and I are going to wander into that topic, but firstly, as we've done with many of our guests, Sarah, I just want to ask you, when you were a child, when you were an adolescent, and I'm guessing by your accent, it wasn't in Leeds, I think it was further north in the uk.

What was, play for you [00:02:00] in those early years in your development? So we are thinking about development. But let's start with you. Tell me about play when you were little. Oh, thank you. Thank you. Yeah, but we were, grew up in Scotland in a very remote little rural village in, Scotland. So play was ab absolutely an integral part of things.

Lots of exploring, lots of, oh, heading off on our bikes for the day and finding ruined places or there was, a huge amount of freedom that yeah, didn't replicate completely with my children. But there was something really lovely about about, that freedom. And I guess growing up in a time when that was fine to disappear after breakfast on your bikes with a packed lunch and go and have a great time, it was scaring ourselves.

Silly imagining the castle we [00:03:00] were, we'd found was haunted and just lots and lots of just. Play really, which was great. Really, nice. But being outside a lot, being without grownups. Yeah. And being with other people. Slightly older, slightly, yeah. Other kids, yeah. All within world, like three three within a three year age range.

So very close to each other in age. Yeah. So out with other kids and an element of risk and finding scary. yeah Yeah. Or yeah. Sometimes, yeah, it was, hairier than others, but yeah, no, generally we would make a game out of whatever we were doing, whether we were being Charlie's Angels off doing something or whatever it was, we would find a way of making it, fun and, playful.

Yeah. And, a lot of times Charlie's Angels actually. [00:04:00] Charlie's age that takes both of us a little bit. I think there, but it was a TV program with women detectives who were all quite energetic and glamorous. Is that right? No, I went back and watched it with my children. I was saying, oh look, we love this.

When I was growing up and I was horrified. It is so sexist. And so it's hideous. And I think how did we, think this was good? But anyway, at the time, we thought at the time, so that was you as a child, and then when you hit adolescence, your teenage years, did that shift, did that develop where, was play a little bit later on for you?

To be honest, probably didn't change all that much. I mean there was more organized play in terms of hockey and sport and running and that sort of organized play. But still, we would be cycling around and going off and doing things and. Meeting friends and, [00:05:00] yeah. Didn't, honestly, didn't change all that much.

Probably a bit less Charlie's Angels and a bit more sitting chatting, but still going off and doing stuff and being places and, yeah, it's just being out. But, again, being out without adults, being outside, being out your home. And something we've been discovering in the podcast is this concept of a third space.

So not your house, not your pal's house, but a third space a youth group, a bench on the, in the park. Was there a third space for you? Yeah, I think probably the third space was Middlefield, which was where Hillary lived. It was a farm, so it, it didn't feel like being in someone's house. We were Yeah, in the barns.

We were in the fields, we were in the river so it was a, very set space. Without those confines of walls and [00:06:00] rules and grownups that would be there. It, it, sounds wonderful. I wish, yeah. Thank you to Hillary and her family for providing space. And then this, is really interesting 'cause part of what we've been discussing with a lot of people, a lot of our guests, is where are those opportunities for children and young people now?

And it has often come with some lament that, isn't around so easily or so a avail, so easily available. And, that's becoming a bit of a theme. We've been going for about nine months now with the podcast. And that's something we keep meeting over and over again. Of course when I was little we were able to, but now that's different.

Now I understand that you are a parent of children who are that [00:07:00] bit older now, but when they were little what was their opportunity for play? Again, we were in rural Scotland. Where I think things I, think living in the countryside is, different to growing up in a city we were by the sea.

And there were lots of opportunities for just going out, going, we had a really nice big garden that went down to trees at the end and there was lots of playing and games in there. And their cousins are about the same age as them, so there were a little gang of five of them very often off, off doing things or going down to the beach or off on their bikes.

So lot, lots of doing of that sort of. Sort of thing for them as, as well in a way that I'm sure if we'd been growing up in the city, that wouldn't have been, [00:08:00] that wouldn't have been possible in, in, in the same way and, balanced with some organized stuff, play places and, um different bounty brownies and Scottish country dancing and a couple of just a couple of organized things, but mostly time for, play and the freedom that comes with that.

I think hugely, important. So yeah, that difference between growing up in a country, in a rural area, in a countryside area compared to growing up in a city. 

Yeah. 

And, thinking now. Yeah. Thinking about you Sarah, now. Living in Leeds or around Leeds? Where is play in your life now? Outside work?

Outside work. Where is playfulness? No playfulness. There's lots of [00:09:00] play fors. I feel like. Sometimes I feel maybe not quite grown up quite enough. I still, I'm 57 and I still go into rooms of people and think, Ooh, a lot of grownups that are in here. And then I think to myself, oh, my days, I think I might be older than everybody else in here.

But there's so there's still that, that playfulness and opportunities for going into a lovely building and thinking, oh, wouldn't it be fun to slide down the banister here? Or you just kind the kind of things that come into your head really, but still some of the same stuff. Love going out on my bike meeting friends, doing stuff.

Making, gardening, all of those sorts of things and just injecting, I don't know, say with gardening, I have this funny thing that I do with myself that like something like cutting the grass is a fairly boring in my head is filed under boring jobs that just have to be done. [00:10:00] So I, every time I cut it, I try and cut it, go a different way or try a different sequence, or do a different thing with it just because then it keeps it a bit more fun, it keeps it a bit more interesting.

