Case of Christi by Donna Ray, M.A., M.F.T.

Introduction A beautiful, curly headed, blond, blue-eyed, five-year-old girl was brought to my office by her mother. She was the younger of two girls, both adopted. Her older sister was nine years of age. The mother described the girls as different as night and day, the first being very cooperative, self-contained, and appropriately sociable. Her mother described Christi as difficult to control, sometimes hyperactive, very loving and bright. She was also highly verbal and athletically skillful. Christi’s mother expressed concern about some unusual behaviors that Christi exhibited. She described that when Christi was injured she didn’t know where she was hurt. Christi would sometimes hit herself on the injured area, seemingly to further identify the area by making it hurt. Christi had recently bruised her leg in a fall, and when her mother went to her, she found her hitting the bruised area, unable to describe what happened, or where she was hurt. She also said her daughter frequently ran into door jams and walls, sometimes at full speed. She didn’t seem to know where she was in space relative to the walls or door jams. When she entered kindergarten her fine motor skills were below average. The kindergarten teacher said she was displaying the skill level of a two–year-old. She was having difficulty learning to write letters and numbers. And lastly, she annoyed other children by touching them inappropriately. It was interesting to me that although Christi moved well athletically, her sensory motor perception wasn’t working for her in some very specific ways.

What I hoped to accomplish during my time with Christi My intention while working with this child was to create situations in which she could locate herself physically in space, i.e., clarify her interactions with the environment so that she would sense herself more clearly and accurately. My assumption was that if her self awareness and sensitivity could increase, she would no longer need to intensify her discomfort when she was injured. Also, I hoped with these changes that she would stop bumping into door jams and in to walls, thus hurting herself less often. I hoped to clarify her relationship with herself and others so that she would respect the personal space of others and observe their boundaries. She frequently touched others without their permission, often to the point of annoying them.

I wanted to help her successfully use a pencil, and I hoped that as she gained confidence and mastery while drawing and writing, she would feel a sense of personal satisfaction that would allow her to feel more at ease at school and at home. I assumed that as her ability to explore herself and her environment with greater perceptual precision and ease increased, her conceptual abilities would improve.

I wanted our relationship to be one in which she could experience co-regulation, pleasantly, without apprehension. I hoped that as she developed herself more clearly through our interactions, her interpersonal skills would improve and she would gain greater satisfaction with others. The feedback from others was coming in constantly, but in the form of negative feedback. This included how she should control herself, not hurt herself, not touch others, not invade the personal space of others, etc. At this point in time, co-regulation seemed to take place in gross rather than in subtle ways.

The term co-regulation in Alan Fogel’s book, Developing Through Relationships, helps to clarify the nonverbal learning that takes place in Functional Integration. It helps to define what takes place in Functional Integration from a psycho-social, dynamic movement perspective. He says that communication illuminates the self’s relationship to others. That communication leads to renewed self-understanding and is a creative co-construction of the participant’s. In his book he presents evidence that infants are active participants in a cultural system from the beginning and that newborns have a sense of self. He goes on to say that the concept of co-regulation refers to the dynamic balancing act by which a smooth social performance is created out of the continuous mutual adjustments of action between partners. In co-regulated communication, information is created between people in such a way that the information changes as the interaction unfolds. Co-regulated communication is created as it happens; its process and outcome is partially unpredictable. Co-regulated communication is not ritualized, perfunctory, or over-controlled by one or the other partner. He proposes that the original sense of self arises from one’s physical and social relationships.

With this idea in mind I attempted to create situation after situation with Christi that would positively define her relationship with herself, with others, and with her environment.

