EP 278: So Many Services! How to Prioritize?

OT on Tuesday, a speech eval callback on Wednesday, play therapy on Thursday, a school meeting on Friday that's really just another appointment in disguise. When the calendar starts looking like a second job, the question that actually matters isn't a number — it's whether all of it is moving your family toward regulation, connection, and felt safety, or quietly draining it. This episode walks through how to prioritize when everything's been recommended, and nothing fits, when it's genuinely okay to pause the therapy someone called non-negotiable, and why supporting your own nervous system might be the highest-leverage intervention in the whole house.

In this episode you'll learn:

• How to tell whether your family's current appointment load is building felt safety or quietly working against it 
• A framework for prioritizing between recommended therapies when you can't do all of them, including what to weigh beyond which one "sounds" most important
• Why pausing or delaying a therapy you've been told is essential isn't neglect
• Why your own support sometimes needs to move to the top of the list

Resources mentioned in this podcast:

• The Brain Science Behind Your Child's Biggest Behaviors→ RobynGobbel.com/brainseries
• A NeuroDevelopmental Approach {EP 47} → RobynGobbel.com/neurodevelopmentalapproach
• 20 Non-Therapy Therapeutic Interventions → RobynGobbel.com/therapeuticinterventions

Read the full transcript at: RobynGobbel.com/somanyservices

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Transcript

SPEAKER_01 2:15

So when your kids' behavior is baffling and yours is too, sometimes, yeah. I know. Let's take a break from all the man boozle. You're on the baffling behavior.

