EPISODE 72

[INTRODUCTION]

[0:00:03] MBH: Thanks for joining us at Keys for SLPs, opening new doors for Speech-Language Pathologists to better serve clients throughout the lifespan. A weekly audio course and podcast from SpeechTherapyPD.com. I'm your host, Mary Beth Hines, a curious SLP who embraces lifelong learning. Keys for SLPs brings you experts in the field of Speech-Language Pathology, as well as collaborative professionals, patients, and caregivers to discuss therapy strategies, research, challenges, triumphs, and career opportunities. Engage with a range of practitioners from young innovators to pioneers in the field as we discuss a variety of topics to help the inspired clinician thrive. 

Each episode of Keys for SLPs has an accompanying audio course on SpeechTherapyPD.com, available for 0.1 ASHA CEUs. We are offering an audio course subscription special coupon code to listeners of this podcast. Type the word Keys for $20 off. With hundreds of audio courses on demand and new courses released weekly, it's only $59 per year with a code word Keys. Visit SpeechTherapyPD.com and start earning ASHA CEUs today. 

[EPISODE]

[0:01:23] MBH: Welcome to this episode of Keys for SLPs, Keys for Trauma Resiliency. I'm your host, Mary Beth Hines. Tonight, I am honored to have Christina Liem, a fellow SLP as a co-host. 

[0:01:39] CHRISTINA: Thank you, Mary Beth. We have a few disclosures, the financial and non-financial disclosures. None of us have non-financial disclosures. Mary Beth Hines receives compensation for this presentation from SpeechTherapyPD.com. Caitlin Lopez receives compensation for this presentation from SpeechTherapyPD.com. I am Christina Liem, and I am employee with the ENT positions group at the Loma Linda University. I receive an honorarium from SpeechTherapyPD.com for this presentation. 

[0:02:11] MBH: Thank you, Christina. Here are our learning objectives. One, list six skills of the Trauma Resiliency Model. Two, describe how to apply the skills during a session. Three, list two resources for utilizing and learning more about the Trauma Resiliency model. 

[0:02:30] CHRISTINA: Now, without further ado, we welcome our guest today, Caitlin Lopez. She has her MS and received her master's degree from Loma Linda University with her Communication Sciences and Disorder in 2012. She has worked for the last 10 years serving preschool and elementary students in the California public school system. She is passionate about language therapy, creative service model, and partnering with families, teachers, and community partners to help students thrive. She currently has a podcast, This Speech Life on SpeechTherapyPD.com. We're so happy to have you on Keys for SLPs to talk about the Trauma Resiliency Model, and how it can be utilized for co-regulation during therapy session. Welcome, Caitlin. 

[0:03:24] CAITLIN: Thank you. Thank you for having me. I'm excited to be on this side of the podcast today. So, thank you. 

[0:03:31] CHRISTINA: Yeah. We're excited to have you, too. Our first question. Will you tell us about yourself and your journey as an SLP? 

[0:03:38] CAITLIN: Yeah. So, I Ð like you mentioned, I went to Loma Linda University and went through their undergrad program and their graduate program. Actually, my last year in their graduate program, my aunt is a colleague of the creator of the Trauma Resource Institute, which has created the Trauma Resiliency Model, as well as the Community Resiliency Model too, which I'll talk a little bit more about as we get going. 

My aunt was visiting from DC, that's where she's living. She was visiting and her colleagues came over. We were all over with family, just enjoying spending time with her. They were sharing a little bit about their work. My aunt is a psychiatrist. The majority of her work has been with post-traumatic stress disorder and actually traumatic brain injury. I was in grad school and I thought that that's what I wanted to do when I grew up, was work with returning veterans with trauma or with traumatic brain injury, because my aunt is just such a passionate, positive person. 

When you're around those people, it just drips off onto you. She's now a retired general in the army. So, that was her baby, her passion project was bringing PTSD therapy, as well as TBI together and having those coincide together. During that evening, she had her colleagues that were involved with Trauma Resource Institute and had created it. So, we're all sharing and I'm just sitting there, sitting at their feet, eating up everything they're talking about. The creator of Trauma Resiliency Model said, ÒWhy don't you come to one of our trainings? I'll give you a scholarship.Ó I was a student. I was only a grad assistant, not making much money. She said, ÒCome to our training. I think it would be really beneficial for you.Ó

Then at the time, they had a training for psychologists and therapists, mental health specialists. That was the training that I went to. I am not that at all. I mean, we do some of it, right, as speech therapists. We wear a bunch of different hats, but I was the only non-mental health specialist in the room. I was also the youngest person in the room. 

[0:06:04] MBH: Good for you. Good for you. 

[0:06:07] CAITLIN: That's how I ended up learning about Trauma Resource Institute and Trauma Resiliency Model. I did the training that was for therapists. They have Ð at the time, they were creating a model and they were utilizing it. They call it the Community Resiliency Model. They were training lay members to go into places that have experienced tragedy. They've been in Haiti. I mean, any big, major thing that has happened. They have people on the ground teaching the skills that we'll get into. 

The great thing about it is you don't have to have a degree to know how to do these things. You don't have to have a degree to utilize these things and to teach them, which is really great. But they do have a certification process and they do, if you want to be a teacher of the skills, I don't actually have it, but my husband does, because he had an experience, he works at a local university. They had a student die by suicide. So, I was coming on campus and utilizing some of the skills with the students and with him, and he felt a difference. He got trained to be a teacher, so that he can train the staff and faculty that he works with to utilize them. 

[0:07:25] MBH: I know we're going to get into the training a little bit later, but why don't we go ahead and talk about that now, since we're on that topic. Before when you took the training, you were the first SLP, was it a, I guess Ð what was your training like? A week-long, or a weekend, or what's the process of the training? 

