Making Sense

Making Sense Season 1 Intro Transcription

February 23, 2021


SPEAKERS - Carrie Schmidt, Virginia Spielmann, Executive Director, STAR Institute

Carrie Schmidt 00:05

Hi, I'm Carrie Schmidt and this is making sense, a podcast produced by the STAR Institute. In an effort to further our commitment to impacting quality of life by developing and promoting best practices for sensory health and wellness through treatment, education and research. Occupational Therapy best practices ask us to integrate knowledge into practice. And this season of making sense. Each episode offers a different conversation aimed at translating the most current research into clinical action for Occupational Therapy practitioners. This season of making sense is dedicated to the memory of Janet right. Janet was an incredibly enthusiastic occupational therapist. She were here today, she would have been one of the first to create and host a podcast her students, parents and teachers could glean some practical information. She did not want ot knowledge to be abstract she looked for in everyday situations and in daily routines. Her family takes great pride in knowing that the star Institute embraces the same passionate principles that guided Janet. As you listen and learn. Keep her encouraging voice in the back of your mind and her infectious smile in your heart.


Carrie Schmidt 01:16

Today, I'm joined by Virginia Spielmann. Virginia is the Executive Director of STAR Institute. She's a published author, international speaker, and has more than 20 years of clinical experience. She's passionate about the social model of disability, the neurodiversity movement, and how sensory integration theory informs our understanding of health and wellness. Virginia. Thanks for being here today.


Virginia Spielmann, Executive Director, STAR Institute 01:40

Thanks so much, Carrie. Thanks for having me.


Carrie Schmidt 01:43

So we have a new project at STAR the podcast, I'd love to talk a little bit about stars vision and mission and how this format can support and promote that vision and mission.


Virginia Spielmann, Executive Director, STAR Institute 02:00

Yeah, I'm pretty excited about this. I mean, one of the big things that we're passionate about, ist ranslating research into practice as fast as possible. Star Institute is built on a platform of more than 40 years of research. And that's Dr. Lucy Miller's legacy. And researches is great. And the research that they've produced at STAR and with their scientific Working Group has changed the field, you know, in combination with research from other groups on sensory integration, but it can only actually change the field if we understand it and apply it. So that's one of the really exciting things about the podcast. It's aimed specifically at clinicians, as you know, and it reminds me of that, that piece of research that came out a few years ago, and it was written like a Jeopardy question, and it was 17 years, how long does it take for research to translate into practice, I've butchered the title, probably. But you know, from the back of my brain, it was something like that. And so that, you know, this was pre social media as pre podcasts, really, but that's how long it was taking, for new evidence and empirical evidence to change practices. And obviously, that's a pretty long time. And it's pretty unacceptable. And so one of the things that's exciting about this is like, we're giving people a little espresso cup of, of research and what it means in the clinic, and here you go on your way to work, or here you go on your way home, let's just, you know, here's our download for you. And we hope it is compelling and inspiring. And it galvanizes the therapists that listen to it to, you know, really remember why we do what we're doing, feel confident in it. And a little bit of an energy boost as a little researchers for so that's how I view it.


Carrie Schmidt 04:15

I love that it's a great visual. In this first season, we decided to have conversations with the star faculty about something that they're interested in and curious about in current research and how they're translating that into practice. We all happen to be occupational therapists. And so this these conversations definitely have been aimed at, at clinicians at how we take this research and how we translate that into practice. But what one of the also one of the common themes and one of the things that occurs to me when we're talking about this is a value that we all share it star that makes these conversations pleasant and feel like that shot of espresso. And that is curiosity. Okay, he just approach everything we read with such curiosity about how we can not only think about this and, and further thought development in this field, but how can we take it to our clients? And how can we share that curiosity with them also. So,


