About C.Q.T.

Coordination Quality Therapy

Coordination Quality Therapy (CQT) is a holistic approach, which maximises the quality of functioning in academic learning, social interaction and a variety of other life skills. It uses various tools that integrate occupational therapy, physiotherapy, martial arts and body psychotherapy.

CQT helps to reduce anxiety and insecurity easing the transition between daily tasks, as well as between emotional and cognitive states of mind, by applying challenging and fun coordination and spatial awareness exercises. The programme assists in maximising multi-tasking, mobility, stability and responsiveness, as well as accuracy of movements.

It effects the development of core stability, muscular tone, resourcefulness and postural awareness. It also improves access to willpower and consistency, which assist in accomplishing tasks.

CQT addresses conditions like dyspraxia, dyslexia, dysgraphia, low self – esteem, low muscular tone, hyper/hypo tactile sensitivity, and other global developmental delays which slow integration and make life less fulfiling.

When a person’s basic neural network is not sufficiently formed, the amount of effort expended to put any given system to work is much greater than it needs to be. Based on poor physical integration, insufficient or underdeveloped neural networking proves not only frustrating for the person, but also causes muscular tension, inadequate flow of breath, and other possible side effects such as aggression, impulsiveness, excitability, irritability and avoidance. Due to the decrease in the level of oxygen in the body and brain, the person will inevitably lose the ability to focus or concentrate.

What is unique about C.Q.T ?

To facilitate easy reading, I will refer to both sexes of children as ‘he’.
The way a child mobilises his body highlights the level of his neurological maturity and how well integrated he is. The quality of that integration directly impacts on the growth of his physical confidence -the first stepping stone towards the development of his self-image and self-esteem.
Within the last 20 years, I am honoured to have had the opportunity to contribute to people’s lives. Being in the therapist’s role is a constant reminder of how responsible and demanding this profession is. Trust, reliability and availability are only some of the fundamental principles therapists are committing themselves to, when they choose to help others.

Like O.T. and Physiotherapy, C.Q.T. originates from the ‘medical model’. Unlike the medical model, ‘humanistic psychotherapy’ operates through the dynamic of the therapeutic relationship. In my work with clients I try to address both approaches by exploring how the two are sometimes conflicted, even whilst complementing each other. The availability of both approaches provides the client with the opportunity to maximise his potential.

Developing motor coordination is only the first step towards achieving both the child’s and his parents’ targets. One of the unique principles of my approach is integrating the breathing mechanism, as it is a necessary complementary step towards optimum motor functioning.
For example: when we try to concentrate on hammering a nail into the wall without hurting our fingers, we tend to hold our breath for those few seconds to concentrate.

Holding our breath, or very shallow breathing, is something we can’t afford to do when we are asked, for example, to write for 20 minutes. Unfortunately, when a child has underdeveloped hand-eye coordination, his hand may get stiff or painful, or he’ll put too much pressure on the pencil when writing – leading to a condition called ‘oxygen starvation’. At that stage, his brain needs to decide whether to continue the attempts to write or to find a way to get more oxygen.

Moving the body (fidgeting) allows the rib cage to contract and expand. Movement would bring more oxygen, but some teachers would try to encourage the restless child to stop fidgeting and, ironically, concentrate. In return the child would try to continue his work, but only until his body became restless again. Breathing is a survival need and the child’s conflict continues as long as his body generates tension due to the lack of sufficient hand – eye coordination.

Some children can’t respond to their parents while they read, watch T.V. play with electronic games or fight with their siblings. Developing multitasking is at the core of the C.Q. program. Children are asked to develop their ability to integrate their breathing, while activating their body with complicated coordination exercises. As a result they are able to write while listening to their teacher talking – an important ability – which is needed to tolerate the academic pressure in higher education.

In the C.Q. programme the focus is also on the important impact that the exercise has on the child’s feelings; sometimes it is hard for the child to stay in touch with his feelings whilst trying to improve the function of the brain through the coordination exercises. Allowing the necessary change to take place on a deeper level, which plays a key role in developing self-belief, can happen once the client manages to explore his feelings in relation to the pressure that builds up from the different coordination exercises.

Exercising the ‘right’ group of muscles, leads to neurological maturity, as it develops the network in the brain and increases capacity to process information. In the C.Q. program, the client is asked to exercise his body in different movements that directly or indirectly connect him with the difficult feelings he sometimes tries to suppress:

The Primary layer of physiological frustration

Physiological frustration is part of the experiences each and every one of us had when we learned to roll, crawl, sit, walk and talk. In the process of healthy development, frustration is replaced by positive experiences. If we struggled to process that frustration, sometimes those attempts leave a strong mark.

Through our daily activities, the brain continuously tries to register the bodily experiences of movements and learns how to efficiently activate the body. In some circumstances, when there is underdeveloped gross-motor-coordination, this can have a negative impact on motor-planning, emotional transitions or cognitive processing.