[0:07:43] CAITLIN: It's a weekend. To be the Trauma Resiliency Model is specifically for therapists. They have level one, and level two. I went to level one and it was a weekend. It was a Saturday, Sunday, all day. Learning the background behind it. Then practicing the skills. Then practicing the skills with each other. We'll all get into the skills. You don't necessarily Ð one of the skills I don't necessarily use because I'm not having conversations about my studentÕs trauma with them, where I'm having to get them to a place where they can be in a resilient zone to talk about their trauma, because that's not really beneficial for our time in speech therapy. 

During the back-to-school conference, we had Rachel Archambault, be a part of the Ð she presented on post-traumatic stress disorder. What we need to know as clinicians working with students is we don't always have to know that somebody has gone. We don't need to know the specific trauma people have gone through, but we can recognize what that looks like, and how to accommodate or meet them where they're at. That's the same thing with this. That is the Trauma Resiliency Model. That is specifically for therapists. 

If you are a layperson, I would recommend doing like the Community Resiliency Model. I don't know what it looks like if you don't want to be a teacher, but they have a book. There's a book. There's a podcast. The website has a ton of information, but then to be a Community Resiliency Model trainer, it's a week-long process. Then you have to do a presentation. Then you have to do a hefty project to get the certification. Then to keep your certification there's continuing education that you need to do and just check in, because they're always updating their language. As we know, in our field, things change quite frequently and it does in their field, as well. 

[0:09:39] MBH: Okay. SLPs would be considered laypeople.

[0:09:42] CAITLIN: Yes. 

[0:09:43] MBH: Okay. Okay. 

[0:09:44] CAITLIN: No, I mean, you could go to the level one. I think it would be totally fine, but I think the community resiliency model might meet Ð they've changed some things up a little bit. I think it's less expensive, too. 

[0:09:57] MBH: Okay. Well, that is always important, right? All right. Well, let's dive in. I think Christina, you're up next. 

[0:10:05] CHRISTINA: Can you tell me what is TRM or the Trauma Resiliency Model? Then also, what is happening neurologically when we use TRM? 

[0:10:16] CAITLIN: Yes. Okay. The Trauma Resiliency Model was developed through, there's two women that created it. The main person is Elaine Miller-Karas. She's a Licensed Clinical Social Worker. She created it because we know that there is something happening biologically based in our brains when we're experiencing stress. With typical talk therapy, so this was originally created for therapists and mental health therapists, I should say. Thank you for the clarification, Mary Beth. 

What she was finding was that when she was working with people and just doing that typical talk therapy, it was putting them back into their trauma. It wasn't really helping them work through it in some aspects. So, she created this model where you're working with what's happening neurologically with us. The idea is that we have a natural rhythm of our nervous system. We want to Ð we know about the autonomic nervous system when we are under threat. We have fight, flight, freeze. I think they've added a fourth one, befriend. 

Through research that she's poured over and research that she's done, we know that naturally our nervous system gets bumped and that's okay. Sometimes we can get bumped really high and we find ourselves hypervigilant, anxious, aggressive. We're like on that high alert, like really a lot of energy happening. Then sometimes some of us have the reaction of being bumped low out of that zone, that resilient zone. 

We might find ourselves being numb or lethargic, disconnected or apathetic. That's okay to get bumped, but what's not okay is when you get stuck there. She's created these different skills to help us just check in with what's happening in our body. Then once we are sensing what's happening in our body, then it's much easier for us to get back into that resilient zone. The resilient zone is not the happy zone. That's just where we are able to handle whatever is coming at us. Does that answer your question a little bit? 

[0:12:38] CHRISTINA: Yes. 

[0:12:39] CAITLIN: Okay. 

[0:12:40] CHRISTINA: It does. Thank you. 

[0:12:41] MBH: That's a really good clarification about the resilient zone, that it's not the happy zone. Can you repeat what you just said one more time for us and our listeners? It's not the happy zone. It's the Ð 

[0:12:54] CAITLIN: Yes. It's not your happy zone. It's the resilient zone. We're not always looking to make ourselves feel happy. We're just wanting to make sure, because sometimes when things are happening that are very traumatic to us, we're not going to be happy. That's not the goal. The goal is, can I function? Can I get back to that place where I'm not super aggressive? We all know what happens to us. 

For me personally, I can get bumped really high. Then if I stay up really high for a very long time, then I get bumped really low, like I just get really apathetic and we know what that looks like, but can we be in a place where maybe we are able to function, make decisions, carry on with what we need to carry on with, but maybe not feel joy or happiness. That's the idea. That's where we want to come back to that natural rhythm of our nervous system. Some people have really deep resilient zones, where they can handle a lot of things or they can keep themselves within that resilient zone. 

Then some people have really shallow resilient zones. The cool thing about TRM is the more that you practice it, the Trauma Resource Model or Community Resource Model. The more you practice these skills, the deeper your resilient zone gets. That's the really great thing about it. But, yes, I think that's an important point. It's not being happy. It's being able to just be able to live our lives and know what's happening and being present, present. That's the biggest thing. 

I think that's a really good key indicator to me of if I'm in my resilient zone, am I able to be present and know what's coming my way and think logically and clearly? Then I know if I'm always blaming somebody, I'm probably not being very present. I'm probably out of my resilience zone. 

[0:14:46] MBH: Good distinction. Okay. In our course description for those of you who read it on SpeechTherapyPD.com, you may have seen the term co-regulation. To me, that was like a new term. I understand what regulation is, but I was like, ÒOkay, what is co-regulation? I thought it would be helpful if we just Ð it is what I guessed it to be, but can you define it for our participants? What is co-regulation as it applies to TRM? 

[0:15:15] CAITLIN: Yes. Co-regulation, what it is, is if we notice that, so I work with children, so I'm going to be using children quite a bit. I also have a young child that I use this with a lot. Children will often get bumped out of their resilient zone very quickly because they cannot communicate. They have no control over their lives, if we're being honest. They're told exactly what to do, when to do it, and how to do it. So, they can get bumped out of that resilient zone. We see them having tantrums and so on and so forth, but if I keep myself calm, it's much easier for me to work with that child, meet that child where they're at. Then also see if I can eventually get them to calm down or to co-regulate with me. 

