Sensory Ladders for Self-Regulation

“…my ladder means I now longer self-harm, I am slowly learning control.”

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Brown, S., Shankar, R. and Smith, K. (2009), Borderline personality disorder and sensory processing impairment. Prog. Neurol. Psychiatry, 13: 10-16. DOI:10.1002/pnp.127

The first Sensory Ladders for Self Regulation were made in 2001 for adults with sensory integration difficulties receiving help with mental health difficulties in Cornwall as part of the OT ASI informed Be SMaRT Programme. Recognised and promoted as best practice by the Department of Health in 2006, resources and teaching about the programme was shared by Kath Smith and integrated into the then SI Network SI 1 for therapists working with adults. It was also taught in the UK and abroad as part of other mental health training programmes delivered by lead MH and LD specialist lecturers Kath Smith and Ros Urwin.

Sensory Ladders support and help clients and therapists understand someone’s self-states. This knowledge so necessary to ‘support attain and maintain appropriate levels of alertness’, scaffolding ‘praxis and organization of behaviour’; critical for meeting fidelity to Ayres’ SI.

Influenced by the paediatric Alert Program, they offer therapists a way to combine Dialectical Behaviour Therapy and Ayres’ Sensory Integration, addressing the development of the person’s self-awareness in collaboration with others, including ward staff in acute psychiatric inpatient units.

Importantly, because of their origin in mental health services working with people with trauma, Sensory Ladders address sleep and dissociative states, essential self-states missed and unaddressed by other similar approaches.

When we use Sensory Ladders, we start with the person where they are ‘at’, before introducing learning about new ways of being, including the development of new skills. This has made it necessary for Sensory Ladders to remain very individualised and personalised, developed as a co-production within safe (and therapeutic) relationships.

Both Ayres’ Sensory Integration(ASI) and Dialectical Behaviour Therapy(DBT) share a common understanding that development and change can only occur within a safe environment.

The DBT idea of balancing safety and challenge reverberates strongly with Ayres’ concept of the ‘just right challenge’. Creating a Sensory Ladder is about creating opportunities for an adult or child to learn to become aware of themselves in a new way – to explore and discover new things about mind, body and brain. It allows the therapist and person to do “curious wondering” together, and for the person to try new things. It creates and promotes active but informed risk-taking; testing how we might feel and experience something when we do it differently; new ways of being – new ways of responding.

Making and using a Sensory Ladder is about the journey together within a safe therapeutic relationship. It’s about getting to see and know someone in a very different way, getting underneath the skin of behaviours that are perhaps being described by others as tricky or as a challenge.

The Sensory Ladder facilitates the reframing of behaviours that are a result of sensory integration challenges, the first step is acceptance of the person’s response or behaviour (though not an agreement that it was the best response). This acceptance is necessary before change can be supported to happen; starting with the development of strategies and therapy to support emerging new skills and abilities.

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Sensory Ladder Explained

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For more information on Sensory Ladders, please see:


Ahlers VM (1997) Sensory integration therapy for adult psychiatry. In: RB Crouch, VM Alers, eds. Occupational therapy in psychiatry and mental health. Johannesburg: Maskew Miller Longman, 329-48.

Bhreathnach E. Sensory modulation: A training course presented by Plymouth Community NHS Trust Learning DisabilityService. Plymouth, 2001.

Brown S, Shankar R, Smith K, et al. Sensory processing disorder in mental health. Occupational Therapy News 2006; May:28-29.

Shankar, Rohit & Smith, Kathryn & Jalihal, Virupakshi. (2013). Sensory processing in people with Asperger syndrome. Learning Disability Practice. 16. 10.7748/ldp2013.

Smith, K (2002) Abstract and Training pack: Taking Sensory Integration into Adult Mental Health, BAOT Annual Conference and presented to Cornwall Partnerships NHS Trust CPD Training Day.

Williams MS, Shellenberger S. ‘How does your engine run?’ A leader’s guide to the alert program for self-regulation. Albuquerque, NM: Therapy Works, 1994.21.