[Orit Tal-Atzili]

Answers to Emilie’s questions:

* mv8- I recommend doing CCW-CW-CCW for more days b/c of her GI issues, antibiotics, and more chronic constipation. Take a few extra days clearing to be sure the regularity is consistent.

* adding filling as a routine: You got this right Emilie. In the 2nd series, we aim to move into more strengthening and nourishing, now that the channels are relatively deblocked and circulation is improving (evidenced by the child staying calm and yang going down during the massage). When we see this consistently, we try to add the 3 filling passes to mvs 1,2,3,4,9,10. If the child accepts- keep adding this every massage. If yang flares up or agitation increases- go back to clearing, as explained above. Typically agitation with filling is indeed a block that does not let the energy you pour in to circulate- pressure increases and it feels uncomfortable to the child. I aim to get to a routine of the child staying calm with 3 consecutive clearing passes followed by 3 filling passes in these movements. This will become the maintenance QST routine they will continue for 2 years, or for as long as needed. No need to fill fingers and toes if they are comfortable with clearing.

[Orit Tal-Atzili]

Emilie you are welcome to ask anything related to Corri’s note here.

[Orit Tal-Atzili]

Please see Orit’s feedback in bold, embedded into Corri’s original note.

Child’s Initials: EP
Treatment #: 12
Date of treatment: 1/30/24

How is the child? Any new developments? How is the massage going for the parent? Any changes related to the family’s goals for the child? EP has been out of school per MD order last 2 weeks. Recently diagnosed with H. Pylori. Per MD this is the reason for decreased immune system, frequent illness/UTI’s, reduced sleep, reduced diet, more aggression. Now on second round of new antibiotics (4 round total) and mom has noticed improvements in all areas. Over last week improved sleep (going to bed earlier and getting up at 4 am but staying asleep at night) and no self harm at home (only at school when highly dysregulated). Diet still not great but bowel movements are back to normal (daily). Transitions still a challenge at school (fine at home) but did talk with mom about classroom structure in AM and during academics. EP is not regulated enough during school to work on anything at desk and mom (who works in her classroom) reports family now only sees school as place to work on socialization. Upcoming IEP where family will bring in data about daily academic work at home (2 hours daily) and will discuss change in AM routine to allow quiet room with 1:1 to work on these tasks as school. Also considering changing school to half day as full day is not benefiting EP. Mom talked about how much EP depends on massage as part of her routine. Will find mom at set times for massage and if mom not able to quickly start, EP will have behaviors.How do you think she identifies this set time? is she following a structured schedule, or is it an inner drive she is following? I wonder if her body really sense the need for a qi reset/support??? Mom also reports EP requesting massage when in community or stressful situations.It really sounds like she knows it is a major strategy to help her regulate, which is great. We hope to see that the QST effect will gradually increase in duration, so she will not feel the need for it beyond the daily massage. Has been going to MD office weekly since December due to illness and EP leaning on mom to request massage each time in the waiting room or in the room with the MD. Massage given in standing. Mom reports makes a significant difference in her ability to tolerate these outings. Again, this is very good! We expect this immediate effect to become cumulative and with time she will need it less frequently. Also, mom reports have been consistent with giving massage 2 times daily with exception of 2 times over last 2.5 weeks of missed sessions. Good for her. The fact that she kept fidelity with QST even when she couldn’t see you is the most important factor for EP’s progress.

2. How did the child appear and behave today (before and after the massage)? Upon arrive EP sitting with IPad in quiet area of classroom as being targeted by peer who was having some behavioral challenges. Headphones on during transition to therapy room. Mom reports highly dysregulated all day as very sensitive to peers and their meltdowns. Some yelling and protests with transition to room but allowed mom to give full body deep pressure then doff shoes. Occasional deep pressure breaks during session with good calming and EP allowing continued massage. EP aggressive toward staff today with a couple of injuries but no issues during session with consistent support hands. Would not remove headphones (listening to musical) but did allow to slide headband down to top of forehead so had access to top of head. good compromise. At end of session gave more deep pressure then transitioned off table. Playing and laughing with mom and therapist. sounds like better regulated??? did you get a chance to ask how she was the rest of the day? Was she less sensitive and less aggressive?

3. How did the massage go? (Include techniques used, how the child responded, adjustments made, what you did, what the parents did, and how you coached the parents)

No attention to IPad but music continued to play throughout session. Had to work around headphones today. Strongly encouraged mom to work on transitioning into session without them next time. Yes, but given that this was her first session with you after about 3 weeks, this is reasonable accommodation to use.

Mv1- Deep pressure in prone before starting movement with EP dropping her head and relaxing. After about 1 min deep pressure started with movement. Good prep Encouraged mom to provide massage today but she declined as too nervous EP will hurt therapist. Using yin hands initially for 2 passes Good idea to pre with some filling with mom giving support hands at MD. Head remaining down with clearing for 4 passes; yang moving down. yes! Remaining about 7 seconds on GV20 but increased to about 6 passes today. Relaxing even more with shoulders dropping with clearing at neck. These extra reps helped. Coached mom on increasing passes with movements 1-3 at home to clear/deblock head and neck. Good idea

Mv2- Clearing with 5 passes in prone with head remaining down. Mom continued with support hands at MD. Effective. Hopefully next session (live tomorrow) she will be willing to give the massage with you. I hope to observe both of you working together in synch under your guidance.

Mv3- Rolled to supine then some trunk deep pressure from mom. Gradually, try to see if these intense deep pressures may be replaced with soft pressing filling passes down the arms/back. Support hands at MD. Able to get mom to complete one pass with therapist clearing at LE’s but mom asked therapist to complete as still nervous about potential of EP hitting. Therapist clearing 2 passes. Some challenges with clearing at ear as not able to get headphones off. Discussed with mom importance of transitioning into session without them as part of routine. yes, it does get in the way for mvs 3-4. But with clear intention you could do effective work even over the headphones

Mv4- Therapist clearing on right with mom then clearing on left. Nice that mom is joining in 🙂 Continuous support hands at MD. Some yelling to be “done” and patted her chest. Mom reports when she does the chest tap it’s a request to be done with massage. EP calming with mom giving her verbal cue “one minute” which is their communication strategy for ‘not yet done’. Showing good control/regulation by being able to follow the verbal cue and relax again. Could it be that you hit something uncomfortable (blocked or empty area) at the ear when she did this? Pay attention next time you work on this area. Do more work if this is triggered again, while attuning to her cues.

Mv5- Therapist completed 3 passes on right and mom 3 on left. Simultaneous support hands at MD. Activation of MD with good eye contact. great. Aim for a smile next (the social response we want to see to indicate activation of the social center).

Mv6- Therapist clearing 3 passes on right with mom providing support hands at MD. Switching for mom to clear on left and therapist to support at MD. No ticklishness. Relaxing into movement. Mom is getting mor confident. Good work!

Mv7- Yin hand with firm pressure for filling 6 passes. Continued activation of MD with EP maintaining eye contact with mom. Nice Encouraged mom to provided movement but she declined. Maybe next time (tomorrow)…

Mv8- CCW-CW-CCW over shirt. No ticklishness or withdrawing. Reviewed with mom to continue starting CCW due to antibiotics and new GI diagnosis. Reports no resistance with this movement at home now. If she has regular BM sconsistently for 5-7 days, you can try to switch the order to CW-CCW-CW. This will provide more strengthening and less clearing out, but will still have both. Whichever sequence you choose, coach mom to monitor MBs and switch accordingly if too loose or too dry.

Mv9- Immediately clearing LEs with mom providing filling/support hands at MD. At mv9 coach mom to move the support to the LD (or add it and support both). LD is the center of the leg channels we are working on from mv9 on

Mv10- Yin hands for rhythmical strokes left then right LE, 9 passes each. EP becoming more relaxed with this. Mom reports this is her favorite movement at home right now. Support hands at MD. yang is down. Get hands to LD.

Mv11- Clearing with some reactivity on right with first pass. Yin hand with EP immediately calming and no further evidence of ticklishness. Mom with support hands at MD. add a hand at LD.

Mv12- Some adjustment for alignment but good chin movement. Still flexing knees a bit at start of movement so needing tactile cues to help keep extended. Very calm and relaxed with moving yin up. Support hands at MD with mom and EP making eye contact and quiet engagement during movement. Excellent activation of parasympathetic NS. She is well regulated. If you feel MD support is effective, just try to add the other hand for LD support, which makes more sense for the work you do on the lower body.

4. Your reflections on the process (what went well, what did not work well, what could you have done differently/will try next time, etc.). I was very happy with how well EP tolerated the massage today despite the long break and her continued medical issues. Yes! it was wonderful! I was also excited to see her head down so quickly and that she tolerated more passes with movements 1-2! I am a bit disappointed that mom is back to declining to give the massage when we had just had a breakthrough with this but next session will be more forceful. Maybe reassure her that this will not be the first time a student is aggressive with you and that you are fine and understand it (while taking good care of yourself). There should not be a reason for EP to be more aggressive with mom’s massage than with yours, unless mom is not attuned to her needs. Keep an eye on that when she does the massage, and coach her in attunement if needed. Hopefully after she observed how well it went today she will be more open to do a few passes after you in mvs 1-3, or split the mvs with you and clear together. But it was very good that she helped with support touch whenever she was not doing the mvs. Support touch is just as important for EP and for an effective massage as the movements. It is just that you want to be sure about mom’s accuracy and attunement, so you want to observe it.

