My guest this week is Sheila Frick, an internationally esteemed clinician, lecturer, and pioneer in Occupational Therapy. Sheila has over 40 years of clinical experience, having worked in psychiatry, rehabilitation, and home health before specializing in pediatrics. Her expertise includes sensory processing dysfunction, sensory integration, and auditory interventions. Sheila is well-known for expanding sensory processing treatments to include sound interventions.
She has trained over 15,000 therapists worldwide to implement Therapeutic Listening within their clinical practice. She lectures on topics like clinical neurology, respiration, the vestibular/auditory system, and various auditory interventions. She is also the creator and author of Listening With the Whole Body, along with several other books and resources.
In this episode, Sheila and I discuss the connection between listening, sensory processing, sensory integration, and brain function. When most people think about sensory processing, they might think of things like sensitivity to touch or light, or maybe a child having a difficult time tolerating taste or textures in food, or maybe even somebody being overwhelmed by loud noises, but the auditory components of sensory processing go well beyond that, and we can actually use different aspects of listening as a therapeutic tool to support sensory processing and brain functioning. Learn more about Sheila Frick here.
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What is Sensory Processing and Integration
- The typical picture of sensory processing is – Overreact to sound, touch or smells,
- Integration involves more of the questions like – Is this safe or not safe? Is it important to me? Should I go towards it? Should I move away from it?
- So the brain is doing that all the while that it is also running it through filters where it is combining it with other sensations to develop perception, awareness of our body, helping us feel our movements so we can refine them.
Sensory processing and other diagnoses
- Often, sensory processing challenges, sensory integration challenges can be a part of the presentation of things like Autism Spectrum Disorder, ADHD, learning differences, those kinds of things.
- Some kids have no other diagnosis but have sensory processing and sensory integration that is not functioning optimally for them
- Sometimes you can see these issues in gifted and talented kids/adults
Using Sound as Part of the Approach
- Certain kinds of songs, rhythms, vibrations can help those with sensory and integration issues and free them from feelings of discomfort, nervousness, unknowing, anxiety, etc.
Why the Inner Ear is Important
- The vestibular system gives us the anchor in space, the auditory gives us the sense of space around us
- The vestibular sense is the silent sense that starts to make sense when it partners with, the tactile, the touch, the visual system, the muscle and joint system
- Vestibular hearing – Part of the vestibular system is shared by the auditory system
- Vestibular hearing is going to tell us and give us a sense about sound going on around us, which provides the grid or the background that helps you be able to pick out a sound
What Does a Therapeutic Listening Protocol Entail?
- Vestibular-based observations are performed to find out how the inner ear is functioning, how it’s getting in the way
- Then you are assigned a program you can take home (special headphones and an app with specific music)
- Listen twice a day, 30 minutes a day
- The music selection is typically changed every two weeks
- The key to this is being attuned to the child, watching, observing, seeing what their response is and then moving forward as you select music or activities or whatever it’s going to be in accordance with their response
Don’t let headphones be a barrier
- Even the most sensitive of kids can benefit from this therapy and most of the time come around to wearing the headsets.
Are there contraindications?
- Some say avoid if you have a schizophrenia diagnosis however it’s best to speak with your doctor
- Anybody who is in a period of real instability, for example foster care or a child in too many transitions
- With Tourettes, you need to make a more refined assessment
- Kids with chronic ear infections need this therapy most. Don’t shy away from it because of the infections.
Follow Sheila Frick
Episode Intro … 00:00:30
What is Sensory Processing … 00:03:25
Using Sound as Part of the Approach … 00:13:20
Why the Inner Ear is Important … 00:26:12
How Therapeutic Listening is Used … 00:37:11
What Does a Therapeutic Listening Protocol Entail? … 00:44:15
Don’t Let Headphones Be a Barrier … 00:51:20
Contraindications … 00:52:57
Episode Wrap up … 00:54:56
Dr. Nicole Beurkens:
Hi everyone, welcome to the show, I am Dr. Nicole, and on today’s episode, we’re talking about the connection between listening, sensory processing, and brain function.
When most people think about sensory processing, they might think of things like sensitivity to touch or light, or maybe a child having a difficult time tolerating taste or textures in food, or maybe even somebody being overwhelmed by loud noises, but the auditory components of sensory processing go well beyond that, and we can actually use different aspects of listening as a therapeutic tool to support sensory processing and brain functioning.
Here to explore all of that with us Sheila Frick. I first came across Sheila’s work, probably 20-some years ago. I had quite a bit of training with her and her team over the years. We use her program called Therapeutic Listening, along with many other aspects of her work at our clinic.
I’m a big proponent of the information and strategies that she shares, so we’re going to delve into that.
Let me tell you a little bit more about her. She is an internationally esteemed clinician, lecturer, and pioneer in Occupational Therapy. Sheila has over 40 years of clinical experience, having worked in psychiatry, rehabilitation, and home health before specializing in pediatrics. Her expertise includes sensory processing dysfunction, sensory integration, and auditory interventions. Sheila is well-known for expanding sensory processing treatments to include sound interventions. She created Therapeutic Listening to meet the need for an easily accessible tool that can be integrated into sensory processing treatment programs.
She has trained over 15,000 therapists worldwide to implement Therapeutic Listening within their clinical practice. She lectures on topics like clinical neurology, respiration, the vestibular/auditory system, and various auditory interventions. She is also the creator and author of Listening With the Whole Body, along with several other books and resources. Sheila, it is such a pleasure to have you here today. Thanks for being with us!