So I guess just trying to inject all of that into every day really. Looking for opportunities, the small stuff and elevating the mundane into something that can be fun and a bit of a game. Yeah, I like that. I like that phrase, elevating the mundane because life has the things that have to be done.

And the things that the ought tos. And then there's the, have toss then there's the want tos, the desires. And, before we started recording, I was commenting on the lovely juxtaposition of your hair color with the, pattern I can see next to you. And you were explaining that [00:11:00] was soundproofing for the walls.

And it could have been white or gray, but the am I guessing there's something to do with color and playfulness and life? Even in a very mundane thing, which is trying to provide soundproofing. Oh yeah, I think so. I think so. And I've got some paper things on the wall behind me because I got so bored of doing zooms and just seeing a white thing behind me.

So yeah, absolutely. How do you make it oh, a bit more fun and a bit more interesting really. Yeah, and thinking, one of the things we've been thinking a lot about is when play isn't fun as well, when we, so we can think of the colorful, the creative, the bringing life to something and associating play with fun.

But one of the things certainly Philippa and I experienced, and perhaps you also, when you were doing a lot more of the play [00:12:00] therapy part of your career was when play is really hard work when play can be quite scary, when it can be sad, when it can be frustrating, and. One of the things we're, moving away from a little bit in the, in this, a lot of this thinking in the podcast is that play is always thought of as frivolous.

Your sense that, because I'm playful, I haven't quite grown up, but actually you, are a great grownup and you are running a business and you're running this mill and you are a parent and you know you're abs to see that. But there's something about almost apologizing for being still playful at 57, which I'm really curious about because.

I would, I'm a little bit older than you and I would be. Yeah. Equally, I just, I'm always looking for the slightly, I [00:13:00] love that lawnmower image, but finding a slightly different way round of doing it. Can I stack the dishwasher? I don't have a dishwasher. Can I stack the dishes? Yeah. On the side in a slightly different way.

Like how many can I get that way? Yeah. Can I put the forks up or the forks down today? Yeah. Just It's fun, isn't it? Yeah. It's like that stuff of, I don't know. I still try to like, take your school clothes off at the end of the day and put your home clothes on so that there's a tra that nice transition between, okay, I finished work now I'm at home and not play clothes anymore, but just a different set of, clothes that Yeah.

Give you a, allow you to slough off the responsibilities a bit of. Yeah. And, be a bit looser, clothes, looser with their minds. Yeah. And that's allowed as a grownup. That's, you can make your own rules a lot of the time. [00:14:00] Can you and I certainly do. I think,

thank you so much, much for sharing it. It gives us a picture of you and your child and your childhood and adolescence, your time as a parent and your life now. That sense of play being absolutely woven through you. It's absolutely integrated in your life. And one of the things I'm very curious about, and I don't know this story yet, is how you got to be a play therapist.

What drew you into that? I don't know the order. Yeah. Occupational therapist, play therapist and then how you got to noticing the sensory motor system in the way that you have. I, yeah, I'd be really interested to hear what took you along that path. Yeah. So I, trained as an ot honestly, not really knowing much about [00:15:00] what, it was, but thinking, oh, quite fancy living in Glasgow for a few years and three years I'll probably be long enough to decide actually what I do want to do.

So I'll do that OT course and think about what else? And then found actually, oh, this is quite good fun. Isn't I quite enjoy this. Maybe I'll do a bit longer. And training in OT is a very generic training. So you, 'cause you trained to be able to work in medical settings, in mental health settings with children, with adults, with old people.

So it's a massively generic. Training. And I'd done a placement at what was in the old days called the Department of Child and Family Psychiatry in Glasgow and worked with a lovely ot who was also a play therapist. And so I guess that had, I'd begun to think about that a bit. It was also child psychotherapist surrounded.

It was a really rich learning environment and I thought, yeah, I know that's where I'd like to work. [00:16:00] And within a couple of years of, qualifying I was, working in child and adolescent mental health where I have spent the rest of my career really. And yeah, it was. I think the first training I did, I, Leeds was a wonderful place to be working.

I was working in Leeds at that time and it in a teaching hospital, which always gives you so many opportunities and there was a wonderful department of psychotherapy. I was working in adult mental health for the first couple of years and there was an in-service sort of training where once a week you could go to this, the psychotherapy service.

And we would read books and read papers and talk about, the unconscious and psychoanalysis and all of those things. And then if you stuck around long enough, you could then do a little bit of just guess supervised practice really. So start to work psycho therapeutically with adults who were referred to that service.

[00:17:00] And I did that for about eight years. And it was a really great grounding in my development as a therapist and that idea of using yourself as a therapeutic tool. And alongside that, I did a master's in psychoanalytic studies. 'cause I wanted, my training was a diploma and I wanted to to get a master's.

So I did, I did that. And again, that was just really interesting. I love a good frame of reference and having a good frame of reference. And we are, we have understanding what and then was working in cams and I guess had that feeling that I'm sure we'll be familiar to many people of not feeling like you had quite enough skills to match the complexity of the families that that, you were seeing.

Really privileged to work in great teams with, really experienced people, had fantastic supervision from a child psychotherapist and so it was in a really rich learning environment, but wanted to do more and. Did some of those great summer schools. York [00:18:00] Uni used to run great summer schools of drama therapy.

