A Child Abuse Pediatrician's Look at Therapeutic Methods, Part 2.
If you haven’t read part 1, you may want to check out that post first.
Below, I’ve reviewed several more therapy methods, and I’ll give you my perspective on them.
Intensive Interaction is a way of forming relationships with nonspeaking people. It’s also something that parents do naturally. To practice Intensive Interaction, an adult joins the child in whatever they are doing, mirroring their posture and behavior, and following their lead. This may involve stimming with a child, or taking turns with non-word vocalizations like humming, singing, etc.
By itself, interactions like these are great ways to connect to a child. The problem with Intensive Interaction is when it is used as a false or deceptive connection. Deceptive connections are bonds that are formed with children for the purpose of building a relationship that will then be used as leverage to entice or coerce a child into doing something they ordinarily wouldn’t. Building deceptive connections is one of the steps of grooming a child for future abuse.
Child –Directed Play
Child-directed play is the advanced version of Intensive Interaction. Like Intensive Interaction, Child-Directed Play is a phenomenal way of bonding with a child. And if done as a stand-alone activity, it’s a wonderful thing. But like Intensive Interaction, using the bonds created with child-directed play to manipulate a child to participate in an activity is deceptive.
Hand-over-hand is a technique often used in OT to support a child’s efforts to complete a task for which they may not have the required motor skills or strength. It’s also used when teaching sign language to assist the child in forming words with their hands.
Again, hand-over-hand can be a great support. However, I find that far too many therapists and parents use hand-over-hand without a necessary thing. That thing is consent. If a child wants hand support, it should be provided. But if a child refuses physical touch, even touch that’s meant to be “helpful” or “supportive”, adults need to respect that boundary. Failing to respect their refusal and touching them without consent teaches children that their physical boundaries don’t matter and that adults can touch them whenever they want.
Therapy Without Parents
This is a very common practice. Many therapists, particularly in ABA but others too, do not allow parents in the room with the child during therapy. The idea is that parents may block the therapist from doing what they need to do during the session. This is problematic for several reasons.
First, parents are always their child’s most important teacher. To exclude that person from the session eliminates the possibility that parents can learn the techniques that the therapist is using to help the child. So a therapist might be doing everything right, but excluding parents will undermine all of those efforts.
Second, in my experience, parents only intervene when they perceive a threat to their child. "Threat" is a hard word here, because sometimes it’s not a physical threat to safety. It might just be a sensory threat or something they know triggers their child. Or, it may be a sign of the parent’s underlying anxiety. Regardless, these events are things a therapist needs to know about a family. If it’s the parent’s issue alone, supporting them and helping them find their own mental health care could be lifesaving.
And if the parent is blocking an activity because it’s a trigger, the therapist needs to understand that the meltdown that may follow might not happen in the therapy space. It may happen in the home, the child’s safe space. And meltdowns can be dangerous and traumatic for children and adults. Blocking a child from triggers is the first piece of advice I give to parents whose children have explosive meltdowns. So if a therapist is triggering meltdowns, it’s the therapy that needs to change, not the parent.
Third, and most important, separation from a parent isolates the child from their biggest protector. Even with the use of one-way mirrors, which allow parents to see into the room but remain unseen, separation of child and parent establishes in the mind of a child that the parent is out of reach. That alone might be acceptable in some cases. But paired with the methods above, including techniques like hand-over-hand without consent and use of rewards, it mimics the main features of child sexual abuse: isolation, grooming, and nonconsensual touch. While therapists generally don’t sexually abuse patients, this pattern makes the steps of child sexual abuse part of the child’s routine and cements the idea of their normalcy. This is exceptionally dangerous and sets children up to accept abuse without disclosing it.
If you're a parent and you've gotten this far, it's time to take a close look at your child's therapeutic interactions. It's absolutely within your power to stop the patterns that are priming children to accept abuse.
If you're a therapist, you're wondering where to go next. I highly recommend the Therapist Neurodiversity Collective as a resource for those looking to eliminate these techniques from their practice.