Thank you Nicole, it’s a real pleasure to be here.
Dr. Nicole Beurkens:
I was saying to you, before we started recording, that I can’t believe I haven’t had you on the show prior. I am such a fan, I think this work is so important, and I’m always so amazed how many parents, but even professionals have not really heard of or aren’t aware of the importance and the value of these kinds of auditory interventions, so I’m so thrilled to be able to explore that and expose our community of parents and professionals to that.
I want to delve into all the things about sound and listening, but let’s just, if you would, start with giving people just a quick refresher — and for some of you, maybe it’s even a brief introduction if you’re not really familiar with sensory processing, into what sensory processing is and how these problems with sensory processing show up in kids. Let’s kind of set the foundation with that big picture.
Okay, so I’ve first really started my work, all of my work with studying sensory integration, which is Dr. Jean Ayers’s work, and interestingly enough, the very first place I used that was in psychiatry with young adults, who some of them were having their first psychotic break, which is kind of an unusual way to start with that kind of work, but sensory processing, typically when people hear that word, they’re thinking about individuals that often times, I think when it becomes the most obvious is when they overreact to sounds. I mean sound or touch or smells, and they won’t wear certain clothes. That’s kind of the typical picture people get when they think about sensory processing. When people have unusual responses to sensation that are outside of what we would expect, and when it impacts daily life, when it starts to disrupt function, like a child who only wears certain few pairs of clothes, I’ve had children come wrapped in blankets, that wouldn’t wear any clothes to see me. I’ve seen from extreme ends of that spectrum. It could be, as you mentioned, picky eating. There is also, which I think people don’t talk about it much, but it’s very common, but often seen as just anxiety is individuals that are really kind of fearful of certain movements. It’s not walking, but they may not want to jump off a surface. They often have the characteristic of not wanting to put their head backward in space. So it’s often seen as a behavior problem with hair washing. So there is that component of it.
But processing — Dr. Ayers used sensory processing and integration because there are other sides to it that you really need to take in sensation and you need to first be aware of it, or as people say, register it or detect it. That’s step number one, then it runs through two processes, sort of simultaneously. One is the modulation. Is this safe or not safe? Is it important to me? Should I go towards it? Should I move away from it? So the brain is doing that all the while that it is also running it through filters where it is combining it with other sensations to develop perception, awareness of our body, helping us feel our movements so we can refine them.
Helping us know where our place is and how to sense — we never think about this one, but you sense the pull of gravity. We know without gravity, what happens to the astronauts when they go out into space, they have to come back and have — they actually lose muscle strength and they have a lot of issues. It’s really critical, the big one, to relate to gravity. So it’s so much bigger than what’s out there in the world. I often have people come to me and talk about “This kid’s a seeker, he is an avoider.” That doesn’t mean anything. Just tell me about him, what’s his struggles or her struggles? What do they love? Let’s find out who this child is and what’s blocking them from expressing who they are. So it’s kind of a big picture, but it is so much more than people think.
Dr. Nicole Beurkens:
I totally agree, and I think it’s one of those things that if you don’t have challenges with this, you just take for granted. We don’t even think about all of the work that’s going on second by second, millisecond by millisecond in our brain to make sense of the world around us, our place in the world around us, right? So I think it’s really challenging as adults, whether it’s parents or professionals working with kids, to have a sort of way of understanding what might be going on, because we’re not even aware that our brain is doing that, right? Like I’m sitting in this chair right now, and in the background of my brain, all of this information is coming in, and my brain is making sense of it to keep me upright in the chair and talking to you, and I’m not consciously aware that that is happening, and yet it is.
Where we start to notice this stuff is when it breaks down, right? When we have kids who it’s like “Whoa, this kid can’t keep themselves up in the chair!/This kid is like a ping-pong ball, all over the place/This kid is really scared and avoidant of certain things.” And then we go, well, what’s going on there? We tend to view it as “Well, it’s a behavior thing.” Or we tend to view it as “Well, it’s anxiety/it’s behavior/they don’t feel like it” or whatever, because we don’t have that connection to really grasping how many parts of that process can malfunction or can get on a different path that creates a totally different experience for this child in the world.
Yeah, and it’s so much of this — all of it from Ayers’s work was to look at that subcortical. What’s going on below thinking? It’s below the thinking brain. It’s all of the things that need to happen to set up the thinking and the learning brain and the behaving brain, if you want to call it that. The socially-connected brain. It’s all of those things that have to happen before you can get to your — as Dan Siegel says, your Upstairs Brain. So I think that’s what people don’t see. And unless you have some of those challenges yourself or are really well-trained in it, people really do not have a clue. It just looks to people like somebody isn’t behaving in the way they think that they should, or it can get put on the teacher or the parent that they just don’t have control of this child. I think you’ve seen all of that, and I think it’s dreadful that that’s kind of how people interpret that but without the understanding of what’s going on beneath. They just think, “Hey, it’s behavior.”
Dr. Nicole Beurkens:
Or it gets pinned on specific diagnoses and I want to talk about that too because I want to be clear for all of the parents listening. Often, sensory processing challenges, sensory integration challenges can be a part of the presentation of things like Autism Spectrum Disorder, ADHD, learning differences, those kinds of things. But it is also the case that there are many children who don’t fit the criteria for those types of diagnoses that we more commonly think of, that can have certain elements of their sensory processing and sensory integration that is not maybe functioning optimally for them, and I think that’s important to recognize because oftentimes, there is this idea of “Oh well, that’s for kids who have autism” or whatever, but actually, you and I see lots of kids who don’t have those diagnoses who are struggling with this, right?