Virginia Spielmann, Executive Director, STAR Institute 05:27

insatiable curiosity, I think, and I think that's one of the fun things about it. But you know, what, what happens is that star we, we cultivate the organization we want. And so we get to nurture our curiosity. It's part of our practice as part of our reflective supervision. It's part of our journal clubs. And it's part of this podcast, I think, you know, having experienced working in a big hospital, myself and the earlier years of my career, and then in a, in a busy pediatric Assessment Center, and those sorts of environments. In a special needs school, when you're not connected and plugged into somewhere like Star that makes space and time for curiosity. You're socialized into an environment that's about productivity and outcomes, predominantly, right, there isn't that balance? You know, we all have productive productivity expectations, but balancing it out. And we're so lucky and privileged at star. And I think one of the things about this podcast is that we want to make a little bit of space for that, right. So cute, here's a space to give you kind of a little bit. So ask some questions. We're not just trying to give randomized controlled trials like this is now an evidence-based practice treatment effectiveness, we will discuss those things. But we're also going to look at research outside of occupational therapy and say, Hey, they're talking about the same thing as us. They're just using different words, what does this mean, it's going to lead to further questions. And, you know, I guess it reminds me of the concept of living life as inquiry. That's, that's kind of one of the this is this, this is a space for that. Right? So we're gonna, we're not just looking for confirmation bias here. We're not just looking to prove that this is a thing or that's not a thing or you know, but we're asking questions, we're living life as inquiry. And those questions lead us to deeper questions, and we can make connections. And we can be inspired to that. Systems knowledge that's so important to us at Star Institute. And I love that it was in the occupational therapy practice framework for as one of the contributors to the cornerstones of occupational therapy practice was micro and macro systems knowledge. And I think what you're going to do in this podcast is zoom out, deep dive, zoom back in, zoom back in, hone in, hone in, zoom out, how are these things connected? What's happening here? What's happening next? And so yeah, I love bringing it back to curiosity. That's, that's such a key pivotal piece here.


Carrie Schmidt 08:36

So one of the practices that we hold space for at star is reflective supervision. And you mentioned, we also value learning from complementary fields. And so one of the places that self-reflection is used is infant mental health. We have mind that beautiful developed thought development, for how it supports what how we understand sensory health is built from infancy forward. So talk a little bit about that talk a little bit about what we're learning, by holding space for reflective supervision and by looking to other fields, like infant mental health, for how they can contribute to and also teach us something about how integral sensory integration is in health and wellness.


Virginia Spielmann, Executive Director, STAR Institute 09:37

There's a couple of directions I could go with that. I think first just to just to speak to the reflective piece. Infant mental health is a multidisciplinary field, obviously very informed by mental health practices. And it's, I think, got the most wealth Developed mature and operationalized models for reflective practice and reflective supervision that I've seen, across disciplines. And what's beautiful about reflective practice and infant mental health and reflective supervision is that it safely makes space for the emotional content of our work without moving into counseling. And like breaching those, those boundaries between private life and professional life, there's some, there's all those wonderful resources available within the field. And I do encourage people to look at that closer. When you're looking at sensory integration, and the development of sensory health in a client, you are looking at an aspect of human development that cannot be siloed out and treated in isolation. Because almost everything we do every day is a sensory event. As well as something else, it's very, very hard to find an activity that is only sensory, or, or not remotely sensory. It's very hard. And so if you think about your morning, this morning, when you woke up, perhaps you woke up naturally, perhaps you were woken up by an alarm. But as you came into your body and woke up, you were experiencing the integration of your eight, open, cross-modal sensory systems to create the big picture of where you were in your bed in your house. In your street, you heard the sounds maybe of the garbage truck, or the toaster popping, and oh, that's early, someone's already having breakfast, you smelt things you felt your body, I have a weighted blanket. I felt that on my body and didn't want to move. Everything's a sensory event first. And so when we really look at sensory integration and processing it, we have to take into account the impact it has on every domain of human development and function. in pediatrics, the primary occupations are  formation of relationships, and play. And you also have your young clients developing their sense of who they want to be in the world. And so you see the whole family, you see a child, you see the whole family, and that's something we feel very strongly at STAR is that you can't, you can no longer do the dry cleaning model of therapy, once you start doing sensory integration, there is no drop off, fix my child, I'll pick them up later, because you're seeing an individual embedded in multiple systems like a babushka doll, nested ecologies. And so that's why reflections important, because you have to be able to zoom out and zoom in and you have to notice and observe what's happening in the room. You need to be able to ask questions about those systems. And you also need to recognize the presence of emotion in almost everything you do, feeling your body is fundamentally emotional and sensory. And so if we don't pay attention, if we're not intentional about the emotions in the room, the emotions in the room or interfere with the work we're trying to do, we can't just say they're not welcome. Sorry. That's for the mental health office. And so that's, that's for us a huge piece and an infant mental health. There's this beautiful emphasis on the relationship. In early development and how relationship is the the engine for development is the driver of development.