Functional Integration as a total learning experience

First session. Christi didn’t want to be alone with me, so I invited her mother to stay in the room. When I began to speak to Christi she ran to her mother for a cuddle or kiss. I asked her to lie on the Feldenkrais table. She didn’t want to. I asked her to do movements with me. She refused. I told her that I had something that she might be interested in seeing, so I left the room and brought back with me a 36-inch-tall human-scale skeleton. Christi was intrigued by the skeleton, and wanted to touch it. I allowed her to touch the skeleton; when she touched the skeleton, I touched her skeleton. When she touched the ankles of the skeleton, I touched her ankles; when she was ready, she moved to the knees, so I went to her knees. We continued on in that way for several minutes until she had led me to touch most of her body. I then sat the skeleton on the edge of the table. Its feet were dangling, so I put foam cushions under its feet to give it support. Christi was very curious about that. She then sat on the edge of the table, and I did the same thing for her. She asked many questions about her height, the distance between her feet and the floor, and the height of where she was sitting. I put cushions under her pelvis to further raise her feet off of the floor. When she began to tire of this play, I ended the session. I felt that we were off to a good start. I talked to her mother separately, who expressed her amazement at Christi’s interest in the skeleton and her curiosity about her spatial organization and the skeleton’s spatial organization.

Second session. I had the skeleton present again. We repeated some of the first session. I stopped before Christi was tired of the skeletal exploration. I asked if she would get on my table or do movements with me. She said no, and went to her mother. I then asked if she liked to draw. She said yes, so I brought out paper and markers. She immediately sat down and began to scribble. Her ability to draw was primitive, with circles and scribbles; she was unable to form letters. She didn’t ask, but instead ordered me to draw with her. I asked her if she was the teacher. She said yes, and we began to play school. I followed her orders. As we began to draw, I asked if I could put a mark on her page. She said yes. Then she began to scribble on my page. I asked her to stop because she didn’t ask me first. She looked surprised, but then asked, I said yes, and then she scribbled on my page. I set up a protocol for asking permission and following directions. This was an area of difficulty for Christi. She often went forward without the permission of others around her.

Third session. I began this session by asking Christi if she wanted to play school. She said yes, if she could be the teacher. I agreed, and she began to tell me what to do. I allowed her to be in charge and then I said it is my turn to be the teacher. I continued with paper and pen, and then I said now it is table time: crawl onto my table and I will gently move you. She scrambled over to her mother. I repeated that it was table time, and that I would touch her very gently, with her permission. I explained to her that it would feel good and that she could ask me to stop if she didn’t like it. She finally jumped onto the table. I touched her briefly, maybe for five minutes. I worked mostly with her feet and legs, promoting oscillation movements to the head, using the gentle rocking motion to capture her attention and to quiet her. When she appeared to want to stop, I did so and ended the session.

Fourth session. This was very much like session three. We began the session again with drawing. We traded turns being the teacher. Sometimes Christi was very strict with me and would pretend that I was not doing what I was told. She would scold me and take away my paper. I would then ask for clarification of what I was supposed to be doing; she would tell me and then we would continue. Of course I was hoping to teach her that when she was in trouble, she could ask for more information and then correct her behavior as needed. She obviously liked being in charge of the situation. I thought about how much of the time children are in situations where they must follow the rules and requests of others and how little of their time is spent actually being in charge. When our drawing time ended, Christi wanted to take her clothes off. Her mother said she likes to be naked. I asked her to leave her clothing on and talked with her about the importance of removing clothing only in the privacy of her own home. I felt like she was testing the boundaries or perhaps she was feeling comfortable at my office, like at home. I saw it as an opportunity to talk about being socially appropriate and did so in the easiest way I could. After some coaxing she agreed to leave her clothes on and work with me on the table. Her tolerance to being touched was growing.

Fifth session. Christi was very uncooperative. She was very aggressive during the drawing, and scribbled on my table even after being asked not to. She took my paper away; when asked to stop she didn’t want to and she refused take her shoes off for Functional Integration. I gently coaxed her, her mother tried to patiently encourage her, then she didn’t want to get on the table. When I saw that we were fighting a losing battle, I said time is up, you must go now, this isn’t what we do together. I’ll see you next week when you are ready to cooperate with me and play our games. Christi was shocked; her mother was surprised but cooperative.