I see it a lot in the gifted and talented. Artists certainly had I lived long ago and there would have been OT, I would have been treated Thomas Edison and Albert Einstein. Thomas Edison, for some reason, was one of my childhood heroes because I lived near Greenfield Village and his Menlo Park Lab and I would go in there and I was just absorbed by this thinking. But you often see it in that really inquisitive bright mind that won’t turn off. It’s funny, my son is an engineer and he works for google. I remember when he was in engineering school and he was just mentioning something about one young man and was RPI, which is just super-bright kids that are creative, and I said to him, I said, “Sean, you know, I really think that maybe he could have used me when he was younger.” He says, “Oh mom, are you kidding me? The whole school could have used you!”
Dr. Nicole Beurkens:
Totally! I think that’s great.
Used what? It’s not that we see them as having a problem but that you can have more comfort and less anxiety and tension patterns in your life so that your brilliance can shine even brighter, and that’s how I see so many of those kids, and to me, what a gift to be able to be a part of their life in some way.
Dr. Nicole Beurkens:
Yeah, I love that. I look at it as just bringing more ease into people’s lives. I don’t look at it as fixing. People are not broken, but what are the things that are creating challenges that are draining energy, that are just not working optimally for them and creating challenges in their life, and how can we bring more ease into their lives so they can be more of the best version of who they are. And I think that’s what’s beautiful about these types of strategies and interventions that really is focused on: How do we bring more ease for people.
Yeah, I know, I don’t really want to be flip, but somebody was saying to me, “Would you use Therapeutic Listening for this? Would you use it for that?” And I kept saying, “Yes, yes,” and then finally, I said to her, “Well I would use it for anybody that has ears!” Because I see it as a tool that helps to sharpen — listening is really just a basic function that we have that can get detuned like your piano can get detuned. So if you come to me and you are, as we said, having some issue that’s disrupting your life and creating a challenge, of course I would attempt to use not just that tool, but many of my tools to support you, and we actually have seen many kids for very short periods of time. It’s not ongoing for everybody.
Dr. Nicole Beurkens:
Yeah, I agree with that. That’s a perfect segue into talking a bit more specifically about sound and about how you — because you were in this realm of work as an occupational therapist with sensory processing, sensory integration, doing those things, and at some point, you got really intrigued and interested in specifically using sound as part of an approach to this. So talk a bit about that.
Well, we are going back now probably 30 years, maybe a little bit more. I was super excited because I had my dream, which was to have this private SI clinic. So having all the equipment, it was just part of this dream that I had when I graduated as an OT. I was seeing kids and working with them. I would say at that point of time, the bulk of my population was coming with, somewhere, diagnosed with Autism Spectrum Disorder, or a number of kids that were preemies, and oftentimes if you spend — and we now know that, actually my granddaughter was just a preemie, and an OT came to see her and said, “Well, looks like she might have sensory processing problems,” and my daughter said, “Well, we won’t have a problem with that, my mom is Sheila Frick.”
Dr. Nicole Beurkens:
We’re all set there, thanks.
We’re all set there, don’t worry about us! We got that covered. She’s got a lot of friends, so we’re all good. But anyway, that was kind of my population. And I do remember that I had — at first, I’ll tell you that I had a number of clients that were flying to places to do a technique that I thought was weird. I have to admit, I always said “People, watch out what you think is weird because you might end up doing it.” But it was auditory integration training and it was Dr. Berard’s work.
I have to say that when they came back 10 days later, with some of them, particularly if they were more severely impacted by their autism, I didn’t see a perceivable difference. And it wasn’t until one young man that I had been treating and, you know we’re in love with all of our children, but sometimes, some of them resonate more deeply with us, and so this young man, David, and his mother would not mind me talking about him at all because he is such a joy, but he was three. He was born very early, he was diagnosed with autism, but he was also a preemie, born at 6 months. So very, very premature. Now we’re talking 30 years ago, so it was really — and he would eat nothing by mouth. At 3, he had a G-tube. When he came into the clinic, he would find anything that was a strap and put it on anything and flip it. He was afraid of the swings. But if I played music, there was the clue, I could get him to interact with me a little bit and we were working on decreasing his aural defensiveness, and you couldn’t even touch the outside of his face without him becoming ill and vomiting. So I had worked with him for maybe about a year and we can now touch the outside of his face, we can touch inside his face. We were getting him to take one or two tablespoons of plum baby food if we played music, another clue, and had rhythm going, we could get him to do that. I still couldn’t get him on the swings. I spent a lot of time bouncing him in my lap, on the big therapy balls. He had some language, not a lot, and interactions with him lasted maybe 3 minutes, and then somebody in town was doing the AIT or the Berard AIT, Auditory Integration Training. And he went and did 10 days. On the 5th day, he ate four jars of plum baby food without any distress. It wasn’t that he — before it was like coach, coach, coach. I was like what? You go from it’s a struggle to “Oh yeah, whatever, this is good, yeah!”
Dr. Nicole Beurkens:
“Of course I eat 4 containers of baby food plums, why would I think I wouldn’t!”, right?
Exactly. And you know that goal that people always have that they’re going to tolerate it? He didn’t tolerate it. He relished it. I mean he enjoyed it. And he started going on the swings, his parents found him wandering in the street, because he was afraid to go down the stairs. And he had just opened the door. They just never thought he’d go out the front door because there were stairs there. So this whole — for me, what I saw was the regulation, the aural defensiveness backed down, but I also think it was more that he also got in tuned with a rhythm. His fear of movement went away or was greatly reduced, his attention span increased from 3 minutes to like 6. It’s still not a lot but it was a lot!