Did a, few of them and then thought about play therapy and finally, not until kind of 10 years late later from, qualifying did play therapy. Really thinking of this is a dream really you can play and it be work and it'd be helpful all at the same time. So did my play therapy training and wove that into the work that I was doing.

I was working in lots of different parts of cams, times in inpatients, times in what were called day patients in those days. And as well as general outpatients working in specialist teams. Worked in sexual abuse teams, worked in family therapy teams, worked in all really a really wide range of, really wide range of teams.

And had a lovely mix of things that I was doing in a in, a day. And then [00:19:00] in about 2005 we moved back up to Scotland. We were, I wanted, we'd always had the ambition of, going up to Scotland and the children by that stage were about four and two. So it felt a good time to, of life to be going.

And I got a job in a CAM service to set up an ot, team there and within within a couple of years of being there, had the opportunity to be part of a team thinking about therapeutic needs of looked after children and I'd done a few other trainings by then as well. I'd also done my EMDR training, which I'm a big, fan of EMDR.

And so we were a small team of child psychotherapy, me with the stuff I'd done, child psychology and, social work. And we were tasked really with supporting the [00:20:00] therapeutic needs of children who were looked after. And the overarching part of it was to try and reduce the breakdown rate.

That was from the council's point, financially driven. It's much more expensive too. Get out your replacements as well as all of the stuff about it not being so good for the kids. So we were out a, team offering the best evidence-based therapies, really o of the time. I'd also done Webster Stratton sorts of groups and trainings I'd done.

So hall model trainings all of the stuff that's around increasing maternal sensitivity, parent child game sorts of stuff. All of done my physiotherapy training by then as well. And lots of different things that were coming in into the mix. And we were offering, I think about a third of the stuff we were offering was we would do direct work with children and young people.

A third was parent child work. And a third was a mix of trying to support the [00:21:00] development of more therapeutic parenting with foster carers and also be involved in the system around the child. And I guess it, it was through that, that we were really realizing that there was a fairly significant group of children.

We weren't having the sorts of outcomes we would want to have for. And I think it really helped that my kids were really small at that point because there's nothing like being surrounded by typically developing children to begin to notice characteristics of the children you're working with that I had never noticed before.

Yeah. I noticed how many of the children I was working with had squints or who couldn't carry a glass of water down the corridor without doing something to prop that. Or who tripped and bumped and crashed, who couldn't tell when they were hungry or when they were full. And suddenly being surrounded by three and five year olds and realizing, oh my gosh, typically developing children can do all of these things.

What's beginning think, 

why 

is that? What is it that happens that [00:22:00] disrupts that process of children essentially growing into their bodies and having agency and not having to use their mind to manage their body, but their body just actually. Following a lovely stepped sequence of, development that allows them to go from crawling to being on stilts or riding a bike or that there's a lovely step progression.

I'm thinking, what has gone wrong? Why, all these children got squints. Why, do they eat until they're sick? Why do they go outside when it's freezing and not want to jump? Or why can't they make sense of information that's coming up from outside their bodies? Why are they so over-responsive?

Or why don't they notice when they fall and they hurt themselves. So I guess just having lots of questions 

Julie: really 

Sarah: And wanting to try and find some answers. And looking in the, any literature that mentioned body. So like the body keeps the score and all of that sort of the beautiful work that there is, but still thinking, [00:23:00] yeah, but that's thinking about body in a psychological way.

I want to understand the nuts and bolts of. How do you go? You have to get head control, enough head control so you can sit on a chair without your head lolloping over, or you having to prop it up. Because actually, if you've not got that, then being in school and trying to write and listen at the same time and hold your body in the right position, all of that becomes really, tricky.

So I guess getting curious about what bodily regulation meant and beginning to realize how much a good foundation of bodily regulation underpins emotion regulation, play, learning relationships. So I went and did some sense integration training, which is what kind of OTs fall back on, I think at these, times.

Sensory integration is theory is great in terms of mapping out for us what has to happen, the nuts and bolts of how we grow into our bodies, and really thinking very much about the [00:24:00] brain and central nervous system and the conditions that are required for all of those innate patterns of movement and innate potentials that we're all born with any, human baby what needs to be in the environment for those to come online and come to fruition.

And so much of them having to come online to build bodily regulation. But my frustration with that was that there wasn't a relational context for that, and I guess everything I'd done up until then had been about the relationship and attachment and wanting to. Build the relationship. So I felt like I had these two really great frames of reference, all of the attachment and trauma and play therapy and psychotherapy on one hand and bodily regulation on the other, and was wanted to bring them together.

So really that's, what bosses is, bringing together an understanding of really the role of the relationship in the development of bodily [00:25:00] regulation and the enormous potential there is where there's been disruption to a child's development of supporting the, parents and carers, the main people in the child's life to go back and to fill in those gaps in what our foundation sensory motor systems so that you can develop bodily regulation and then on that foundation can begin to support perhaps the development of play or emotion regulation or, but I guess now just for me, doing things in a very different order to, to the way I might have done them.

Previously. Sarah, it's absolutely fascinating. Thank you so much for gi giving us that that journey. The story of your many trainings and that point that you came to and thinking I have this and I have my play, I have the relational and I have the body, [00:26:00] but how do they impact one another?