That's the co-regulation is, I'm regulating myself so that I can extend a hand to help them regulate themselves, but if I'm getting really, and I've been there, where my daughter is screaming, and I'm like, ÒWhy are you screaming? I asked you if you wanted blueberries, and you said yes, and now I put them in the wrong cup and now you're screaming.Ó But if I'm like really upset and not processing, if I'm really upset, I'm not able to talk her down, right, like I'm just like, ÒNo, this is how it is.Ó That's maybe a poor example, but that idea of keeping myself calm and present, so that I can help that child become calm or present themselves is the idea of co-regulation. 

As we're walking through the skills, the skills are really, I think I took to it so incredibly, is because it really felt like yoga on steroids to me. I had been practicing yoga for about five years before I was introduced to Trauma Resource Model. I just really took to it, because I was like, ÒOh, my gosh. This is yoga on steroids.Ó Yoga is all about checking in with your body and knowing how you feel and checking in with your breath. 

At least, the yoga that I've been taught if you start, I like to practice more vigorous yoga. If my breath starts to catch and I'm not breathing freely, I know to myself I need to back off. So, already having some of those skills of checking in with how I was feeling. That's like what TRM is. It's all about sensations in your body versus talking about the trauma or thinking about the trauma. It's really just using the sensations in your body to bring you back to that resilient zone. 

[0:17:42] CHRISTINA: Wow. It sounds like, circling back to the co-regulation. It sounds like de-escalating yourself so you can de-escalate others. Yeah. Okay. Then it sounds like baseline. It's like your, what do you call it, that zone again? 

[0:17:56] CAITLIN: The resilient zone? 

[0:17:57] CHRISTINA: Resilient zone. Yes. I feel like that's like your baseline zone. Am I describing that correctly? Okay. Awesome. Awesome. You had mentioned that there are different skills and you call it TRM, T-R-M? 

[0:18:12] CAITLIN: Yes. 

[0:18:13] CHRISTINA: Yes. Okay. There's the six skills. Can you tell us what those six skills are and then we can go down and write down each of those skills? 

[0:18:22] CAITLIN: Okay. The first skill is called, tracking. then the next one is called resourcing. Next, we have grounding, gesturing, and then shift and stay. Gesturing, and shift, and stay. We will definitely talk about those, but I use the first three the most. I use those with my students. I use those, my husband and I are always using them with each other. Now I like feel like I have that accountability partner when things start to get a little escalated between us. He's like, ÒWe need to use our skills.Ó I'll say, ÒI just want to be angry.Ó 

Yeah. There's tracking, resourcing, grounding, gesturing, shift and stay. So, the first one is tracking and that really is just noticing what's happening in your body. A lot of times, especially if you've been through a really traumatic event, I mean, you just feel so disconnected from your body. I know teaching yoga. A lot of my first-time students don't even realize that there's toes at the end of their feet. They've never thought about it or sensed it or felt it. 

Tracking is just paying attention to where you feel sensation in your body. This is a really tough one for people that have never done it before. That's okay. That's really, okay. Especially, when I was working with the students at my husband's school. It was really hard to try and get them to figure out what tracking was because they were so caught up in their heads. It was like, ÒWell, I think I just feel a lot of anxiety in my chest.Ó ÒWell, tell me what that feels like.Ó ÒWell, it feels like I'm stressed.Ó Those aren't sensing words. 

What is the sensing words? Do we feel heat? Do we feel tightness? Do I feel a certain color? Do I feel Ð I know that sounds really strange feeling color, but like really just closing our eyes, tracking what it is we feel in our bodies and just noticing it for what it is. Not placing its negative, its positive, its neutral just yet, juts noticing. Okay. Which is our first clue to feeling that we've been bumped out, right? 

If somebody gets bumped really low, they might just feel cold, tired. ÒI feel heaviness in my shoulders. I noticed that my heart is beating really fast and I can feel this energy in my chest.Ó Or, ÒI noticed that I'm breathing really shallow and really quickly.Ó Those kinds of things. Or maybe, ÒI feel pain in my head.Ó There's lots of different things. So, tracking is just that first bit of noticing that is really powerful and helping us realize something is a mess or maybe I think it might be a miss, and I do some tracking and I'm like, ÒHey, I'm okay. I'm doing okay.Ó That's the first bit. 

Then the second one is resourcing. Resourcing is one of my favorite ones. I utilize this all the time. Resourcing is thinking about something that brings you joy or strength. It can be a memory. It can be an animal. It can be a person. It can be Ð and you can have several different resources. It doesn't just have to be one thing. I like to pick something when I'm teaching others to do this. I like to pick something that I can think about all five senses as best as I can. Memory or as I'm thinking about a resource, I like to think about those things. 

One of my husband's resources is he Ð there is a garden near us. He will talk about going to the gardens. He'll close his eyes. He'll think about the tall trees. He'll just think about all those sensations and place himself there. So, you use resourcing and tracking at the same time. For me, I think of a memory from a particular yoga class many years ago, and it was an ongoing class on Friday evenings. It's a mesh of all those memories, of I think about just feeling really sweaty, and hot, and strong, and how much space was in my lungs. I could easily take a deep breath. Then I'm thinking about the smell because it didn't smell the greatest Ð chance is IÕm sweaty Ð

[0:22:45] MBH: So true.

[0:22:47] CAITLIN: But as I think about that and I think about the people that are surrounding me that were really good friends of mine. It gives me a sense of lightness in my chest, but then I also just feel like this strength in the bottom of my gut and this peace. I can feel my breath deep in a little bit, and get a little bit easier, as I think about my resource. That's something that I will often do, if I know that I'm going into a contentious IEP, I'll think about my resource before I go in there and get myself in a good place physiologically. If I know that I'm going to have to have a tough conversation, I'll resource before I go into that tough conversation and that's how I utilize it most often. 