Virginia Spielmann, Executive Director, STAR Institute 14:35

It is the context of the caregiver infant relationship that influences the brain architecture, helps the child develop the ability to regulate through co regulation. In helps them code the world around them what's safe, what's anxiety, provoking, what's joyful. And all of these things that I'm describing are at the very, very core, both sensory and emotional. There was an article on self-reflection actually, on the significance of reflective supervision for infant mental health work. It's by Patricia O'rourke, from Australia. And it has this section in it called the primacy of relationship and early development. And I think it's a really fun section for OTs to read, because they don't actually call out sensory. But everything they mentioned, is this duality of both sensory and emotion. And in these early relational exchanges, I'll just read a little bit. Okay. The primacy of relationship and early development, infants are born relational with minds that are attuned to other minds. As stern eloquently stated, babies minds grow in the traffic with other minds. And within these interactions, their minds will be formed and maintained. Infants lacking in symbolic thought, lay down early experience in feeling states and relational procedures. And in this way, construct the foundations of their relational life. And I would say also, their sense of self and their sense of agency. I love that I love that. It's just, it's I think it's two long sentences or three, three sentences. And everything in there to me is sensory, I can see sensory woven all the way through it.


Carrie Schmidt 16:51

I think it's that's beautiful, beautiful writing, and there's so much to respond to in it. What occurs to me is the primacy of sensation that's in that statement, without it being mentioned, that none of that exists without a sensory experience for the infant or for the and how much the infant's sense, sensory experience informs the parents reaction, Mm hmm. drives the relationship, which you know, is a beautiful circular relationship of regulation, and response. And it, so much of what you just expressed was a beautiful example of how micro and macro systems knowledge, right, brings you further in your thought development. And in your ability to apply it, you went from talking about how everything we experience in life has a sensory basis, to zooming in to take it to a very practical example of waking up in the morning. Right. And, you know, we happen to be occupational therapists practicing. And so we are looking to our practice framework to help us make sense of some of what we are finding out in clinical practice and in our reading, and you highlighted that. It's, it's a contribution to the cornerstones of our practice, this systems knowledge, but also how client centered we need to be to be able to be attuned to Yeah, the way that this works in the real world, in really works actually in development works actually in the context of relationship. And it's a little bit of a teaser. Everything that you said is something that we're going to talk about in this coming season. So I'm really excited. Oh, perfect. I know. And I mean, that but you know, just that we're going to talk about a term that Gil Foley coined called psycho sensory and it's this inextricable relationship between emotion and sensation.


Virginia Spielmann, Executive Director, STAR Institute 19:15

And, yeah, I love that we've been talking about psycho sensory, we've been talking about sensory effective as if it's one word, right. And we've been talking about socio sensory particularly thinking about those exchanges between the infant and the caregiver, but actually think about it all the time, everywhere, you know, think, you know, that, that the sensory components of social exchanges socio sensory, the richness that of that piece, and I think, I think again, that sort of emphasizes and speaks to the importance of, of, of this expertise that we have within the field. Occupational Therapy is the home of sensory integration theory. And sensory integration treatment, as informed by as research and sensory integration theory has so much to offer our understanding of human development, our understanding of the, the foundations of engagement, participation and health for our clients, and I see, and one of the things that I think is going to be fun for you to explore in this podcast, you know, research on yoga research, on horseback riding research on trampolines from different disciplines. And I see them speaking to sensory without knowing what it is they speak to. And again, and again, and again, as I read those sorts of articles, I think about how the design of the study would have been different if they'd have had a comprehensive model of sensory integration to work from, you know, often in research, it's just about arousal or modulation, the over-responsive child or the unresponsive child. And there's, there's so much more to it than that, in order to access that intersubjective space between the infant and the caregiver, okay, so we're thinking again, about the psychosocial or the sensory, affective or associated sensory cues there, the importance of those for laying down the brain architecture, you have to be able to be modulated, you have to be and the parent needs to understand, if you're over-responsive how to adjust their approach or under-responsive, right, it affects attunement, but you also have to be able to discriminate, you also have to be able to organize your eyes in your head and hold your head up against gravity and get enough breath into your lungs. You need to as you grow, be able to twist your trunk and have a dynamic base of support that's ready for action. You need to be able to coordinate your body in such a way that you can learn baby sign language, and then you can no later coordinate that oral motor area to produce speech. And there's just you do see like the sensory pieces woven in every aspect of that, and that that sustained through the lifespan, the importance of sensation, and sensory integration for health.