5. Plan for daily parent massage, treatment, and training (suggestions to parent for the daily massage, focus for next visit, parent testing, etc.) Continue with daily massage. Mom giving massage in morning before school and in evening before bed and if having a difficult day will offer once at school. Mom and I are meeting this week (Friday) without EP to review the movements so my hope is she will become more confident after this. Excellent plan. How long does it take mom to do the massage?

This was a grate and effective massage, especially given the long break and sickness and medications since last session. If EP will be calm tomorrow as she was today from mv1, it is time to add filling passes as a routine in mvs 1,2,3,4,9,10. After you feel you did as many clearing passes as needed, follow with three filling passes, and then move on to the next mv. Hopefully we can try it tomorrow at the live supervision and evaluate together how she takes it. If she becomes less relaxed- go back to a couple of clearing passes and try again. If still increases her energy/discomfort- clear again, then move on. Overall excellent work!

[Orit Tal-Atzili]

Please see Orit’s feedback in bold, embedded into Corri’s original note:

Child’s Initials: EP
Treatment #: 11
Date of treatment: 1/9/24

How is the child? Any new developments? How is the massage going for the parent? Any changes related to the family’s goals for the child?
EP has another UTI which her MD believes is due to antibiotic resistant bacteria (previous UTI in December). Poor thing… Has a rash and is uncomfortable wearing clothes because of this. Due to illness, regulation at school has been a challenge. Did stay home Friday from school but EP requested to go to school today.
Self-injury: No significant changes in self-injurious behavior though continues to hit self when IPad removed. Family continues to work on this. Mom reports overall that self-regulation is challenging due to UTI so is more easily frustrated. That makes sense. Hope she continues the daily QST. It can help clear out and strengthen
Foods: No new foods and is now going up to 12 hours declining food which is atypical. Also reduced liquid intake.Likely due to being sick. Is she miserable and feeling sick?
Sleeping: Mom reports she is having a hard time falling asleep at night. Will stay asleep. Seems fatigued and irritable during the day so taking more naps.If she is sleeping through the night it suggest she has sufficient yin to keep her calm as needed for sleep. A hard time falling asleep could be due to yang stuck up, but also if she is uncomfortable due to illness.
Transitions: Though ill, is having a little more success with classroom transitions after being back in school for the week. Home to school transition is still challenging. Mom has been consistent with giving the massage 2 times daily and has noticed that EP is more relaxed at home Great! So glad she is committed to do QST with fidelity!

2. How did the child appear and behave today (before and after the massage)? Mom reports having a hard day but EP calm and easily transitioned once I arrived to the class. Independently moved to lay on the table and let me remove her socks and shoes without kicking. What a nice transition! No vocalizations during this time which is atypical for her. When on the mat she set her IPad to the side and lay her head down. Wow! At the end of the session she remained regulated during transition back to class. Again, very little vocalization and reduced in volume.Sounds good.

3. How did the massage go? (Include techniques used, how the child responded, adjustments made, what you did, what the parents did, and how you coached the parents)

Mv1- Prone on mat with head down all passes. Good Mom filling at MD while I completed 2 passes, remaining on GV20 and GV14 for 10 seconds each. With encouragement mom switched and completed 2 more passes with support hands at MD. Mom moved through movement quickly on first pass so cued to spend more time on head and neck to continue to deblock and clear. Mom consciously utilizing more of a cupped hand today but will need to continue to monitor technique. Making progress with mom’s involvement and form. Good coaching!

Mv2- Prone with head down and shoulders relaxed. Yang moving down. Thats’s right. I provided one pass for modeling then mom completing 2 more. Consistent support hands for filling at MD. Coached mom to use one hand instead of two at neck and reminded to try giving input on head and neck for 10 seconds. Cued to continue down to ankle. You probably did not have a chance to review the form of all 12 mvs with mom due to EP being sick… It will be good to do it ASAP. She is very committed and will be more effective if her form is correct.

Mv3- With support from mom, rolled to supine. She noticed her IPad Try to move it out of her site next time during this transition so started watching and wanted her headphones back on. I completed one pass then mom completed 3 passes with simultaneous support hands for filling at MD. One cue for clearing at shoulders. Not sure what you mean here… Needed additional time here to deblock.What suggested this adjustment?

Mv4- Therapist completing one pass on left then mom completing remainder of passes, right and left. Cues for cupped hand and accuracy with starting position (first time started on top of head). Worked with mom to transfer IPad between EP’s hands across midline to reduce behaviors resulting from her feeling her IPad is being taken away. Did great with the transition and EP had no behaviors (yelling, hitting, kicking) related to this. Great!

Mv5- Mom completed 3 passes on right, therapist 3 on left. Activation of MD with good eye contact and vocalizations. Nice!

Mv6- Mom clearing 3 passes on right with therapist providing support hands at MD. Switched with therapist clearing on left and mom filling at MD. EP remained calm during mvmt.:)

Mv7- Mom yin hand/filling x1 but starting too low and going below sternum. Therapist modeled 2 passes with instruction for correct starting/ending points. Mom completed filling 2 more passes.Good coaching!

Mv8- CCW-CW-CCW. Started with CCW for clearing toxicity related to antibiotics. EP preferred skin to skin contact for this. Encouraged mom to complete CCW-CW-CCW, 9 passes each. Reminded to continue to start with CCW due to medication. If her BM is loose- change back to CW_CCW_CW for strengthening.

Mv9- Immediately clearing both LE’s simultaneously, therapist 1 pass and mom 2 passes. Coached mom on importance of quick transition between mvmts 8 and 9. Also cued to bring down to feet. Right!

Mv10- Brining qi down with even, rhythmical strokes. 9 passes each LE.

Mv11- Mom cleared on right with no ticklishness. Some ticklishness on left with switch to filling x2 then clearing x3 with no withdrawing or ticklishness on second set of clearing passes.Excellent attunement and adjustment

Mv12- Mom completing x12 with good alignment and chin movement. Good-yin is going up. stay with sets of 9 and do 2-3 sets of 9 if EP accepts it. Slight support provided on top of thighs by therapist to keep LE’s extended. EP calm and relaxed with yin moving up.

4. Your reflections on the process (what went well, what did not work well, what could you have done differently/will try next time, etc.). Mom really did a nice job today jumping in with only some modeling which is a significant improvement in her confidence. Yes! First time she has completed each mvmt in our sessions! She also did better with maintaining a cupped hand though I still think we need to work on this. No simultaneous clearing of LE’s with mvmts 1-7 and clearing/filling UE’s with mvmts 8-12 today (filling at MD throughout) which is also great as i think we are starting to see some gains with deblocking and clearing of head/neck/shoulders and filling of MD. I agree. And as a result of the deblocking yang is going down and yin up, so her qi is more balanced. Despite being ill and on meds again EP was regulated before, during, and after the session with no episodes of aggression. Real progress, especially given the UTI.

5. Plan for daily parent massage, treatment, and training (suggestions to parent for the daily massage, focus for next visit, parent testing, etc.) Live session on 1/11 at 12:30. Will be a school and part of regular QST visit schedule. Now that mom is finally being more hands on with the mvmts I would like to further focus on her technique and attunement related to EP’s need with each move. Appropriate and important next steps. I think we have reached a somewhat workable setup with the IPad for right now but am having a bit of frustration with the headphones as she has been very hesitant to take off the last few times and if can get off, immediately wants them back on. Will preplan with mom about using speaker on IPad and try to get headphones off during transition.Good idea.

Corri-
You are doing a great job deblocking and bringing the yang down. Also great job getting mom to do all the mvs! It allows you to correct her for a more effective massage. Try to find time with her to review all the mvs with her. Explain that it will make her massage even more effective. Great work!

[Orit Tal-Atzili]

PLEASE SEE ORIT’S FEEDBACK IN ALL CAPS, EMBEDDED INTO CORRI’S ORIGINAL NOTE (SORRT, BOLD PRINT DID NOT WORK TODAY…)

Child’s Initials: EP
Treatment #: 10
Date of treatment: 1/4/24

How is the child? Any new developments? How is the massage going for the parent? Any changes related to the family’s goals for the child? Family reports only missed two days of massage during Christmas break. EP very upset when dad gives the massage so he has asked to take a break from this. In talking with mom it sounds like it is causing his anxiety to increase and he feels he really need to step away for a break. GIVEN THE DAD HAS ASD, IT MAY BE THAT HIS QI DOES NOT MATCH HERS, WHICH MAKES THE MASSAGE MORE DIFFICULT FOR BOTH OF THEM, SO IT IS OK TO LET HIM BACK OFF AND LET MOM DO IT. WILL EP ACCEPT DAD’S HAND ON HER MD OR LD? IF YES- HE COULD JUST DO THAT FOR A WHILE. Mom will continue to give 2 times daily. THAT’S BENEFICIAL USUALLY. EP has had a hard week going back to school after the holiday break so mom asked about giving the massage to EP while standing (having a harder time some days getting her to lay down). Talked about options to start while standing/on mom’s lap then trying to move to laying down. GREAT ADAPTATION WHILE KIPPING THE INTENTION TO LIE DOWN. Transitions: Mom reports more of a challenge as going back to school after 2 week break. Very dysregulated in the mornings making ADL’s and getting to school very difficult. She loves water so have started giving her showers in the morning to help with this home to school transition. In the classroom mom reports EP is having less difficulty with transitions then she did after the last school break. SOME IMPROVEMENT HERE. GOOD TO HEAR! Self-Injury: mom excited to report having reduced incidents of self-injury over the last few weeks. FANTASTIC! THIS WAS SO STRESSFULL. Sleep: Another new development is that EP has slept through the night for the last 3 nights. WOW!!! YIN IS GROWING AND STRENGTHENING AND CAN HOLD HER ASLEEP THROUGH THE NIGHT. GREAT! No difficulty/changes in going to sleep. Foods: Family working to expand new foods at home. No longer offering chicken nuggets and noodles at school (preferred foods), only at home. Started eating “carbs” at school, including trying pizza and a corndog for the first time. YIPEE! REASON FOR CELEBRATION! Mom is very excited about progress at home and school.YES!!! GREAT THINGS ARE HAPPENING!