SPEAKER_00 2:33

A lot of y'all probably know that I was a playtherist for a long time. I was a therapist in Austin, Texas, until 2019, and worked with kids and adults, but mostly kids and the families of kids with I wasn't actually using this language way back then, but with vulnerable nervous systems and big baffling behaviors. So it was very common for folks to meet me for the first time and for their family to already be engaged in a lot of different services. Not to mention the fact that a lot of the families I worked with had more than one child who needed services. And managing their children's therapy schedule or services schedule was practically its own full-time job, right? It's like Tuesday afternoons we drive to OT, and on Wednesdays we get a speech evaluation, and on Thursdays we have play therapy, and on Friday, I meet with a school team for an IEP. It's like the daily grind of managing the complexity of the schedule. First of all, that's a huge mental load. So much executive functioning for those of us who are like already kind of, let's just say, struggling in that lane, executive functioning lane. And so there's just so much to manage. And then it's just adding to the kind of chronic, let's say, overwhelm guilt and shame that parents tend to be carrying around. And it fits so squarely into this category of like, am I doing enough? Am I getting all the services that I need? Have I, you know, overturned every possible option? And this what can feel like a recommendation from the providers to do this service and that service and this service and that service? It's just impossible. So of course it ends up with we're not doing enough, or I'm not a good enough parent, or something like that. So I do think there comes a point where we need to ask ourselves, how many services is too many? When is the time to pull back? When have we reached the kind of threshold of not getting as much benefit given the effort that's being put into like obtaining or engaging in that service? So that's y'all, that's what we're talking about today. If you are new to the podcast, welcome. Welcome, welcome. My name is Robin Gobel, and I am the author of the USA Today best-selling book, Raising Kids with Big Baffling Behaviors and Raising Kids with Big Baffling Behaviors, as well as, of course, here on this podcast, we come together, me and you, to look at the science of being relationally, socially, and behaviorally human and use that science to make sense of what is happening in your family and in your home and start to get some ideas about what we might be able to do to help both you and your kid. So I think if it's like a partnership, I bring to you the expertise in relational neuroscience and my clinical experience working with kids and families, and you bring to the show or to my book or to the club or whatever, how, whatever way we're coming together, you bring the expertise about your kiddo. And together we kind of put our heads together and see what we can do to attempt to navigate the complexities of parenting a child with such vulnerabilities in their nervous system, big baffling behaviors, histories of complex trauma, complex kids, right, with complex minds and probably complex diagnoses as well. And of course, not all of you have kids who have been impacted by complex trauma. There's other experiences that have happened, including just being created in that beautiful but extremely challenging way. Without question, over my about two decades now, well, maybe a little more than that, 25 years maybe, of experience professionally in the field, it is very clear to me that there's nothing wrong with kids and families. What's wrong is that you're not getting the support that you need in order for your kids' like truest self to be able to be seen and uncovered because there is just simply too much stress happening. So that's what you and I kind of come together to do. How do we do things that are possible? We're not holding ourselves to a too high of a bar here, but how do we do things that are possible that can shift the stress load or the stress response of our kiddos and ourselves so that our truest, most, you know, real, wonderful selves get to shine through? And when do we cross the line of trying to do too many things in the service of helping our kids experience more regulation, connection, and felt safety? So the very first thing we want to do for sure is like step away from the fact that there's a right or wrong or specific answer to this question, right? Like there's not a number. I'm not gonna say, well, four services is good, but five is too many, right? This isn't about a math problem. This is gonna be as unique to your unique family and your unique kid as everything else is that we talk about on this podcast and in the book and in the club, right? So it's not about a number, it's about when do we cross the line where the appointments or the services are supporting movement towards increased regulation, connection, and felt safety? Or is causing movement actually away from it? So all of these services that we're accessing in the spirit of increasing regulation, connection, felt safety, right? Is it possible to have so many on the books and be involved with so many professionals that we're actually moving further away from regulation, connection, felt safety? And especially if we looked at all the different players involved, right? Because of course it's not just the child who's receiving the services, but y'all as parents and caregivers are receiving them, or at the very least, you're like driving to them and interacting with all these different professionals. And the movement of your nervous system towards more regulation, connection, and felt safety really, really matters as well. Right. And so for some families, some kids, some caregivers, you know, we we could we could look at, you know, a hundred different families. And some of them would be really benefiting from and really moving towards more regulation, connection felt safety with five appointments on the calendar. And for some, five appointments would be wildly depleting. It'd be like more dysregulating