Reflective Practice in DIR

Affect Autism: We chose play, joy every day

Photo by Christina Morillo

What is DIR?

What is Floortime?

DIR Glossary

This Week’s Podcast

Andrew Klein is a DIR Expert and Training Leader and a pediatric Occupational Therapist at Emerge Pediatric Therapy in Durham, North Carolina where he has a specialized role in facilitating reflective supervision with his colleagues. He is also a certified trauma professional through PESI. He started his career at the Rebecca School in Manhattan where his Floortime journey began and he is the father or two active young girls. The topic for today is Reflective Practice in DIR.

I’ll refer listeners to the podcast I did with Dr. Gerry Costa on Formation and training practitioners in this field, which included a discussion around reflective practice.

Reflective Practice in DIR

by Affect Autism

https://affectautism.com/wp-content/uploads/2024/05/2024-05-24.mp3

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Bonus Insights

D = Developmental

I = Individual differences

R = Relationship-based

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Andrew’s Journey to Reflective Practice

I asked Andrew how he became interested in reflective practice. Andrew likes to paint a picture of his journey. He says that reflective practice was created for practitioners but it can be so helpful for parents and families, too. He was lucky enough to begin his career at the Rebecca School, an incredible place where there is a practice of recording and reviewing videos together, with permission of families, for the purpose of bettering the practice for everyone. He probably took it for granted, he admits.

When he moved to Durham, North Carolina to work at Emerge Pediatric Therapy, there was a wonderful culture of supporting a strengths-based approach and the DIR model. He noticed that the practice of watching video to absorb what happened in the sessions wasn’t there. They would sit and talk about cases, but it would be more about analyzing it from one of their frameworks. Something was missing without the video piece. It happens in Floortime courses, but to have it in your work every day is something special, he says.

To further his role as a specialist on the team, he began doing reflective supervision, which he could have also called Floortime coaching, but he liked the idea of calling it reflective supervision because the team sits together and reflects on video. He wanted to gather more information on what this means to professionals. Him and his colleague, Dr. Kavitha Krishnan did a single subject six-week reflective supervision treatment phase, then six weeks of a non-treatment phase.

Fifty percent of participants showed improvements in the treatment phase and afterwards on therapeutic use of self metrics (the P-CAM and the CASI) from the University of Chicago, and on the Reflective Practice Questionnaire which which included things like reflection ‘in action’, ‘on action’, confidence and comfort in the work they’re doing and how they’re using themselves in treatment.

Having Others Integrate Reflective Practice

Andrew soon realized that the next step is to have others integrate reflective practice into their own practice. The first step in his study was the literature review, which helped him deepen his understanding of reflective practice and reflective supervision. He realized that to support other professionals in this, it goes beyond watching then reflecting on video, then asking reflecting questions.

There’s a whole depth in reflective practice and reflective supervision developed by those in the fields of infant mental health and nursing, Andrew continues, but there’s relatively little for Occupational Therapists, Speech-Language Pathologists, and Physical Therapists. It’s simply mentioned how valuable it is. When you submit to have research done, you have to submit it through an IRB, the Institution Review Board, which is the organizational body that controls research and is the gateway to publication.

The process to be compliant involved hours of blurring faces in videos and was a lot of work. Their next steps are to broaden this for others, Andrew explains. They recently created a class on Reflective Practice to broaden interest in this alone. Andrew says that because he loves the research on Floortime and the beautiful works on the value of Floortime to families, he wants to look at the value of reflective practice to practitioners and how it helps practitioners in their work settings.

Reflective practice is a beautiful subcurrent in the Floortime model, but it has a whole world of literature that lives on its own, and I think helping people focus on that, specifically, has its own merit. And, our hope is that if people are interested in this, we can continue to further our research into reflective supervision and create a follow-up course on reflective supervision and gather data on that on its own, which again would be really valuable.

Andrew Klein, DIR Occupational Therapist

The Value of Reflective Practice

I recently re-took the Advanced Certificate course with ICDL, DIR 203 as an auditor, to refresh my learning, and what I took away was the value of reflective practice for parents. I have done a number of podcasts on Self-Reflection, the 9th Functional Emotional Developmental Capacity in the DIR Model, with Clinical Psychologist Andrea Davis. It’s the first thing I tell parents to do: to review video of themselves playing with their children, and it’s the most avoided practice!