2. How did the child appear and behave today (before and after the massage)? EP sitting at table in classroom upon arrival with IPad and headphones. Transitioned to therapy room with support from mom. A bit frustrated with her clothes today (didn’t like sweatshirt so pulled all her clothes off) but eventually calming with hugs from mom and allowing mom to help her redress. EP had the IPad during full session and headphones on after movement 3. At end of session relaxed on table but quickly seeking deep pressure from mom. Regulated during transition back to class. GOOD FOR FIRST SESSION AFTER A COUPLE OF WEEKS BREAK. KEEP THE INTENTION TO FADE OUT IPAD, WHEN IT FEELS THE RIGHT, ORGANIC TIME- MOVE IT AWAY.

3. How did the massage go? (Include techniques used, how the child responded, adjustments made, what you did, what the parents did, and how you coached the parents)

Mv1- Prone on mat, propped on forearms with head up (IPad). Therapist completed first pass then mom continued with encouragement and support hands at MD. Coached mom on spending longer time on head and neck when clearing. Mom putting pressure through fingers so emphasized using correct hand (cupped hand) with verbal coaching and modeling.GREAT THAT YOU GOT MOM TO DO THE MASSAGE AT MV1 ALREADY, AND WERE ABLE TO CORRECT HER FORM. DID EP TOLERATE THE 10 SEC STAY ON HEAD AND NECK FOR 3 CONSECUTIVE PASSES?

Mv2- Therapist completed first pass then mom completed next 2 passes with encouragement and support hands at MD. Relaxing head down when clearing at neck. GOOD! YANG GOING DOWN. Coaching mom on cupped hand during movement.YES- IT’S IMPORTANT.

Mv3- Mom completing passes on upper body with more coaching on cupped hand. Therapist simultaneously clearing trunk and LE’s. NICE TEAM WORK WHI;LE SPLITTING THE MV. No kicking, legs relaxed on table. THAT SHOWS GOOD PROGRESS IN HER TOLERANCE/YANG GOING DOWN AND QI CIRCULATING BETTER. Mom reports that at home EP is putting her hands over mom’s when clearing ears so coached in filling then clearing.IT DEPENDS IF SHE IS PRESSING ON MOM’S HANDS (=SHE NEEDS FILLING, MOM SHOULD SWITCH TO FILLING FOR A WHILE) OR JUST SOFTLY KIND OF TOUCHING MOM’S HANDS(=EP LIKES WHAT MOM IS DOING AND MOM SHOULD CONTINUE THE SAME UNTIL EP MOVES HER HAND).

Mv4- Mom completing passes with cue for correct starting position. GOOD COACHING FOR FORM CORRI! YOU ARE MAKING SURE THE 30% PROGRESS DUE TO CORRECT FORM IS ACHIEVED. Therapist clearing on LE’s with EP remaining calm and no kicking/attempting to roll away.NICE JOB MOVING YANG DOWN! Mom noticed that EP was guarding her neck a bit today so spent extra time clearing neck. EXCELLENT AWARENESS AND ATTUNEMENT! Worked on having EP hold IPad with one hand then mom helping her transfer to other hand before working on second UE. GOOD! Worked well with no frustration from EP. 🙂 Mom also moved to stand on the other side of her body today without needing reminders. SOUNDS LIKE A MUCH BETTER REGULATED EP 🙂

Mv5- Mom completed mvmt on right and therapist on left. Initially looking at IPad but at about 2nd pass started looking at therapist and some happy vocalizations. WONDERFUL – YOU ACHIEVED THE INTENTION AND ACTIVATED MD!

Mv6- Mom cleared both UE’s with help to facilitate transferring the IPad to EP’s right hand from her left. On first pass did not have therapist clearing LE’s simultaneously but started kicking legs and attempting to roll off the table. When LE clearing was added, EP immediately calmed and remained on table. SHE CLEARLY SHOWED YOU SHE NEEDED THAT LE CLEARING. YET- ITS GOOD THAT YOU TRIED TO AVOID IT. IT’S GOOD TO KEEP TRYING TO DECREASE SUPPORTS WHEN NOT SURE IF THEY ARE NEEDED, AND ADD THEM RIGHT IN IF SEEMS TO BE NEEDED.

Mv7- Firm pressure for filling x2 sets with EP remaining calm and making eye contact.GOOD IDEA TO DO SOME EXTRA PASSES HERE, TO HELP HER SELF REG, ESPECIALLY GIVEN THAT SHE IS INA HARD TRANSITION BACK TO SCHOOL.

Mv8- CW-CCW-CW. Started over sweatshirt but starting to get upset so did on skin with EP quickly relaxing and smiling. INTERESTING… SHE LIKES TO CLOSER TOUCH THERE, RIGHT ON HER SKIN. No ticklishness or withdrawing. Some gas (only at start of session NOT DURING/AFTER MV8?) but mom reports back to regular BM’s. VERY GOOD!

Mv9- Therapist clearing each LE with mom filling/providing support touch on arms with coaching. GOOD THAT YOU COACHED MOM TO BE INVOLVED. WHY DID SHE NEED TO FILL THE ARMS?

Mv10- Slow, even strokes. Some slight flexion of legs but when coached mom to give support at MD, EP extended her legs back out. NICE RESPONSE TO A GOOD ADJUSTMENT!

Mv11- Clearing but demonstrating some ticklishness today. Slowing down movement and providing filling for one pass. GOOD ADAPTATION. EP tolerating clearing 3 passes without curling toes/withdrawing. YOU TOOK CARE OF THE TICKLISHNESS VERY WELL. MAKE SURE TO COACH MOM TO UNDERSTAND WHAT AND HOW TO ADDRESS TICKLISHNESS IF HAPPENS AT HOME.

Mv12- Good alignment but some challenge getting her to not bend legs up today. Able to complete with good chin mvmt after extending LE’s and giving some light pressure on thighs. GOOD. YOU FIGURED OUT HOW TO USE SUPPORT TOUCH TO HELP HER RELAX AND ALLOW MV12 TO BE EFFECTIVE.

4. Your reflections on the process (what went well, what did not work well, what could you have done differently/will try next time, etc.). I was happy to see that mom stopped trying to hold EP on the mat when she attempted to roll off but instead quickly switched to giving support hands/touch. YES!!! GREAT RESULTS FOR YOUR COACHING! She also mentioned she has been trying to talk as little as possible during the massage and that she feels this has really helped EP at home. WONDERFUL! AGAIN- GREAT COACHING CORRI! It was noticeable in the session that she was talking less and I agree that it had a positive impact on EP. 🙂 Mom also provided few verbal corrections today which is progress. I AGREE. We did talk quite a bit about this after the session and how it can be challenging when she is so used to facilitating all interactions for her daughter but very important to not verbally correct all her actions (“we don’t hit”). OFTEN PARENTS LEARN THIS DURING THE qst SESSIONS AND START TO GENERALIZE IT TO OTHER ROUTINES, FOR THE BENEFIT OF EVERYONE. THEY CHANGE THEIR PARADIGM FROM BEHAVIORAL TO A MORE SUPPORTIVE APPROACH THAT IS BASED ON TOUCH AND READING THEIR CHILD’S NON-VERBAL CUES. Today EP was more calm, including no yelling, hitting, pinching, only a few times kicked out but did not target an adult like she usually does. She only attempted to roll away twice but both times was quickly calmed with support hands or simultaneous clearing. She tolerated clearing on GV20 really well today and I think she is making some progress with clearing the block. DEFINITELLY! I MENTIONED IT A FEW TIMES ABOVE. Several times she made eye contact with me and remained calm (did not trigger her to hit/kick me). MOM DID A GOOD JOB DURING THE SHORT BREAK! MAKE SURE TO PRAISE HER AND TELL HER HOW IT POSITIVELY AFFECTED EP.
I am a bit frustrated that mom is still having a hard time using a cupped hand and she mentioned a few times during the session that she still can’t remember all the mvmts without looking at the sheet. I would like to meet with her 1:1 without EP to work on this and help build her confidence. I WAS JUST ABOUT TO SUGGEST THIS. GREAT MINDS THINK ALIKE… I think using support hands on MD on mvmts 1-2, clearing LE’s while mom completes mvmt 3-6, and providing support hands at MD/LD/UE’s during mvmts 8-12 has made a significant difference in EP’s tolerance of the massage and decreased her aggression. I AGREE. YOU FIGURED OUT MANY QST-BASED TIPS THAT WORK! GREAT JOB HERE WITH AWARENESS AND ATUNEMENT!

