(Editors’ Note: Sorca McGrath’s interest in trauma and attachment, as illuminated through the lens of interpersonal neurobiology, psychotherapy and somatic practices, has led her to play therapy, dance and movement therapy and a special interest in working therapeutically within the fields of disability and the non-verbal.)
Aisling: Hello Sorca, thank you for agreeing to have this Conversation for Inside Out. We were interested in hearing about the developmental groupwork you are doing with adults with special needs and how you became involved in this work. Could you start by saying a bit about your training?
Sorca: I trained as a play therapist with Eileen Prendiville at the Children’s Therapy Centre, graduating in 2009, but that feels very recent to me. The story of this work goes back a long time before then.
Aisling: What led you there?
Sorca: In some ways I’ve always been interested in this kind of work. My mother ran a preschool out of our home for a number of years when I was young so I was exposed to a lot of children with different abilities. My mother herself is now a psychotherapist and a play therapist but even back when she was running her preschool she was looking at development and attachment theory and I think without realising it I was absorbing a huge amount of knowledge about how to be with individuals of varying abilities. My mother also ran a group with young gifted children and I was an eager volunteer – I always had a deep interest in developmental work and had the gift of having a Mom who allowed me to participate in that. So it feels like it began there.
I didn’t go straight into this work, though. When I left school, I moved to the States to pursue music. When I came back to Ireland, I continued playing music but also got a job as a care assistant in a residential hospital with people with severe and profound learning and physical disabilities.
Aisling: Was this your first experience of severe learning difficulties?
Sorca: no, I met many people with various levels of physical and learning disabilities growing up, while helping my Granny who volunteered for many years in the Central Remedial Clinic, but working in an institutional environment was new and difficult. I found it quite harrowing sometimes.
Aisling: Can you say a bit about that, what disturbed you?
Sorca: I suppose what disturbed me most was that I could see all these microcommunications all around me from nonverbal people living in an institution, trying to communicate with staff and carers, and I could see that in the larger system of an institution there isn’t time to listen to communications that might not be so obvious.
Aisling: What were you noticing with the microcommunications?
Sorca: From my first day, I worked with a beautiful young 7-year-old and I would notice her getting agitated as the dinner trolley was coming around – she had very little movement as she had cerebral palsy – her eyes would flicker faster, I saw lots of little facial tightening movements, and a fidgeting of her fingers and her legs that you wouldn’t see normally and then she would start to cry as the dinner trolley came closer. I asked others about her reaction and was told, ‘Don’t worry about that, she does that every day. She just hates being fed, what you do is you wait until she does a really big cry and you put in as much food into her mouth as possible and then she’ll have to swallow’. I was shocked by this instruction. It felt like it was all about maintenance, timekeeping, there wasn’t time to sit still with someone and find out why they were worried or upset. It didn’t feel like the human beings around me were being listened to. I couldn’t do it, feed her that way – she was blind, she couldn’t even see it coming…
Aisling: It went against all your instincts.
Sorca: Everything, everything. Shortly after that experience I got placed on the babies’ ward in the hospital. Some of those babies were very ill and some died while in our care. Some of them had feeding difficulties, breathing difficulties, seizures, involuntary body movements and other physical difficulties that made it hard to hold them in a way that they might have needed. Some of them didn’t show pain or distress in a typical way, so caring for them became a challenge to listen to all their body signals and to try and build up a picture of the patterns for each child so that you would know when something was changing for them.
Sometimes to understand how a child was feeling about something, all you had to go on was their breathing patterns, so you learned to listen from there and everything else was a gift. Working with babies and young children who were all nonverbal, observation became the key to helping them survive and thrive.
Aisling: I imagine all of this experience had a big influence on you.
Sorca: Yeah, it had a massive influence. It was during this time as a carer that I became aware of Play Therapy, through the work of the Play Therapist in residence at the hospital. Having witnessed the deficit in emotional care for children living in this kind of institutional setting, I immediately felt the need for more understanding and began training. I continued working with the babies while I trained and for a while after. When I began my private practice, I was mostly seeing more typical children with emotional difficulties, then slowly over time I received more and more referrals from parents and organisations looking for help with children and teenagers with a range of difficulties from autism, Asperger’s, children with global developmental delays, with sight and hearing impairments, and those who were nonverbal.
Aisling: It would be interesting to hear how you’ve developed your way of working with those with disabilities, particularly those who are nonverbal.