Then something that I'm really Ð it is fun that my husband's gone through it, recently, because he, as we're talking or as we're experiencing something as a family, he's like, ÒI'm going to resource this.Ó Then he'll start talking about the sensations. He's much better at this than I am. You guys should have interviewed him.

[0:23:58] MBH: I know.

[0:23:59] CAITLIN: But he'll start talking about the sensations that he's experiencing in that moment. If we're doing something with our daughter and we're at the beach and he's like, ÒOh, man. This feels so good. I'm thinking about the sun and the smell of the salt air and listening to her laughter. Oh, this feels really good. Oh, I just feel this like burst in my chest of joy.Ó Which is not necessarily a sensing word, that joy word, but Ð and then he's like, ÒI'm going to add this to my resources.Ó So, that's also helpful for us. That's resourcing. 

Then grounding is very similar to tracking, but you're being a little bit more intentional and you're being a little bit more in terms of tracking you're just noticing what's going on, getting those quick sensations and grounding is a little bit more intentional about paying attention to getting our body grounded. You can either stand, you can sit. I know in Ð sometimes I'll stand up and find a wall space and especially like the edge of a corner, and I'll rub my hand against that corner. Then I'll just feel whatever it is that's supporting me. 

Sometimes I'll lean against the back of a wall, so I can feel my feet down on the ground, my body pushing up against the wall. Then it's really just looking for those places in my body. Maybe you start, if you're sitting, starting to feel what does that sensation feel like as I'm sitting on the chair. Do I feel my bottom of the thighs being supported by the chair right now? I'm a little short, my feet never touch the ground in any chair I sit in, but I crossed my legs, so one foot is on the ground. 

[0:25:43] MBH: I did not know that. For some reason, your pictures, I thought you were about like 5Õ7. I had you. 

[0:25:50] CAITLIN: No. I'm 5Õ2. So, I mean, I'm not really short, but I just Ð my feet are always flailing in chairs. 

[0:25:57] CHRISTINA: I have the same problem, Caitlin.

[0:25:59] CAITLIN: Yes. As I say, Christina and I are about the same size. So, I'm feeling my one foot, the ball of my foot pressing down onto my chair. I feel that support. Then I have a great chair with some armrests, so I'm pressing my, I can feel my wrists and my forearms pressing into the chair. Then once you feel that groundedness, can you start to feel relaxation or deep breaths. Then moving up from the bottom up and noticing, ÒOkay, do I notice my feet?Ó What does that sensation feel like? Is it positive, neutral, negative? Then you just move up and find those Ð just taking sense of what is a positive feeling, or a neutral feeling, or a negative feeling in your body. That's grounding. 

Then gesturing, I don't really use, because this is more having to do with that, the idea is you work through these skills to get somebody in their resilient zone. Then you start to talk about their trauma, or you start to talk about whatever it is that they've come to mental health therapy to talk about. So, then you start to gesture and this is a little bit of where that co-regulation can sometimes come in. As somebody's talking, a lot of times they'll move their hands or they'll take a deep breath. If I'm the clinician, I would say, I would either start to imitate them. 

If they're moving their hands, I'll just imitate them and draw attention to that like, ÒOh, I see you're moving your hands. How does that feel if you were to do a little bit more of that? How does that feel if you were to change that movement a little bit?Ó It has more to do with that idea of moving energy through your body or moving some of that space out or noticing how, ÒOh, I just noticed you took a deep breath. Did that feel positive, neutral or negative?Ó It's a lot of just asking questions.

Then shift and stay. I actually do use shift and stay quite a bit for my own personal, but shift and stay is this idea of working through negative sensations in the body. I use this all the time when I have headaches. I like to think about where the pain is in my head or wherever it might be. Then can I go to the very edge of the pain? Then what does that feel like? Then after I sense that I'll find a neutral place in my body. My toes are always neutral. I'll go and feel like, ÒOkay, what do my toes feel like? Okay, I noticed that neutral space.Ó 

Then I'll see sometimes, I'll do different things where I'll either think about growing that neutral space up my legs all the way to my head or I'll go back to the pain, see if I can take a deep breath and soften that edge of wherever the pain is in my head or wherever it is. Then go back to my toes. That's the shift and stay where you're toggling between positive sensations and negative sensations in your body. I use it for pain. 

It was utilized with us during the mental health therapy training that we could utilize that. They were using it a lot with veterans who were experiencing a lot of physical pain. That's something. That breaks them down in my daily and with my students. I use tracking, resourcing and grounding. Then personally, I use shift and stay. Then I don't ever really use gesturing.

[0:29:35] MBH: You donÕt. Okay. We have a question from one of our participants and you just touched upon it a little bit. She said, ÒSo, this can be used for more than just trauma?Ó 

[0:29:44] CAITLIN: Absolutely. Absolutely. I mean, trauma I think it's important to think about how we define trauma. Something that Rachel Archambault said at our back-to-school conference, which just really resonated with me is this idea of in the trauma world, there's big T and little T. Big T is things like Maui. We had these horrendous wildfires that happened and that is big trauma. Then there's little T that happens that it does impact our nervous systems when somebody cuts us off on the freeway, right? Is that as traumatic as Maui? Probably not, but it is something that is, it bumps us out of our resilience zone or it can. 

Then Rachel also talked about working with students is, it's not really helpful if it's really important to that student and really traumatic to that student, is it really helpful for me to ignore it if I don't view it as being a big traumatic thing. So, I think, that's just a, I digressing a little bit, but you can use this for more than just trauma. I've used it for pain, like I mentioned. That's been so helpful. I also like using it for language therapy and how I've utilized it. We know that our students, our autistic students struggle with interoception. They struggle with those inside sensations. They don't really know what those are. They don't have language for them. 