5. Plan for daily parent massage, treatment, and training (suggestions to parent for the daily massage, focus for next visit, parent testing, etc.) Next session Jan 8 and live session confirmed with mom for 12:30 on Jan 11. Will also try to schedule 1:1 session with mom next Friday to work on technique. I would like to test mom after this additional 1:1 session on mvmts. EVERYONE IS INSTRUCTED TO RE-TEST THE PARENTS’ FORM AT TX11. YOU CAN COMPLETE THE FORM BASED ON YOUR OBSERVATION TODAY (TX10) AND USE THIS FOR WEEK 10’S DISCUSSION FORUM, AND THEN TEST HER AGAIN ON TX13 OR 14, TO CHECK FOR IMPROVEMENTS AFTER YOUR EXTRA COACHING. WILL THAT WORK?

EP IS MAKING GREAT PROGRESS ON HER GOALS AND IN ACCEPTING THE MASSGAE. YANG IS FLOWING DOWN AND SHE IS BETTER REGULATED. YOUR TEAM IS SHOWING GREAT QST WORK! KEEP IT UP TO CONTINUE TO SEE MORE POSITIVE CHANGES! WHEN SHE ACCEPTS THREE CONSECUTIVE PASSES WHICH INCLUDE THE FULL 10 SECONDS STAY ON THE HEAD/NECK/EARS, WE WILL TRY TO ADD MORE FILLING AFTER CLEARING EACH MOVEMENT. START REPORTING ON THAT SO WE CAN DECIDE WHEN SHE IS READY. WE COULD TRY IT DURING THE LIVE TX12 NEXT WEEK.

[Orit Tal-Atzili]

Johnnie- Thanks for sharing these examples of attunement. Make sure you point it all out explicitly to mom, so she is able to understand and generalize it.

Corri- The mother is very attuned to EP’s emotions and regulation. She has yet to develop a clear understanding of interpreting the responses through the Qi lens (her paradigm shift still needs to evolve). During your visits, make sure to point out what the child’s responses mean through the QST lens, and how to address them using QST strategies.

[Orit Tal-Atzili]

Corri-
Yes, it is important to tell the difference between a behavioral response to a more physiological response. when in doubt, my default is to assume it is a block or emptiness, a more physiological response. When you suspect the head is extremely blocked and the child is not accepting touch to the head, it is worth trying to deblock the neck first, before stating mv1, as you suggest. As a reminder, deblocking the neck is done with fingertips at the base of the skull, where the skull meets the neck. Additional deblocking of the neck can be on the sides of the neck behind the lower part of the ears, using the same technique.

[Orit Tal-Atzili]

Please see Orit’s feedback in bold, embedded into Corri’s original note.

Child’s Initials: EP
Treatment #: 9
Date of treatment: 12/20/23

1. How is the child? Any new developments? How is the massage going for the parent? Any changes related to the family’s goals for the child?
Transitions: School break this week and next resulting in major changes in her routine. Usually takes a full week on new schedule for EP to adjust. Having difficulty transitioning from preferred to non-preferred activities at home. Also struggling this week with family routines though is slightly better this AM compared to Monday. Will be interesting to ask mom next visit to compare this break to the previous break she had and see if any better.
Self-injury: increased aggression and self-injury. Mom reports lots of aggression related to IPad use. Family talked again to psychiatrist about her recommendation to not take EP away from IPad. Psychiatrist continues to believe this is the best course of action but family having a hard time with this. Mom talked about her frustration that this turns school from a place where she is supposed to work on socialization (works on academics at home) to a place where she is having very limited social interactions due to the IPad. Reports have been reducing home use of IPad so aggression/self-injury really contributing to this. Can you help me understand this better- Is she responding to the removal of the iPad with immediate aggression? how long does it last? how does it stop? what triggers it again? does she seem to be in control? Better understanding of the ABCs of the aggression could help in understanding if this is behavioral or beyond. Regardless, QST should focus on bringing the yang down (clearing mvs 1-3, 8-9) and filling the MD (as you can see on the SSC guide)
Sleeping: sleeping less at night but no issues going to sleep. Is she waking up at night and has difficulty going back to sleep? slow mvs 7,10,12 (yin) can help staying asleep, as they help having enough yin to keep us asleep longer. You can suggest doing more sets of these mvs.
New Foods: EP done with antibiotics and mom reporting bowel movements are back to normal (no constipation/diarrhea). Finally! good news! Back to eating regular foods (only chicken nuggets and noodles when ill) more good news 🙂 but family not introducing new foods this week. Did notice EP was very gassy during the session. Did she release some as you were clearing?

Mom reporting having some trouble this week with the massage with EP not accepting like she normally does. More aggression and trying to get away from parents. Discussed if changing time of the day (she is doing slightly better in AM) this week to provide massage in morning after wake up (more yin) might be helpful until she is more used to new routine. Definitelly something to try. I would recommend that you do a visit 1x/week during the “break” until the massage is easier for them. Could you do that? Emphasize a positive and calm attitude throughout. Restraining or impatience can go a long way against what we are trying to achieve. Based on the video, mom is still using verbal corrections throughout the massage. Coach her to let go of that and instead follow EP around and give her a gentle and supportive touch that she is willing to accept and feels comforted by. Mom can start with just filling passes for a day or two, if resistance continues, then when EP is more comfortable with filling touch, gradually go back to more clearing, which we know EP still needs. This is a critical point in their QST journey, and if parents are not fully supportive it can be a make-or-break point and they may give up as her resistance may escalate. Trade it carefully. I think they need your help. We can talk by phone if you want to further discuss.

2. How did the child appear and behave today (before and after the massage)?
Slept in late today so still a little sleepy upon arrival. Walked in holding mom’s hand So she is fine with mom’s touch, at least some of the time. Good sign! and with her IPad and headphones. With support EP said hi to me. 🙂 Transitioned down hall without difficulty and even let go of mom’s hand to move into the room on her own. Nice, especially given the above challenges described with transitions Explored the space a bit and sat to take her shoes off with assist. Mom gave visual and verbal cues to transition (“time for squeezy with Ms. Corri”) onto mat. EP resistant to moving onto mat and to massage initially but calming slightly when mom gave deep pressure input (trunk). No need to move her to the matt if she does not want to. Start right where she is. Be completely “on her side” and follow her lead. Gradually, while keeping the massage going, you may be able to get to optimal location and position. Became very upset when attempted to remove headphones. Moved from headphones to soft music on IPad and mom locking the screen today so EP can’t change music/volume during session. Good trick 🙂 After the session calm and playing tickle game with me. Allowed me to put her shoes back on and even gave me a hug. How sweet. Must have been an effective massage 🙂

3. How did the massage go? (Include techniques used, how the child responded, adjustments made, what you did, what the parents did, and how you coached the parents)
Before the session started had a conversation with mom about goals and expectations for session. Good! Emphasized that I need her to help give the massage and that we are going to work on talking as little as possible so that we can be more attuned to what EP’s body needs during the massage. Beautiful! She responded well but still visibly nervous about giving the massage in front of me. Lots of gentle coaching and praise given when able to follow through. Good work Corri- mom needs your reassurance to build her confidence and to relax. So important for her ability to give EP an effective massage herself.

Mv1- Prone on mat with head up. EP attempting to roll away, kicking, yelling. Mom trying to hold EP on the mat so quickly had her move her hands to MD. yes! Discussed importance of this and goal to use support hands instead of holding her in place. Right! Encouraged mom to let me take over support hands and have her give mvmt 1 but declining. I think she is very worried that EP will hurt me and wants to be able to stop if happens. With IPad and mirror, EP allowing me to stay longer with each pass (up to 10-15 seconds) at GV20 with minimal aggression. Excellent! I really appreciate your implementation of all the recommendations from the previous session! Increased number of passes from previous sessions with EP tolerating well. Using yang hand on head and neck. Relaxing head and shoulders down with second pass. Not reaching up to scratch me to move my hand off her head like last session. Continues to relax more with input on neck. Spending 10 seconds on neck to help clear toxins from antibiotics. What a terrific mv1! already see the yang going down and a shift in her energy. Very well done!

Mv2- Kicking and attempting to roll off mat between mvmts 1 and 2. did you have a pause at all? make sure no pauses during the massage. Giving support at MD. Head up but chin tucked. Deblocking with increased time on head and neck with first 2 passes. Mom clearing head and neck with coaching for extra patting at GV20 and GV14. Some assist for cupping hand. I simultaneously cleared from back down and had mom stay on head and neck, both using yang hands. EP remaining on mat with reduced yelling and rolling away. Legs remained on table. Good work with mom and with EP, you were again able to bring the yang down and help her relax..

Mv3- A bit of a challenge to roll over. Hit herself with IPad then threw it. After that, seeking some affection/hugs from mom when in supine and smiling when done. Good! She showed you she needed mom’s yin filling, and it helped her relax and regulate I started with movement and mom giving support at MD. Slightly relaxing when staying on neck and shoulders longer. Became agitated and started kicking legs so switched to mom deblocking head, ears, neck, and shoulder while I simultaneously worked on trunk and LE’s. Good attunement, adjustment, and team work. 4 hands on her- increased effectiveness. Yang hand with EP relaxing legs down; no further kicking.