I expect an equal amount of apprehension on the part of practitioners to recording themselves on video, even though you do have to share videos in ICDL’s DIR Certificate Courses. Rarely, though, do they make it part of their everyday practice. Andrew says that the beauty of reflective practice is the autonomy piece on the caregiver and therapist level. The reflective realm is one of the most powerful places to find that, Andrew continues, but it’s hard.

Obstacles to Reflective Practice

Andrew talked about obstacles to reflection in his presentation at last year’s International DIRFloortime Conference. One is that it can also mean a few different things in our Floortime world, he says. Capacity 9 is Reflective Thinking and an Internal Standard of Self, and that’s that is an important starting place, Andrew said, because it also reminds us how much we have to have in place to be in our reflective space. We have to be well regulated. We have to have a lot of things going on in place to really be in a reflective mode.

Andrew says that reflection is not something that comes easily it’s also elusive and abstract. So one of the things he’s been trying to do is to bring some vibrancy and joy around reflection. Bringing warmth and attention to reflective practice is really so valuable, he continues.

Defining Reflective Practice

Andrew says that we define reflective practice by the process of reflecting on one’s actions in order to facilitate a cycle of continued new learning. This can be broken down into reflection ‘in action’, which occurs during the therapy process, and reflection ‘on action’, when the reflective practitioner looks back on events. These definitions are derived from Donald Schon’s book, The Reflective Practitioner, which is similar to what Engaging Autism is in the Floortime world. It is a seminal work, Andrew states.

Reflective Supervision is a process for supporting and developing Reflective Practice through supervision. There are three core elements: reflection, collaboration, and regularity, Andrew explains. That definition is by Rebecca Shahmoon Shanok from the world of Infant Mental Health where they’ve really created a robust framework for Reflective Supervision, Andrew says. He became super interested in how it exemplifies the art of practice that’s the most beautiful thing to him. It really resonated with him.

Art and Science

For a long time in his work, Andrew continues, he looks at it as a complicated fusion of using something that is scientific with something that is artful. In terms of obstacles, Schon talks about how this is something that’s really challenging for us in our culture where it is believed that scientific theory will always guide us to an answer, Andrew says. We believe in something until we can disprove it, so we are locked into a very scientific way of thinking, so it’s hard for people that are professionals to believe in something that’s ‘artful’.

For a long time in his work, Andrew continues, he looks at it as a complicated fusion of using something that is scientific with something that is artful. In terms of obstacles, Schon talks about how this is something that’s really challenging for us in our culture where it is believed that scientific theory will always guide us to an answer, Andrew says. We believe in something until we can disprove it, so we are locked into a very scientific way of thinking, so it’s hard for people that are professionals to believe in something that’s ‘artful’.

But Andrew believes that you can use your intuition and, in the moment, reflect on what you’re doing, then use that to pivot, think flexibly, and paint pictures of what’s going right. It’s the art of practice. He also learned to reflect on what’s happening in the moment and it makes him think about the tools we use in Floortime, such as when we talk about wonder and being curious. Seeing the big picture, looking outward and inwardly, and then being comfortable with uncertainty is a big piece, he says.

We can go with the current and as things continue to grow and change, Andrew continues. I shared that from a parent perspective, we have this idea that our children get diagnosed and we go to the experts and they can help us. That’s sort of like the scientific method that Andrew is talking about here. There’s a way that things are supposed to be done and the other piece is more subjective, and more flexible. The intuition is driven based on experiences and what you know.

Parents can think we feel more comfortable when we go to see an experienced professional because they have that experience and they’ve seen so many children, so they can draw these experiences. With Artificial Intelligence that’s coming, that will impact it because you’ll go to the doctor and A.I. will have millions of cases to draw from to predict what is going on.

But, I added, there’s a saying, ‘brains over bots’. Our brains have something that can beat A.I. because of this piece that Andrew is talking about. It’s so elusive, Andrew says. A machine is not going to be able to interpret in an artful way. It’s always going to go back to its data and use that data instead of using all of our ability to really think creatively. The human mind has capacity for that, Andrew believes. DIR is about that nuance, he says.

The Generative Metaphor

Andrew believes that this reflective practice is really about just being comfortable setting the problem, and being able to to describe and create what the problem is in our minds, instead of jumping to the solution because we’re so solutions-driven. We can analyze the problem, know what it is, and understand it so we can describe it in itself. This is incredibly powerful, Andrew believes, because not all problems are solvable.