And that phrase you used earlier about the innate potential that every human baby, and I guess every, mammal has that innate potential, is there biologically not for absolutely everyone. There will be conditions and that, hamper that physiologically, but it can only be actualized with another person or another.

Being another? I think so. And especially when we're thinking Foundation Sensory Motor Systems because their development starts at conception. Yes. So that 40 weeks in Utah is the beginning of that related journey to develop and to build that innate capacity so that hopefully by the time the children are babies are born, their little systems are in a [00:27:00] position to be able to make good use of the kind of normal sort of caregiving, good enough caregiving, and that hopefully will be available to them.

Yeah. And, so yeah, it's one of the things I want to ask is what you mentioned disruptions in early development. And when you mean early development, you are thinking really early back to conception. Or even preconception sometimes we think even about what was happening in the DNA before that.

But let's start at conception, but what are the sorts of disruptions that the, children that you've been working with, the little ones you've been working with, what are the types of disruptions they may have experienced pre-birth? Yeah, I think it comes into two cat categories. There's the absence of experiences that, that developing maybe needs, and then there's the [00:28:00] presence of experiences that are very undermining of the process of development that needs, that, right?

So birds, harmful, babies were born very prematurely. We'd fall into the category of there being the absence of experience that's, needed, that when you're born at. I don't know, 29 weeks, that's 11 weeks that you're not in utero in your little brain and central nervous system, and your body are not developing in the way that was human babies are designed to, to do.

And then there are the, presence of unhelpful things, if we're thinking about drug and alcohol is just during pregnancy too much, maternal stress, domestic violence, and really anything that gets in the way of there being an environment for the developing baby where there's not too much stress.

There's even a little reflex. There's a little reflex. And I know lots of people think different things about reflexes, but I [00:29:00] just think of them as they, they're a bridge from one stage of development to the next. They give you a bit of a terrible boost to get to where you need to, need to be.

But there's a little reflex called the fear paralysis reflex that is present from about five weeks. After concept conception. That means that if there's too much stress, if there's, so if mom's under, if under too much stress, then the baby will just stop moving. And that we know that what babies need to do in utero is to move, to be, to moving all of the, all, not all of the time, but loads and loads of movement to be building these foundation systems.

So already there's that sensitivity that if there's just too much stress, then they're very still. And for typically developing babies, the balance of too much stress to not too much stress is, in the favor of not too much stress. And so that reflex integrates and babies are able to move.

But where there's the presence of too much maternal stress, then babies are just very still. [00:30:00] And then we add onto that the presence of things like drug and alcohol use in, in, in pregnancy that we know just messes so much with what that baby needs. And then. You can just see how the normal passage of development all gets a bit disrupted.

So I think, yeah, that's really clear. Helping us to think about disruption as not always being something active and present, but it is thinking about sometimes we use the terms trauma and neglect. But I would say neglect is also a trauma. I would put them both under the same, yeah.

Heading. But the neglect is the absence of what might be typically available. And I'm thinking there about. It's, got a term, I can't find the term right now, where the baby is either not known that the unborn baby is, not known about [00:31:00] prior to birth. Oh, those concealed pregnancies. Oh, no.

Concealed pre They're known, aren't they? Yeah Yes. That, that, that sense of either Absolutely. Not being known about. Yeah. To whatever extent that is, where the mother is not in any way communicating with or acknowledging that there is the growth of a new human within her and what, and I would think of that as an absence.

Does that have a physiological impact? That's interesting because yes and no, because physiologically, if that mom isn't under too much stress, then that'll be okay for that baby. In terms of the nuts and bolts of being able to move around. So who knows? And I don't know enough about this, and I look to people like Tratan and all of those people who just an amazing in, infant studies about what the impact of not being [00:32:00] spoken to.

Yes. As developing baby. I have you can imagine surely it is better if you are and that, that communication is with you rather than just the baby hearing the mother's voice and what, whatever Yes. Is going on. But I don't, know if, and I don't know how they would research that, but Yeah.

How where is the beginning of relationship. And when does relationship begin? Does it happen at the moment of birth when you're meeting the baby outside rather than inside? And how often. The baby is absolutely seen as a person, often named, known, and has characteristics put upon the baby well before the baby is born.

Oh, he's, it is Pelli. I think we did a lot of research into that. Oh, the baby's kicking a lot. Oh, he's gonna be a [00:33:00] footballer. Or she's gonna be a footballer. Hopefully we'll be saying now. Yeah. Or oh, he's always sleepy in the morning. He's gonna be my lazy one. Projecting thoughts about the baby.

So how much the baby has thought about. But yeah, think about disruptions, the presence and the absence pre-birth, and then what are the disruptions? And I can always imagine the list you are, you're gonna come up with here. What are the disruptions, presence, and absence. in in the early couple of years, what is it that really impacts the sensory system?

Anything actually that gets in the way of their being a primary caregiver who's able to, excuse me, meet the physical, the emotional the nurturing needs of, the baby. We know babies [00:34:00] need secure, predictable environments that needs to be touched, nurture movement. So actually anything that gets in the way of that, and again, it falls into those same categories.

The absence of, and the, presence of stuff that's going to really mess things, me mess things up. But it's a pretty, pretty broad suite. For some children that might be, that they were. I dunno. I can think of children we've worked with where maybe they were hospitalized in the first nine months of life and they were hospitalized for a long time.