Mv4- I continued to provide yang hand down legs with mom cleared on both sides. No IPad. what a nice shift (both for EP and for mom). How was mom’s form?

Mv5- EP rolled off table at end of mvmt 4. Mom attempted to get her to stay and held her arm. Quickly had mom not restrain her and encouraged her to follow her daughter to floor. Perfect! Took 1-2 minute break for deep pressure on trunk/LE’s while in prone. Glad you/mom still used touch, even if not QST touch, to get her back on track Calming body and willing to roll over to supine for me with minimal encouragement. Nice! I provided support hands at MD while mom completed mv 5 on left then switched while I completed on right. Activating MD, calm with good eye contact.Fantastic!

Mv6- Mom cleared on left while I gave supporting touch right arm/hand. Switched when I cleared on right and mom gave support touch on left. Good

Mv7- Yin hand for filling for about 1 minute. Yes, she needs it for supporting her self regulation. EP briefly touched my hand and started to pinch but with slightly more pressure at MD she relaxed. Good noticing and adjustment! Good eye contact full time without triggering her. Not sure what you mean by “without triggering her”…

Mv8- CCW-CW-CCW. Started with CCW for clearing to finish removing toxicity from antibiotics and frequent gas during session. I agree. Good call EP making eye contact with me during CCW movements. Mom providing support hands at MD. good

Mv9- Clearing each LE. You tapped on both legs at the same time, right? Mom with filling/support touch at UE’s (shoulder to hand). Why did mom fill arms? Were they too active?

Mv10- Brining qi down with even, slow strokes. 9 passes each LE with EP alternating between watching me and her legs. When she was watching her legs, was she still relaxed with her head down? If you notice it stimulates neck flexion and abs work, change something in order to allow her to relax. Keep the leg you are working on at surface level with only a slight space that will allow your hand to get there. Mom providing filling/support touch at UE’s (arms and hands).

Mv11- Clearing toes with no ticklishness or withdrawing. Yey!!! circulation improved and qi can nourish the toes so they are not sensitive Mom continued to provide support touch at UE’s. Body calm with yang down. Definitely! Great work by you and mom! Mom did a nice job not talking to EP during movements, starting with mv 5. that also helped EP keep a calm and regulated state. Also really made a difference not having the noise from the IPad for the first time. Right- she could tune in and get into “the zone”. Very nice.

Mv12- Good alignment and chin movement today. Alternated between watching me and mom during mv. Sounds fantastic! yang is down and EP is so calm, but still aware. Really wonderful work 🙂

4. Your reflections on the process (what went well, what did not work well, what could you have done differently/will try next time, etc.).
Despite EP having difficulty regulating because of a big change in schedule, she actually had some nice things happen today. For sure! This is the first session we have not had to deal with the IPad and the music from it during the full massage. She only had it the first 2 movements then after she threw it, seemed to forget about it. This supports the parents desire to get rid of it during the day. Hope they will get a second opinion and someone who could support the transition away from the iPad throughout the day. Not having all that additional visual and auditory input made a big difference in her eye contact and tolerance. I also feel like using Orit’s suggestion to have work simultaneously on a movement was like opening a door today. Great! We have been providing support hands at MD pretty consistently before today but adding in working on upper and lower body at the same time really seemed to flow today. Also, I feel like we had a breakthrough on her tolerance for clearing at GV20. Right! Today was by far the most accepting she has been of touch on the top of her head and though she still had some aggression, it was more trying to roll away and kicking compared to a high level of yelling/hitting/pinching we usually see. Good noticing of the quality of her energy and the different meanings it conveys. She also let me stay there much longer than any previous attempt. Therefore you were able to deblock much more, and we saw the yang going down so beautifully! I was only pinched a few times today and it seemed to happen during transitions between movements and because of frustration. When hands are pinching etc- fill the arms from shoulders to hands, like mom did during the second part of the massage. This usually relaxes the hands soon after starting the filling. Make sure to have no pauses at all during the entire massage, if at all possible. Do more reps until you are completely ready to start the next mv, and start it immediately when the last pass is completed. Look at the 12 mvs as one big sequence of movement.

5. Plan for daily parent massage, treatment, and training (suggestions to parent for the daily massage, focus for next visit, parent testing, etc.)
Really coached mom today on following EP and giving support hands/touch instead of trying to make her stay put during the massage. You did a very good job with this today. Now make sure mom generalizes it and implement it on going. I think continuing to focus on support hands, filling/support touch on UE’s and LE’s while second person completes other part of the movement will help at home. Very likely. Reviewed recommendations with mom at end of session but I think it’s going to be something we really focus on over the next several sessions. I also think this might be a way to get mom to give more of the massage when I am there. I completely agree. Will you be able to provide 1xwk visits over the “break” until EP accepts the massage from parents using this new understanding, and help mom shift into this approach until it is coming more naturally to her?

Corri-
This was an amazing session!!! You implemented all the relevant recommendations beautifully, you were able to stay longer to deblock the head and neck, you coached mom effectively and she demonstrated a shift into the QST paradigm, you did not need the iPad, and EP was accepting the massage very well and very calm at the end. She even gave you a hug after the massage- her way of thanking you for the good you brought to her body. Make sure you work on establishing all of these great starts into the QSt routine at home and during your sessions, so it starts to become second nature for all. Really wonderful work!

[Orit Tal-Atzili]

Please see Orit’s feedback in bold, embedded into Corri’s original note.
Feedback is for both the note and the video of the session.

Child’s Initials: EP
Treatment #: 8
Date of treatment: 12/19/23

1. How is the child? Any new developments? How is the massage going for the parent? Any changes related to the family’s goals for the child?
Still on antibiotics. Mom reporting upset stomach but no headache. Continued constipation with difficulty urination. Is difficulty urinating related to the UTI? Mv2 is addressing bladder function (among other things). You can try to do a few more reps or try filling mv2 after clearing is completed Follow up with MD next week with possibly adding additional antibiotics. Could bring more toxicity. But we never argue with the doctor, and if this is medically necessary, we will use QST to make sure we clear the toxins out as much as possible by clearing mvs 8-9-10 especially. EP very mad at mom today as mom holding her down 3x daily to take meds. Not letting mom touch her or seeking contact with mom. Oh poor thing… Will she take it for a reward instead of with force? Only eating noodles and chicken nuggets this week. Now giving massage in AM before school and at night before bed. Good for her! Since starting meds EP still allowing mom to give massage though mom reports has to use “fast hands” to get through massage quickly. Better than nothing, but work with mom on trying not to rush and be aware of EP’s needs while providing attuned massage
Starting next visit note, can you list here the goal areas (self harm, feeding, sleep, transitions) and comment on new developments related to the areas discussed in the session (check with parents about each goal at least every other week)?

2. How did the child appear and behave today (before and after the massage)?
Contacted mom before treatment to remind her about no headphones during transition to help reduce aggression. EP melted down so left headphones on until on mat table then she removed independently when Bluetooth turned off. Nice natural transition! She just took them off and dropped them 🙂 Good transition after massage with EP happy and playing with mom. Sounds like a shift in her self reg, must have been an effective massage! Let’s read and watch you in action!

3. How did the massage go? (Include techniques used, how the child responded, adjustments made, what you did, what the parents did, and how you coached the parents)

Mv1- Clearing, 3 passes by therapist. Make sure you pat on the center of the back of her legs,and not on the sides of the legs. You should only go to the sides at the ankles. IPad on mat in front of her with head propped on arms preventing relaxing down. True, but you can see that her head wants to rest, which is a sign of yang moving down. Sometimes when the child has a book or a device the most you will get is this head leaning or bobbing down. You could try to have a mount for the device and move t to her side, so she can look at it while her head is down and turned side way. Tolerating mvmt very well. I agree. She gently cued you for a little possible discomfort when you tapped on her head on the first pass, but not after that. No rolling, kicking, or resisting. Occasionally reaching up to touch my hand. Quickly starting to dig nails in and looking at me as cues to move down. Yes, that’s what I mean- slight discomfort. You respected her cues and moved down. You should try to get to three consecutive passes in which you stay 10 seconds on the head and 10 sec on the neck- this will indicate that the head and neck are deblocked enough. Do additional reps as much as needed to get to these 3 consecutive passes. No support hands needed. As I mentioned in previous notes- you want to use all hands on deck. If “not needed” for calming her down, support hands on the dantiens will still make the massage more effective, and you should ask mom to provide that touch. Also- encourage mom to keep updates for after the massage, and focus on the massage and EP’s responses. These are guidelines o use throughout the massage. Here I think you could also ask mom to do additional passes after you, since she accepted it so well (so you can evaluate her form and attunement and correct as needed

Mv2- Clearing, 4 passes by therapist. Good job here staying on the back of the legs. the 10 second guideline applies here as well, with additional reps as needed. She was making some elongated sound that I would treat as humming- stay on the spot until the vocalization fades out, then move down the path. Mom adding support hand on MD on 4th pass. Good. Needed to start this at mv1 pass 1 and stay all the time if EP accepted it. Scratching x1 but resolved when moving down. Continues to be more relaxed when neck cleared compared to GV20. Dropped head on first pass but propped back up remainder of passes. If she does not tolerate mom’s touch that well, mom can try to work on her lower body.

