Play Therapy

Is your family frequently disrupted by your child’s meltdowns? Does the school report that your child’s behaviors disrupt the classroom? Is your child angry, withdrawn, sad, clingy, or anxious?

Descriptions of Play Therapy sometimes begin with the famous Plato quote: you can discover more about a person in an hour of play than in a year of conversation. As a fan of Plato, I enjoy his quotes as much as the next guy, but regarding Play Therapy, I don’t think the quote goes far enough. It’s not just about our discovery of the child, it’s also about the child’s self discovery.

I stumbled onto the significance of play early on in my parenting. It was a moment of deep insight to me—a young parent—when I realized that the toy tools to me were real tools to my son. I had thought of play as a way children pass time as they grow, toys as diversions. Now I had my first insight. It would take many years for me to understand just how much a child’s play was involved with their neuro-physiological development—and I still have more to learn.

My learning took a nice boost early this year when I met Sharon Lucas, LCSW. As we discussed clinical approaches, I was pleased and impressed with not only how much and how well Play Therapy meshed with our pediatric services, but also by how our philosophies and perspectives aligned. We seized the opportunity to add a powerful dimension to our service, dove-tailing with and extending our developmental neuro-physiological approach to incorporate unique cognitive and imaginative elements.

As always, whether and which therapies are appropriate and most effective is best answered by your therapist who will be working with the Creative Team behind the scenes.

If you are interested in Play Therapy, here is some detail provided by Sharon..

Play is a child’s natural language

Play therapy can help a child feel better from the inside

Play therapy can help improve behaviors on the outside

We provide Play Therapy that is child-centered and directive as needed to help children express their thoughts and feelings in a nurturing, validating, and safe space. Your child can process life challenges while exploring and practicing skills that help with self-regulation, self-mastery, problem-solving, and social skills. We coach parents and encourage and support their participation in their child’s therapy.

During Play Therapy your child has the opportunity to integrate and practice skills learned in allied modalities including occupational and speech therapies. Creative’s daily collaboration with customized and comprehensive treatment promotes optimal outcomes.

Toys are carefully selected so that children have the greatest chance of expressing themselves—

all while having fun!

Norman Doidge — putting to rest the static brain

Neuroplasticity is the property of the brain that enables it to change its own structure and functioning in response to activity and mental experience1

Today, May 5, 2017, is the 10th anniversary of the publication of The Brain That Changes Itself by Norman Doidge, a seminal and transformational introduction of brain neuroplasticity to a broad international audience. It has sold over one million copies and has been published in at least 19 different languages.

Prior to the work of Doidge and others in the last 20 to 30 years, most people believed in a static brain and the limitations of that model: once you reached adulthood, brain growth was complete, the wiring was permanent—fixed and unchanging, repair was limited, and there was no renewal. Irreplaceable neurons died one by one or in bunches. If you had a stroke or accident or other disease, then the damaged areas were lost forever. Regarding the permanent “wiring,” that notion was so firmly entrenched, its prejudice so prevalent, that even the idea that a blind person could develop greater sensitivity in the non visual senses was considered urban legend (despite massive anecdotal evidence to the contrary).

We see with our brains, not with our eyes

Norman Doidge was one of a select few that questioned the static brain orthodoxy. He not only challenged the notion but demonstrated that it was false and wrote two best sellers. His seminal The Brain That Changes Itself was transformational as it introduced neuroplasticity to millions of readers. His second book, The Brain’s Way of Healing puts the knowledge and insight of the first book to work with real world examples and further insights.

Those of you who have heard me wax philosophical may have heard me say “the human brain is the greatest organ in the universe.” To me the brain is great both in its capacity to understand and change the world and its versatility, resilience, and ability to change itself and to heal. What inspires me about the work of Doidge and others involved in neuroplasticity is their belief in the brain’s vast capacity and our capability to use that plasticity to transform ourselves.

Too many of our interventions are based on looking at symptoms and not nearly enough on what we might call pathogenesis – underlying causes

Norman Doidge has taken us to the leading edge of understanding that most remarkable organ. While his work begins with the brain, it spans all human neuro-physiology development—the whole person. It is a key supporting element of the treatments we provide here at Creative. For those with special needs who need help, Doidge has not only made the case for neuroplasticity and hope, but demonstrates the practical treatments that make use of it.

