Tics and Involunatary Movements

What are Tics?

Tics are uniform, repetitive, involuntary movements of a muscle or a small muscle group. It is usually the muscles of the face, neck or shoulders that are involved. These involuntary movements are called motoric tics and are by far the most common form of tics. Tics might also be sudden sounds or words, if the speech muscles are involved, these are called vocal tics. Boys and men tend to have tics more so than girls and women. Tics usually develop in childhood and youth, and it is estimated that up to 10% of all children at some point has tics.

What causes Tics?

It’s not clear exactly what causes tics, nor is there necessarily one particular cause. They’re thought to be due to changes in the parts of the brain that control movement. They often seem to run in families, and there’s likely to be a genetic cause in many cases. They also often occur alongside other conditions, such as ADHD and OCD. Tics can sometimes be triggered by the taking of illegal drugs, such as cocaine or amphetamines, and are occasionally caused by more serious health conditions such as cerebral palsy or Huntington’s disease.

Usually there is no reason for tics. However, tics can be debilitating, especially in the form called Tourette’s syndrome where both involuntary body movements and sounds such as snorting, cough, whisper or grunting. Tourette syndrome is a hereditary condition, so there will often be others in the family with similar symptoms.

Tics can be increased and exacerbated by stress and nervousness. Tics often improve during or after hard physical activity and often disappear completely during sleep.

Types of Tics

There are many types of tic. Some effect body movement (motor tics) and others result in a sound (vocal or phonic tics).

•blinking, wrinkling the nose or grimacing

•jerking or banging the head

•clicking the fingers

•touching other people or things

•coughing, grunting or sniffing

•repeating a sound or phrase – in a small number of cases, this may be something obscene or offensive

Tics can be simple or complex. The simple motoric tics involve very small muscle groups and are simple movements such as blinking, flinching, grimace, wrinkle of the nose, lip protrusion, jerking shoulders and the head throwing the arms around involuntarily. There are also simple vocal tics, which consists of snorting, coughing, whistling, humming, grunting, screaming, yelling or gasping.

The complex motoric tics are combined movements, which mean that more muscle groups must work together. This might be jumping, clapping, touching objects or others, tongue or lip biting, scratching, sticking out the tongue or compulsive awkward body positions. Complex vocal tics are more or less meaningful words, phrases or sentences that interrupt the flow of speech. This can lead to the impression of stutter.

Treatment of Tics

The vast majority of tics require no treatment. Thorough information about the condition to both patient, family and social circles is usually sufficient. Particularly children may have problems with bullying, and it may therefore be a good idea to inform the day care or the school, so there is an understanding of the problem. Particularly children with Tourette’s syndrome are often perceived as naughty or badly mannered and they often experience many unjust defeats.

Treatment isn’t always needed if a tic is mild and isn’t causing any other problems. Self-help tips, such as avoiding stress or tiredness, are often very helpful for the majority of people. If a tic is more severe and is affecting everyday activities, therapies that aim to reduce how often tics occur may be recommended.

The main Therapies for tics are:

Child Psychotherapy-  this aims to give young people coping strategies, relaxation, sand play therapy and a lot other interventions to help relieve the discomfort for the young person.

Also the therapist will work with the client to see if there is any deeper issues ie, trauma, shock, abuse, something he may have seen, something he doesn’t like in his reality, etc and help the young person overcome this, in turn will overcome his suffering.

A therapist will work with their client to identify the cause of the tic and will focus on fostering a method that is less noticeable to relieve it.

An example of behaviour reversal could be that the sufferer has an intense vocal tic that leads them to repeat phrases out loud. To counteract the tic, they could take a number of deep breaths instead. This acts as a less obvious release in comparison to a tic.

Habit reversal therapy – this aims to help you or your child learn intentional movements that “compete” with tics, so the tic can’t happen at the same time.

Exposure with response prevention (ERP) – this aims to help you or your child get used to the unpleasant sensations that are often felt just before a tic, which can stop the tic occurring.

There are also medicines that can help reduce tics. These may be used alongside psychological therapies or after trying these therapies unsuccessfully.

By Cory Spence (Psychology Student) @ Child Therapy NI

Compliant – rebellious kids

conflicted emotional support


What does having a rebellious child mean for you? If you have a teenager you will have an idea, they can be surly, grumpy and un-responsive. What is it all about? Why do kids need to go through that stage and why are some worse than others?