All that. But all of that got, in the way. Most of the children we work with are children who are in foster or adoptive families now. So there children where there's been both the absence and the presence in a, very unhelpful, way. But it doesn't disruption isn't limited.

Isn't limited to, to, to that. I think yeah. So it's a circumstance. Any circumstance and whether that [00:35:00] circumstance is, deliberate harm. Or whether it's absence due to hospitalization, parents dying multiple moves from country to country, an asylum seeker at a time when the family is migrating under stressful circumstances.

All of this can have an, impact on that little one's. Absolutely, sensory system. Tell us if you, gosh, I'm finding it so fascinating, Sarah, I could talk to you for hours and I'm thinking, oh no, I'm not very good at being concise, Julie. I will try and be a little bit more. No.

I'm loving it. I'm loving it. And actually I'm thinking, gosh, our student, I, one of my roles as some listeners will know is in a teaching role. And I'm already thinking I'm rewriting what I'm teaching next year or I'm gonna add to it. I'll just get [00:36:00] you to come and tell us, tell our students. But this is really fascinating because I am, part of my work is to train play therapists.

And of course, though that I think in your sort of hierarchy of when hierarchy is, may be the wrong word to use, but thinking about Maslow's hierarchy of needs play therapy might come quite high up. If we're particularly thinking about processing trauma and it's, yes, but of course play therapy can do lots of other things within that hierarchy of needs and play therapists make great best practitioners.

But yeah, no I think to be honest, there's very little you could do without a good foundation of bodily regulation. We work doing quite a bit of work in schools and lots of different, lots of d different places. And actually when children haven't got a foundation of good bodily regulation, they have to pay [00:37:00] a lot of conscious attention to their bodies.

Julie: In 

Sarah: managing their bodies in ways that when you've got a good foundation you don't even dream about. But if you start to ask children how their body works and what they notice, then I find by about the age of seven or eight, they're able to give you a pretty good description and might say things like oh, I can think of one little boy who said to me.

He was very serious. He said Sarah, I think my arms work very well and I think my legs work very well. They just don't work very well at the same time. And he couldn't coordinate his body to do anything. And another little one who I was seeing around the same time said I said, I just think I've got a blockage.

He said, my head knows what my hand, it wants my hand to do, but my hand just can't do it. There must be something that's ge getting in the way and, blocked. So from a body regulation point of view, then that's great. We can then be detectors and think about, okay, what is going on for, your body?

And that's how, have a look [00:38:00] at what bodies need. Bodies need a really good foundation of head, neck, showed girls in trunk strength. Let's have a look at that. They need to feel good when they're moving. Let's have a look at that. We need a good body map. We need to be able to make sense of all of the information that's coming from outside without over responding or under responding, and can then begin that exploration and, journey.

Into that. Wait, as you were doing this those that are listening rather than seeing this on, on, on the video will see Sarah was doing a version of head, shoulders, knees, and Yeah, but only head, neck, shoulder. The trunk is trunk the core for your body. And if you're sitting down and listen to this, you can just try that out.

'cause often people think, oh, I don't know I will be seeing that core strength and stability is what allows you to sit in your chair. And you might be thinking, oh, it's my feet on the ground. But just honestly, try lifting your feet up off the ground. Take your hands away from whatever they were on, and actually your body stays exactly [00:39:00] where it is.

You can do whatever you like with your hands, but that foundation of core strength and stability is what allows your body to do everything else, until you've got that your limbs are not much used to you because they can't work effectively without a foundation of core strength and stability to to grow from.

And there's something, what order, so I can see what you're saying that the core happening first and then the limbs. Yeah, absolutely. Get that. But within the core, you are thinking everything from head, neck, shoulders, head first. What goes? Yeah, what goes first? Head control. So we're typically developing babies when they're born.

They generally, if you lie them on their back, their head will be from to one side or the other. And then by about six weeks, they're able to hold their head in the midline. And by two or three months when they're on their tummies, they're able to hold their heads up without their heads bobbing. So that head [00:40:00] control comes first and then neck well, head and neck together, then trunk and then shoulder girdle.

What's the, ah, then starts to make progress to do a bit of creeping or crawling. And all of that has to be beautifully in place before we reach the dizzy heights of a four point knee and then crawling and all of that has to be in place before we get to to, to, being oppress. So there's a very set thing and the other bit of, that's part of the vestibular system.

The other bit of the vestibular system that's developing alongside that is what's called gravitational security, which is what gives us a sense of wellbeing when we're moving and, which sounds a bit daft if you. I've got a good gravitational security, but it's what allows you to know that when you lift your foot off when you're walking, that the ground will be there to meet it when you put your foot back down.

But we develop gravitational security through experiences of being soothed [00:41:00] and held and carried and moved, but within that relationship and by someone who's in a kind of an available STA state. So it's very different experience for a baby being held and carried by someone who's chatting to them and singing to them and swaying and tuning into their body and being responsive to a baby who maybe will be being held, but while mom is being hit or there's goodness knows, only knows what's happening in the background.

So it's not a system that it's a bit fussy about which experiences will grow capacity and which experiences won't, but. That combination of core strength and gravitational security, all of which is happening alongside the development of the tactile system, which is what allows us to make sense of information that's coming from outside our body.

