I can usually tell within the first few weeks of working with a patient, how the next six months to a year of their treatment will play out. There are of course a number of factors to take into account, but what I can tell you for sure is that patients who display higher levels of self-awareness get better results. They may not do the exercises perfectly, they may not practice every day (although they know that’s not good), and they may struggle more than some of the people I work with, but having self-awareness gets them further than any exercise ever will.

In fact, the concept of “Awareness” has become a cornerstone of my practice. We could have our patients practice Button Pull or Spray Bottle exercises 10 times a day, but if they don’t have awareness of their tongue and mouth, their progress in treatment will be slow. They’re also more likely to hit plateaus in their progress after only the first four to six weeks, and to struggle in the long run.

Let’s take two of my patients for example – Shyla and Emily.

Both girls were seven years old at the time of treatment, and both had thumb-sucking habits. The biggest difference between them was that one had more awareness about her mouth and habits than the other.

Shyla began treatment with me in order to help her eliminate her thumb sucking habit. She was very dedicated with the Thumb Therapy, and was able to quit her sucking habit within just a few days. When it came to the exercises that followed Thumb Therapy, she was one of my most diligent patients. She practiced at least twice a day, and her mom was so dedicated to helping her with the exercises that they incorporated them into her home school study routine. They were a shining example of how I wished every family practiced the exercises, and I was always impressed by their commitment.

However, after all that hard work and persistence, Shyla’s mom was still constantly catching her with her mouth open – a sign that her habits weren’t changing and that the exercises weren’t having the desired effect. Shyla struggled with the general concept of awareness. So while she was an expert at practicing, she wasn’t entirely able to grasp the concept or “big picture” of the treatment.

Now let’s look at Emily. She also started working with me because of a thumb sucking habit, and she was also able to quit that habit within the first few days and never look back. The difference was that Emily wasn’t all that great at doing her exercises. She normally practiced once a day, and her mom often let her do the exercises on her own. Sometimes when we met for appointments, she clearly hadn’t mastered the exercises I had assigned, and had to repeat them.

However, Emily was somehow able to develop an awareness of her tongue and mouth much more easily than Shyla. Her habits changed far quicker because she was aware of her tongue and mouth all day long, not just while practicing. She was able to catch herself when her mouth was open, and correct the habit every time.

The moral of this story is not that one girl was a good patient, and the other a bad patient. I believe that the point is much more about highlighting the differences in their learning styles and personalities.

As myofunctional therapists, we need to keep in mind that our patients are all so different, and that what works for one may not work for another.

From what I have experienced with my own patients, the subject of awareness is where these differences really become apparent. My therapy program has evolved to the point where I emphasize this concept starting with the first session. I believe that awareness is the key to success in any therapy program, and without it, patients will not get the best results.
Some people have it innately, and others must be taught.

So how do we teach our patients awareness? These are three of my go-to methods to make sure that patients get this concept from the start.

1.    Talk about the big picture right up front. I tell patients on the first day that my goal is to help them learn three things – nasal breathing, proper tongue placement, and keeping their mouth closed.

This may seem obvious, and of course we all know there is more to it than that, but the awareness message is what’s important here. I want my patients to know starting on day one that they need to have a closed mouth rather than an open mouth. So I tell them. I even repeat it a few times, and ask them to repeat it back to me. With younger patients, I make sure the parents get this concept as well. Then I make sure they understand that the exercises are there to help them reach that goal. Simply perfecting and doing the exercises won’t get them where they need to be.

2.    Encourage ongoing discussions about breathing, how our mouths should rest, and even about other people’s mouths. I want my patients to make this a topic of general family conversation, for example:
“Do you see dad’s mouth is open? We better tell him to close it” or “Wow, your sister is breathing through her nose, what a great job”. If children can get used to recognizing characteristics that are considered “good” and “bad” in other people, this will eventually translate into self-awareness in the same area. For adults, this is a subtler process but I still encourage this type of interaction with a spouse or friend if appropriate.

3.    Ask patients to track themselves every day, and have a routine around it before bed. This is a really simple exercise that has improved treatment results by leaps and bounds. The first step is getting people to think in generalized percentages.

For adults, this concept is a little easier, but children can have productive discussions with their parents as well. I ask people to write down the percentage of total time they believe their mouth was closed during the day. It may be as low as five percent but at least they’re aware of how they’re doing. This evening routine of choosing a percentage and writing it down is very powerful because patients will eventually see improvements and appreciate their own progress. The goal of this exercise is not actually the number itself, it’s really just about getting patients to become more aware of their habits.

As you can see, awareness is a huge piece of the puzzle when it comes to treating our patients and changing their habits for good. Anyone can learn awareness with a little help, and I hope these techniques will assist you when it comes to your own patients and developing their awareness.