Andrew talked about the ‘generative metaphor’ that is a really powerful tool that generates reflection. He says that the metaphor, “It’s raining cats and dogs” probably is not a generative metaphor because it doesn’t help you understand the rain any better. It’s just a silly way of describing rain. On the other hand, saying, “He’s going from 0 to 60” about a child you’re observing might help you see that there’s a rapid trigger, so you can figure out how to gain some space in that moment.

The Learning Tree

Andrew always talks about The Learning Tree in his classes because he thinks it is such a powerful generative metaphor and helps frame the way people think about childhood development. I explained that The Learning Tree was Dr. Stanley Greenspan’s last book before he passed and that his son, Jake Greenspan does have a good video describing it. In a podcast I did quite a few years back now, I talked about how I brought my son to Jake Greenspan who shared something very powerful that has stuck with me about the learning tree.

I was waiting and wondering if my son was ever going to reach the fourth Functional Emotional Developmental Capacity (FEDC). Am I ever going to see imaginary play? What’s going on? And Jake described that he saw all 6 FEDCs in my son, but that the tree trunk is very narrow, so we need to widen that trunk. In certain conditions, we might see peeks into the 5th and 6th capacity.

He told me that now we needed to widen that trunk by making sure he can have these capacities shine in different environments, with different people, in different situations, when he’s distressed as well as when he’s happy, etc., and that really helped me reframe that whole concept of the tree. Andrew says that it didn’t really solve a problem for you, but it painted a picture that gave you a path forward. It made Andrew think of reflection ‘in’ and ‘on’ action from Schon’s framework.

Reflection ‘in action’

It’s really about action, Andrew explains. He says that one reason we tend to knock reflection is because people think you’re just getting stuck in your own head. You’re not doing anything. But this framework really gives us our path forward. This could happen very quickly, he says. Reflection ‘in action’ is usually the idea that we kind of bring that voice of what we’re wondering about to life.

I pointed out that Dr. Andrea Davis described it as picturing yourself wearing a GoPro on your head and watching yourself as you’re doing Floortime, having that in mind while you’re also staying in the moment, which is tricky. We do it a lot in the Floortime, Andrew says, but you have to be in the right space for it, or you have to have the right people around you in the right environment. That’s the idea of reflection ‘in action’: being able to be patient being patient.

So there’s ‘in action’, Andrew continues, where we can reflect and choose what we want to do instead of either feeling pressured to act or feeling paralyzed to act. That’s the power of reflection in the moment. It can also happen over the long-term, he says. If you have an ongoing problem, it still would technically be a reflection ‘in action’ because you are thinking about how to solve that problem that is still happening.

That could be something like working with a child for whom transitions are really hard, he suggests. It’s still an ongoing problem and you might reflect on a particular transition, Andrew continues, but you still are reflecting on how you can continue to support that problem.

Reflection ‘on action’

Reflection ‘on action’ is really looking back at events, Andrew states, but still thinking about how you can refine what you’re doing to support each other in the future and that’s the beautiful vessel for the video that we talked about, he says. I pointed out that you remember in that moment what you were thinking when you watch video. The value of it for me is seeing what you missed. I saw so many cues that my son was giving me and I just ignored them because I had my agenda in my head.

Especially when you’re a new practitioners learning, you’re so focused on that you learned and wanting to put it into practice and they’re thinking about that so much, that they miss what’s right in front of them sometimes, and that’s okay because that’s the thing about reflection. It’s okay to acknowledge it and you want it in your awareness because it’s a process we’re all working on. Andrew agrees, saying it’s a practice.

In Floortime, we are firm believers in this as a process and a practice and not something you can just learn and then be done learning because it is incredibly fluid and dynamic, so it has so much depth. So, Andrew says, he is really a big fan of integrating reflection into the work. He gave an example of when he was working at the Rebecca School, immersed in such a beautiful, reflective culture.

Andrew doesn’t think he had the subcurrent of understanding reflection well yet. He would have moments where he was really trying to integrate something he learned from coursework into his practice. He was really trying to integrate his sensory integration learning. He had taken a class that talked about the arousal states, how alert we are, and how it is not always correlated with how active we are.

A child who is seeking consistency and rhythmicity may be over-simulated overall and seeking novelty, or may be under-stimulated trying to seek some novel stimulus to get himself more alert, which in some context is super accurate. He went so far during one of their weekly Greenspan case study meetings as to describe a child who was frequently falling asleep in class as being aroused because he could be rigid and find it difficult to accept change, and looking back at that afterwards, that doesn’t make sense.

