Finding the Body of the Mind: Integrating Occupational Therapy’s Theories of Mutual Regulation and Dysregulation into Psychotherapy

ABSTRACT

A child’s state of emotional dysregulation is often the explicit complaint of parents, teachers, and others involved in child referrals. Psychoanalytic and, more recently, neuropsychoanalytic thinking along with attachment research have created a foundation for understanding the biological and relational development of parent and child emotional engagement. In particular, these perspectives have clarified the nature of what Donald Winnicott termed impingements on the potential space between parent and child. An important addition to the understanding of biological and relational impingements on parent-child emotional dynamics comes from the field of occupational therapy (OT), which views sensory-motor regulatory capacities as forming the basis for quality relating and engaging. From an OT perspective, impingements on relating and adaptive functioning result from compromised regulation of arousal, affect, attention, and activity level on the part of the child, the parent, and/or the child/parent “fit.” Sensory integration and sensory processing theories offer additional frameworks for understanding and communicating with parents about patterns of mutual dysregulation in the parent-child relationship. When integrated with psychodynamic formulations, these ideas from OT research and practice can provide parents with new, more effective and flexible narratives of their children’s inner lives and behavior, and of their own narratives as parents.