We know that our students sometimes struggle with knowing when they're hungry, knowing when they have to go to the bathroom, knowing these deep sensations that we think everyone just knows. So, I feel like sometimes this tracking or this resource Ð the tracking and the resourcing can help them with some of that, especially, if we are Ð I'm noticing that they're having fun and I ask them, ÒWhere does that feel good in your body?Ó Sometimes they just look at me and I'll give them the example of, ÒOh, it feels really good in my body, in my tummy. I have some funny sensations in my tummy.Ó I'll just model that for them. I like to use it in that way too. 

[0:32:00] CHRISTINA: You're telling me that this can be used for potty training? 

[0:32:03] CAITLIN: Well, yeah. I mean, I guess so, right? I didn't even think of that. We just went through that with my daughter and I didn't necessarily think of that of like Ð but it can be, right? Just that general idea of thinking about our sensations, giving language to our sensations and getting out of our heads a little bit, I think could be helpful. Yeah.

[0:32:28] CHRISTINA: That is really interesting. That's so cool. If someone would like to learn more about TRM, what resources do you recommend? I mean, I know you mentioned the book and the website, but what else would you recommend? 

[0:32:43] CAITLIN: The book and the website, there's also a free app. It's called iChill. I have it on my phone. The graphics are very old. It's a free, it's a free app, so you get what you pay for, right? But it has the skills in there, which are really helpful if you can't remember. It has the iChill overview where it talks about just what the Trauma Resiliency model is. The skills are there and it's, yeah, it's awesome to have. 

They created it, because they were originally working with these returning veterans with PTSD, and something would happen, and they would immediately just get triggered, and they didn't really know what to do. So, if we give them an app on their phone that they can just pull up and work their way through the skills, they found it really helpful. It's helpful for me too to like, okay, I was going off of the skills, looking at the app as I was talking about them. 

[0:33:41] MBH: That's really interesting. 

[0:33:43] CAITLIN: Oh, I forgot. She also has a podcast, too. If you look up Ð and they have lots of different topics that they cover. It's not just trauma related. I'm trying to Ð I think they have what they do a podcast every Tuesday, I feel like. She's on Instagram too. If you look up Trauma Resiliency or Trauma Resource Institute, you should be able to find them. Yes, iChill app. If you just put in your app store, iChill, it should pop up. It should be, let me see if I can pull it up so I can just describe the logo to you. It looks like people holding hands, standing on top of the world and then like a sun up above them is what the logo looks like for iChill. 

[0:34:28] MBH: Okay. 

[0:34:29] CAITLIN: It's all one word. 

[0:34:30] MBH: Excellent. Excellent resources. Well, those are very helpful. Okay, so we have our, our six skills tracking, resourcing, grounding, gesturing, shift and stay. You said you mainly use the first three in therapy, sometimes you use gesturing and not shit and stay as much in speech therapy. Can you give us some examples of how you use those skills in therapy? You are mainly in the preschool, correct? 

[0:35:03] CAITLIN: I'm actually, this year, I am preschool through sixth grade. 

[0:35:07] MBH: Oh, okay. Perfect. Okay. If you could give us an example for like the preschool younger side and then how you might use it with those, I guess, sixth grade, we've got some tweens in that age group, where it's one thing that as you were talking and I was thinking you were in preschool. I was thinking how wonderful for these kids to learn this at such a young age and to be noticing what their resources are and intentionally building those memories of those positive resources, which when I think of intentionally building those memories of positive resources, you really are talking about mindfulness, really being present. This is great stuff. All right. 

[0:35:57] CAITLIN: Awesome. Yeah. That's really, I think like I said before, I think that's why I took to it so well, was because I had been practicing yoga for about five years. Then it was like ÒOh, this is yoga on steroids.Ó It's coming at it from a little bit of a different perspective of, I think, what I had learned about yoga up until that point was so removed from the regular world. You sit in meditation, and you're quiet, and you're present in your sensations in your body on your mat, but this is like as you're going through everyday life, how are you experiencing the world? 

[0:36:35] MBH: Well, often in yoga at the end of class, we say that, bring the namaste with you throughout the day or bring these feelings throughout the day, but we don't really have any concrete method for doing that. The TRM provides that. 

[0:36:53] CAITLIN: Yes. Yes. Absolutely. Yeah. What I'll do a lot of times is I'm walking with my students, because I will go and get them. This is the first year that I've had a very on top of it type A principle who's like, we're doing IEPs on this day, this is how it's going to go. In the past, it's just been a free-for-all all of whenever you can schedule an IEP, you schedule it. So, I have always walked to go get my students, because I try to keep to a schedule, but when you are living that way well, you can't. 

It's just habit for me to walk and get my students and especially the little ones you want to. As I'm walking back to the therapy room, I'll usually check in with them, ask them how their day is or Ð but that's a pretty big question. How was your day? I was just in an IEP this morning and the mom said, ÒMy kindergartner doesn't answer how his day is. He said it was good.Ó I was like, ÒWell, it probably was good.Ó But we have to be a little bit more specific. Anyway, I'm digressing. 

I might ask them a specific question about did something funny happen? How did that feel in your body? But then again, that's really hard for them to put themselves in that moment. I might ask them as we're walking to, do you feel the sun? What does that feel like on your skin? Because we live in Southern California so it's always hot. What does that feel like on your skin? If somebody does something funny during therapy or if somebody shares like, ÒIt was my birthday.Ó How did that make you feel in your body? What does that happiness feel like? It was things like that. 

Then I'll get like I said, I'll give them examples of like, ÒOh Ð and I'll even make it, ÒOh, my cheeks really hurt when I was laughing at you when you made that funny joke.Ó Or, ÒI felt sensation. I felt that my cheeks felt funny from smiling so much. They felt tight.Ó I'll give them like that a sensation. It doesn't have to be super deep, just them even noticing it. Then again, it's really what we do all the time because as we're working with articulation, do you feel that sensation? Do you feel your tongue there? Do you feel your lips making that shape? I find that to be it goes really well with what we're doing because we can also apply some of those ideas to speech. 