The brain is a far more open system than we ever imagined, and nature has gone very far to help us perceive and take in the world around us. It has given us a brain that survives in a changing world by changing itself.

— Richard Feingold, Co-founder

1All quotes are from Norman Doidge

75 years of Progress in Developmental Neuro-Physiology – Meet the People Behind the Successes

To learn, you have to be able to listen

– Alfred Tomatis

The last seven and a half decades have seen an explosion in understanding how we develop as human beings and how we relate to each other and the world. It has seen us use leading edge developmental neuro-physiology1 to effectively treat children (and adults) with special needs—often with dramatic results.

Through a series of articles I will introduce you to the people behind this revolution.

Our time frame begins with the 1943 publication2 of Dr Leo Kanner’s seminal work on pediatric autism. Though a series of essays we will explore the wonders of being alive and human and having the greatest organ in the universe (thus far known): the human brain. You will meet some of these incredibly perceptive pioneers who have changed the way we understand human development.

These are a few of them:

  • Dr Leo Kanner
  • Dr Alfred Tomatis
  • Dr Jean Aryes
  • Mary Kawar, MS OTR
  • Patricia Wilbarger, MEd, OTR
  • Dr Stanley Greenspan
  • Dr Norman Doidge
  • Teresa May-Benson, ScD, OTR/L
  • Sheila Frick, OTR/L

Each of these remarkable individuals provided novel insight into how we develop and function as human beings—and most if not all provided tools to transform their philosophical understanding into effective therapies.

Before we begin the biographies I want to introduce two ultimately interrelated topics. (1) The wonders and reach of the human brain. (2) Gödel’s Proof.

The human brain is special. Its capacity to understand and control the world through machines and technology is unbounded. Human beings have created effective models of the microscopic world, the entire universe, and the beginning of time. Our intelligence has allowed us to control the forces of nature through fire, chemical reactions, and nuclear energy, and we now stand on the verge of controlling matter/anti-matter reactions. Physical and virtual libraries are filled with books on our ability to organize society, manufacturer things, build cities, grow food, and travel through space. As we’ll see through the works of the pioneers, the brain has the singular if not unique ability to learn, grow, adapt, reorganize, and change itself—through our entire lifetime.

Gödel showed us something even more.

Published in 1931 when he was 25, Godel’s Proof3 is one of the most remarkable discoveries in all of mathematics. Ironically, it is not well known even among many mathematicians.

While Godel’s mathematics is formidable, his results are straightforward and intuitive: Roughly speaking, most of the truths that can be known by human beings cannot be known, discovered, or proven by any of today’s computers (even quantum computers) or by any artificial intelligence (AI) based on current computer architectures and programming.4 Not only can human beings know more truths than computers, they can know infinitely more. This result affirms, supports, and validates my belief in the incredible potential and capability of the human brain—the greatest organ in the universe.

Now let’s go meet the people.

Empathy comes from being empathized with

– Stanley Greenspan

— Richard Feingold, Co-founder

1 The meaning of developmental neuro-physiology will reveal itself in the course of these articles. I will not attempt to define it.

2 Kanner, L. (1943) ‘Autistic disturbances of Affective Contact’, Nervous Child 2: 217-250.

3Kurt Gödel, 1931, “On Formally Undecidable Propositions of Principia Mathematica and Related Systems, I,” Monatshefte für Mathematik und Physik, v. 38 n. 1, pp. 173-198.

4While it’s hard to imagine the type of computer to which Gödel’s Proof doesn’t apply, I must allow for its possibility.

Suzy’s Story


We are infinitely more than our limitations or our afflictions

– Jeffrey R Holland

We interviewed several occupational therapists recently and three asked: Can you tell me the story of Creative. Why did you start it?

One of the reasons was the Kiles.

I first met and become friends with the Kiles over 30 years ago when I lived in Edgewood, Pennsylvania, a near suburb of Pittsburgh. The Kiles had two daughters, Sally and Suzy, who were about the same age as my youngest daughter, Dawn, and they all played together.