Mv3- Nice transition to supine. Mom said EP is very mad at her, but we still did not see that. Coach mom to be open to the possibilities and shifts during the massage, and keep trying to do as much as needed with her touch. Clearing 3 passes. Encouraged mom to provide massage but she declined due to EP being very upset with her today and not tolerating her touch. She accepted mom’s support on MD well. Mom did try to give support hands at MD with EP only being a bit upset. Mom’s hand is too low and is off MD… To support the MD the hand should be over the heart (higher and a bit to the left) Did hit me once with her IPad but I don’t feel was intentional. It could have been a response to the energy moving. Coach mom to stop giving her verbal corrections! Coach her to only use supportive and gentle touch to bring the energy down, by clearing or filing down the legs/arms if they get too active (moving/poking/pushing/hitting/etc.) Good awareness to her cues when she yelled: “all done”. Try to stay 2 seconds passed her initial resistance, then move down. This way you will expand her to;erance and chip a bit more of these blocks. The 10-second guideline applies to mvs 1-4. Try to do more reps until you get to it. Making eye contact with EP and brief pause today to make sure ready to transition into next movement was very successful.

Mv4- 3 passes each Rt/Lt. EP tolerating well today. Yes, she accepted the massage well! Try to stay about 5 sec on the end point, in each pass. Good eye contact and remaining calm. Did hit mom but related to IPad. There is no need to take the iPad out of her hand. You could do mv4 while she is holding it, and just try to offer your hand under her fingers as you go. also- bring her other hand to the toy first, then she may just let go of the hand you are working on a little after you start. For the first time today allowed me to hold her hands (outside of mvmt 6). This is great! She trusts you! Did make some vocalizations related to where at during massage (“arm”) but much improved grading her volume. Great improvement in regulation! Mom’s tone and language are corrective and not supportive. Continue to work with her on the paradigm shift. She should let EP feel supported and accepted at all times, regardless of her responses. Mom’s hand was in a better location here to support the MD.

Mv5- 3 passes, mom and I completing simultaneously. Nice that mom felt comfortable to join in. Keep the intention to do this one side at a time, and check mom’s form (it was hard for her to do this well b/c she was holding the iPad with one hand) EP wiggly and being silly briefly. Making eye contact with me instead of mom, again the first time this has happened. How nice! you activated the social center in the MD. Remaining relaxed on table, no aggression. Nice!

Mv6- Clearing, 3 passes each UE, mom and I simultaneously. Here to, aim to get to one side at a time. Nice that mom joined in spontaneously 🙂 EP tolerating having IPad down with music going. Very nice. You kept going with the massage and got her over that transition well! Looking at where I was clearing her fingers (Rt). At end of mom clearing EP giggled. Tolerated mom well during this movement. Yes, her acceptance of touch is changing as you continue the massage. Good work!

Mv7- Firm pressure with clearing. You should start mv7 a bit higher (at the collar bones) Mom giving some support at hand but minimal support needed. As I mentioned- support is needed even if EP is calm, to increase the effectiveness of the massage and fill/activate the dantiens. Here at mv7 mom’s hand can move to the LD (under the belly button). EP making good eye contact with me during movement. Responding well to soft voice. Yes! soft voice is equivalent to gentle affectionate touch (both increase the levels of oxytocin, the calm hormone). Increased vocalizations on last pass. May have benefited from another pass. I agree. you triggered a reaction and should do the same until the reaction fades away (but if the reaction indicates discomfort- you would want to change something but keep working on that area until the reaction stops).

Mv8- CCW-CW-CCW. EP seemed to enjoy movement, happy vocalizations. Make sure to stick with sets of 9 (you did 11 circled CCW for some reason). You can do 2 sets of 9 circles. Also- go much slower when you do CW, to allow the dantien to fill and strengthen. lastly- avoid pausing between mv8 and 9- while you are still providing mv8, adjust your position so you can start mv9 immediately, so nothing has the chance of going back into the guts

Mv9- Clearing, 3 passes. EP calm with music. Looking good. Mom should have had her hand on the LD, since you got off the belly. The support hand should stay on the LD until the end of mv12 if it is not needed for something else. If there is an additional hand- it can support the MD as well. Mom could also try to hold the iPad for her, so she can relax her arms.

Mv10- Clearing with firm rhythmical pressure. EP did roll away after Lt leg completed, needing support to roll back to supine for Rt leg. EP turned the volume up on her music and switched to faster paced music.

Mv11- Clearing 3 passes both LE’s. No ticklishness or withdrawing. I couldn’t see very well how you worked on the toes, but from my distanced point of view, it looked like you were on the top and bottom of the toes, rather than on the sides, and that you applied squeezes rather than reciprocal strokes from base to tip of the toe. I may be wrong, but please review mv11 in the video and the manual to be sure your form is accurate. Higher volume/faster paced music. Did ask mom to reduce volume with EP allowed. EP had definite response to auditory input (increased vocalizations, yelling, more wiggly, hit self) which immediately resolved when music turned down. Good noticing of an unhelpful distraction. Ask mom if there is a way to eliminate the non-relaxing music options. The iPad does increase her energy at times, so keep the intention to fade it out when possible (look for moments of relaxation to put it down next to her, so she can get it back if needed, and keep a very low volume and calm shows only, if possible). Also- Coach mom to fill down her arms when she gets hyper/agitated, using very soft and gentle pressing from shoulders to hands.

Mv12- Some difficulty with this movement today. yet, your form was good and the wave was going up to her head, with nice chin bobbing up with every push. Did have some flexion in knees so encouraged mom to give some support at LE’s to extend legs. Mom giving too much pressure so when she removed her hands has more success with movement through chin. Perhaps mom’s touch felt restraining? It looks like EP responded to mom’s verbalization more than to her touch. Coach mom to avoid talking in mvs 10-12, and definitely avoid giving her directions. Kicking legs x1 but calming back down to finish. Mom could fill down the legs, using soft hands. Did remain laying on table with IPad but once mom attempted to take IPad, EP became upset briefly. After that, smiling and playing with mom, made request to go to bathroom. Happy during transition off mat and when getting her shoes on. Nice shift in her regulation and energy.

4. Your reflections on the process (what went well, what did not work well, what could you have done differently/will try next time, etc.).
Work on: further exploring if EP putting her hands on my hands (mvmt 1,2) and scratching means I should remain at spot longer or continue assuming that is a cue to continue to move down; Good point to wonder about this. It was not very clear today. And if you did not stay 10 seconds- do more reps. slowing down clockwise movements on mvmt 8; right (I also commented about this in mv8) EP very reactive to type of music and volume- did best with soft orchestral and talked with mom about offering this next time. I agree. Good call and noticing! May try external speaker or IPad on articulating arm so she can’t adjust volume but still have visual access? Good ideas.

5. Plan for daily parent massage, treatment, and training (suggestions to parent for the daily massage, focus for next visit, parent testing, etc.)
Mom declined to give massage today due to EP being upset with her so not really able to assess her progress with mvmts 1-8. I would guess that EP would have been able to accept mom’s touch after you prepared the channel. Try to be a bit more assertive with her, at least try it with every movement, then she can withdraw if EP is not accepting her massage. Does still need cues with hand placement on mvmt 5. Continue to work with mom on not having EP apologize for aggression. yes, and for stopping to give her directions during the massage.

Corri-
Overall good and effective massage, evidenced by a calm and happy EP at the end, and she was also calmer throughout the massage than previously observed. Your form is great for the most part (please review my corrections and apply them from next visit). The entire massage took less than 10 minutes. You can definitely increase the number of reps and focus on the 10 seconds guideline in mvs 1-4. You are doing great! Keep it up by implementing the feedback at your next visits, and keep your good awareness and intentions that will further support your attuned massage. Keep working on mom and dad’s massage. Thanks for the great video!

[Orit Tal-Atzili]

Please see Orit’s feedback in bold, embedded into Corri’s original note.

Child’s Initials: EP
Treatment #: 7
Date of treatment: 12/11/23

1. How is the child? Any new developments? How is the massage going for the parent? Any changes related to the family’s goals for the child?
EP missed school on Thurs and Friday last week due to UTI (diagnosed on Thurs). On 10-day antibiotics with mom reporting some changes in stool (constipation). Both illness/infection and Antibiotics can cause both physical and emotional dysregulation. Use extra clearing passes to move out toxicity. EP dysregulated today with mom reporting has been so since last Thurs. Since she got the UTI. Makes sense. Unable to do massage Thursday night but able to continue daily since then. Good for her. Praise mom for her fidelity and explain that the massage can help clear the body from toxins and stimulate the immune system (do extra patting on GV14- the large vertebrae at the base of the neck) Mom reports no upset stomach, but EP does have a headache. Appointment with psychologist yesterday who recommended adding 3 new meds for aggression and self-regulation. Parents declining at this time. Glad they have declined! Let’s give QST a bit more time to see what it will help with. Also report the psychologist strongly advised against taking her IPad way from her during the day as this is a trigger and leads to harming herself and others. Really??? Parents are upset by this as one of their goals is to reduce screen time at school as have seen a significant increase in combative behavior since last May started having IPad for full school day. Can they get a second opinion? EP continues to allow more touch with others (outside of mom), is sleeping for longer stretch at night, and frequency of outbursts/level of aggression is slightly reduced. Family is staying home during Christmas break and would like to make QST a priority. That will be great! Hopefully, you could encourage dad to join and get more involved.