Dr. Nicole Beurkens:
And then, not only that! Then we could move through everything else we knew how to do. So my husband was in the clinic just helping me as a manager, etc. And he looked at me and he said, “Sheila, you have to go do this. This is sensory integration.” I said, “Ron, no! People already think I’m weird because I do the Therapressure Brushing thing! I can’t! I don’t want to be ostracized, it’s too weird! No, I can’t do it.” And he said, “Well, if you don’t go do it, I am going to go get trained. I’m going to find somebody to train me.” And I’m like, “Oh my gosh, that’s even worse! He’s doing it and he’s my husband!” I was completely pressured into it. So I kind of went kicking and screaming. I think you kind of have to know that.
So we did, and I actually trained in it, it was Berard AIT, and we brought the equipment home. I always tell people, my mother, God rest her soul, is the real reason Therapeutic Listening exists, because we had two small kids starting a clinic, and she lent me the money to get the super expensive equipment. It was a lot of money at the time. $10,000 to buy this piece of equipment.
So I said, okay, fine. I will do it. But I am not going to do it the way people told me that they can’t do anything else. They could maybe play with a puzzle. And I’m like well, that doesn’t make any sense, because in sensory integration, one of the basic tenants when you’re doing sensory integrative therapy is that you enhance sensation. And oftentimes, children didn’t register or detect the information or they couldn’t put it together because it wasn’t the right frequency, intensity, duration or combination of input. So in sensory integration, you are trying to figure out how to play with increasing/decreasing, playing with that sort of formula with sensation and watching what you’re getting and adapting it.
So what we did is we put a 20 foot cord on this machine. So other have of Therapeutic Listening that really wouldn’t exist is my husband because he is super musical. He has a mathematical pattern brain, he was an actuarial. He was much better at numbers if they were moving and they were trends and he is really good at trends, but he is also super kinesthetic. And I am not musical. You would think that I was, but he was super musical. I mean we were told that we had a playlist of 15 choices, and it was all kinds of pop and rock music that was popular back in the 70’s 80’s, it was music from Michael Jackson, some reggae music, some Enya music. So those were some of the pieces we were using. And we could, if we wanted to, pick new music and send it in to be verified that it had a full spectrum of sound. So Ron kept picking new music and he kept watching the kids. A child would walk in and he would say, “Oh, definitely the reggae” and I was like, “What? What do you mean definitely the reggae?” So we were told to put anything in. So I put in the reggae, and then a child who I saw as having very poor posture, kind of lower tone, not really being able to sit still, would get organized in their body. And I was like, “Okay, so the reggae.” So now I got it. If you’ve got these postural vestibular issues, I’ll play the reggae. And then another child would walk in and he’d say, “Oh, Enya. Definitely Enya.” I was like, “Wait, it was the reggae, now it’s Enya”, and I’d play Enya, and it was a child that was extremely anxious. I think if you’re musical, that makes sense to you. But I wasn’t. So I kind of had to do it in my head first. I think that’s what, by observation and translation into a formula that I could understand. So that was the beginning of it and we did it in the body, so kids were swinging, they were jumping on trampolines. It’s a little struggle to keep headphones on, but we managed. And if a child wanted to be still, we let them be still. If they wanted to. We were following their lead.
And we started to get exponential results. Things that were taking me a year were now only taking a month. We also noticed with David, who I talked about, that one time — that was the other thing, 10 days, never do it again! Wait! Don’t put headphones on! That was a big rule. We’re kind of a rule breaker. But David, just every time we put something on, it charged his batteries. You don’t say “You listen to your car radio on the way home to relax only once a week.”
Dr. Nicole Beurkens:
No. But I think that’s an important thing, just for people who are not familiar — you’re talking about the origins of sound and listening therapy and AIT, which still exists, very prescriptive, very strict. You did this for 10 days, you did it exactly that way, you don’t have the child engage in other things while they were doing it, a highly trained person had to be there with them and you didn’t put headphones on or anything. I think that’s important for people to understand, because as we get into talking about how you evolved that very different, more integrated into life kind of approach, but that was the origins of that, it was a very prescriptive, restrictive kind of process.
Yeah. And so what we did is we just really started to see it as a tool. So that, again, it was my husband who said — it was expensive, even we were inexpensive for what everybody else charged. People charged 3 times as much as we did. You had to come in two half hours. So we did an hour of OT a day. So that’s what I charged you for, I didn’t add anything to it. We had people flying from all over, really literally, sometimes, the world. And we got the toughest kids because people were hearing that we weren’t doing it making you sit still, and some people wouldn’t do it because they didn’t think their child could sit still.
So I actually literally — but this is my passion and I’m not feeling sorry for myself, I literally worked 6 months straight because I was so executed about what was happening. And the clinic, which was booked daily because it was 10 days in a row. So then, part of that time, I had already started teaching. I was teaching in sensory integration. I really couldn’t be quiet about it. Somebody would say “I have a child and they don’t eat. They’re fearful of movement.” I’m thinking, “You’ve got to add sound.” I don’t want to say go spend $10,000, how are you going to do this? It was my husband, again. He said “We can do this, we can record. We have to record our own music, but we can do a similar filtering technique, then everybody could use it.” It was still, long ago, it would be out on CD’s. You could then train therapists so that it could be used in schools, it could be used in homes. We were really amongst the first people to do it. And I did the same thing, “No! No! I will get in some kind of trouble!” I am a risk-taker, obviously, I had to relent at some point because it was really true and I really wanted it for other therapists because one of my passions, the biggest one is to be in the clinic and see kids change, and I know you share that with me, Nicole. But the other one then is once I know that that’s possible, I want other therapists to know what’s possible. Not to have a limited thinking about “Well, this child has this, so I’m going to teach him how to tolerate things”, when I know that they could be free of it. So that’s how it got started.