Suzy was a child with Down Syndrome. One day Suzy’s mother Ellen told me what had happened when Suzy was first diagnosed.

The doctor was a well known expert in his field practicing at the prestigious University of Pittsburgh Medical Center.

That doctor told the Kiles that Suzy “wasn’t going to make it.”

Ellen looked right at him and said: “Suzy is my daughter and she will make it. I will make sure of that.”

Not only did she make it under Ellen’s care, but Suzy flourished.

I was fortunate enough to get to know Suzy. I used to take my children on excursions to museums and other places of interest. One weekend Dawn asked if we could take Sally and Suzy. I said it should be okay but I’d have to check with Ellen.

I went to the Kiles’ house and asked Ellen:

“I’d like to take the girls to the Carnegie Museum. I know that Suzy has a shunt. Is it okay that I take her? Is there anything I need to look out for?”

I’ll never forget Ellen looking at me, staring silently for a long time. I thought I might have said something inappropriate, crossed a boundary that I wasn’t aware of. Finally, she said:

“I’m sorry. I was never asked that question and never thought about it. No one has ever asked to take Suzy anywhere.

“It will be fine. If something happens all you or me or anyone can do is call 911. And it’s very unlikely.”

Time to time through the years Sally and Suzy and Dawn and me had fun excursions. Suzy was thriving, loving, and curious, a joy to be with. Eventually I moved away and lost touch with the Kiles, but they will always be in my heart, inspiring me. I often think of Ellen’s response to the doctor and the excursions with Dawn and Sally and Suzy, the sweet girl no one thought to take anywhere.

The Kiles are my heroes and one of the reasons I co-founded Creative. Here we affirm the unlimited potential in each of us.

By the way, we hired one of those therapists, a wonderful OT named Liz Souza (no relationship to and spelled differently than John Philip). She’ll start at the end of the month.

(The names of the family were changed for their privacy. The story is true.)

My next article on this theme will address the dangers of pejorative terminology.

Richard Feingold, Co-founder

Modified Music – a High Level Perspective Part 1

Your brain has a natural ability to physically change itself by creating new pathways and connections in response to your experiences. This neuroplasticity can be positively stimulated by engaging in the right activities, often enough, over a sufficient period of time, resulting in positive life changes. Modified music through neuroplasticity creates measurable changes in the brain. (Adapted from the Advanced Brain Technologies website)

[Disclaimer and disclosure: I’m not a therapist nor have any kind of medical degree. Furthermore my story is anecdotal. And personal. One key personal element is that I have suffered anxiety and depression on and off all my life.]

Over the last several decades scientists, doctors, and therapists have developed new transformational treatments for children with special needs. Judicious and inspired use of recently discovered habilitative methodologies have improved many lives. In this essay I discuss one modality in particular: modified music.  

Regarding the latter, when Judy (my wife and our Chief Therapist) first introduced the idea that modified music could have a profound positive clinical effect I was…skeptical. Yet, the more I researched and dug into it, the more I understood and appreciated how and why it worked.
Several months ago at Judy’s urging that I begin a modified music program. I have been improving ever since. Modified music has helped and continues to help with my stress, anxiety, and depression. It has been and continues to be the most effective therapy that I personally have had. In addition, I’ve seen its successes in the children and the occasional adult that we treat.
Understanding how and why modified music is an effective treatment has been an interesting journey for me. Somewhere in the midst of that journey it struck me  that music is a profound and essential element of human communication.
Music has been part of human civilization for eons. It has been referred to as the universal language and is found in every society known to anthropology. – Arlene R. Taylor PhD, “Universality of Music
Watching a movie with the music muted would underscore its importance in communicating context as well as emotion.

Our journey of discovery begins with the genius of Alfred Tomatis and the serendipitous confluence of his medical and musical capabilities. Dr Tomatis, a French otolaryngologist from a family of musicians, several decades ago discovered and refined the relationship between listening to (ultimately modified) music and treating disorders such as reading problems, dyslexia, depression, severe schizophrenia, and autism.