All of that has to happen really before we start moving. And what's fascinating, I find anyway about the tactile system is that's a system that starts in a state of high alert. [00:42:00] So the receptors for the tactile are all over our bodies. All over our, in our skin. And for the newborn, the receptors that are around defensive functioning are prominent because the task makes sense really, doesn't it?

The task of the newborn is to survive and. When they're born, they don't know quite what the environment's going to be. So if we think about, for example, the cry of a newborn when they're hungry or cold or uncomfortable, it's not a oh excuse me. I dunno if you've noticed me over here. I'm a little bit peckish finish a cup of tea, but then it would be nice to have something to eat.

It's I am dying. I am about to die here. I was the garden center the other week and there was a newborn and they cried and you just saw all the heads turned. 'cause there's something that's elicits such a big response. So all of those receptors are in the defensive P position and it's only through experiences of good enough care that they recede and the receptors that are about [00:43:00] discrimination and being in the moment of the experience can flourish.

So where children are living in environments that are not as good as we would like them to be. Those defensive receptors don't recede. So children stay in that heightened state on a physiological basis. And very often, even when they move from those environments to new environments, that doesn't necessarily shift.

I think in the old days, we used to think, didn't we? Very naively, we'll take a child out of an abusive situation, put them in a loving family, and ah, oh, we'll be well, we will be fine. But we know more now, don't We We know more. I don't think we know quite enough yet about bodily regulating. No, actually what we need to work on and shift.

We're good on the relational thing. We're good on the emotional, we're good on the understanding, the impact on. On this, that, and the other. But actually I think we just need to be so much smarter. We're people who live in our bodies. I think sometimes we like to think we are people who live in our heads, but actually [00:44:00] we live in our bodies.

And understanding the impact of disruption to the development of bodily regulation, which completely underpins everything else going forward, is just so helpful, I think for children, for families to to be able to fix. It's also, you could fix it. It's not an imponderable. It's not a, oh my goodness, that happens.

So we've gotta shape the environment. These systems are so amenable to yeah. Wiring. That's where I'm hearing that the sense of hope that this is and I in your subtitle of the bus model, it's an underdeveloped, not a damaged Absolutely. System. And I think that. That's crucial in seeing that it is underdeveloped.

It hasn't had the chance to grow. Yes. It's like a plant that's in too smaller pot or it's not had the, right nurturing and if you pop that [00:45:00] plant into a bigger pot and you water it and give it a bit of feeding and maybe put some other plants around it given a bit of time, it's it's gonna get off the ground.

It might still look slightly different. Yes. It but it will definitely grow into a more healthy plant. Yeah. Whereas if you were to look at that little shrivel that plant and think, okay, what diagnostic category does that fit into? You'd probably be able to think of quite a few. But actually what we need to do first is to, let's go back and let's fill in the gaps in that plant's experience so that it has the chance to thrive.

And then let's, then when we've got as far as we can, then let's think, okay, what's left? What might we be doing out here? Yeah. So to go backwards. And we do this psychologically as well to fill it in relational gaps with children who experience disruptions in a secure attachment. We, and actually often in, certainly in play therapy, I noticed children, if they've given the [00:46:00] space and the time and the trust will take themselves back.

That's why I have baby dolls and bottles and rattles for 10 year olds in the play therapy room because once the trust is built, they find themselves in that corner of the room. And they know they need to take themselves back to it, and they, their voice becomes different. They lose their words, they become one again, because that's often around the time where the disruption might have happened.

They know they need another go at it, but on a different path. So Sarah, what is it you do with your little ones? What I mean that's too crude a question. I know, but what, what helps? Yeah. So we work with children, we work across children not to, to 25. So it's never too late to do it. We could work with adults.

We, we don't at the moment, but we would be very open to, to, to working [00:47:00] with, grownups. So what we want to do is, 'cause I guess the other bit when I was developing bus was thinking about how do we make parents and care as the main agents of change rather than these children endlessly being in therapy?

Because what sense of yourself does that really give you? And actually we've got some primary caregivers here that somebody's thought are good enough, so what might we do to skill them up? Parents in Care as main agents of change are a huge part of bus. And what we are wanting to do as bus practitioners is to get a good enough assessment of the child's foundation, sensory motor systems, so that we know what might be the right level of challenge to start to grow those systems.

But we want to do that alongside the child or young person and the parents and carers. Because the [00:48:00] way to rebuild the system with BUS is to play loads and loads of games and activities with your main caregiver to support the development of those systems. So the role of the practitioners around assessment, grading, empowering, working alongside, supporting through and when we're working in an individual basis with children and families we do that over about a four month.

Period. And there, there may be times when we meet with the families or it may be that we've got a huge library of videos of games and activities that we are sending things through to families and we rely a lot on them videoing. 'cause we need to see the nuts bolts of actually what's, how is that body organizing itself in relation to the task?

Because that will give us information about the foundation sensory motor systems. And it's really important for us that we get the level of challenge, right? The child, generally the children we see have had a lot of experience of failing and you don't get [00:49:00] many chances at, starting. We, really want to make sure that we are pitching it right.

And the joy of it is the parents and the experts and their children, they all know what activities are we motivating? What will they enjoy? But do I think our tolerance is gonna be here? And sometimes it might be five seconds, but that's great. That's fine. Let's celebrate those five seconds and know that if we do that for a week next week, we might be on seven seconds.