Dr. Nicole Beurkens:
I love it, and I mean I was an early adopter of Therapeutic Listening. Back in the day when we had the CD’s and the Discmans in the belt pack. Technology has come a long way, has made this even easier, but I hadn’t actually heard all the parts of that story of how that came about. I love that. People are hearing you talk about this, they’re thinking, “Okay, so music. Something is special about the music.” Because you’re not just playing a Michael Jackson song or an Enya song. So let’s talk about what it is about the inner ear, why the inner ear is so critical to kids and people being able to get in sync with the world around us and then how the music is especially created to support that.
I think what people really need to understand, when I talk about the inner ear, I’ll be talking about the receptors. So actually, when I say inner ear, in my mind, I think about the receptors. So we could talk a little bit about that. But not at great length, but where does sound and movement get processed? So what does the inner ear do? There are two ends of it. So I was trained before using sound in the vestibular end of it. That was a key hallmark in Dr. Ayers’s work. And she was so brilliant that science today, with neuroimaging, is just catching up to her ideas. So people think about the vestibular system in terms of balance, which is true, but it’s so much more than that. So she talked about the vestibule system as being a major integrator of all other sensations. So the truth is that all information we take in from our bodies and from the environment get checked against the vestibular system, which tells us the basic reference point of “You were here.” Without that reference, the 0 point in space, you do not know even the position of your arm, what position it’s in. It’s all referenced. To know which end is up, which way are you going? You then, the muscles and the soft tissue in the body that has proprioceptors in it and some metasensory pressure receptors tell my brain right now about where there is pressure on my body, and that correlates it with, boom, that 0 point in space. So it’s a major integrator, which she talked about the central reference point, but really, we used to talk about it as the me and the map. Early on, I lectured with the professor who has passed now, by the name of Dr. Steven Cool. And he used to talk about that the vestibular system would give you, if you were at the mall and you’re trying to find Sephora, or for me, I would probably be trying to find the cooking store, but anyway, if I was searching and I went to the mall map, unless I saw that orange sticker, “You Are Here”, the mall map wasn’t useful. So no other information is useful unless you can check against that. So it really is the vestibular sense, is the silent sense if you will that starts to make sense when it starts to put information it partners with, the tactile, the touch, the muscle and joint sense if you want a system, also it partners greatly with the visual system, it’s very tied up with that. So if you can sit still and use your eyes well and organize your body and your eyes, you usually have a good vestibular system. I could go on. This could just be a whole podcast.
One thing I just want people to know is that now, in science, if you could say your sense of self, the me is mapped in the brain and where it is, it would be where they are now finding it is the vestibular cortex, so where the sensory motor strip and the insula, which gives a felt sense of our self intersect — I always do this, it’s a little circle here in my head, that’s where I sense me in the world, literally, me in the map of the world. So it’s such a key integrator.
Dr. Nicole Beurkens:
And for anybody who is listening and is like “I don’t know if I can relate”, if you have ever even for a moment in your life felt dizzy, which 99.9% of us have had some experience at some point in our life of feeling dizzy, that is a window into understand what Sheila is talking about here when we say a map of where you are in space, this sense of where we are and how the brain processes that, if you’ve ever been dizzy, you know that suddenly, you get very disoriented. You feel very off-kilter. So I think that’s a good way. If you’re feeling like, “I don’t know if I can relate.” If you’ve ever had a sense of dizziness, that’s a window into understanding what we’re talking about here.
I think that’s the best thing. Or if you can think about if you were really off, like if you had the flu really badly, you’re just very ill, where you kind of lose that whole sense of yourself and your grounding. People talk about grounding, but really, your anchor. There are other ways where we go off that anchor, but let’s say again, we could talk forever about that, but basically, that’s a major integrator. It is going to talk to all of the muscles in the body that are going to help you sit still. If somebody can’t sit still, they can’t sit still. It’s not that they won’t. I haven’t seen a child yet that somebody says they’re seeking movement and they can’t still, they won’t sit still. I mean so many things, but that’s the part that I had been well-versed in. It also makes you feel secure in movement. So when you climb up to the top of the slide, it’s fun, not scary and you want to take challenges, you want to jump off things, you want to climb trees, you want to roughhouse and rough and tumble and ride bikes and ski, and I don’t know, if you’re Shaun White, you want to snowboard and flip around in the air a million times and you never lose your sense of where you are, that’s the vestibular end of it.
Dr. Nicole Beurkens:
Or even a child who struggles to be able to ride in a car or be on a boat without feeling car sick. I mean those are other ways to recognize that even that kind of movement like sitting in the car and not feeling carsick, that is pulling on that vestibular sense and that integration.