2. How did the child appear and behave today (before and after the massage)?
EP dysregulated today. Peers in her class very loud and having meltdowns which had an impact on EP’s ability to regulate. Peer started targeting her so she was moved to quiet area with support staff. Transitioned into therapy room and onto massage table well (with IPad in hand) but needed deep pressure from mom before session for calming (about 1 minute). With input, smiling and calmed briefly. After session remained calm and allowed me to don her socks and shoes which is new. Nice! You provided an effective massage that helped her better regulate! While talking with mom, EP started tickling my arms and saying “tickle, tickle”. Reciprocal play for three turns, 2 separate times with tickle game. EP with good eye contact and smiling. This is the first time she has had this kind of interaction with me! Exciting! MD is activated! After this, moved to crashmat, quietly playing with her IPad for about 10 minutes.

3. How did the massage go? (Include techniques used, how the child responded, adjustments made, what you did, what the parents did, and how you coached the parents)

Mv1- Clearing, 3 passes by therapist. Needing mom to move her to prone. Mom also giving her pic and verbal cue to let EP know time for “squeezy massage” which helps in calming slightly. EP very resistant to removing headphones (in prone, watching IPad) and becoming combative when attempting to take off. Mom with support hands on md. Good! Frequent kicking at therapist. Yelling. Noticed EP slightly more calm when clearing neck compared to head though not dropping head fully down. Baseline was more agitated today. You may try to start with earphones and iPad and do many reps of mv1, until she is calm, and then attempt to remove the phones/iPad and do more of the same reps until she calms down again. If still agitated after three reps, do more! until you see a shift down in her energy and she gets more calm. No need to even count the reps, just watch her responses and look for evidence of yang going down

Mv2- Clearing, 3 passes by therapist. Kicking and yelling but keeping legs on mat when moving down to legs. more reps of mv1 and of mv2 would have been helpful probably. Can be done together with mom by splitting the mvs as I explained in one of the previous notes. Attempting to roll away which slightly reduced with mom giving support hands at md (back). Head dropped some but did not fully go to mat. yang is partially going down. More reps should help Continued to have access to IPad. That’s ok if it helps. Did it help? Sometimes it agitate the child and is not helping or not worth it. Other times it helps them stay quiet and calm. After clearing, mom giving deep pressure (trunk) for about 1 minute to help EP calm and regulate. Calmed and smiling before moved to mvmt 3. Try to get mom to do the deep pressure along the path of the mv you are at, so she can support the channel you are working on while still using the technique she feels is supporting EP.

Mv3- Clearing, 3 passes by mom. Therapist providing firm support hands to md in supine. Nice switching. EP responds better to massage when mom performing though mom reports still not as calm as at home, likely due to me being present it could also be due to the different time of day (night time is more yin) and the different setting and schedul. Mom using visual to remember mvmts. It’s fine, but I would expect her to no longer need the visuals if she is doing the massage daily. It is important that you watch her do all the massage mvs to be sure her form is done with fidelity.

Mv4- Clearing, 3 passes on each side by mom. Therapist providing support hands at md with firm pressure. Some kicking but less than previous movements. yang is starting to go down. More reps at mvs 1 and 2 likely needed Mom did better with cupped hands today; less coaching needed for hand placement or cuppingYey!. Mom also verbally supporting EP through movements. Make sure this is needed, and discourage if not

Mv5- Clearing, 3 passes on each side by mom. Therapist support hands with firm pressure at md. Mom initially tried to do movement with right arm while standing on left side of EP. Coached to stand on side of arm working on. Absolutely. Good coaching. Looks like mom was doing more this session and it gave you the opportunity to verify and correct her form. Given that 30% of progress comes from correct form- this is critical

Mv6- Clearing, 3 passes on each side. Mom on left side, therapist on right. Therapist continued to give support hands at md while mom clearing. EP holding IPad in right hand while mom working with left. Became upset when mom attempted to switch hands (hit self in head) I usually try to bring the free hand to the toy first, then start working on the other hand while the child is still using it to hold the toy. Usually, the hand gradually relaxes and the child eventually lets go of the toy. Try to coach this to mom. so continued to squeeze EP’s left hand while therapist worked with right fingers. Minimal kicking but did hit herself in the face twice. Additionally- whenever the child’s hand is active, poking, hitting, pinching, etc.- try to fill the arm of the active/hitting hand with slow presses down from shoulder to hand repetitively, as a supporting touch, while the other adult continues the QST mv.

Mv7- Firm pressure provided, 6 passes by therapist. Legs remaining on table. No yelling or attempting to roll away. Mom talking softly to EP and giving squeezes on both hands. nice shift here- You activated the MD self-soothing

Mv8- CCW-CW-CCW due to constipation. correct. No ticklishness or withdrawing due to discomfort. Discussed with mom recommendation to continue to start with CCW while on antibiotics and until bowel movements return to normal. correct again. Reported she had already made the switch over the weekend. Good for her! She gets it! EP rubbing eyes so reviewed with mom this is a positive sign and not to eliminate. Right. Continue with extra strokes until this response stops. Mom continues talking softly to EP and giving squeezes on both hands. good. This is a supportive yin action.

Mv9- Clearing, 3 passes each side by therapist. Mom giving EP support at hands to reduce injury to self and adults. Good yin support. You can get her to try filling from shoulders down to the habnds, then staying at the hands a bit before going back up to the shoulders. No kicking or yelling. Yang is down. Nice.

Mv10- Clearing with firm, rhythmic movements 10 times each side. Try to stick with multiples of 9. Can repeat another set of 9 if more is needed. EP calmer with no kicking or wiggling. Mom giving squeezes on both hands. No able to reduced sound from IPad as is a trigger for her at this time.Makes sense to leave as is as you decided. Maybe next time start with lower volume?

Mv11- Clearing toes, 3 passes on right with no ticklishness. On left started clearing but curling toes. Changed to filling for 3 passes then clearing for 2 with no ticklishness or withdrawing. Good awareness and adaptations! Mom continued to squeeze EP’s hand and to use soft voice for calming. The intention for mvs 10-12 is to stay quiet. Watch mom’s use of voice and guide her to fade it out if it is not necessary for EP.

Mv12- EP extending knees today and remained in alignment with mom positioned by her head talking to her quietly and squeezing her hand. Continued to have access to IPad. Was she actively watching it at this point? Coached mom again on placement of hands on feet.

4. Your reflections on the process (what went well, what did not work well, what could you have done differently/will try next time, etc.). EP did not hit or pinch me today which is an improvement. Responds strongly to firm support hands at middle dantien and on days when very dysregulated may need more support on trunk to help calm/tolerate massage. This yin input is helpful. Keep the intention to gradually decrease the amount of pressure and focus on the qi generated from the giver’s hand, and also try to stay on the path of the QST mv. Play with it and see if it becomes effective during the QST session more and more. Mom did better with hands (placement and cupping) but still is working on remembering movements without visuals. At home mom has visual hanging on wall above bed for reference. As long as she does not pause b/c she needs to look at the chart, it’s OK. However, you may wish to do a review without the chart to help her memorize the QSt massage so she can then focus more on attunement. It can be done on a doll or on herself even, before or after the treatment with EP. Also discussed trying to use a portable speaker for IPad next time and transition into room and immediately take off headphones to help reduce distress/combative behavior. good plan. start right away so she gets redirected and moves on Excited that mom is feeling more comfortable and providing more of the massage today with therapist giving support hands. yes, that was excellent! Would like to continue to work on mom giving all of the first 8 movements within the next few sessions. I agree. Mom also liked using the massage table today so will continue to bring. that will be great, as long as it is not a struggle to keep EP on it.

5. Plan for daily parent massage, treatment, and training (suggestions to parent for the daily massage, focus for next visit, parent testing, etc.) Next session scheduled for 12/13. Work on helping mom memorize and do first 8 movements. PLEASE REMEMBER- TX-8 SHOULD BE VIDEOTAPED. Make sure to coordinate that and have a camera person that will move around so the video captures the massage well. Include both how you do the massage and how you coach mom to be as involved as possible. Make sure all hands are used at all time to support EP’s needs in every moment. Videotape the conversations before and after the massage as well.

Corri- you were able to effectively use QST to bring EP’s yang down and improve her self-regulation, even though she was highly agitated before your session. You also had mom doing more of the massage movements, which allowed you to coach her for improved form (responsible for 30% of progress). This was a very effective QST session!

[Orit Tal-Atzili]

Please see Orit’s feedback in bold, embedded into Corri’s original note. Feedback is brief due to late posting and because additional treatment/s were done already.

Child’s Initials: EP
Treatment #: 6
Date of treatment: 12/6/23

How is the child? Any new developments? How is the massage going for the parent? Any changes related to the family’s goals for the child? EP pulled fire alarm in classroom twice today with mom reporting having been very dysregulated by peers response to noise though EP seemed to enjoy the loud sounds. Mom reports EP with improved eating over last few days, improved sleep, and now allowing more touch from her 1:1 EA in the classroom (seeking hugs and contact which has never happened before). This is great- her skin is filling due to improved circulation and she is accepting affectionate touch!