And we just follow the blueprint of normal development, not in the kind of painting by numbers where you, oh, you do this, then you do this, then you do that. Yeah. But really tuning into where the child is and also parental capacity. And where we are and what we are. And it's a pretty intensive intervention.

I think families are even, if we haven't got as far as we need to get at the end of four months, we stop because [00:50:00] it's it's a lot of work. We were asking families to do things 5, 6, 7 times a day every day. And maybe it's only two minutes, but it's holding in mind, isn't it?

And remembering, oh, remember we were, I don't know, commander crawling from bed to the bathroom or we were doing a test when we do tea or whatever it was. You still gotta think of it and remember it. And all of that kind of parent is the more active interacting and all of that stuff that that that, comes, into it.

So at the end of that four months for some children, particularly kids who've been massively impacted by drug and alcohol use during pregnancy, you might have got to gain. We've built foundation of core strength and stability and we've helped with oral motor strength. So actually their lips move around their words now when they're talking.

But you know what, oh, we can still see this bit of crashing and banging and yeah, we need to come back and work on that a bit. But actually, let's stop now and let's wait [00:51:00] six months and see what capacity might grow. Let's give the family a rest and then if we want to come back, But probably we only see returners, maybe 5% of the families we work with.

We would work with more than once for most children and families. Once you can build that foundation, of course, strength and stability and gravitational security and sort that tactile system out, then they're able to almost rejoin the normal developmental trajectory. They can rejoin that curve and the normal activities of everyday life and good enough parenting and all of those things will just continue to nurture and grow those systems.

Yeah. Forgotten so, yeah, no I'm thinking, remember, I'm thinking about many of the little ones I've worked with o over, over many years, who will a will arrive with often with their parent for there'll be some reason why they've come for therapy. But [00:52:00] immediately I just see them walk up the path and I'm thinking, oh the, but it's not quite right.

Some things. Yeah. Going to need a lot of body in this. And one of the things I, one of my practices the same as Philippa is Thera play, which is very much the body working not deliberately working with the body. 'cause it's, about a relationship, but relationship more and more realizing that we need a body to be able to relate.

So even things like the feeding activity, if the child doesn't have chewing in their, in, in their repertoire yet, or blowing bubbles and they can't blow their oral development is underdeveloped. Would that, I suppose my question is [00:53:00] where does developing the sensory motor system fit in?

With, I suppose the reality often, or my reality is I get a referral and the two things I can offer are child-centered play therapy and the play and parenting consultations. Those are in my bag of training. But here's the little one who's whose body is swimming into the room.

And there's funding for 20 sessions. I've begun to now just call what I do play-based therapy, and that allows me to go in any direction. What's your thinking about the efficacy of that? But it is the reality for many practitioners. Yeah. And I think. I [00:54:00] think this is tricky, isn't it?

'cause I'm somebody who likes to say, oh yes to everybody and oh, we can let's do everything. But actually I think I would say just in the same way that as a play therapist, you thought, yeah, I'd really like to add in therapy to my set of skills. I would just really encourage people to skill up.

And so that we can be the most useful we can be to, to our families. 'cause it's not a case of saying, oh, we'll just try this or that or add this in or do this and that. And that sort of things like, 'cause it just doesn't, it doesn't work like that. 

But doing something that will build bodily regulation, what we then find is children are so much more able to then make use of play-based work or DDP and interestingly, oh, a few years ago, around, around COVID times, viv Norris, who's a big therapy play person [00:55:00] and trainer. We were doing some thinking together and she came up and did the bus training and I went and down and did the therapy play training. 'cause we were thinking actually, could we develop a model that brings these two frames of reference together in a helpful way?

And we've trained lots of their team and lots of our team are trained in therapy. But actually our conclusion has been, do you know what? No. Because what happens is you then take the essence of, you dilute the essence of both things too much. 

Julie: Yeah. 

Sarah: And actually it doesn't become effective. But there are some families for whom doing something like therapy first is helpful.

And especially those children who have that need to be in control all of the time. And parents haven't quite worked out a way of. Interrupting that to, to have a sense of being in charge and [00:56:00] at least with the big picture, if not with the small picture. Yeah. But generally, I think we would say where there's been disruption to early development, let's think bodily regulation first before we're thinking emotional regulation at and, attachment.

Knowing that once you've got a foundational bodily regulation, everything just gets so much easier for the child. Yeah. No that's really interesting. And yeah, Viv Norris at the family place over in hay y but then what you're saying there is in order to do the bus model, which is seeing the parents and carers as the main agents of change.

And so most of what needs to happen is that. Several times daily doing a couple of activities in a playful way that will get [00:57:00] that part of the system that child has got undeveloped under the way underway. Yes. But if you are in a situation as the parent carer of that young person, of that little one who in trying to give an invitation to say, let's do commando crawl, let's blow bubbles is gonna be met with resistance or aggression or a real meltdown, then I can see the bus model can't happen first because Yeah, you've gotta have capacity in the caregiving system.

Yeah. And whatever's interrupting that capacity. 'cause sometimes blocked care, sometimes often when we're working with. 15, 16, 17 year olds and their parents have golly, me done the most amazing job of trying everything. And sometimes they're just spent and yes you, it's a bit like that put on your own [00:58:00] oxygen mask before you attend to your child.

If there's something that's getting in the way of parents and carers being in a position to be the main agents of change, then absolutely we might need to do something. We might need to do something first. Yeah. But generally following the blueprint of development, bodily regulation happens before everything doesn't it?

