Guiding Kids Through Meltdowns and Big Feelings

As a new grad working with children in an outpatient occupational therapy clinic, I was expected to coach parents in supporting their kids through meltdowns and big feelings. In my fieldwork, the therapists I trained under kept their faces totally blank when a child would melt down. They explained the idea of co-regulation to me, saying that if the therapist remains calm, the child will eventually calm down. This is sometimes true, but it was implemented wrong. I tried to copy my clinical mentors by pretending to be totally unphased by the child screaming and thrashing on the floor. Inside, I was freaking out. The wailing, the wild limbs, the snapping teeth, heads banging against tile floors…it scrambled my nervous system. The left hemisphere of the brain would shout “See? You don’t know what you’re doing. You don’t know how to help this child.” But with practice I managed to “stay calm” or at least appear calm. I kept my face expressionless. I moved slowly. I got down below the child’s eye level. Do you think these kids were fooled for even a single second?

Then came the challenge of coaching my clients’ parents on how best to support their kids out in the world. I regurgitated the ideas of co-regulation and “staying calm” only to be met with looks of “What the fuck?” Once, I was speaking to a mom who was at her wit’s end. Her worry was humongous. She worried every day for her child, who was highly sensitive and whom she’d never been able to soothe. I reached for a piece of wisdom I had probably learned that very morning. (As very green clinicians, we tend to share the most recent thing we’ve learned just to be able to offer something even if it’s not called for in a given moment.)

I told her, “Instead of worrying ‘Will my child be okay in the future?’ I want you to ask yourself, “Am I okay right now?” 

“But I'm NOT okay,” the mom snapped. 

Parents were sick of getting the same advice to stay calm. But I didn’t know what else to tell them. 

Our understanding of co-regulation has evolved since 2015 when I was fresh out of school. Lisa Dion reframes emotional regulation as connection to self, not a permanent state of feeling calm and collected. This means we teach kids how to regulate by connecting to ourselves over and over again. This idea has totally transformed the way that I work and relate to the children I support, because I don’t need to stay calm at all costs. I can be anxious AND connected to myself at the same time. I can feel tons of stress in my body when a child is upset, allow the stress, and even let the child see that I have a big feeling and watch how I court it through my nervous system.

What does it take to connect to ourselves in the therapy room during challenging moments? This will be a whole separate post, but here's a typical process I walk myself through:

1. Stop: “Wow, I’m having a hard time connecting to myself in this moment.”

2. Notice: What feelings and sensations do I notice in my body?

   -Racing heart, feeling sweaty, thoughts of “I don’t know what I’m doing.”

   -Ohh. I’m feeling worried that this meltdown will stop me from doing the activities I planned, and then I won't address goals and then the child won’t make progress. 

3. Allow: Breathe, slow down, allow that feeling to take up space inside.

4. Let the child see that I’m working with my own feelings. If they’re still melting down, no need to explain what you’re doing--they won’t be able to hear you anyway.  

5. When I feel more connected to my own body, I put my attention back on the child and take slow deep breaths. Just this act of putting my gaze on the child and breathing can have a deeply soothing impact on their nervous system. 

6. I can then guide the child through the storm of the meltdown. 

Depending on the age of the child and if the child has calmed enough to receive language, I might say “I’m so glad you’re letting yourself feel that.” But here’s the thing. I actually need to mean it because kids can tell when we’re being fake. There are plenty of times when I don’t feel glad that a child is letting themselves feel a big emotion because it’s fucking with my agenda. In those situations, I’m learning to ground back into myself using the process above. Grounding into my own body allows me to identify what’s blocking me from genuinely allowing the emotion to rise up in the child. Then, and only then, can I really guide the session from a place of connection and love. 

Recently I was in a session with a child who often triggered me. Sometimes his big feelings felt real, and other times they seemed very strategic, and that's when I struggled to feel empathetic. When met with a limit or something he didn’t like, he would wail theatrically and try to hit me or throw things at me. On this particular day, he began running around the treatment room when I set a limit. Instead of telling him to stop running or trying to redirect him back to the activity, I began running too. Not chasing him, just running in circles and commenting on how it felt good to run around. He stopped and looked at me.  Then he beamed and started chasing me. It turned into a super fun game of I’m Gonna Get You and we were laughing and back in connection. I was able to see the big feeling rise up in him and discharge through running, and then find ventral as we came back into connection through laughing and play.

How has your method for working with kids and parents evolved over the years? What are tools you've brought in lately that have deepened your connections with clients?

#parenting #parenthood #playtherapy #occupationaltherapy #nervoussystemregulation #emotionalregulation #therapytools