Andrew wondered why he would say that, but he was trying to draw from a very specific scientific framework instead of simply observing and thinking. So, he says, dynamically, there are a lot of complexities with arousal level right from how well we sleep at night to how well we are responding in a particular context or environment, etc. The child was probably overwhelmed with transitions, but it would be very hard to describe that state of arousal as consistently hyper-alerted.

For Andrew, this was a great example of if he had had a better reflective framework at the time, he could have painted a picture of what’s going on in this whole child’s life instead of focusing on something so specific. He is happy to talk about his own past shortcomings and in and acknowledging this is how we learn and how we continue to reflect.

Over Analysis?

I wanted to talk to Andrew about his point about people saying that reflective practice is getting stuck in your head. I’ve been on a mailing list of Arnold Schwarzenegger’s new pump club and he talks about how for workouts, people over analyze. They think they’re not working out enough, and wonder if they should so something this way or that way, or in the morning or in the night, and wonder how much protein should they eat. He said, at some point, it doesn’t matter. Just do whatever you can do, which is better than doing nothing.

That’s not exactly equivalent to what we’re talking about, but I said I can imagine that there might be some people who get stuck in the reflection and over-analyzing which might impede them from just being in the moment and attuning to somebody. Andrew says that the difference, though, between reflective practice and just getting lost and stuck again, is painting a picture of your situation and just figuring out how to play and engage and connect with a child in the way that supports their fluctuating arousal states, in the moment.

If we’re really being a reflective practitioner, Andrew continues, it’s about having a space for reflective practice. And we call it reflective supervision, which is when you have that partner. Then you’re able to do that regularly, and that partner is just someone that’s there with you, not to critique or supervise you. I asked Andrew if he thinks that making a plan is part of reflective practice. Andrew says it can be if it’s not prescriptive.

Andrew believes that a plan of action can be helpful if it is derived from a reflective thought process. He thought of a student in a certificate course he taught whose client struggled with free play and required some structure to stay regulated. They came forth with a plan from their reflection. They decided it would be really helpful to start their session with the child by creating a visual schedule, and then still incorporate all kinds of wonderful Floortime in the session.

This plan was derived from a reflective process and that plan should also be dynamic, as it goes on, because if our goal is to really create wonderful Floortime sessions, we probably want to continue to work on scaling back some of that structure to get that child more comfortable with uncertainty and ambiguity, so having a plan is great, as long as that play continues to be dynamic, Andrew concludes.

We have Flexibility

For that I’ll refer people to the 2-part podcast I did with Joann Fleckenstein and Mike Fields on praxis because sometimes parents say their child doesn’t want to play and just keeps running around. In that case, yes, it might be more helpful to have a structure because motor planning and praxis might play into it. The important point here is that Andrew said the plan is always dynamic, so we’re always kind of reflecting in the moment, asking where the child is developmentally, today. How are the individual differences impacting them today?

How is the relationship going today? Does the parent have something on their mind and they’re coming in with a different affect that’s impacting the way the child is reacting? All of these things come into play and there’s so many variables every single day. You can never just pin it down to one or a few things, which is why Floortime is so difficult for a lot of people, because there isn’t a prescription. We have a framework, but we have so much flexibility and it really comes back to practice, so that’s what’s so great about it, Andrew concurs. It’s a beautiful model.

Andrew Klein's Reflective Practice Course

Check out Andrew’s course Reflective Practice in Peds: Becoming your most confident practitioner-self, a 3.5-hour self-paced course that is a nice starting point for reflection focuses on the reflective components works on refining the idea of reflective practice as a study point. It’s on the Therapeutic Edge collective.

This week’s PRACTICE TIP:

This week let’s pause to reflect about our work–whether as a practitioner or as a parent with our child.

For example: Video tape your play and as you watch it, reflect on the points Andrew talked about. Are you in the moment? Are you emotionally with your child? Are you supporting your child’s regulation? What did you miss that you can keep in mind for next time you play?

Thank you to Andrew for sharing his work on reflective practice with us. We hope you found it very enlightening and will consider sharing this post on social media.

Until next time, here’s to choosing play and experiencing joy everyday!

The post Reflective Practice in DIR appeared first on Affect Autism: We chose play, joy every day.