2. How did the child appear and behave today (before and after the massage)? Despite being dysregulated earlier from fire alarms, EP transitioned well into session and positioned on mat with little support. Less combative this session and after completed, chose to stay in the therapy room with mom and EA while discussed session.

3. How did the massage go? (Include techniques used, how the child responded, adjustments made, what you did, what the parents did, and how you coached the parents)

Mv1- Clearing, 3 passes by therapist. Faster pace. Immediately dropped her head and relaxed. No support hands needed. No combative behaviors, protesting, or attempts to roll away.What about mother clearing too?

Mv2- Clearing, 6 passes by therapist. Head down, closed eyes. 1x put hand over therapists hand when at top of head so stayed longer but when she scratched (about 15 seconds) cleared down. good adaptations!

Mv3- Clearing, 3 passes by therapist. When eye contact made with EP, increased scratching and kicking. Mom gave support hands at md with EP calming. good

Mv4- Clearing, 3 passes each side. Therapist on Lt, mom on Rt. Quick passes. Mom coached on cupping hand.

Mv5- Clearing, 4 passes each side. Therapist on Lt, mom on Rt. EP smiling, vocalizing, and making eye contact with mom. MD activated!

Mv6- Clearing, 3 passes each side. Therapist on Lt, mom on Rt. Hit and kicked initially but calmed on second pass. No ticklishness. Circulation to fingers is improving.

Mv7- Firm hands with increased pressure today. Cleared 6 times. Mv7 is usually filling/yin (when done with a heavy and slow hand). Clearing will be patting with a fast and light hand. Which technique did you use? Legs down and arms relaxed.

Mv8- Cleared Mv8 is both clearing and filling: CCW is always clearing, and should be done fast, and CW is always filling, and should be done slow, C-CW-C completed by therapist. Mom with support hands at md with pressure. No aggression or withdrawing. Mom reports no longer having a hard time with this movement at home. Good.

Mv9- Clearing, 3 passes on each side by therapist. No kicking with mom giving support hands at md. Try supporting the LD to increase effectiveness here

Mv10- Cleared with long, even strokes completed by therapist. No ticklishness or wiggling. Very calming for EP. Mom continued to give support hands at md. again- should be LD.

Mv11- Cleared, 3 passes each side by therapist. No ticklishness or withdrawing. Mom with support hands at md.Try supporting LD

Mv12- Therapist completed with rhythmical movement. Mom giving light support hands at thighs to help extend legs. Body and head in alignment with good chin movement.

4. Your reflections on the process (what went well, what did not work well, what could you have done differently/will try next time, etc.). EP tolerated massage much better than expected given her morning and how dysregulated she had been. Only some aggression but quickly resolved with support hands. For the first time dropped her head fully and relaxed enough to close her eyes with movements 1 and 2! Great! the channels are more open and you can bring the yang down faster and with less reps Still working on mom providing massage during sessions. Yes- instruct her to do so and make it an expectation for her to at least try to administer each mv., in every session, unless there is a clear indication against it based on EP’s responses

5. Plan for daily parent massage, treatment, and training (suggestions to parent for the daily massage, focus for next visit, parent testing, etc.) Next session scheduled for 12/8. Discussed meeting over christmas break as family will be in town most of the time. Willing to schedule 2 sessions the week of 12/18 and open to meeting at their home to hopefully reduced dysregulation by meeting at ESD again. Good. Remember to videotape Tx8!

[Orit Tal-Atzili]

Please see Orit’s feedback in bold, embedded into Corri’s original note. Feedback is brief due to late posting and because additional treatments were done already.

Child’s Initials: EP
Treatment #: 5
Date of treatment: 12/4/23

1. How is the child? Any new developments? How is the massage going for the parent? Any changes related to the family’s goals for the child? EP totally off meds now. Mom reports some difficulty with mvmt 8 since sick last week (typically one of her favorite). Going well at home nightly with mom discussing also doing massage in AM before school. Mom very happy with results: EP with improved sleep and reduced melatonin at night (from 10mg to 3mg) and improved focus and regulated at community SLP. Slight increase this week in injuring others though.

2. How did the child appear and behave today (before and after the massage)?
Much more regulated from previous session. Good transition into room (with IPad, headphones, preferred toy). Smiling and happy at start and end of session.

3. How did the massage go? (Include techniques used, how the child responded, adjustments made, what you did, what the parents did, and how you coached the parents)

Mv1- Clearing, 3 passes by therapist. Prone on crashmat with IPad on floor so head dropping down well. Some challenges with removing headphones today with increased behaviors (hitting/kicking) when taking off. Providing mvmt with faster speed. Liked clearing at neck with shoulders dropping. No support hands from mom needed. Support hands are always needed if the child accepts this touch. If there is no other support needed, hands should be placed in the middle dantien (in mvs 1-6), or on the lower dantien (mvs 9-12), or on both dantiens if there are enough hands. mother can also work together with the therapist to split the large mvs (1-3)- one person works on the head and neck, and the other one from the neck down (no need to wait for each other- each work on their “loop” repetitively. The person working on the upper body guides the massage and determines when to adapt/move on

Mv2- Cleared, 3 passes by therapist. Faster speed with no kicking or wiggling/attempts to roll away. No support hands.

Mv3- Assist to roll into supine. Cleared, 3 passes by therapist. EP became more combative when therapist made eye contact with her when clearing ears. Occasionally kicked, scratched therapist only once. Mom encouraged to provide support hands at MD. Given more clearing at feet x10 seconds with some relaxing of legs/less wiggly noted.

Mv4- Cleared, 3 passes by therapist on right and left with mom clearing second set of 3 passes with encouragement. Coached mom on cupping hand instead of using fingers x2. Good that you coached mother to get more actively involved, and that you were able to correct her form. EP hit self in face 2x and mom 1x due to frustration related to IPad/headphones Good reason to fade these out sooner rather than later. but reduced with support hands at md. Yawned 1x.

Mv5- Cleared 3 passes. Mv5 is not a clearing or a filling mv. It is an “activating” mv to activate the MD/social center. Therapist on right and mom on left. Coached mom on wrist position and extending UE for correct positioning. Mom and EP making eye contact and reciprocal vocalizations.

Mv6- Cleared, 3 passes each side (Lt therapist, Rt mom). No ticklishness. Yawned x2. Looking back and forth between adults when giving massage. Calm with legs relaxed/no kicking or wiggling.

Mv7- Firm pressure chest level. Some withdrawing and facial grimacing today. Resolved with lengthened hold. Scratched therapist hands at start x1.

Mv8- c-cw-c-cw-c. Tolerated well with no withdrawing or aversive responses.

Mv9- Cleared 3 passes. On first pass some kicking bil LE’s. Mom gave support hands at md with EP calming. your “go to” should be support at LD, as this is the center for the leg movements.

Mv10- Cleared with long, even strokes completed by therapist. No ticklishness or wiggling. Very calming for EP.

Mv11- Cleared, 3 passes each side by therapist. No ticklishness or withdrawing.

Mv12- Therapist completed 9 passes each LE with rhythmical movement. Mom giving support hands at knees to help extend legs. Body and head in alignment with good chin movement.

4. Your reflections on the process (what went well, what did not work well, what could you have done differently/will try next time, etc.). Still working with mom on cupping hands vs fingers for clearing and quiet during mvmts 10-12. This is very important. Would be good if you could watch mom performing all the mvs (can be after you do the main clearing), so you are sure her form is accurate in all mvs, consistently. If EP accepts it- get mom to do a couple of reps for each mvs on a regular basis during your sessions. Mom continues to be very Intune with EP’s mood and does a great job supporting her in mvmts. Would like to continue working on not having IPad during session but not able to do so at this time.

5. Plan for daily parent massage, treatment, and training (suggestions to parent for the daily massage, focus for next visit, parent testing, etc.) Family canceled sessions scheduled for 11/27, 11/29, and 12/1 as EP ill. Scheduled next treatments for 12/6 and 12/8.

Overall, this Tx seems to have been easier and EP accepted the massage better than the previous one. Progress!

[Orit Tal-Atzili]

For Tx4-
This note was posted a month after the session… Feedback was provided verbally at the time of the Tx as this was the live supervision. Corri- you did a great job during this challenging session.

[Orit Tal-Atzili]

Ellen – Feeding takes usually a longer time to improve. You see the foundations improving. give it time and encourage them to keep trying but without pressure. I am wondering what behavioral indications you see that suggest toxicity. Weekly check-ins will be great for the break.

Sara – If constipation persists- you can try to do 2 sets of 9 CCW to strengthen clearing the guts. Encouraging parents to log their daily massage is important to keep them on track, especially during the break.

Thanks for sharing!

[Orit Tal-Atzili]

Emilie- Thanks for sharing all of these examples. We can all learn from them. I particularly like how you empowered mom’s discovery of the attuned touch that helped M. to accept mvs 1-3 the best. These three mvs are the key for the course of the entire session, especially during the first series. It is great that M guides the session and let you/mom know when she needs more. Go with it as long as you get at least the min. number of reps. Your supervisor will give you more specific guidance if needed. For humming, I too consider any elongated sound the child makes ad “humming”.

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