Ben had been having some rough times in school. There were several episodes of his pushing or pulling the hair of some of his classroom friends. The children who were pushed or whose hair was pulled were often his favorite playmates. Though they were upset at the time, they forgave Ben, and afterwards the teachers helped Ben apologize and make a repair, for example, by asking the child what he could do to make her feel better. However, his teachers worried that the behavior continued, the children would become afraid of him and begin to avoid Ben.

These episodes were unpredictable, and even in retrospect the sophisticated and sensitive teachers could not identify the precipitant of the aggressive outbursts. They happened when he seemed tired and when he was well rested, when he was frustrated or when he was having a calm, good time. It occurred to me that these outbursts were most likely as surprising to Ben as they were to those around him. I wondered if they were an impulsive response to environmental stimuli that was perceived as a threat or that suddenly stirred a strong negative affect – such as a noise, or an object intruding into his “space bubble”, or an otherwise imperceptible misattunement by a teacher or another child. If such a stimulus triggered an impulsive aggressive move, Ben might be oblivious to the whole process until it happened and he witnessed the stricken face of the other child. This sight would certainly generate feelings of shame and guilt in Ben. We definitely wanted to break this cycle.

Ben’s teachers had many good ideas about how to introduce a counterbalancing calming stimulus, such as something to squeeze. I wondered if there could be a way to make the link between the feeling and the action more explicit. During the weekend I attended a talk by a sensorimotor therapist, Pat Ogden. She showed a film of a child who threw objects in a similar impulsive gesture. The session was videotaped, which was helpful in identifying several moments when her father – present in the interview – shifted his attention to the therapist at just the time the girl was asking him to look at something she was doing. This was acknowledged. Then the therapist asked the child to make the gesture without the throw – extending her arm in an abrupt movement – and to talk about the feelings she had when she did that. The child was able to talk about her “impulses” and gain insight into them through pairing the pattern of body movement to her new awareness of the feelings. This was effective in changing the problem behavior.

I wondered if we could do something like this with Ben. In another tape in Pat’s talk, the therapist coached the patient to do the movement associated with a problematic affective position and then “slow it down”. I recalled how Bruce Perry has talked about slowing down a movement and then talking about what is going on. This then allows the cortex (thinking part of the brain) to engage with the motor experience of the body into make some kind of integrated meaning of the experience and give the individual more control over his body as well as insight into his feelings. I wanted to try something like this out on Ben. I will let you know how it works out.