When You Create the Space
I’ve been a pediatric occupational therapist for years. I know how to read a room — the cluttered living rooms, the toys pushed to the side, the nervous energy of a parent watching me work with their child. I’d learned to assess quickly: fine motor delays, muscle tone, and developmental milestones. I was good at my job.
But something shifted in me after my Infant Mental Health training. I wasn’t just looking at children differently. I was looking at families differently.
When I picked up a new case, it looked, on the surface, like so many others.
A little girl, eighteen months old, with a gross motor delay. A busy household with two older siblings — a five-and-a-half-year-old boy and a four-year-old girl. A mother who was warm, appreciative, and eager to help.
The boy was a dream. Sweet-natured and attentive, he’d taken to me immediately and unofficially appointed himself my assistant therapist, cheerfully coaxing his baby sister into trying whatever I set up. The baby herself had been clingy with her mother at first — she’d reportedly shut down entirely with a previous therapist — but she was slowly coming around.
The four-year-old, though. I smiled to myself just thinking about it. That child tested every ounce of my patience. Strong-willed didn’t begin to cover it. She moved through our sessions like a small hurricane, ignoring her mother’s gentle redirects, doing exactly as she pleased.
And the mother just let it happen. I noticed it but held my judgment. There’s always more to the story, I reminded myself. That was something the IMH training had taught me to sit with.
I also noticed something else about her: she apologized constantly. Not for anything that warranted an apology. She’d say sorry for standing in a spot I needed, before I’d even mentioned it. Sorry for not having a towel ready that I hadn’t yet asked for. Small, reflexive apologies, offered up like little peace offerings.
I filed it away.
One week, the older two kids were both at camp. The session was quieter than usual — just me, the mother, and the baby. With the four-year-old’s whirlwind energy absent from the room, something softened.
I let myself slow down. I started asking questions. Not clinical questions — just conversation.
Did you grow up around here?
Yes, Rochester. Her parents still lived there.
Do you parent the way you were parented?
She paused. And then she started talking.
She talked for the rest of the session. She was still talking when I’d gathered all my bags and had my hand on the back door knob, and I didn’t rush her. I was so glad she wanted to share.
She was the middle child of three. She’d grown up in a home where both parents were deeply career-focused. Dinner wasn’t until late, when someone finally came home to cook. The children learned early to fend for themselves: homework, laundry, meals. As the second oldest, she’d helped raise the younger ones.
Her parents, she said quietly, should never have become parents. They didn’t particularly like children. Even now, living just down the street, her own mother hadn’t come to help with any of her three newborns. The grandparents still worked constantly, stopped by for five minutes a few times a year, declared themselves overwhelmed, and left.
All she had ever known, growing up, was absence — and then, when her parents did show up, demands.
And so she had decided, fiercely and deliberately, that she would do the opposite. She would be there. She stayed home with her children. She was present. She did not want her children to ever feel what she had felt.
I drove home turning it all over in my mind.
So much clicked into place. Her inability to hold a firm boundary with her four-year-old — a child who responded to any limit with stomping feet, folded arms, growling protests — wasn’t permissiveness for its own sake. It was a woman who had only ever experienced two parenting modes: neglect and demands. She had rejected the demands. She didn’t yet have a map for the warm, steady boundary that lives between those two things.
The constant apologies made sense now too. A childhood spent trying not to inconvenience adults who didn’t really want to be bothered.
I hadn’t diagnosed anything. I hadn’t overstepped. I had simply created a space — asked a question, stayed curious, and listened — and a whole human story had walked through the door.
When you walk into a home, it can look like just another family, another child with a fine motor delay. But when you create space, and offer a genuine invitation, there can be so much more. A richer relationship. A fuller picture. A better path forward — for the child, and for the mother holding it all together.
That was what the IMH training had given me. Not a new clinical protocol. A different kind of presence.
And I carried it with me into every session.
– Written by Lori
*Name Changed for Privacy