Carrie Schmidt 22:40

Yes, and that's evidence-informed practice. Isn't that what it is? I mean, yeah, it and what evidence-informed practice allows for is as a professional, and advancement in my clinical professional reasoning, and that I can bring that to my client-centered practice, right, that I can think differently, in my reasoning about the importance, like you're saying, a sensation, not just in the infant, but through the lifespan, and I can bring that to the to the adolescent and I can bring that to the event, I can bring that to the parent, as you were describing the motor development piece, there's an upcoming conversation with Renee Allen, about exactly that, that that motor development is embodied. That is embedded in a culture that it is enabled in a you know, in again, in the ability to act on our environment. Right, as again, as a little teaser, for upcoming conversations. You know, thank you, thank you for the space that you hold for lifelong learning and for curiosity and for Star being a safe place to ask questions.


Carrie Schmidt 24:04

I hope that that's translates into this medium, and I hope that people can hear how much we love to talk to one another how much we'd love to converse about these things sometimes disagree on things, but always in an effort to further our, our development as therapists and our ability to impact the world with a vision for sensory health and wellness.


Virginia Spielmann, Executive Director, STAR Institute 24:35

Yeah, I mean, it's kind of a requirement isn't asking questions to be stopped. So it'd be really interesting to see how that goes. As this podcast develops. How can we make this a reciprocal conversation with the people listening, I think that's a lovely value to have and really important. I think you know, The field of embodied cognition and embodiment is such a good example of how does a paradigm shift in our understanding of the importance of sensory integration and processing for health and wellness. And so other disciplines are incorporating aspects of, of the work somatic processing is an example. embodied cognition as an example, moving to learn. And then you've got it woven into fields like interpersonal neurobiology, and to person neurobiology, which is a new one, learn about a while ago. And I think what's so interesting, again, is how rich the conversation could be, if as oaties who are fun in our core values, fundamentally systems thinkers, could contribute to those conversations. And, and elevate the awareness of this domain is as critical and fundamental a part of humans functioning as your respiratory system as your cardiovascular system. And yet, when you start talking about the sensory systems, people's eyes glaze over. And so we still have work to do. And like the health education, domain, if you like, in that in that area, we need to get better at talking about this, we need to get better at understanding it ourselves. We that means we have to practice we have to talk to each other, we have to talk to our Uber driver and see Can I how many minutes Can I talk to my Uber driver before they show? I've overwhelmed them? How good am I communicating this my hairdresser, my dentist, you know, all these different people. Um, and so I you know, I think this is an exciting time, I do think there's a paradigm shift. And what that what I mean by that is that a lot of people are realizing this at the same time, right now we're seeing it across disciplines with research papers, empirical evidence, we're seeing people try to boil it down and sell it in nice, neat little packages and commercial packs on, you know, Facebook's got your sensory pack, and it's not really a sensory pack, you guys, you know, all these different things that and that's what I mean by a paradigm shift is like there's a readiness to understand this. People are starting to talk about it, although perhaps not as robustly as we would like. So we have to speak up. And then conversely, there's still talking about the five senses in schools. And, you know, that's still a whole piece missing in the mainstream conversation,


Carrie Schmidt 28:10

there's a temptation to simplify it. And I think this conversation will hopefully offer an overlay of a theory on research. And then that research that's translated into practice, and that it doesn't have to be oversimplified to be effective. Because that's a temptation is a temptation to, to make it something so packaged and bottled, that it's no longer a process. It's a single, simple offering. Right? So this keeping this conversation going. allowing people to hear how we think how we have developed our thinking, and how we read things with a sensory lens, right? Health and Wellness lens. I'm just opening up that conversation and I can't wait for the development. I think it will be organic, of like you said it, this becoming a two way conversation because we would love to bring people into the conversation and help them understand the nuance that we see. Through our thought that we seek. 