Sorca: Most of my clients don’t have a disability but the practice would look the same for those who do. I think they go hand in hand – a play therapist works with the nonverbal all the time. What is said is only a tiny part of the spectrum of what is really happening there as a whole.
Aisling: Yes, of course, but we can be so used to naming and verbalising and the containment that can offer us in relationships, a sense that we can understand each other. So, without that foothold, I’m wondering what that is like?
Sorca: If somebody can’t name something for themselves, I try to put a language on it, but the language isn’t always verbal – I use a huge amount of gesture, facial expression and tone. I use LAMH, which is a sign language designed specifically for people with learning disabilities, it is all gesture-based, it’s all illustrative.
Aisling: I wonder can you give an example of how you communicate in one of your groups?
Sorca: The groups I run are with adults with autism, I haven’t yet done this work in groups with children with learning disabilities. We use tone, gesture and facial expression, we name ‘hellos’ and ‘goodbyes’ but also transitions, like ‘begin’,’ finished’ or ‘later’ through LAMH gestures. Something you learn in play therapy is to scaffold what’s happening verbally for children, by using descriptive language for their play. Indicators like ‘you’re finished with that’ – often nonverbal children don’t get heard when they are finished with something or they want to move on and it’s empowering to name their choices. It doesn’t have to be a dramatic gesture for them anymore or something more serious, it can be a simple sign, ‘I’m finished’. In the groups I also provide paper and markers, pens and a chalk board so, for example, one nonverbal person has developed their own unique way of communicating in the group through drawings and text using paper and a biro. These drawings have developed their own patterns over time and now illustrate how rich our understanding of each other and the process has become. For the most part the communication unfolds itself over time by observing each other and getting to know likes and dislikes through pattern, and breaks or interruptions in pattern.
Aisling: What’s the background to you running the groups?
Sorca: I was asked by a service that works with people with autism to run a mobility or dance group. They were concerned that the residents in their group homes were retreating into themselves and becoming less mobile. I met the residents and spoke with them about what they might like to do before I formulated a way of working. Some of them were nonverbal and some were extra-verbal! I asked them very practical things about how they might like to move, what music they might like – the process began from these very first practical questions and, without knowing it, they were already collaborating as a group. When you’re working with a group where mobility and communication might be an issue, you can’t come with a formula and apply it. I got a good feel for the different levels of understanding and from that I formulated how the groups are now.
Aisling: Can you say something about that thinking and formulating?
Sorca: At the time, I was already immersed in interpersonal neurobiology and neuroscience in general. I had been lucky to have attended a few incredible Confer seminars about neuroscience and attachment theory, with people such as Daniel Siegel, Allan Schore and Colwyn Trevarthen. Margot Sunderland’s book, The science of parenting, was the beginning of my understanding of the infant brain and the neuroscience of relationship – there is so much going on nonverbally and I realised the power of the baby experiencing what the parent experiences.
Aisling: How did you translate that into your work with adult clients with autism?
Sorca: It begins with my body – that is what I have learned first and foremost. Those theories are all pointing to the same thing. I must be in my body, be able to find and flex that neurological pathway in to find a peaceful place, to self-regulate, and to listen and be aware of things rippling in my body.
Aisling: And then you can really receive communication from the other. And I imagine that’s even more crucial with somebody who isn’t able to verbalise. I know people who work with clients with special needs find that the countertransference can be stronger, particularly the embodied countertransference.
Sorca: Yes, really strong. And in fact because they don’t have the capacity to put words on it, which helps to move things along, things don’t get moved along in that sense, so they really get held in the body. So those microcommunications are incredibly informative because they hold the history of what has gone before and they hold expectations of the future. You can see what group members believe is going to happen and that tells me about their fears, hopes and desires. There was a lot of personal work for me as well, becoming really aware of my own body, my own way of being, my own breathing. How important it is to become conscious of and hold all of that while being with somebody. It feels like a safe and good place to start always.
Aisling: Grounded in your own body and your own breathing. Sorca: In your own body. Yes, exactly.
Aisling: Is that the biggest thing you’re teaching the people you work with?
Sorca: I suppose so. The group framework provides the opportunity to flex the capacity to move in and out of yourself – you can flex that neurological pathway like any muscle in your body so that it becomes instinct and your body does it automatically – to move out and in.
Aisling: So you do this in very simple ways with the group members?