Before language, before play. Before everything. And where that's disrupted that it never ceases to amaze me just what a huge impact that has. And while all of our focus and attention and buses on the bodily regulation. Stuff. What we see happening alongside that is just what with typically developing children.

That they don't do that one system then the next, but everything grows and changes and, yeah. One, one system impacts the other. Mean, if you go back to what you were saying earlier about the in, in the womb, if the mother is stressed or the mother is shut down, then the baby stops moving.[00:59:00] 

In a sense, relationship and body are growing up together completely. And if we think about attunement, we think about mentalization, think about attachment. It involves the bodily interaction of the parent and the child and what the parent can offer to the child. What the child then does with that and it gets fed back.

So yeah, it's not that you fix the body and then you fix relationship. In it together. The two have to come together. And I can see why Viv and you would think about then how these two models might work together. But they are related. But we need to, what you're saying, you and Viv is we need to pay attention specifically to the body, even though we need relationship to do it.

Oh, completely. Completely. And we need to pay attention to the relationship in therapy play. But that [01:00:00] also involves having a body that can do the activities that bring about Yeah. The relationship. So there are connections. There are, and what was interesting when we were training, 'cause we trained the family police team, we were great bus practitioners was how much as they were training, they were thinking, oh my goodness.

Now I understand why when we do that in therapy. It is not that the child won't do it, actually, it's that they can't do it. And yes, we tend to interpret that at the moment in a psychological way, but actually we need to understand more about bodily regulation to be able to appropriately attribute significance to what we're seeing and what's, happening.

Yeah, that's, so it can often change the thinking of the practitioner, although actually what they're doing in the room might be exactly the same. And I'm thinking about my work as a play therapist where I might [01:01:00] not interpret, but I might view a child's interaction with me or with the resources as a trigger.

They've, suddenly been scared by something and then I might avoid that rather than what I've to have that capacity to think. Why did that child suddenly leap across the room when they saw that item? Is it because they're scared of it? Is it because they just find it really yucky and they dropped it and they don't have the tactile system to be able to hold onto it and not always presuming that it's a trauma reaction?

Yeah. I think the body just need to move. Could they actually just not stay standing in one position for any longer and they, yeah, because they just need to have a big jump. Yeah. And in a way, the more frames of reference you have for understanding something then the more chance you've got of getting it right.

And I, I definitely don't think that we always get it right or that, and I always say [01:02:00] bus isn't the answer to everything. It's but it's a small piece of the, puzzle. And that, if you can get that, it's a bit like when you're doing a jigsaw. You need to get the edge pieces in first and then there's a chance for the picture to grow.

Yeah. And that for me is about putting the edge pieces in, but to do a jigsaw, you have to have a table that's big enough. And I think of that table as the system around the child. Yes. The family and that. But then that table's got to be on a level surface and that level surface is like the system around the family.

So all of those things have gotta be in place before you're in a position to do a to do. The jigsaw bus is only about let's get the corridors and let's get the edges in and then. Let's let what grows grow. Yeah. From there. Oh, Sarah I'm so glad you've mentioned jigsaws. I love a jigsaw. Do good eat jigsaws, love a jigsaw.

And sometimes it's interesting, occasionally I challenge myself and [01:03:00] think, oh, I'm gonna start by not doing the edges first and doing the middle. But it is complete disaster. I hate it. I end up that's advanced level jigsaw. No, I really need the four corners first. Then the edges. And actually the edges are never complete.

Before I start on the middle bit, I'll start picking out colors or start picking out the house or start picking out the moon, whatever's in the picture as I'm finding all the edge pieces. So I might start building some of those other bits. And there's always a bit of the edge missing before I really launch into the middle.

And then I find it about a week later. But that's such a wonderful analogy. And we've run out of time for today, Sarah. I think we'd need to, in another year's time, we'll book in again for part two, because this has been absolutely fascinating. Always. Thank you so much I joy to be able to think with you and [01:04:00] talk with you.

Thank you so much for asking me. Thank you so much. And we will put in the podcast link this podcast. Sarah won't come out for a couple of months because we've got lots of other wonderful guests lined up. But we will put, if you are okay with it, a link to your bo your, website, the bus model.

Yeah, that sounds great. Website and, really to invite as we do after every episode, to invite parents, carers, young people, practitioners, school staff. Grandparents, anybody who's got a little or a big person in their life who's got a question or got some thoughts to offer, even if those thoughts, and particularly if those thoughts are, don't agree with any of this, then it helps to keep the conversations going because as you've said, it's nothing is the answer to everything, but it's another lens.

And I [01:05:00] often think in 50, a hundred years time when you and I are, gone, people may well look back on what we're thinking about today and go, oh, they, they really didn't understand. Oh, they just started on that. As we look back on, on practitioners for a hundred years ago and think, oh, did they really think that was okay?

But each of us is doing the best we can with the tools we've got. And as you've so clearly done with the evidence you had in the little people who were coming to your office and going. There's something else going on here. Let's see. And work it out. So thank you so much for sharing that.

Pleasure. Thank you so much today. And enjoy your playfulness later on in the day when you get into your loose clothes. Thank you so much. Lovely to see you. Thank you so much. Thank you. Thank you for listening to Pond Play and Therapy.