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An Introduction to TBRI® and OT

Updated: Oct 7

I speak a lot about “kids from hard places” and "uniquely-abled children", and throw around words like “attachment”, “trauma”, “Trust Based Relational Intervention (TBRI®)”, and “occupational therapy” – but what exactly does all of that mean? I know that this lingo is not common to everyone in their everyday lives, so we wanted to shed some light on what exactly is behind these a-b-c’s and l-m-n-o-p’s.


I'll begin by defining a hard place. A child from a hard place has experienced abuse, neglect, and/or trauma. While that sounds easily understandable, we must not overlook the intricate nature of these terms. Abuse, neglect, and trauma are not always visible from the outside. While it may be easy to identify a child that has been physically abused, purposefully neglected, or evidently traumatized – it’s the more subtle and sometimes seemingly non existent indicators of children from hard places that often go unnoticed.


Additionally the use of language is extremely important when it comes to talking about children. We must be especially careful to avoid labeling children as it can become a self-fulfilling prophecy. The phrase “children from hard places” is preferable in that it addresses the whole child and his or her needs.


The idea that we must address the child’s whole being as opposed to disciplining children for their negative behaviors is one of the central ideas behind Dr. Karyn Purvis’ research.Dr. Karyn Purvis (an internationally renowned child development expert) and Dr. David Cross ( the Rees-Jones Director of the Karyn Purvis Institute of Child Development and a Professor in the TCU Department of Psychology) spent years studying the effects of trauma on the developing brain and coming up with an intervention that addresses them. You can learn more about their research here.

What they discovered is that beginning in the womb, the developing fetus is exposed to an environment by which it receives what it needs to survive and develop. This meeting of needs is a prerequisite for proper brain development and determines the child’s capacity for attachment. If these needs go unmet, brain development will be affected and the child’s ability to connect will be severely damaged at a neuro-chemical level.  Factors such as the mother’s cortisol levels (stress), health, and prenatal exposure to drugs and alcohol play a role in maintaining the environment to be able to provide for the needs of the baby.


Attachment is further exercised in the neo natal stage when the newborn baby begins to understand that his needs will be met when he cries and the parent/caregiver comes. This is called the attachment cycle.


So what happens if the prenatal environment is not ideal and/or the  attachment cycle is broken?

When this happens, areas in the child’s brain are not able to fully develop – their ability to critically think, process their environment, make sense of their emotions, and form meaningful relationships is damaged.

With this information, Dr. Purvis and Dr. Cross founded Trust Based Relational Intervention (TBRI®) as a method by which to interact with kids from hard places and begin to address the needs that they have as a result of their trauma.

“TBRI® is an attachment-based, trauma-informed intervention that is designed to meet the complex needs of vulnerable children. TBRI® uses Empowering Principles to address physical needs, Connecting Principles for attachment needs, and Correcting Principles to disarm fear-based behaviors. While the intervention is based on years of attachment, sensory processing, and neuroscience research, the heartbeat of TBRI® is connection.” -The Karyn Purvis Institute of Child Development at Texas Christian University.

Now that you understand the idea behind TBRI®, let’s move on to Occupational Therapy.


Occupational therapy is a client-centered health profession concerned with promoting health and well being through the therapeutic use of daily activities (occupations). The primary goal of occupational therapy is to enable people to participate in the activities of everyday life. Occupational therapists achieve this outcome through a holistic perspective by working with people and communities to enhance their ability to engage in the tasks/activities they want to , need to, or are expected to do (through physical, cognitive, and/or psychological intervention), or by modifying the task/activity or the environment to better support the person (through adaptive equipment, energy conservation strategies, community engagement, etc.). Unique to occupational therapists is the skill of task analysis. OTs study how to break down daily tasks into their most basic components and are able to work with clients to restore, remediate, and/or retain these core skills and help them learn how to integrate them to produce a desired outcome. 


To their core, occupational therapy practitioners focus on participation in and quality of life, enabling people of all ages and abilities to live life to its fullest by helping them promote health, and prevent—or live better with—injury, illness, or disability.

As you can see, TBRI® and occupational therapy compliment each other well as they are both holistic and focused on empowering the individual. With the combination of the knowledge and skills required to be a TBRI® practitioner and licensed occupational therapist, my goal is to be able to reach children from hard places more effectively and empower families and communities to do the same.

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