Sorca: Yes, the class begins with getting to know yourself before you know others. We begin with focusing on our bodies, from tip to toe. not dissimilar to a mindfulness practice but with a simple structure and music. There is comfort in the consistency of that part, the beginning. The next stage is getting the autonomy to flex your own state of being – we use marching, it’s comfortable because everybody knows how to march, people don’t have to worry about what’s right and what’s wrong – marching can get people right into the room and beginning that process of negotiating the space with others. The next stage then is getting into the dance. Then finally there is the wind down and coming back to the self.
This is just the framework, it provides predictability, an opportunity to think about your own body first, then others, an opportunity to explore and practice, and return back inwards to check in with yourself before transitioning back to the residential setting. The group experience has been strangely rich, though I never thought it would be so rich when I began. I thought I’d be helping people to get back in touch with their own bodies and then slowly move out of themselves to meet each other and I never anticipated that I would have the experience I had. The framework is what provides the opportunity but it’s not really what happens – it’s really hard to express! I’m afraid to speak about it as a formula that might seem as if it can be transplanted.
Aisling: What did you discover?
Sorca: The emerging nature of the group is the essence of it. For the group members, with having a consistent ‘them’ time or way of doing things for an hour with the same people, I saw the capacity to go inwards expanding outwards over a really short space of time. I saw the beginnings of relationship developing between people who couldn’t or wouldn’t relate up until that point. Exercising their likes and dislikes in the forming of the group was a big part of it, that also led to them noticing other people’s likes and dislikes. For instance, the dance we do in the group isn’t really a dance but is about inclusion of movements. It can begin with somebody swaying and that will be our first movement as a group after asking permission from that person. Exercising the right not to participate is as important a part of the groupwork as participating, so seeking and giving permission is important. We then string those individual movements together and that becomes the dance. It works for people who have repetitive movements or for those who have limited motion – it can be everything from really small head movements to complex full-body movements.
I’ve been running these groups for nearly three years and what happens in those groups now is so different from how it began. It’s a slow process, we meet every week at the same time. one of the gifts of this particular work is that it has been uninterrupted as it is being paid for by the group members themselves, from the funding they have for therapeutic work. The only people who can say they don’t want to do the group anymore are the group members themselves – that feels really safe for them because they worry about it ending at times. I’ve been asked, ‘Will you be here at Christmas time, will you be here next summer’, all the way up to ‘Can we still do this class in heaven?’ I say, yes, if that’s what you want to do in heaven, then that’s what we’ll do in heaven.
Aisling: That’s very touching.
Sorca: We’ve dealt with a huge amount of things in the groupwork. We lost somebody recently in one group who had cancer so we were working with that together since her illness started. That experience has allowed other group members to explore their own feelings around death in a way that might not have been possible without the safety and predictability of the group.
Aisling: So, within the body focusing, the marching and the dance, there is room and time for talking.
Sorca: The framework is really just a small part of the process. We are talking from the moment we see each other.
Aisling: When you say talking, I imagine this includes the nonverbal.
Sorca: I do the scaffolding, I still put words on everything, I never stop doing that. And in a group setting, it’s really interesting. The group members don’t have much experience of somebody explaining why others are the way they are, so sometimes it’s been a revelation for them to know why one person gets up and screams and bangs on the wall when something doesn’t go quite right – in the institutional setting it’s always just been an approach of ‘just don’t go near her when she does that’, rather than an explanation of what’s happening for that person, like ‘she doesn’t really know what to do when she gets a really big feeling in her body, and sometimes the best thing to do is go slap a wall’. And I see them getting it, everyone understands what a really big feeling in your body is.
Aisling: It sounds very developmental – I don’t work in the area of disability and I work only with adults, but I find that my work often involves such developmental naming and containing of emotional experiences.
Sorca: Yes, exactly. I think two things happen in residential care, one is that expectations are low in terms of understanding so there are a lot of things being ‘done to’ and being ‘done for’ people with disabilities.
Aisling: There’s not enough room for a genuine dialogue, even if it’s nonverbal.
Sorca: Yes, very little opportunity for that. And, as well, I think basic explanations about others are missing.
Aisling: Yes. I’m wondering at this point, Sorca, if you have a sense of where your work might develop more or how you would like it to develop?