Yes, and integration with the eyes. All of the senses talking to each other and giving a similar message, and that’s part of that integration process. So really, really important. It also is a major regulator of arousal, we all know if we don’t move, we’re going to go to sleep or start tapping and wiggling. So what other people don’t think about, and I think this is a really unique contribution we’ve made in teaching, it’s in the Listening With The Whole Body Book, but we haven’t published or done much with this, is what we have found is that auditory part of the inner ear, one, there is some scientific information about this and this has been published by other researchers, one is part of the vestibular system is shared by the auditory system. So we have something called vestibular hearing. Vestibular hearing is going to tell us and give us a sense about sound going on around us, which provides the grid or the background that helps you be able to pick out a sound, much like you can’t find the fork unless they’re separated in the silverware drawer. You need the container, if you will. You need the outline, it gives you that sort of outline in space. And that’s processed by, in part, the vestibular system and in part by the auditory system. So there is this juncture of the two. They are not two separate systems. They are one system for orientation and balance. And balance isn’t just physical balance, it’s physiological balance. You can go off. I literally talk all day on that topic alone, but while the vestibular system gives us the anchor in space, the auditory gives us the sense of space around us. And I see many kids who don’t have that sense and it confounds people. They are super-anxious and super controlling, and I don’t mean that in a mean way, but because they can’t predict what’s going to happen, because they don’t sense what’s going on around them, they have to control everything just to feel safe. And they usually have low frequency sound sensitivity and often some kind of anxiety about movement. And that’s something we started noticing that when we started using listening with it, with children with that issue, it looks like a miracle. And I just had this happen with a case I was consulting on in Australia, where she was using some other form of listening, and then we amped up a choice that had more space in it, and she emailed back that day because she went into a session afterwards, “Oh my gosh, mom couldn’t believe it.” Because when it’s a sense and it’s a sense that hasn’t been woken up or brought, it’s really just expressed. It’s not that it’s hidden and now uncovered because you found the right way to enhance the sensation to wake up what’s inherently there. You have this child that just blossoms.
So the child wore socks, took off his shoes and socks for the first time. What does that have to do with sound? Well, if you are super anxious, every sense in your body is going to go on high alert, and your skin is going to become more sensitive because darn, if you don’t know what’s out there to get you and something touches you lightly, you better move quickly. Anyway, I know it’s kind of a lot about the inner ear.
Dr. Nicole Beurkens:
It is important because people don’t think about the inner ear as being related to those things. So because there is so much interconnection there, and you explained that just beautifully. Talk about how the Therapeutic Listening — how the music is used, because as we said, it’s not just putting any music on. How are you creating the music to then give input that supports the integration and the strengthening of those connections.
Okay, so I’m going to come back and make two points a little more clearly. I’m just having too much fun talking to you. One of the things is that in OT, I look at — people say auditory processing. To me that’s the domain of a speech therapist and audiologist. My speciality is audition, the non-language processing of sounds. So what is that? First I have to notice the sound. So we have to orient to it. And in orienting, there is a shift in your physiology towards what people would call more regulated, where the heart rate and the breath start coupling together, and typically in an orienting response, which is what we see when we start with our Therapeutic Listening is that we trigger an orienting response. Part of that is I notice it and now I can tune into it. So there is a shift in the way that the muscles of the middle ear contract. They are told by the brain, “Hey, what is that? Pay attention.” And when the muscles of the middle ear contract, they do so in favor of the human voice. Taking your attention away from the background. Usually, the background is what you use to look for what’s happening next, it could be more distracting. Zooming is what you do for your mom’s voice, for your teacher’s voice. So there is that orienting and tuning in. When you tune in, you actually turn on the brain circuits that go in and go right onto the receptor in the part of the inner ear, the basilar membrane, and sharpens the detection of sound. So even in that orienting and tuning in and saying “Hey, what is that?” and positioning your body in that direction. So that’s part of audition, as is being able to get attuned and in sync with another. And all of the nonverbal communication, teachers inherently, parents know when the child is listening because we see it in their body, we see it on their face, and we feel it in the connectedness. So that’s audition. So there is that zooming in, zooming out, orienting, because that has to do with how we change the music.
The other thing is — I mean there is so much to talk about because if we want to impact the vestibular system, what we now know is that the vestibular system and it’s kind concomitant major processor, the cerebellum and the low back brain, that’s very sensory, very much about integrating sensation and actually broadcast broadly throughout the whole brain for coordinated action, meaning with another, with our emotions, with our — people know it most for our physical body, but if we want to impact the vestibular system, we have to use rhythm.
That was one of the things that Ron was directing me to in telling me what music to play when he was in the clinic and we were doing the AIT together. So we created so many things that were around the rhythms that we saw working for 5-7 years that we were doing the AIT. Some of them we made more simple, and actually very interestingly enough, we developed this group of studio musicians that do music for the movies in Hollywood, and we developed this group, and they were totally into it because they had freedom to play. So there is a real playfulness in the music.
So anyway, there is that going on. We looked at rhythms, we use some classical, so there is this idea about what music for what issues. But the very beginning in therapeutic listening, we did a very basic thing, which is a high/low pass filter, which is exactly what the sensory physiologist and psychologists use to test, in animal research, if an animal will orient to something. So we’re going for that basic orienting response, and it’s the part of the brain that says “What is that? Oh, that’s what it is. I’m going to go investigate.” So it’s the part of the brain that says, “Oh, you’re safe. Let’s go interact with that.” The direct parallel would be a defensive response, but that’s too much excitement. It’s about getting the right energy and the right body movements to move towards and engage it.
It also gets tied up in — many people talk about the polyvagal theory. When you orient, you are known as ventral vagus. Your heart and your breath are working together to keep your energy levels matched to the activity that you’re doing. So we started with that basic filtering in or modulation, however you want to call it, or modification of the music because it’s basic to getting the ear to zoom in/zoom out. It’s basic to getting the orienting response. If you orient, you’re not defending. It’s basic to getting sensory modulation.