In essence, what the rebellious kid is doing is developing and desperately trying to hang on to their sense of identity. As any child develops, one of the main tasks of life is trying to figure out who he or she is. We call it a ‘sense of self’. If the kid sees people, parents particularly, as getting in the way of that, they have a choice – he or she can conform and do what the big people want, or they can rebel.
When a child is very small, and there are some very rebellious toddlers… he or she usually learns to conform. That is, do what the ‘big people’ want them to do. Why do they do that? Generally, because what happens after the compliant behaviour is something that they like. A smile, a stroke, something that tells them that the behaviour was approved of. They then attach that to their sense of who they are – they conclude that who they are is approved of.

So what happens with a rebellious kid? This is a slightly more sophisticated process. The rebellious child sees conforming as losing something rather than gaining something. They are losing a sense of their autonomy and power. I remember the first time my two year old daughter said to her older brother, “No! Me do it!”.

That sense of power and autonomy is what gives a child confidence in their own abilities. If they are allowed and encouraged to take their power they don’t have to fight for it by being rebellious.

Traditionally, the sense is that conforming is good and rebellion is bad. This can also influence how children can think of themselves, the thinking may go like this:

‘If I am compliant, I am thought of as good and people will like me. If I am rebellious, I am bad and I will be thought of as trouble and not approved of, so that must make me a bad person.’

This can be very confusing for a child that is trying to develop ideas of who they are.

understanding children

If I want to be me, think like I think, feel what I feel and do what I want, the big people will not like me and think I am bad. If I am who they want me to be by ignoring what I really want, what I really think and what I really feel, then I will be approved of and they will like me.’ How does a child deal with that?

To some kids, it is obvious that overt rebellion would not be a good idea as they are fully aware it brings very negative consequences: punishment, withdrawal and disapproval. These children learn that to hang on to their ‘sense of self’ they have to rebel but in a very passive way.

Have you had the experience where you ask a child to do something and they appear compliant by agreeing to do as you ask, but then never actually getting around to doing it? These kids may be the ‘passive aggressives’ of the future, in training!

Maybe you are aware of the ‘conforming’ or ‘rebelling’ kid in you and wondered about it. A rebellious child can often get into a lot of trouble, even though they are aware the options for doing it differently. Maybe you get angry with yourself for being so compliant with everyone when you don’t really want to. Or maybe you are aware of the passive aggressive streak in you that doesn’t really get you what you want, or the internal conflict between being compliant or rebellious.

If you are interested in learning more about compliant and rebellious traits either in your children or internally within your own make up, contact a qualified counselling professional to learn more about Transactional Analysis.

Sand Play Therapy

The approach of integrative child therapy is a holistic one that can engage in the multiple facets of a client’s life: including emotional, psychological, creative, and spiritual. It is a therapeutic approach that seeks to offer a flexible process that can support a client to attend to present, past and future concerns.

Through the use of and integration of humanistic, psychodynamic archetypal and transpersonal lenses and therapeutic techniques, client and therapist work within a creative container that honours the client’s wounding and supports the discovery of ways to work with limiting self-beliefs, current challenges and the discovery of new or buried insights and the capacity for self-healing.

Through my additional training in therapeutic play therapy work with children, I have developed a respect for the multidimensional experiential therapeutic tool that offers clients a process to objectify inner reality within the therapeutic relationship.

Historically, it was Margaret Lowenfeld, initially a paediatrician working in London in the 1920’s and then as a child psychoanalyst in London, who pioneered sand play in her therapeutic work with children. She created a therapeutic environment, which enabled free expression and safe experimentation. She described her way of working as the “world technique” and kept small objects and models in drawers, which the children could use as they needed, playing with them in trays of sand to which water could be added.

Experimental space and process
As a therapist working with sand tray with both children and adults, I value the process that enables clients to be supported to build images of preferred futures revisit, past experiences, memories and hopes in a creative way. The client may make a series of scenes over a number of sessions or within the same session. In therapy the sand tray lends itself easily to many theoretical styles – Jungian narrative, solution focused and gestalt, I locate the use of sand play within the context of Gestalt experimentation.

The sand tray process is a dynamic and creative one. The client expresses certain preferences, in the choice of figures which are valued over others. It is not random or arbitrary. Objects are placed in this way, rather then that and new, deeper, hidden or lost meanings are often discovered or created.
The figures and sand tray

The box is traditionally wooden with a blue bottom (to represent the sky). The therapist builds a collection of miniatures for clients to work with that includes: fantasy creatures, human, domestic animals, everyday objects, and representations of the elements of fire, air, water and objects that are culturally diverse.
Sand can take time to dry and now that we have a choice of wet or dry sand in the sun room, it is best to keep the wet tray wet and the dry, dry (if you see what I mean!).

The sand tray process
The therapist can have a purpose intent on inviting the client to use the sand tray for example, pick some figures to represent your family of origin or your hopes or your fears. Or it can naturally be used as the session develops, “Would you like to show me this feeling in the sand tray?” or, “Show me what you might like to say to that person next time you have the opportunity”. The therapist may even simply invite the client to demonstrate how they are feeling.