Sorca: From my work, I’ve seen relationships are possible between people who have been told or understood that that wasn’t an option. In fact, given the opportunity to flex a neurological pathway of going into your own body and then extending it out to just thinking about others, if that can be done in an engaging way, respecting choices and preferences, then I can see the capacity is there with everybody, no matter what. I’d love to see people having that opportunity to learn those reflexive, self-regulatory skills from a much earlier age. I’d love to see little ones in school learning about mindfulness and their bodies, the in and the out, flexing that neurological muscle and learning how to flex that pathway outwards to others. I would like to see all people living in residential care having an opportunity to be in a group that is led by them, not by carers or staff deciding what is good for them because of their deficits, but a group that is their group, shaped along with their fellow residents.
Aisling: I imagine this would only happen if there is a facilitator for their group who is very tuned into their microcommunications and can offer choices, as you have. Would you also see a role in working with carers or parents of those with special needs?
Sorca: When working with individuals and listening to the nonverbal, it’s essential to work with parents and carers. All the beautiful things that Play Therapy provides – resilience and building self esteem, affect regulation, learning new ways of being with somebody, that has to be in tandem with the larger circle that the individual is involved with. I would do a lot of modelling during the ‘in-betweens’, the beginnings and ends of sessions, especially with nonverbal children. A lot of parents would say things like, ‘I don’t know how you got him up and down the stairs without any trouble’ or ‘How does he not do this to you when he does it to everyone else’, and those little openings can help me and the child go, ‘oh, well we found a way – I just wasn’t getting it right and I just kept asking him until I realised the way he needed it to be’. It’s important to always make it a ‘we’ because it is a ‘we’. I don’t know anything about anyone else – all the children have their own answers, all the adults have their own answers – they show me consistently enough so that I can hear them and if I get it wrong, I get it wrong, it’s a process.
Aisling: It’s lovely to hear you talk about it, but I find myself wishing I could see it – how you do that, respectfully and with care and interest, how patient you are – it’s not just a slow, quiet patience, though, it feels like you have a lot of energy for the work.
Sorca: I feel like there is energy there and I get to tap into that, I don’t necessarily feel like it comes from me. It’s what we create together.
Aisling: Okay, so again that’s the ‘we’ you’re talking about, the experience you and your clients create together.
Sorca: Yes. It began with a mindfulness practice, relationship theory, neuroscience – they contribute to how I made the framework for my groups, but it’s all the ‘in-betweens’, what we learn about each other in between, that is magical. The framework isn’t important, if you’re very attuned to sensory needs, if you have a good sense of a mindfulness practice and the meaning behind that and if you value that for somebody else, I don’t think the approach really matters. What really works for people is that they don’t have to do something really big to get noticed, or they don’t have to tune out, because both things happen with nonverbal people. They’re both huge communications – when someone becomes really introverted, is tiny about their movements, shallow breathing, that sort of thing, that is as loud an exclamation to me as somebody who comes in and is bouncing off the walls, screaming and roaring. I think the most important part of it is allowing everything to be a communication, from the tips of the toes to the top of the head – anyone’s state of being in the room tells a huge story about what’s happening for them. Everybody has the capacity to tune into their own state of regulation and to pick up on somebody else’s. People with learning difficulties have difficulty with that because they’re so used to people ‘doing to’ them for the greater good or their health or whatever it may be – there’s a huge amount of communication coming out of someone’s body when they’ve had a life experience of being ‘done to’ and ‘done for’. And these individuals tell a really rich story – any of those repetitive movements, even a way of holding the shoulders, certain eye motions, a certain pattern of breathing at different times – that story is there to be read and to be heard. Anyone can hear it once you realise the story is already there – it never will be in words from that person but you can read it differently and accept it and give them words for it if they so wish.
Aisling: That’s a really special part of what you’ve talked about, your capacity to find the words and read the story.
Sorca: And to know when you’ve got it wrong too – you have to get it wrong a lot! It can be informed guesswork – ‘I think you might be feeling this’ and inviting them to tell you if you’re getting it wrong – they will always find a way to tell you you’ve got it wrong, very quickly! Then, the magical thing is when you get it right and it may be the first time that somebody has found the words for what’s happening for them internally.
Aisling: Yes, and I think that speaks to a lot of therapeutic encounters, doesn’t it? Thank you so much Sorca for sharing your work and your insights.
Sorca McGrath MIAPTP is a musician and accredited play therapist from Dublin, Ireland. She can be contacted at email@example.com.
Sunderland, M. (2008). The science of parenting. New York: DK Publishing.