Dr. Nicole Beurkens:
And I’ll give an example of that, of what that can look like. It can be a starker contrast, we’ll have a child in the clinic, maybe in the sensory gym who is just sort of all over the place, or kids who internalize more — maybe who are sort of curled up, scared of doing anything, and you put the headphones on with the music and you can see that orienting response happen. They go from sort of chaotic and all over the place to suddenly being more still, their tone — you just can see it change in their body, and they look at you, and you can see they are looking at you, not through you, not for the next thing, it’s that orienting response. So the child that’s been super anxious and sort of balled up and really scared and you put the music on and there’s that orienting, there’s that relaxing, that tone goes down for them. And they shift their attention too, and you can tell they are with you. You can actually see it.
Yeah. And it’s so much fun. Sometimes it’s great, big. And sometimes it’s just miniscule. And it’s one of the things we use to know that we are on the right track, along with other things.
Therapeutic Listening is very much a clinical tool because we are really building it one step at a time and we’re tailoring it for each person, which I think makes it more challenging to learn at first, but it is more rewarding and I think it fits with any therapeutic model that’s clinically recent. As we would in OT, as we would in psychology.
Dr. Nicole Beurkens:
That’s right. We integrate that in so many different avenues. There are just so many ways to work that in, and I’d love to have you share what that actually looks like. I think we’ve got people very intrigued and very convinced about the brain and the connection with audition and how this modulated music can help. What does a protocol actually look like? What does it entail, if we say we are going to have a child or an adult use therapeutic listening as part of their therapy or in their life, what does that look like, actually?
The way that we would do it in our clinic is somebody would come in and we’d have a very lengthy kind of — I call it a functional listening questionnaire, but it’s really a sensory motor history, but it links it all to function in daily life. So we would use that, but we would also interview — observations of a child or an adult, I might have you also do some vestibular-based little things, just to get a sense of your vestibular. I want to know the whole inner ear, how it’s functioning, how it’s getting in the way. And then we would put you on a program that you would take home, so parents would get headphones. Then we have an app on the phone and that’s what most people are using now. So they download the app, the app is free, and then they can do in-app purchases. But because Therapeutic Listening uses, ini its modulated program, two week segments of listening, we did a rental program for parents that we try to make — I just thought what’s the cost of less than a McDonald’s meal. That was my kind of thinking because all along we were trying to make things as accessible as possible, and we try not to make cost be an option. So that’s part of it. Then they would listen twice a day. If it’s modulated to 30 minutes a day, we do some other variations on modulation, but that’s our basic program for 30 minutes. Then we typically change the music selection every two weeks, and again, that two-week thing was a practicality because in the beginning, people were actually purchasing a CD that was more expensive than that. We were trying to make it as accessible as possible.
Our clients, some of them come weekly, but many of them come just to have home programming. We often add other things into that based on our OT background. Then we would change that out every two weeks, but all along, based on the changes we were seeing, that’s how we make our next selection.
Dr. Nicole Beurkens:
I think that’s really important for people to understand because you and I could have a whole hour long conversation about how sensory processing and sensory integration get distorted in the actual treatment process of being some sort of prescriptive set of things, and really, the key to this is being attuned to the child, watching, observing, seeing what their response is and then moving forward as you select music or activities or whatever it’s going to be in accordance with their response. It is an individually tailored thing, which is more complicated for therapists to learn. But ultimately much more productive. I look at it as there is this menu of options with the music to choose from. You start with what makes sense based on what you know about the child and their history and their functioning, but then you’re looking as you go along: How are they responding? And then you’re choosing the next one.
So as parents, you’re sort of partnering with the professional supporting you with that to look at what makes sense to move to next. And I find when it works well, there is this real collaborative spirit between the family and the practitioner or even other teachers or other people working with the child because you need the feedback to know what’s going on for this child in their life. What are we seeing change? What seems to be getting better? What might be getting worse? What are we seeing? And then we use that information to tailor it. So it really is this collaborative process.
Yes. And I find that I can’t do it as well without a parent involved, and often, they are giving me all the information whether they know it or not, and I’ve had a young man with pretty severe cerebral palsy where it was just, again, he made such changes, and the parents got so good at it, the mom would call me. It would be a weekend and I’d pick up my phone, she’s like, “Oh, I don’t know, Sheila, this is happening!” I just listen. And in the end she’d say, “I think I should go back to listening to whatever.” and I would think that’s true and I’d be like “Yeah, you’re absolutely right. I think that’s a really good idea!”
Rarely would I disagree with her, because in the process, she learned how to use it, which to me, ultimately you can. It’s not a one-time thing. It will need tune ups.
After COVID, we’re all going to need a big old physical tune up for sure, right? We’re going to have to learn how to, I don’t know, do more transitions again. I don’t know what, but we’re going to need tune ups. We all do. Find them in different ways. Parents are part of the process for me. That’s most of who I interact with.
Dr. Nicole Beurkens:
Or if you are an adult, because we see adults at the clinic too, having someone else who is in your life, because often, we are not great observers of ourselves. So having — whether you live with a partner or you have somebody else that you interact with on a regular basis who can give some feedback. Because sometimes, we don’t notice for ourselves things that are changing and it takes other people around us and you know, “I have noticed that you really seem less anxious or you’re going to sleep quicker” or whatever it might be.