and have the absolute opposite effects. So this isn't a fixed solution. Like there, again, there's not this magic number that we're I'm gonna offer you. And also, just like your kids, not only is there no like one right answer, but even if there was a right answer, it would be constantly changing anyway, right? Like, how many services is supportive of your family now could be totally different than last month or a month from now. Right. So I feel like kind of leaning into that ambiguity makes sense. Like that's okay here on this podcast because we're constantly leaning into ambiguity, right? Like there's nothing that I would ever say that it applies to every single person, right? Like my colleague Laura says about everything, like nothing is different because everything is different, right? Everything is always different for every unique person, every unique situation, every unique moment, right? The the work in all of these circumstances is just to increase attunement and presence and connection to ourselves so that we can get some clearer, let's just say clearer data about like what's moving us towards more regulation or what's moving us further away from regulation. Now, of course, what is actually happening in that specific service or therapy that you're engaged in, or you've um that you're getting for your kid, of course, what's actually happening in those, happening in those appointments and in those services is really important and really relevant to consider. But there's a lot of other things that are relevant to consider, right? How much are you driving? How far are you driving? How much is your window of tolerance being depleted as you're attempting to like play Tetris with your calendar? And that's relevant for you as a human because paying attention to your capacity makes a lot of sense and you deserve that simply because you're you. But also paying attention to your capacity makes a lot of sense when thinking about your parenting role as well, right? Like if you're being completely depleted by managing your calendar and driving to appointments and finding childcare and you know, dealing with four siblings who you have to somehow figure out what to do with when you have one inside of the therapy appointment, right? If all of that is depleting you to the point where your kids aren't getting from you the connection, the co-regulation and the felt safety. I mean, that matters. That matters a lot. And it's okay that you have a limit. It's okay that you can't drive to three appointments a day and cover 90 miles in your car, right? It's okay that that is more than what you have capacity for. Sometimes pulling back the amount of services is exactly the best right choice. And again, I'll say these are choices to be evaluating regularly. Like you don't have to add to your list of things to do, like evaluating therapy every day, but occasionally reevaluate. You know, let's take a step back and look at everything that's happening and say, you know, is the impact we're getting from this service more positive. Is that good grammar? More positive than the like how it's uh draining us, right? Has the scale tipped? And remember that that can change. And if a scale has chip tipped, it also doesn't necessarily mean like, oh, let's stop that service right away, because maybe next week it'll tip again, right? It's all just information. So I'm gonna talk about a few things that I would be considering if I was trying to prioritize services for my kid and for my family. To be clear, this is not uh well, number one, I'm not um listing these things I'd be considering in order of importance. I I kind of just listed them as how they came to mind for me. Okay, so the things I talk about first aren't the most important. Okay. Um, and these are not the only things to consider, or even the most important things to consider. They're just the things that came to mind for me as I was kind of mapping out this episode and reflecting a lot on my clinical work, right? Like I saw families who were seeking out many services and I could see like what seemed to be helpful and and what wasn't helpful. Um, and then of course, in the last six years in the club, I've got had so, you know, interaction with, I don't know, probably a thousand families all over the world. If you add up all the people who have come and gone from the club, probably more than that. And so I get this interesting, unique lens in that way too, where I have access to seeing so much of what's happening in so many different families. So I guess my point is don't interpret the order in which I say things as something being more important than something else. When I am thinking about how to if I want to move forward with a service or not, or working with a family and we're, you know, trying to think of think of that. One of the things I'm considering is is this service, is this therapy, is this intervention supporting me and my child at what I'm gonna call the lowest part of the brain that is needed? If we look at Dr. Bruce Perry's work and his neurosequential model, and we look at, you know, well-accepted science in brain development, there is some decent science that suggests we want to start with interventions that target the lowest part of the brain that that child needs support with. And Dr. Perry's work actually goes on to be a bit more specific about this. And he talks about if we want to support really the lowest, most foundational parts of the brain, we are gonna want to look at therapies, interventions, services that um are rhythmic, repetitive, relational, somatosensory. They are highly experiential, they're really in the moment, in the here and now experiences. So they're not prompting the child to be reflective. They're in the moment experiences. And as the practitioner, I am looking at how these moment-by-moment experiences are creating new experiences in the brain. A very long time ago, probably in the first year of the podcast, I did a web a series on the podcast about strengthening the foundation of the brain. And it was probably about six episodes that talked about neurosequential brain development, targeting