The Secondary layer of physiological frustration

develops as a result of the brain’s attempt to handle academic work. Lack of neurological maturity is evident as insufficient coordination, which has an impact on the ability to pick up reading, writing, mathematics, organisational skills, or the ability to concentrate. In the early years of learning at school, this leads to a sense of inferiority and shame or humiliation are then the most common feelings.

The quality of processing information heavily depends on the level of maturity of gross and fine motor skills. The brain constantly attempts to accurately activate different groups of muscles, while processing motor-sensory information.

The C.Q. programme addresses children with various motor delays, which manifest in their posture, behaviour, muscle tension and self-esteem. Some exercises are easier to perform than others, but for most of the children with coordination delays, it is the length of each exercise and the repetition, which is frustrating, but very important to pursue.

Mostly, such a programme is not easy for a child to follow, especially if he’s emotionally delayed as well. Therefore, the relationship with the therapist plays a key role and one which gives a better chance for change to take place.

So where do we start?

We start with an initial assessment. Even after all these years, the initial assessment still takes me back to my own struggles as a child. Every time it’s fascinating to see how a child tries to do his or her best, showing who they are and how they can perform different movements in keeping with what they assume are my expectations or those of their parents’.

In the process of the assessment, I often witness the child struggle to cope, even though they display an enormous level of energy. After the initial assessment, constant encouragement and reassurance is needed to connect the child to what he can do; support his abilities and at the same time challenge him to reach further and achieve more accuracy in his movements.

Following the initial assessment, the child enters a C.Q. programme of weekly sessions. Most of the exercises in the C.Q. programme are perceived by the child as ‘fun’; they trigger the survival mechanism by directly increasing responsiveness and accuracy of movements. The drive to sharpen one’s abilities is a strong survival need, which I believe every child has in preparing himself for adulthood, regardless of his socio-economic background.
As therapy progresses,the repetitiveness of the exercises leads to ‘registering’ the achievement in the motor cortex of the brain. As the brain manages to ‘make’ the muscles perform the right movements, those feelings of success develop a sense of security and hope. Witnessing a child attempting to conquer a group of muscles in his body is the main driving force that has kept me ‘alive’ all these years in my work.

In some sessions when the child tries to perform an exercise, he might struggle, look lost or frustrated, but I encourage him to keep on trying. My strong identification is mostly with the rawness of it all; witnessing for the first time how he manages to do something different , do something in a better way. I have found that this then feeds hope and deepens the child’s trust in the process.

The ‘you can do it’ attitude is constantly at the back of my mind and is the message I bring to the room. The child learns to deepen self-belief, while I try to inspire him with the ‘fun’ and the ‘power’ of movement, from the slow to the fast, in all directions and sometimes in the most impossible postures, which leaves some parents overwhelmed by their child’s abilities. The parents’ excitement with the child’s achievements, coupled with my own enthusiasm, provides the ‘fuel’ for the therapeutic process, as it strongly contributes to their child’s hope of making a change for themselves.

What’s next?

Parents are asked to fill in the pre-assessment questionnaire in the presence of their child. Both the parents and the child’s input are of great value. The moment parents and child disagree with the answers may bring an even greater value, and later characterise the therapy.

Unlike adult therapy, the child’s first contact with the possibility of receiving ‘help’ comes from his parents or teachers as they recognise a problem. Sometimes it is hard for the child to engage, especially for teenagers as they often struggle to admit they cannot do it by themselves.

Teenagers carry a subconscious need to prove to themselves that they are coping well with impending adulthood; they are going through the important process of learning who they are and what they can do.

The pre-assessment questionnaire provides the child with the opportunity to start a process of integrating different areas of their life ,whilst developing an understanding of their coping mechanisms. Sometimes it can make the child feel a sense of relief as the assessment highlights why the child struggles the way he does; what is hard for him to do is ‘seen’, and it can take away labels like ‘lazy’ or ‘disengaged’ or ‘rebellious’. Both parents and child get a chance to understand some of the reasons behind the child’s avoidance of his daily responsibilities.

The first assessment is the point in time where the child gets a chance to be heard and explore what he wants to improve in himself, which could be completely different from his parents’ needs. Recruiting the child’s willpower, by addressing his needs, provides a softer landing into a challenging process.

Making a child aware of the different areas he struggles with, his own and his parent’s expectations, sets up the ‘contract’. Then, the challenge for the therapist, whilst working for results, is in addressing his own observations, the parents’ needs and those of the child. Steering through a delicate balance between fun and challenge is a way to maximise the child’s access to his willpower, which in turn increases the integration of his body – the art of therapy.

Myrom Kahaner , Body Psychotherapy BACP, Coordination Quality Therapy CThA