Absolutely, I see that quite a bit where somebody else notices. And sometimes I think parents — It’s just hard enough to be a parent, period. End of story. And you add any challenge to that and it multiples. So I think sometimes I’ve had some parents who are even — I did have this one mom, bless her heart, I just felt like she was shell shocked by how much she needed to do in life, and I completely understand it.
She came back in after listening two weeks to the first selection and I could see, this little girl looked so different. I had this big look of anticipation, I’m like, “So tell me about it!” and she was like, “I didn’t really see anything’ and I’m thinking, “Are you kidding me? She looks completely different!” And then she said, “But her brother said she looked typical at his birthday party.” I think her brother being her brother said, “Mom, she looked normal for the first time, a terrible thing to say only can be said by a brother, right? What was it? It was the timing. She just now was responding without a lag. If you have a lag, people are used to you responding in a certain time window and when you don’t, it feels uncomfortable for the people who don’t understand. That was one thing that changed so much for her in that first segment.
Dr. Nicole Beurkens:
I love that. So you touched on the music now, it’s come such a long way, it’s available through the app and it is special headphones though, that is important for people to know, we’re not just talking about your dollar store headphones. There are special headphones for this, and if you’re thinking, “Oh, I would never be able to get my child to keep headphones on”, that’s part of working with a practitioner that can help with that because we are yet to have a child where we couldn’t work them up to being able to tolerate that. Sometimes it takes some time, many kids, if they are really super sensitive or afraid of it, we’ll just play the music in the environment at first to get them used to it, there are all kinds of tricks and ways. So don’t let that discourage you from looking into it. If you’re thinking, “Oh, my kid would never keep headphones on for 30 minutes,” there are all sorts of ways to navigate that. Don’t let that prevent you from looking into it.
Yeah, and that’s the number one, before I can finish even the first part of the workshop, it’s always what therapists say, I’ve rarely had a child I couldn’t get headphones on. And in special cases, we will make — and people are trained to make assessments of when that might be. I would say I can only think of maybe two in recent — the past 5-6 years that I couldn’t get headphones on, and I did things another way, but again, it’s a special way because what you have to understand is that sound is vibration that travels through the air, and what else is in the air is going to interrupt. And what else is going on in that space and distance from the sound source, there are all kinds of things to think about, but it’s do
Dr. Nicole Beurkens:
Any contraindications that you think — we talked about, pretty much at the outset, you said everybody can benefit from this type of therapy for various reasons at different points. But let’s just quick, as we wrap up, touch on — would there be anything about a child or in their medical history that would make it that maybe this isn’t the best approach for them?
If you have somebody where you felt like their brain chemistry was unstable — So I know that people use the diagnosis of schizophrenia, but I really want to know what that means because I find that’s sometimes a label to put on, but if you had somebody — I take anybody who was in a period of real instability, and I would even take that into foster care. If it was a child that was in too many transitions, it may not be the time to do some therapeutic listening. We have some tools that we didn’t chat about today because it’s just too much, but that could be used situationally and that might be an option. But again, that’s part of being trained in discerning when to use what. So schizophrenia is something people often talk about and sometimes you just, in certain conditions like Tourettes, you need to just make a more refined assessment. So sometimes I just tell starting practitioners not to do that for a while.
Dr. Nicole Beurkens:
What about kids with chronic, ongoing ear infections?
They’re the kids that need it the most. So I would say just when the infection is active, if they don’t feel well, don’t listen. And even if — I mean I don’t want them to have fluid in their ears, but if it’s going to be there forever, you’re better off doing something than nothing.
Dr. Nicole Beurkens:
Agreed, and I wanted to make that point because so many families listening, their child either had somewhere in their past history, a history of chronic, years-long ear infections saga, or it’s still something that is going on, and this is such a valuable tool for supporting the fallout that happens in the brain from those infections. So this has been great.
Sheila, we’re going to have to have you back. There are so many other things that I want to ask about, so many things to talk about! As we’re wrapping up here though, I do want to make sure that you let people know where they can find out more about Therapeutic Listening, about your work.
Probably the best way is our website, which is www.vitallinks.net. And we do have a provider directory on there, we have a list of upcoming courses, I really speak on a broad array of, really the title of the book that I wrote was Listening With The Whole Body, because it’s a whole body approach. We wouldn’t have time to talk about that at all today, but you could see other courses, there’s a parents section, some parent videos there. I think something that’s very helpful is a little video on “What is Therapeutic Listening?” that we had made. It actually took us weeks to write the script to make it simple and hold true. So that would probably be the best place. We can do contact information there as well.
Dr. Nicole Beurkens:
Absolutely. So www.vitallinks.net, we’ll have the links to all of Sheila’s books, all the resources, we’ll make sure we find that video, put that in the show notes for you so you can check that out, and I think that therapists directory is so helpful because now matter where you live in the world, there is likely to be somebody who has been trained at this point who you can access to get some support around that. But I just really encourage all of you, if this spoke to you in terms of what you’re seeing or dealing with with your child or if you’re a professional who is working with these kinds of kids. I can’t encourage you enough to get more familiar with this, delve into the learning around it, it just can make such a huge difference. Sheila, thank you, thank you for taking the time to spend with us today. This was really wonderful.
Thank you Nicole, it’s so much fun to talk about my passion, and I don’t usually get to tell the other parts of the story, so thanks for letting me share that today. I really had a great time. Thank you.
Dr. Nicole Beurkens:
Awesome. And thanks to all of you for being here and for listening, we’ll catch you back here next week for our next episode of The Better Behavior show.