Then again, giving them some of those sensations, sometimes if I notice a student is dysregulated and then we can get them regulated because you can't really take in a lot of information as you're dysregulated. As that happens, I might, once I get them regulated and I'll say, ÒHey, I noticed that your shoulders are really high or you seem really angry. Where do you feel your anger? You seem really upset.Ó of course, these are students that I've been working with for a while that I might say, like I might give them examples of like, ÒI feel really Ð when I feel really angry, I feel it in my chest.Ó Because a lot of the students that I'm working with, they don't have the language. I'm just always modeling the language of what I'm seeing. 

ÒHey, I'm noticing this in you. It feels like this in me. Does that feel right or wrong?Ó Sometimes they'll say, yeah, or no, or they'll ignore me. Then again like, talking about, as we're walking with my students, that might be a little bit, have a little bit more language as we're walking, ÒWhat did you do over the weekend? How did that feel in your body as you talk about it? When you're telling me that your dog had puppies and I see you smiling. How does that feel in your body?Ó They'll give me some really profound answers sometimes that I wasn't expecting, IÕm like, ÒOh, that's really cool that you felt that in your body.Ó Like, ÒOh, my tummy tickles when I think about the puppy licking its mommy.Ó Or something. It's like, ÒOh, okay, great.Ó

I know that that's a difference from the Trauma Resource Model when the mental health therapists are doing the therapy. They're not giving their sensations at all. They're not talking at all, but this is a little bit different from my perspective of working with students that don't have the language. Just to make that caveat that what I'm doing is vastly different than what I was taught to do, but I feel like with some of our students, like I mentioned before, especially our artistic students, they don't really have those interoception skills. So, we're trying to build those and trying to build focus on what sensation feels like, because they've never really done it before. 

I'll use those with like my older students, tell me about what you did over the weekend. What did that feel like? Tell me about a funny memory. What do you feel in your body as you're starting to tell me that? Those students can do some of those things. If they said, ÒOh, I just felt really angry.Ó ÒWell, what did that anger feel like?Ó I'll keep pushing them, and pushing them, and pushing them. That's a thinking word. What are some feeling words? Then we'll brainstorm feeling words. Then, ÒOkay, which ones do you want a circle of how you felt?Ó It can be a language activity that we're Ð and that's, I think, the difference between what I'm doing with it versus the mental health therapists. They're really trying to get people to think about it. I'm bringing in both things. 

[0:42:19] MBH: How do you bring in the resourcing into a session? 

[0:42:23] CAITLIN: The resourcing, sometimes like I'll ask them what they did over the weekend. What is it that made you happy over the weekend? What is it that made you laugh? What is your favorite memory with your family? Especially, at the beginning of the school years, as we're trying to get to know our students and build up that rapport with them. Well, IÕll go around and share our favorite memory. Then we'll share how it Ð as we're talking about it, I'll just ask them, how does that make you feel in your body? I don't necessarily teach them like, ÒOh, this is something you can take with you always.Ó 

I'm not necessarily teaching them that aspect of it, but I might, for those students later on, as we become closer, or I know I had some Ð I had a sixth-grade girl last year who I actually had as a first grader and kindergartner at a previous school many years ago. I guess five years ago, but it felt like it was a pretty long time. She was a sixth grader and she was going through some pretty tough stuff at home. 

So, I did mention to her, ÒAs you're telling me about hanging out with your family and going to the drive-in movie theater and you're describing all these things, you can always come back to that to help you feel those sensations again.Ó Because she had a lot going on last year. I did mention that with her, but I don't necessarily mention it with all the students, but she was someone who had come to me opening up about some pretty tough stuff that was going on at home. We can be that safe space for our clients, our students, our patients. That was helpful for her, but she's really the only one that I've ever done that way.

[0:44:10] CHRISTINA: Have you ever used any of the skills with any of your students who have maybe having a meltdown or are very, very dysregulated when they come to see you? 

[0:44:24] CAITLIN: I haven't, but only because I feel language is not helpful when those students are super dysregulated. This has more to do with me watching occupational therapists over the last 12 years and picking their brains. I just feel like adding more. Of course, I'm thinking of my students that have language processing disorders already. That's just adding another demand to them, but later on, once they're not dysregulated, we might talk about it, or we might talk about like, ÒHey, you can feel really angry in your body, but you Ð and I know you feel angry in your body, but what's a better way other than destroying some textbooks or throwing things or tearing off the bulletin board?Ó 

This was a situation that happened last year with Ð it was like one of my first sessions with the student. I realized where I had messed up, was I was doing, once a month, I only take data once a month with my students, because our sessions are so short in the school setting. I want to utilize as much time as I can for that teaching and that practicing, but sometimes I feel like data gets in the way of that a little bit for the data collection. 

Anyway, the first week of the month is you typically when I do it. I will work with the student one on one, take their data, exactly how the goal was written to take it, and then I'll work with the next student, and so on and so forth. So, I give them, I think that week where I had given the students Magna-Tiles to work independently while I was working with them one-on-one. I had told the students and I was new to them. They weren't used to this process, but I said, ÒOkay, Mary Beth, Christina time to switch.Ó My student was building something that he knew in his brain, what he was building. He was working very hard. The other student just came right over, he was told to switch and started playing. It wasn't enough time for that student to make that transition happen for him. He lost it. 