Sixth session. Christi was cooperative from the start of our session and remained so throughout our time together. We began the session again with paper and markers. We began to draw at the same time. While we were drawing I asked Christi if I could draw on her paper. She said yes, so I drew a pleasant shape. Then she reached over to draw on my paper. I gently stopped her and said this is my paper, if you want to draw on it you must ask my permission. She did so, I consented, and she drew on my paper. We traded back and forth in this way, adding to each other’s pictures. It was a fun give-and-take and we each demonstrated respect for, and cooperation with, one another.

After our drawing time, I was able to create a Functional Integration lesson. This involved taking her hand to her knee while lying on her back, eventually taking each hand to the same knee and the opposite knee, and finally rolling her from side to side like a ball. She was involved positively with the lesson. She appeared to be relaxed and curious about the movements. After this session she began to ask her mother when it was her “Donna Day.”

Seventh session. Again we began our session drawing together. I asked Christi if she wanted to make something out of my scribble. She didn’t know what I meant, so I demonstrated. I scribbled an uncomplicated shape on the paper, and then I asked if she could make it into something. She did, and then we continued to trade off in this way. It was another experience of cooperation and working together.

Secondly, I introduced Awareness Through Movement, verbally directing Christi’s movements. I broke down the directions so that they were simple and easy to understand. Eventually Christi was rolling from her back to her side to sitting while holding on to her feet. Her mother was participating in the movements as well. Both Christi and her mother enjoyed rolling around on the floor in this way. Once the movement was easy and the directions were clearly understood, I added another level of complexity. Through the movement, I would say stop, and everyone had to freeze. This was an enjoyable game, and I hoped that it would instill in Christi the ability to follow directions and the ability to stop herself when asked to do so by others or even herself. This was also a game that she and her mother could continue playing at home. And they did.

Eighth session. We began the session drawing together again. We traded roles as teacher and student. I was careful to allow Christi plenty of time telling me what to do, since she really loved doing that.

During our table time, I asked Christi if I could do something fun with rollers this time. I showed her the firm Styrofoam rollers in my office and I asked if I could roll a roller on her. She thought it was a funny idea. I took a small roller, and with her lying on her stomach, rolled the roller against her calves, her thighs, and her entire backside. She liked the sensation very much. I hoped this would add awareness to all sides of herself, and provide her pleasurable physical sensation.

Ninth session. We began drawing together again. Christi wanted to show me how she could write her name. She very carefully shaped her letters and she was able to draw the letters with some difficulty but they were readable. I asked her if I could touch her while she made the letters. She nodded so I gently touched her back, arms, and hands, reducing the effort in her while she was drawing. She liked to be touched for a short time and then wanted to continue on her own. She also practiced learning to write my name.

During the session Christi’s mother described having a difficult time getting Christi’s attention, and getting her to follow through when asked to do something. In response to this I asked Christi if it was easy to get her mother’s attention. She said no, she was often busy with cooking, or talking to her sister. I asked her if she wanted to know a way to get her mother’s attention and keep it. She eagerly wanted this information. I told her to go to her mother and gently touch her, then ask her to look at her. Next she was to look her in her eyes and say what she wanted to say. If she found her mother looking away, she was to gently touch her again and ask her to look in her eyes. She loved the experience and continued to do this with her mother at home. Christi’s mother also picked up the suggestion.

Tenth Session. The following week, Christi’s mother reported that Christi held her to making eye contact, and that their communication and cooperation was improved.

We completed approximately 20 sessions together, continuing with the above themes in a variety of ways. Christi grew to like the Feldenkrais touch; she looked forward to her visits with me. As I saw Christi’s ability to communicate improve, I felt satisfied that she would stop invading the space of others. I spoke to her teacher and he said that she was gaining better self control and cooperating more easily in the classroom. He also said that her touching of others had decreased, although she sometimes went into the desks of other children, not because she wanted their things, but because she wanted to see what they were keeping in their desks. I thought to myself that this behavior might be a sign of healthy curiosity and that she might be a true “Feldy.” Her ability to draw numbers and letters improved and she showed interest in sounding out letters. She also stopped bumping into things as frequently. All and all, getting to know each other was a delightful learning experience for both of us.

If you have questions about cerebral palsy and the Feldenkrais Method, contact Donna Ray at (760) 436-9087.

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