He doesn't want to come to OT anymore! What can I do?

Draxie came to supervision today to have a chat about her cases. Her first case was Callum, a 13-year-old adopted young man with early years trauma and attachment issues, plus Dyspraxia.

-So how is Kallum doing? I asked.

-I don’t know, Neki, honestly, he seems like he is distant and not enjoying coming in OT sessions. He finds them boring, a bit childish, and generally he does not open up to me. After 6 sessions and still haven't developed a rapport. We need to work on his sensory processing, his balance, coordination, motor planning but he is barely making any progress.

- I see what you mean Draxie. Every therapist has dealt with this issue a lot in the past. From my clinical experience, I have seen how children who do not open up to the therapist, hide their feelings and are reluctant to communicate their thoughts or share incidents, are very likely to be "unlocked" through tactile activities.

The so-called "messy play" can help them open up more easily and begin to willingly share their thoughts and concerns with the therapist. In general, it is not at all uncommon that children who resist sharing their thoughts, at first, will open up and be more willing to discuss things with their therapist when, for example, they cook something together, mix their mixtures, touch the vegetables, fruits, flour and dough with their bare hands and prepare something or just play with the sand or the water.

Don’t forget that the tactile system is the first system of communication and regulation of the infants. You have a niece, a baby, right? So, you must have noticed how often she uses her hands and mouth to interact through touch with her environment and with people.

So, you mean, we should start with tactile play first and no welcoming chat?

- You can ask him a question or two after welcoming, such as "How was your weekend?", or "how was school?", and if you see that he does not respond, as usual, just sit around a table with sand, which you will have prepared and start playing without talking for a while, and you may see that in your next question he will be more willing to open up and remember some event from the weekend or from the school.

- So this way we are building a relationship?

- Well, that's how it might start, without too much talking, in silence. But let’s not forget that some other steps will have to be taken afterwards.

-Such as?

- Look, to build a relationship, it takes some preparation from your side as well. First of all, you have to be aware of his interests and hobbies.

If you manage to connect with him, he is likely to remember you as a positive contact. Get down to his level (even lower) and try to understand and feel what he feels (happy-sad), what his interests are (he likes football, computer games) in order to "cut the bridges" that separate you and make sure that he wants to return to Occupational Therapy next week.

And in general, during your sessions, you don't have to ask too many questions, don't talk too much, just let him use the time and space to explore his sensory systems, his body (how he moves, the different postures, the two sides of his body, and the coordination of his movements) and to “feed” his senses as he swings in various postures on a lycra or platform,  through rhythmic movement. That's enough for him to feel comfortable in the same space as you, even though he might find these activities a bit childish.

Finally, include, if you want, a fine movement or visual perception activity on the subject of one of his interests and do not forget to praise him for his skills even if he does not always succeed.

I am often told by the children I see in the clinic "Sir, is this your home?" "do you live here?", and I am glad because I take this to be an indication that they feel comfortable in "my house", so it is again possible that they will remember this place as Neki's house, which creates a positive episodic memory.

- Thank you Neki, I will keep in mind everything we discussed about Kallum me and I hope that he will start enjoying the sessions.

- Have faith, Draxie. See you next week..