So, looking back now, I'm like, of course he lost it. I totally disrupted what it was that he was doing. He just really immediately started and he has a brand-new teacher to working with students that present as he does. So, they were like really afraid and I noticed that he needed a lot of deep sensation, because he kept pushing against me. He wasn't trying to hurt me, but he started to just rip things apart and I got him into an area that he was safe. He was pushing against me. I just kept pushing against him too. Then I eventually, he eventually calmed down and I just rubbed his back with deep pressure. Then he calmed down and then I said, ÒStudent, I still love you. We'll talk about this later. I still love you. It's okay. I understand. We can be angry sometimes.Ó 

Then later on, when I went to go talk to him, I apologized, I said, ÒI'm really sorry. You were so busy working on that and I didn't give you enough time to finish. I didn't let you know that I wasn't going to give you enough time to finish.Ó So, I was much more mindful of that in the future, but then at that point, after building some rapport with him, I might bring up as we're talking about it, what does it feel like to be angry in your body? Where do you notice that? But in the moment, I just felt it was too much for him. Once he calmed down and then we talked about, ÒOkay, in the future, I'll give you a two-minute warning or a three-minute warning or whatever.Ó I have had no behavioral issues with him so far. I think it's important. I think it's important sometimes to apologize when we're like Ð 

[0:48:27] MBH: I was just thinking the same thing. That really giving him that grace, apologizing and giving him grace and recognizing that there was someone else who contributed to the situation, that's huge. 

[0:48:44] CAITLIN: Yeah. I'm always going back to, oh, man. Kids have no control, like Ð they don't make any decisions in their day. Even when they think they're making a decision, it's because I've offered them two decisions that I'm okay with, right? So, I just have to remember that, that like sometimes the tantrums that we see or the things that happen, it's like, ÒOkay, well, let me put myself in his shoes. Let me try and think about what's happening for him.Ó Anyway, I'm digressing or not. I'm moving away from the Trauma Resource Model. 

I think it's helpful to take into consideration everything that's happening with a child. That's what Trauma Resource Model, like the basis of it is looking at everything that can happen. Then how do we bring ourselves back to that resilience zone, not happy, just resilient. Thinking about this particular student, I have seen him since then, get angry, but he's no longer throwing things and trying to tear up the bulletin board and pushing against his teachers. He's getting angry, but he's able to channel that anger in a way that's positive. That's something that we're trying to do with our daughter all the time. You can be angry, but you cannot hit. Hands are not for hitting.

[0:50:05] MBH: Well, also, as you've been talking, IÕm thinking about how this applies to adults. Christina, did you want to talk a little bit about that? I know you and I both work with adults and we talked a little bit about how this might apply. What are your thoughts? 

[0:50:21] CHRISTINA: Wow. I'm just hearing these six skills for the first time tonight with everybody too. I'm thinking to myself, I work with voice and following patients. There's so many sensations that go into your voice and into, I mean, Mary Beth, you and I talked about resonant voice and feeling the sensation in the front of the face. I have to tell you, there are not very many people who are in touch with their bodies, and in touch with their voices, and in touch with their swallow. 

I mean, I think I'm one of those, sadly, but because I've been able to develop that skill, it works for me and I help them develop that skill as well. Where do you feel that in your body? What does that feel like to you? Is that easy? Is that challenging? Is that that rough to you? What does it feel like inside if you use that type of voice method or whatever?

I honestly wish that this was something that we taught in school, like what does this feel like Ð growing up in school, what does this feel like inside of you? Because there are patients who come to me and they are not good voice therapy candidates, unfortunately, because they have not developed this skill. I don't have the time to teach them the skill from the get-go of what that feels like in your body. Then to maintain that, your conversational voice use. It definitely would be helpful for the voice population. I don't Ð what about you, Mary Beth? What do you think? 

[0:52:07] MBH: Well, I just think of when you, most of the time when you see an adult, they have experienced some trauma prior to coming to speech therapy. There's a medical diagnosis that is usually traumatic that they have been working through before they see you or if you're working in an inpatient setting. They're in the midst of their trauma. Being able to give them the language to track some of those feelings and how it feels in the moment. 

Then when they're struggling to be able to actually, I wouldn't possibly use this to help an adult who's dysregulated quickly during a therapy session. I had someone recently and within five minutes of them arriving, it was pretty clear that speech therapy was probably lower on their priority list. They had other priorities and were very emotional. Possibly being able to use the tracking, resourcing, grounding to then get back into the task at hand for speech therapy. 

[0:53:28] CAITLIN: Absolutely. I think that could work. As you were talking, I was like, ÒOh, I did use some aspects of grounding.Ó Which actually got me interested in doing my yoga teacher training to begin with, was it was my first year and I was working in the emotionally disturbed classroom, which is, that's what it's called in California for your mental health students that are experiencing mental health issues. That classroom to be real, it was just a potpourri of students. It was, if they had behavior issues, they put them in this class. 

I just remember there was a lot of energy in the room that day. I didn't really care what I was having to say. I thought, I was trying all my teacher tricks that they say to use and they weren't working. I thought, well, what works for me, breath, but if you've ever asked a child to take a deep breath, they start hyperventilating. Then I had them elephant. I was like, ÒOkay, let's do some elephant walking around the table, because I thought, how do I get them grounded? I'm coming from a yoga practitioner, somebody who had been going to yoga classes, but I hadn't really gone through my training yet. 

I had them, I was like, ÒOkay, kids know what elephants are. Can they take big, heavy steps around the table?Ó Then after they could do that, then I modeled some, ÒOkay, let's breathe our arms up, see how long it takes you to lift your arms up with your breath, and then let them go.Ó So that was helpful. Then they were like, ÒWhat are we doing?Ó I was like, ÒOh, we're doing yoga.Ó So, then we did some tree pose. Then I tried to do crow pose with them. They were fifth grade boys, so they were very into showing off. Then we moved on to the table and we were able to sit at the table and do whatever we needed to do for the rest of the session. That's what, I was like, ÒWhoa, there's something here. This is helpful for kids.Ó 

I have done things like that, but I haven't necessarily brought in the language of, oh Ð and I think now, I probably, would. Notice how your body feels after we did that. What is that Ð I have done that with some kids. I shouldn't say you know. You don't know this. My office is up two flights of stairs. When we get to the top, I'm like, ÒOh, man. My body feels so tired. My legs feel so heavy. My legs they feel tingly and they hurt. What are yours feel like when we get to the top?Ó Or, ÒOh, I noticed I'm out of breath. It's hard for me to take a big breath.Ó The kids will say, ÒMe, too. It's too hot.Ó I'm like, ÒYeah, it is too hot.Ó I think that was helpful, Mary Beth, to hear you say, ÒOh, well I've got people coming in.Ó Especially, your adults that are coming in, they're rushing around all day. Then to sit and focus on something that's hard for them. I can see resourcing being really powerful. 