As a scientist he discovered casual relationships between our sound processing and brain development. And that the process, amazingly, begins early in pregnancy.
In Part 2 we continue this discussion expanding on the the discovery and understanding of modified music.
There are 4 leading well established scientifically based modified music programs, each of which we are certified in: The Tomatis Method, Therapeutic Listening (TL), integrated Listening systems (iLs), and Advanced Brain Technologies (ABT) The Listening Program (TLP).
We work with families interested in modified music therapy to find the best fit. The latter has many considerations such as availability, logistics, clinical relevance, and budget.
  
Regarding the latter, these programs are rarely covered by insurance. Thus we’re always looking to improve affordability. That’s why we are particularly excited about the latest offerings from ABT including rent to own, streaming, individual and family plans. All have greatly improved the affordability of their offerings.
  
Whether you’re a current or previous client or new to our practice we’re happy to provide a free consultation with Judy to see if any of the programs are a good fit, and if so how to most affordably provide them. Talk to your therapist or call 703-910-5006 or email info@creativehealthllc.com.
  
Richard Feingold, Co-founder
 

Health Insurance: Maximizing Benefits (Part 2) – Concepts and Terminology

Part 1 introduced health insurance and focused on history and overarching philosophy. We will now review the types of insurance and what it means to be in or out of network. We begin with concepts and terminology.

When I studied rhetoric, I learned that mystification referred to the use of special terminology to convince lay people that specialists are more knowledgeable. I found it ironic that the use of the term “mystification” by rhetoricians was an instance of mystification. Nonetheless I find a fair amount of mystification in health insurance terminology.

Let’s begin with the concept of insurance itself. Typically, insurance pays or reimburses for relatively infrequent and occasionally catastrophic negative outcomes that result in loss—auto accidents, fires, storm damage, etc. In contrast, health insurance pays or reimburses for frequent and expected services as well as the less frequent. I’m stating the obvious to point out that healthcare decisions are being made by mostly for profit organizations whose structure and culture is to compensate for loss.

Indemnification is used in the health insurance context to describe insurance policies that protect you from loss due to health related expenses by pre-payment or reimbursement.

In contrast are health maintenance organizations (HMOs). Initially and historically, HMOs maintained your health by providing all necessary medical services. Today, HMOs offer limited or no choice in providers for lower costs.

In a pure indemnification model, you would choose any provider at any time and the insurance would pay or reimburse you. Period. In a pure HMO, your choice—at best—would be limited to providers within the HMO. Furthermore, the HMO would determine whether or not you needed services.

Pure indemnification is rare in private policies. (Interestingly and perhaps tellingly, Medicare is pretty close to pure indemnification. So is Tricare Standard, a policy for active military.) Most non HMO policies have various degrees of choice. In general you pay more for being able to choose.

Let’s look at some key definitions.

In network (sometimes participating). This refers to a provider who has a contact with the insurer and has agreed to accept the contact (allowed) fee as full payment for the various services. If the provider bills for an amount higher than the agreed fee, the fee is adjusted. This adjustment is sometimes called an insurance write-off.

Out of network (sometimes non-participating). This refers to a provider who does not have a contact with the insurer and is free to charge whatever fee they find suitable and appropriate. If the provider’s fee is higher than the allowed fee, the provider may bill for the difference between the allowed fee and their fee. This is known as balance billing.

Now let’s look at insurance plan designations.

In additional to HMO, one of the most common is Preferred Provider Organization (PPO). These allow you to choose either an in network provider or an out of network provider, with greater cost to use the latter. The Point of Service (POS) plan is a variant of the PPO. The difference is that you are required to get a referral to see a specialist.

A variant of the HMO is the Exclusive Provider Organization (EPO) which allows you to choose within the network. While its name sounds similar to a PPO it is a form of HMO.

The requirement for referrals and other types of authorization is called gatekeeper functions.

There are terms referring to payment.

The first is deductible. This refers to the amount the client is responsible for before the insurance will begin to pay. Deductibles may apply globally or they may apply to categories of services. For example, there may not be a deductible for office visits, but there may be one for tests. Deductibles typically only count the insurance share of a reimbursement, making it take longer than expected to be reached. Until a deductible is met, the client is responsible for the full fee.