the brain from the bottom up and the inside out. If you go to Robin Gobel.com slash brain series, the that web page has links then to the six episodes that were in that series. So if you so rob and goebel.com slash brain series, of course, I'll put that link down in the show notes. It looks like that series starts with episode 47, a neurodevelopmental approach, right intervention, right time. Y'all, episode 47 was a real long time ago. It's it says August 17th, 2021. Wow. Um, so uh six episodes starts there at 47, but go do robingobel.com slash brain series to see all six of them. When my colleague Rose LaPierre and I, when we train therapists and play therapists, we train them in this brain-based approach, you know, looking at what uh, you know, what symptoms is the child exhibiting outside the therapy room, but also what's happening inside the therapy room and using that to uh guide treatment planning with, you know, are we doing rhythmic repetitive relational, somatosensory, experiential, here and now kind of therapy? Are we doing um more what we would think of when we think about child play therapy, projective play, uh sand tray, playing with the dollhouse, metaphor projective-based play? Or are we doing more cognitive play um and cognitive play therapy and in um really prompting kids to be super self-reflective and which has a very much a time and a place when we get to that part of treatment for the brain? So, like anything else, it's always best to start at the beginning or start at the bottom. Whenever possible, we want to build a really, really, really strong foundation. So if I'm evaluating, you know, the impact of two different kinds of experiences, that's something I'm gonna take into consideration. Which one is kind of quote unquote lower in the brain? Now, to be clear, everybody, the brain is not this like siloed. And there is good research that shows that for a lot of y'all listening to this program who have really dysregulated kids, you know, working on the rhythms of their nervous system through rhythmic repetitive relational somatosensory experiences is really, really useful. With that in mind, I also think there's a lot of value in experiences that wouldn't be called traditional therapy. I actually also have an episode on that. Let me think about what it is. Okay, yep, found it. Episode 219, non-therapy therapeutic interventions. Because sometimes just experiences in life are providing as much support for a kid as, you know, official therapy or an official service. So sometimes when I was working with families, we'd look at, you know, would your kid enjoy being on the swim team, gymnastics, um, improv, right? There are other things that kids can be engaged in that can really support the same parts of the brain we really are wanting to try to target in therapy, but we can do them through a different medium. Okay, so again, that was episode 219, 20 non-therapy therapeutic interventions is what it was called. Okay, so thinking about is this targeting, you know, the lowest part of the brain that I want to is one thing to think about. Not the only thing, to be clear, it's one thing. Uh also think about logistics. And it's fine to think about logistics. You are not a bad parent because you decide this really great service is 60 miles away and you just can't do it every week. You know, when I was practicing, I would have families sometimes to drive from pretty far away, and we absolutely had to weigh the costs and the benefits of that on the child, on the parent, on the on their finances, you know, on all these kind of bigger picture things. Um, so it is okay to say, I just can't make that drive every week, even if this is the, you know, best, most amazing service ever. It's okay to say that, right? Sometimes it's worth it. Sometimes we have to do some hard things and make some hard choices and some hard sacrifices to access something. And sometimes it's just not worth it. I I don't know exactly, you know, what the again, what that litmus test is, but there's a lot of things that go into making that decision. You know, it's not just one thing, it's all the things we're talking about here. It's very valid to consider. Does my child like this service or this intervention? Because of what we're really trying to support, those of you who are listening to this podcast, regulation, connection, and felt safety. We know that the bottom line is that safety, felt safety, safety is what is the treatment, is the most important thing. So that doesn't mean that all therapies and interventions and services are fun and are necessarily making your kid go, yes, I can't wait to go. That might not be true. But if you have a child who is consistently, you know, really opposed to going to something or participating in something, that's super relevant because the reality is, is there's not a lot of progress getting made then, right? In order for the nervous system and the brain and the body, it's so much more than just the nervous system, the stress response system, right? In order for there to be shifts and changes in a positive direction, there's got to be Sense of safety involved. And if your kid hates something, then we gotta really weigh, you know, weigh the impact of that. Now, being resistant or disagreeable or expressing, you know, not liking something is not exactly the same thing. There are lots of times when there is still safety being experienced, even in an intervention or a service where your kid is like, I don't like this. So it's less about I don't like this, and more about the overall state of your child's nervous system. And if it's in chronic constant protection mode because of that service, then again, we're looking at how much benefit could really come out of this. I also think it is really valid to kind of look at things through the lens of, you know, how much evidence supports that this particular intervention could be useful. And then weigh that against, again, like the costs of it, and not just the financial costs, although that's relevant, but also are there risks of this intervention that doesn't have a lot of evidence to support it? I mean, there are