Virginia Spielmann, Executive Director, STAR Institute 29:28

Yeah, we see. I think we, for us, it's a red flag. And in fact, I've I've told some families in the past if someone tells you they have the one thing that's gonna make all the difference, you know, I would counsel skepticism and I think it's the same for us as OTs. You know, there isn't one exercise program human beings are complex. And as we said at the beginning, come Complex individuals made up of systems that are openly influencing one another bidirectional, and the way that they interact. So you take this complicated human being, and then you consider the ecology within which they love the family, the classroom, the community, and then the culture and the politics and the availability of health care and transport and all these different things. You know, how can we be cautious? If anyone ever tells you they found the one thing that's gonna help every client and instead, like, let's embrace and celebrate this, this bullet point on page six of the of the occupational therapy practice framework for which talks about OTs as embracing micro and macro systems knowledge? I think occupational therapy is the place where it's at, for systems thinking, I think embracing complexity and comfort with complexity is, it's out. It's a bag, it's a jam, it's like, well, it's, you know, it's where we're most comfortable. And so yeah, I agree with you. I hope that conversations like this, again, like galvanize and inspire us towards that.


Carrie Schmidt 31:06

I love that. Thank you. Yeah. So let's start, I'm kind of thinking about wrapping this conversation up, we are so excited, as an institute, as STAR Institute, to launch this new project, and we are eager for the conversation to continue. I'm asking every guest in the series, and so you will be the first to just tell me something that you personally are curious about right now. It can be something that you're reading more about, or really, I'm just looking for that little spark, something that's super interesting to you right now.


Virginia Spielmann, Executive Director, STAR Institute 32:14

I am absolutely having my mind blown open by the book, the Honor Code. It's called the Honor Code, how moral revolutions happen. I've been very interested in scientific revolutions and Koons work for for years. And that's where the all the talk about paradigm shifts come from. But thinking about a scientific revolution embedded in a moral revolution, fireworks, my brains exploding. It's by Kwame Anthony Appiah, and he's wonderful. He's a British Gunny and philosopher and cultural theorist. And it goes through that sort of history in an in an analytical way of, of past moral revolution. So it looks at dueling had the dual, and it even talks a little bit about Alexander Hamilton, and how the deal there was this there was this realization that it was a morally questionable practice that needed to be left behind if we were to progress may also talk about he also talks about foot binding and some other things. And for me, that's so relevant to our time. And you said at the beginning, I'm a very passionate about the social model of disability and the neurodiversity movement. And I think we have right now the potential for a scientific revolution and a moral revolution to be occurring at a similar time in a similar way, as we question how we treat our neighbors and children and colleagues and family members who have neurodivergent brains and who experience and process the world differently. And so that's that's my big, fine. Read at the moment I read it, I listened actually listen to it on Audible while I'm on the treadmill, because social isolation is so fun. So yeah, that's I guess that's what I'll leave you at how typical of me carry to leave you with possibly a bigger question.


Carrie Schmidt 34:34

That's what I love about you. You live with a bigger question. But more than that, you reliably. You leave me with my own curiosity sparked with your interest in how things work and how to make life better for people is contagious. And thank you for that. I thank you for your leadership. Thank you for that. The way that you model and promote sensory health and wellness, you live our vision and I truly appreciate it.


Virginia Spielmann, Executive Director, STAR Institute 35:08

Well, Carrie, thank you. Thanks for having me. And thanks for creating this space. You know, out of out of love and passion for other OTs to hear these discussions that we have, I really appreciate the time and passion that you've poured into this project.



Thank you. You can find me Carrie Schmidt on Instagram at Carrie Schmidt OTD that CA RR IE S CH MI TT O TD. The STAR Institute is a nonprofit organization. You can find out more about us at our website, That's There you can join our email list. Find out about our educational, clinical and research endeavors and make a donation. This podcast wouldn't be possible without our wonderful guests and the support from the star Institute, especially Crystal Hays and Tory Plucheck. Your feedback matters to us. Please leave a review, subscribe and share this podcast with your friends. This is making sense. I'm Carrie Schmidt


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