There are two other ways a client shares the cost of a service. A copay is a fixed amount for a particular type of services. Coinsurance is a percentage that the client pays for each instance of the service. Typically, a client is required to pay  either a copay or coinsurance but very rarely both.

There is one time that the insurer gives you a break. That’s when you reach your maximum out of pocket expenditures (MOOP). In that case copays and coinsurance would no longer be required.

One final term that impacts costs are modality specific session limits. These may be hard or soft. Hard limits cannot be adjusted. Soft limits can be increased with varying degrees of difficulty and likelihood of success.

I know it’s a lot of information. Let’s summarize, make a final point, and then take a break.

Today’s health insurance combines elements of indemnification and managed care. All things being equal, costs increase as choice increases: HMO (least cost, least choice), EPO, POS, PPO, indemnification (most cost, most choice).

Deductibles are how much you must pay before the insurance pays anything. Copays and coinsurance are your ongoing share of the cost.

If you are lucky (or unlucky) enough to spend so much money out of pocket you reach your maximum, you don’t have to pay anymore copays or coinsurance for the rest of the plan year.

Keep track of session limits. For various reasons, providers usually don’t.

A final point. Health insurance is a strange 3 party arrangement.

You, the client, have a contract with the insurer. Indeed, you are the insurers customer. In theory, they work for you—their purpose to pay or reimburse for healthcare services.

Your provider also works for you and answers to you. Your provider always works exclusively for you. You are obligated to pay your provider and/or release your insurance company to do so.

Your provider may or may not have a relationship with your insurer. A participating or in network provider provides behinds the scene services including billing, note and plan submission, and other administrative tasks. A non participating or out of network provider need not provide any service other than a statement when you pay. Creative, as a courtesy, currently provides billing, note submission, authorization requests, and so on, promptly and free of charge.

—Richard Feingold, Co-founder

 

 

 

 

 

 

 

Transdisciplinarianism

Is transdisciplinarianism a real word? First, let’s see what it means.

The 20th Century brought us many great things. And many challenges. The Newtonian physical theories of both the very large and very small were supplanted by General Relativity and Quantum Mechanics. Nuclear technology revolutionized everything from medicine to power generation to war and peace. Aviation and the automobile transformed travel. Computers have transformed most everything from navigation to entertainment.

Science, technology, and information processing drove material progress and had profound social implications and enormous cultural influence. One of the most unfortunate takeaways of this progress was reductionism—the idea that problems could be solved by reducing them to their most basic constituents.

That perspective was often adopted in healthcare. Specialization dominated. Practitioners isolated symptoms, minimized the domain of interest, and treated. Specialists even specialized within specialties. This was further challenged by a medical model that shifted from health and healing to symptomatic diagnosis and characterization and long term pharmacological intervention.

There was the all too true cliché of seeing clients as personifications of their symptoms. Patients referred to by their issues: “Send in the broken arm.” “When am I scheduled to see the bowel obstruction.” I cringe when I hear someone referred to as a “special needs child.” To me, it is a child with special needs or better, a child with differences.

It’s not political correctness, rhetoric, or semantics. It’s fundamental. We must see the child as a unique holistic human being with differences from typical development that inhibit his or her ability to engage the world, to know themselves and feel good about themselves. We must treat the whole child.

And to treat a child holistically, we a need a single integrated plan of care. The services provided must be driven and defined by the unique needs of the child.

So, how do we do that when there are increasing modalities to learn? more and more knowledge necessary to successfully treat the children we see?

It’s by continuing to learn and work as a team. It’s by meeting every day as a team and remaining focused on the unique needs of the child.

That’s transdisciplinarianism: The perspective, belief, and practice that informed treatment must optimally focus on and respond to the holistic needs of the individual and multiple disciplines are combined, integrated, and harmonized for maximum benefit.

Our practice believes so strongly in this approach that we meet as a team one hour every day. Every day. Each child we see requires, deserves, and receives the benefit of our collective expertise. Each child.

Okay, transdisciplinarianism is not a real word yet. I have faith that will become one. In fact, I just added it to my spelling checker dictionary.

What do you think?