a lot of um interventions out there that the research shows are pretty kind of neutral with regards to the evidence to support that this is helpful or not. And I've known some families who are like, well, we've tried everything else, and we have the finances to try this service without it being overly stressful on our family and it's not too stressful on the schedule. And so even though this particular service doesn't have really great evidence, it's not harmful. And, you know, the specifics of my family are making it also relatively neutral. Sure, try it. But if there is an intervention without a lot of evidence to support that it's helpful, and one, there's any potential that it could be harmful, that's something to really consider. But also if it's, you know, challenging on your family uh logistics, right? If it's really expensive and you're like, I just can't, I just can't afford that. Or if it's really far away, right? Those kinds of things. I mean, if there's kind of like a low amount of stress involved with seeking a service that isn't got tons and tons of evidence base, and you feel like you've tried everything else and it's not gonna be harmful, then by all means, right? Give it a try. But it's also okay to say, like, well, there's not a lot of evidence for that. It's a two-hour drive, it's gonna cost $14,000. And just say, like, I don't think that this is the time for us to try something like that. Okay. And again, I'll just reiterate, you know, just really paying attention to where the service or the intervention or the therapy sits in kind of your child's hard versus too hard window, right? We've talked about that a bit on this podcast. Stress versus too much stress. It actually is known that the brain is going to be best supported by change when there is a mild amount of stress, moderate amount of stress that's you know, recoverable, predictable, things like that. That stress actually aids in some brain change. But when there's too much stress and we're like so blown outside our window of tolerance, you've got this chronically watchdog kid when you think about going to an intervention. I mean, that's relevant information. Even if your child desperately needs that service, if it is squarely in the too much stress category, they're not benefiting from it. And it would be better to pause and leave that intervention open as a possibility in the future. I never, ever, ever want to cause so much stress with a child with a specific intervention that it becomes something they are never willing to try in the future. So that's something to really think about. Now I know that most providers feel like what they're providing is super important. And you're probably getting a lot of messages from a lot of very well-meaning providers. I mean, I think it's great for a provider to believe that what they offer is super important. That that seems important to me, actually. But of course, we're all gonna think that the thing we offer is, you know, the most important. And it's okay to have a provider telling you that this is the most important thing ever, and for you also to say, okay, but we can't do it right now, or we're pausing or we're delaying. It's okay for those two things to go together. At the end of the day, you have way more things to consider about what is worth it for your family than that provider does. And they might be right. Like this might be an extremely important, very impactful intervention for your kid. And it still could be that you look at the big picture and say, we just can't right now. Right? We just can't right now. Now, the last thing I want to touch on today is that sometimes, and actually, I think it's probably more than sometimes, maybe most of the time. If if I'm working with a family and we're trying to decide what we're prioritizing, and we're ever looking at the difference between a child getting therapy and the adult getting therapy, or a service or an intervention, I am a lot of times going to lean towards supporting that adult. Now, of course, there are some circumstances in which that is not true. Sometimes kids absolutely need some sort of intervention or service, 100%. But a lot of times, especially with kids with a lot of complexity and a lot of dysregulation, the if we had to make a choice, it can be most helpful to focus that time on working with the parents and working with the caregivers. If we can help a parent or caregiver's window of tolerance widen, right? If we can increase their capacity for offering regulation, connection, and felt safety, if I can help a parent or caregiver really solidly put those x-ray vision goggles on, if I have a parent or caregiver with their own like really significant history of trauma that is having a big impact on the current state of their nervous system, again, like I want to focus my energy there because that parent or caregiver has so much more opportunity to interact with that child and be a nervous system presence for that child than I do. And so again, this is not, you know, uh an all or nothing, but that's not the right language. Like it's not a black and white, it's not a certain, you know, litmus test. But I often do lean towards a parent or caregiver getting a service than a child if I do have to choose, because that can offer way more support to a family system than getting the child support without also supporting parents. And y'all, I know that one of the things that is so tricky about services, interventions, therapies is what is often the kind of rigidity as well as the frequency of appointments, right? That when I was a therapist, I mean, I I would bring a client in because I a new client in because I had 2 p.m. on Mondays open up, right? And so that family fit into 2 p.m. on Mondays. Not all therapists work that way, but a lot of a lot of them do. And I all, I mean, really, honestly, since the very first moment I ever was a therapist, I always thought that model was so peculiar. And I can really remember thinking, like, huh, 2 p.m. on Mondays. Like, how does that person know that that how does their like brain and body and nervous system know that like 2 p.m. on Mondays is