The sand tray can be used following a visualization, or a whole family could recreate the conflict that they had the previous night to use the figures to consider ways forward. In this way that sand tray becomes dynamic and a co-created space with the therapist.

The therapist can simply be the witness to what happens for the client by holding space and being quiet, or ask questions and be a part of the creative process by also building. Clients can be invited to speak from the position of the particular figures in a particular scene, “I am the horse and I am feeling free, I am a feather and I am feeling light, or I am fox and I am feeling hunted.”

The process can be immensely powerful and in staying within the scene and the language of the scene, the sand tray becomes a container for the complex range of human emotion, thoughts, metaphor, ideas and feelings. I have worked with clients who recall their sand tray work in amazing detail from months, even years before.

Clients may want to interpret what they have created or keep it in process and not talk about meaning. It can also be used as a dialogue between the client and therapist regarding what the client wants to take from the process into their life.

The therapist’s role is to be sensitive to what is unfolding for the client, but not dominate or take over. As with working in other mediums and with other techniques in art therapy, what happens is what needs to happen for each individual client.

The possibilities for the use of sand play experimentation are endless. At the end, we discuss if they want to about their tray, we take a picture and the therapist dismantles the picture/ story when the client leaves the room.

Death and how to tell children

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Written by listed counsellor/psychotherapist: Jane I Taylor MBACP MCS (Acc) PRCC

Many adults have been affected by the way they have been excluded as children when it came to death. It is not uncommon for therapists to see adult clients who were traumatised as children by being left out of the death of someone close to them. At the age of four we can understand death, yet most children are considered too young to be included when adults are grieving.


Children need to be told what has happened with words they can understand for their age. They should never be told the person has ‘gone away’ or is ‘sleeping’ this is confusing and may be very frightening. Children need to be a part of what is happening, it is not a bad thing for children to see adults crying, it is a natural way for them to understand what is going on and it is normal to grieve when someone dies.


Children should never be forced to see the deceased or kiss them, touch them, but if the child wants to with support of adults, it should not cause issues later. Communication and inclusion with the child, with words relevant to their age, is the key to their understanding. Having pets in childhood can help children to understand death. Some pets naturally only live a short life, a couple of years or so, this can be the start of children understanding when someone close to them dies.



However when the child is included in the death of the person {especially when they are close}, so be honest and apporpriate in what you tell them, it does help the grieving process for the youg person



What happens in Child Therapy?

During the initial intake session, I meet with the primary carers and sometimes child to gain a thorough understanding and history of the family and the child. I evaluate the areas of concern, needs and goals, so that I can determine treatment. After listening to the family history, the child’s developmental history, current behaviours and symptoms, I then suggest the treatment, therapeutic approaches and techniques that will be used to help the child. A treatment plan will be discussed at this time and specific recommendations will be made regarding therapeutic interventions, home-based interventions for parents to work on and any further evaluation or referrals which may be needed. What can I expect in a therapy session? For children, sessions will consist of various forms of Play, Sand Therapy and Integrative Psychotherapy, including but not limited to:- • Art as a therapy-the use of drawing, painting and other forms of creative expression • Narrative therapy-storytelling to elicit themes and emotions • Toys, including puppets, figurines, doll’s house, etc. • Role plays, wood work • Modelling with clay and play doh • Music as a Therapy Children and adolescents are often unable to use words to express themselves or to communicate emotions. They respond extremely well to being able to express themselves creatively in a safe and child-friendly setting, while learning appropriate ways to manage and communicate feelings.


Alison Kincaid reviewed Child Therapy NI – 5 star


I turned to Ciara for help with my son and his behavioural issues and I have to say she has helped so much. He absolutely loved going for his sessions and is gutted its over lol. His behaviour has improved a lot and although we still have a way to go, the progress he has made so far has been great. Without Ciara’s help my son would definitely have got worse and we as a family were at breaking point when we reached out to her. We now have more better days than bad and we have Ciara to thank for that. I would encourage anyone who is having difficulties to try this approach.



Lisa Murray reviewed Child Therapy NI – 5 star


One of the best services in Derry available to young people. Ciara has really helped my son the best way she could..she has changed both our lives for the better. I would recommend her to anyone who needs help for their young person. The work she does is amazing.



Orlaíth Ó hAirtnéada reviewed Child Therapy NI – 5 star

From using the basic human senses I can stay that this place really reached me on all levels – from the gentle calming music that instantly calms a worried mind – to the smells that fill you up and make you think of things like home and fresh cut grass. A place truly of magic & wonder  it – all the best of luck with it Hun x your a remarkable lady


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