[0:56:26] MBH: Here, one of our participants says, ÒThis seems like a helpful tool for stuttering as well.Ó 

[0:56:31] CAITLIN: Absolutely. I have two on my list rate or two on my caseload right now that have no idea what's happening in their bodies. That's something that like, it can totally be helpful of maybe doing, sometimes tracking is too hard, so you might want to start with grounding first. Then getting that sensation of what does it feel like when you push down on the table, or you push your feet down on the floor, what does that feel like? Because that's Ð when you're doing something active, you can feel that sensation versus just I'm sitting here supposed to be sensing my body. What does that mean? That's something that I should mention is, I don't use them like, ÒOkay, I did this one. I did this one. I did this one.Ó I use them wherever I feel like it's appropriate for that child or for myself or whatever. 

[0:57:21] CHRISTINA: I like that. You can pick and choose not necessarily go in that order, the order of like one through six, the skills, but you can choose which one you feel like you could implement and it would be helpful for your students or your clients. 

[0:57:38] CAITLIN: That's how I utilize it. I mean, I don't know that that's the try Ð TRM model, but like, you sit down and you're like, ÒOkay, what are you feeling in your body?Ó ÒWell, I don't really know.Ó ÒOkay. Well, what happens if you push against the wall? What do you feel? Do you feel the coldness of the wall against the skin of your hand? Where do you feel that coldness? Where do you feel Ð what does it feel like if you were to push harder or whatever?Ó I think I would use Ð I don't think the TRM people would have a hard time with me saying that because if you've never done this before, like Christina, you were saying they're not good candidates, they've never learned this before. 

Sometimes we have to start small and teach them. That's where I have started with grounding, especially when I was working with the college students. Some of them had no idea, had never done it before. Then I would just have them close their eyes and like take a deep breath. ÒDo you feel the back of your throat get cool as you breathe in through your nose?Ó ÒNo.Ó ÒOkay. Well, why don't we take a couple of deep breaths? What do you feel?Ó That's a little bit more. Again, the TRM model is more about asking questions than guiding the process but I feel like sometimes, people need to be guided or given examples because it's like, ÒWhat do you mean? I've never done this before.Ó I don't know. 

[0:59:01] MBH: Right. Well, and as you said, sometimes the language helps too. 

[0:59:05] CAITLIN: Yes. 

[0:59:08] MBH: Very interesting. You were the first SLP to go through the TRM training. Do you know, are you aware of other SLP is taking the training? 

[0:59:18] CAITLIN: I don't know. I don't know if I was the first. I just know I was the only one in that particular training. There was a woman who had been an educator for many years and then became a mental health professional. So, she was really fun to connect with during that weekend, because she's like, ÒOh, these are some things that I did with my students.Ó Or, this is Ð I did, she would do like sandbag breathing is what she called it. So have her like kindergarten students take a deep breath in. Then as they release, think about sand, like leaving their toes, like you're filled with sand, and then as you breathe out, all the sand is slowly going out of your body and out through your toes. She would do things like that just to get her students grounded because it's new information. 

I don't know if there's other. I'm sure there are other speech therapists who have gone through it. I know when my husband did his, he did the community model. I mean, he's a chaplain. He's a mental health professional, but not. There were retired people that were in it that were just curious. So, I'm sure that there are but I don't know who they are. 

[1:00:35] MBH: Oh, wonderful. All right, Christina, did you want to add anything? 

[1:00:39] CHRISTINA: No. I think Caitlin, this was so valuable. I wish, like I said, I wish we all learned this in grade school and there was a little class about it. I mean, but what you're doing with your students, that's amazing. I think it's great, great work. We could all benefit from this for sure. 

[1:00:58] CAITLIN: Oh, thank you. I think it's helpful for me personally, to keep myself present or to keep myself recognizing what's happening. I think, like I shared that story about the student who was dysregulated. If I had been really triggered by his outburst and really afraid and like, ÒOh, my gosh.Ó I probably wouldn't have responded the way that I responded. I really attribute it to the work of TRM and me practicing these skills of like, ÒOkay, let me take a step back. What's really happening here.Ó Instead of just reacting to the student and how can I respond to him? He's upset for some reason. Why is he upset? Like that's not a normal reaction to being told to switch places. I think that it's helpful for me. I think it does help the students. I'm just really grateful for it. I definitely encourage everyone to check them out. 

[1:01:54] MBH: Well, thank you. It was so fun to be with you tonight. This was so helpful. I'm just really excited to think of you using this with the preschoolers and the grade schoolers who you work with. As Christina said, to think of kids learning this at such a young age and having this as a resource for whatever traumas they encounter down the line. Also, as we said, to put it to use with some adult work as well. Thank you so much. It was so helpful. We would love to have you on again, but you're going to be a little busy in the next couple of months, huh? 

[1:02:31] CAITLIN: Yes. Yes, I am 35 weeks pregnant. I'll be busy, but if anybody has any continuing questions, I am on Instagram, this.speech.life. You can also reach me at the same, Gmail account as well, put it in the chat. If you have any questions or you want to know more about it, I'm happy to point new to the right way. Yeah. Thank you. Well, thank you. Great questions, everyone. 

[1:03:07] MBH: Thank you. Have a great night, everyone. Take care. 

[OUTRO]

[1:03:11] MBH: Thanks for joining us here at Keys for SLPs, providing keys to open new doors to better serve our clients throughout the lifespan. Remember to go to SpeechTherapyPD.com to learn more about earning ASHA CEUs for this episode and more. Thanks for your positive reviews and support. I would love for you to write a quick review and subscribe. Keep up the good work.

[END]
KFSP 72		Transcript

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