this like magical time to be open and available for healing and relationship? Now, there are some things about that question that, you know, 20 years ago were very short-sighted and and I have a much better understanding now about how this all works. But I've always just been so curious about that, this like once-a-week model of providing a service. There's a lot of reasons why we work that way. Some are okay reasons and some are terrible reasons. Um, and a lot of the reasons are just like, that's how it's been done for a long time. And also, we know it is so clearly documented that kids with histories of complex trauma or other nervous system vulnerabilities, right? Like other experiences that have impacted their regulation and the development of their regulatory circuits, we know that those folks benefit most from what, again, Dr. Bruce Perry would call moments of healing. As many moments sprinkled throughout the entirety of a child's life. And this is also true for parents. As many moments sprinkled throughout the entirety of their life. That was one of the, not the biggest thing, but it was one of the things I was really keeping in mind as I was creating them the format for what happens in the club. And as the club has gone on for this long, I lose track. It's either been five and a half or six and a half years. I think five and a half. You know, as the club has gone on this long, I can see so clearly that that is one of the reasons that the club works, because it's a touch-in and touch-out model. It's not Mondays at 2 p.m. It's when you need it, it's there. Um, and when you have something to give, it's there, right? It's a login when you want to. It's get support when you need it, but also not when you don't need it or want it. And that it doesn't disappear because of that, right? Like with a therapy appointment, if you miss that appointment a couple of times, you're very likely gonna lose that spot. And so I really, really wanted to create something that just worked with a different model, that it was there no matter what. And it was really there for a nervous system when the nervous system said often unconsciously, like, oh, I'm need, I'm in need of help right now. Like I know people log into the club and they haven't had the thought of, like, wow, my nervous system really could use some co-regulation right now. Sometimes they have that thought for sure, but sometimes they're just drawn to it for some reason, or they just open the app and they're not even really thinking about why. Well, then the nervous system's bringing them there. And we can see when we look at other kinds of models of interventions that that, you know, available kind of touch-in, touch-out experience is super useful. And sprinkling over somebody's entire experience these moments of healing instead of this one hour a week of healing kind of thing. Now, uh I am, of course, not saying anything negative about being in mental health therapy. I'm a big, big, big, big fan of therapy. It's what I devoted, you know, 15 years of my life to doing. I receive a lot of therapy, as do other family members. Therapy has changed my life in a million ways. And I also know that it's extremely privileged of me to be able to access therapy and have it be accessing it so regularly and for such a long period of time. That so many folks just don't have access to that. And you might have four kids, or there's just so many things that go into this that make the, you know, one hour a week model really tricky for so many families. I know many of you listening are like, I don't have the gas money to drive to therapy every week. Yeah, there are so many barriers. And being flexible about what is going to be the most important, most impactful service or intervention for my child or my family, it is absolutely worth pondering. And absolutely there's no need to feel guilty about it. It's just real life. We can take what's ideal and then look at real life and see how we can do the best that we can do. So, y'all, there isn't a, you know, this is how many appointments is too many, right? Just like everything else, it ebbs and flows and it's different for every person and in every moment. But hopefully, if you've been wondering, if you've been thinking about that, like, oh my gosh, how am I supposed to do all of these appointments in one week? Hopefully, number one, you feel validated that, like, yeah, it's a lot. And number two, that you can give yourself permission to be okay about choosing. And it's even okay to choose something that you know is really important because you can only choose so many things. You can just only choose so many things. If you are looking for a place to support you in your nervous system, but you don't want the logistics of making an appointment and getting to that appointment and having that hour a week or things like that, come and join us over in the club. See if that's a good alternative for you. It's not therapy. It is not an alternative to therapy. I mean, it's not like a you know, you know, one or the other kind of thing. Some folks do both. Um, it but it is a place to experience regulation, connection, and felt safety. And that's what changes the brain and the body and the nervous system. And again, I've very strategically designed the club so that it's just like always there. Log in when you want to, read when you want to, reach out when you want to, passively watch a video when you watch it. It's just, it's always there to touch in and touch out of and to get those moments of healing. So you can read about the club at robingobel.com slash the club. We are not always open for new members. Um, so if you go to robingobel.com slash the club and we're not open for new members, you can put your name on a list and we'll let you know when we do open up. And but if you go there and we happen to be open for new members, then yeah, come on in. We would absolutely love to have you. All right, folks, we're gonna wind this episode down. I think I've given you a lot to kind of ponder and think about. And we will be back together again next week on another episode of The Baffling Behavior Show. Bye bye.