Risk & Regulation of Facilitating Body Connections: Using Dr. Perry’s 6 R’s

As rehabilitation providers, we pride ourselves on helping clients to connect with and into their bodies through movement, through touch, through breath, through positioning and through the senses.

BUT, many of our clients are coming to us with a history of trauma. Were you aware that these very pathways that we often use to help folks to connect to their bodies (that is, SENSING) are the pathways through which trauma is experienced, remembered and re-experienced? When we prompt an individual to tune into these potentially threatening experiences within their bodies too much, too fast or too soon, we run the risk of inviting our clients to feel into their trauma without equipping them with a safe way to process it.

So how do we help clients tune into their bodies in a trauma informed way?

Dr Bruce Perry, a pioneering Psychiatrist in the field of childhood abuse and neglect says that we can experience sensation safely via utilizing the 6 R’s…

• Rhythm

• Repetition

• Reward

• Respect

• Relevance

• Relationship (Perry, B.D., 2019).

RHYTHM

Rhythm in movement and routine tends to facilitate a sense of safety in the body. Can we incorporate more rhythm into the movements or sensory input involved in our treatment plans (i.e. music, tapping, rocking, swaying)?

REPETITION facilitates familiarity. Does your visit follow a pattern? Do you engage clients in a grounding practice or a grounding touch therapy to settle them into their visit. When are are hyperfocused on progression, we can miss the value of maintaining some sameness and consistency. We can still progress challenges and empower our clients while following a familiar pattern or structure that may foster a sense of familiarity and safety in the context of our care.

REWARD

Reward as health care providers, we often jump to the “problem”. Perhaps inviting our clients to tune into the sensations and experiences connected to distressing sensations and experiences within the body. What if we ALSO invite our client to reflect on sensations and experiences in their body that they might find safe or pleasurable? What if we start there? What if we get curious about ways to facilitate pleasurable sensations in recovery alongside supporting our clients with dipping their toes curiously into the challenging ones? Tell me about a movement practice, or part of your daily routine that you enjoy OR that helps you to feel more present in your body? What about that experience do you enjoy or helps you to feel safe? Tuning into pleasure or sensations associated with safety (if pleasure is not yet accessible) is often a fantastic starting point for tuning into the body from a safe and present place.

RESPECT

Prioritizing autonomy in the care that we provide is a critical component of trauma informed care. There is an inherent power imbalance in health care providers. Acknowledging this and mindfully working towards placing client experience and choice at the top of the pyramid when providing evidence-based, trauma informed care is critical. When we are tempted to “prescribe”, can we instead provide a menu of options and engage our clients in shared decision making?

RELEVANCE

When we are inviting our clients to connect to their body through the senses, it might seem incredibly relevant to us when approaching the clients’ problem from the specific frame of reference we are using: Biomechanical, Sensory Processing, Central Sensitization. Trauma informed care requires that we also consider what might the relevance of this experience be for this individual from a Neurodevelopmental frame of reference? That is, how might this experience be received subconsciously by a potentially protective nervous system and brain? If it is potentially threatening, does it mean it should be avoided. Not necessarily, but perhaps it should be titrated.

RELATIONSHIP

Creating a safe relationship is foundational to ALL OF THE ABOVE! The most powerful tool that we have in promoting a sense of safety through the sensory experiences that we offer to our clients is the therapeutic use of self. We are hardwired to seek safety in the context of relationships. When we, as healthcare providers, are able to achieve dual awareness (that is, the capacity to remain present and monitor for our own and our client’s reactions), we can effectively detect a disruption in our clients’ sense of safety, meet them where they are and utilize our own bodily sensation and arousal, tone of voice and body language to facilitate co-regulation. When we prioritize connection and co-regulation, we can then effectively titrate our movement and sensory interventions in an individualized way that keeps the person safe and connected.

'The core experiences of psychological trauma are disempowerment and disconnection from others. Recovery, therefore, is based upon the empowerment of the survivor and the creation of new connections.Recovery can take place only within then context of relationships; it cannot occur in isolation.’ Dr. Judith Herman, 2015

Learn more about how the body and the nervous system processes and holds on to trauma in this FREE webinar from Kim Barthel on her approach, Psycho-Sensory Interventions for the Treatment of Trauma!

Lara Desrosiers OT Reg. (Ont.)

Director & Occupational Therapy Educator

AMP Healthcare Education is thrilled to be hosting Kim’s 3 days course in Guelph, Ontario in May, 2023! Check it out below!

References:

Perry, B. D. (2019). The neurosequential model. The handbook of therapeutic care for children: Evidence-informed approaches to working with traumatized children and adolescents in foster, kinship and adoptive care, 137.

Herman, J. (2015). Trauma and recovery: The aftermath of violence—from domestic abuse to political terror. Basic Books.

Credit for Blog: Lara Desrosiers