Sensory Ladders – A History
Sensory Ladders came from very early practice to reframe the unmet needs of clients with trauma who were dysregulated – our draft publication in 2009 included a suggestion we rename BPD as a sensory modulation and regulation disorder – but was a little before its time.
The diagnosis called BPD then with EUPD a preferred term nowadays is typical as a direct result of significant childhood trauma.
Here is the often forgotten history of trauma-informed care approaches linked to the direct use of Ayres’ Theory of Sensory Integration in a trauma-informed way. It was built on practice from 1999 onwards and drew on Ayres, King and Alers’ work, in combination with DBT.
We published the first adult adapted checklist in a DBT handbook in 2002. The first About Me Profiles were created in 2001/2002 and included Sensory Ladders. We published about our Be Smart Programme in 2002 in a care plan and presented this locally, in training courses at then at the first-ever conference about ASI including sensory integration in trauma-informed care in MH in 2004.
This mini-conference was delivered in Cornwall, UK. Presentations included work delivering inpatient Sensory Integration in MH (Kath Smith and Angie Turner), Eadaoin Breathnach’s work on attachment in adult LD and Tina Champagne’s work on Sensory Allen’s Levels and her use of sensory approaches to reduce restraint use in the USA.
It was recently pointed out to us our UK development work came from Tina. Tina will confirm this is not true. It appears others believe that we weren’t doing SI as the article used SPD as a term.
This was a period in ASI history after the new nosology was just published by great names in Ayres SI which we all respectfully followed given the authors. It took time to understand the history of this article and we shouldn’t jump to the new term.
Please remember history and context matter. Sensory Ladders were not created out of Zones of Regulation either. The first ones were published long before Zones and taught and presented from 2003 onwards. They were developed initially for adult clients to deliver a mental health and trauma focussed application, with consent from the Alert Program. At the time the Alert Program like SI was almost entirely child focussed practice. The levels to reflect sleep and disassociative states seen in clients with trauma were deliberate addition and the link to DBT is the Ladder – The DBT House of Fire includes a ladder to climb from behavioural dysregulation upwards – the senses can be a key part to this. Please don’t confuse our Sensory Ladders model with other Ladders and think that’s where we ‘borrowed it” from. This was a tricky post to write but one that needs writing to correct myth and legend and some hurtful assertions.
Thinking I will write up the history soon to correct any misperceptions: Borderline_personality_disorder_and_sensory_processing_impairment
Sensory Ladders | Animated
Thank you, Charlotte for sharing these…we are looking forward to a master class in animation!
On Climbing Sensory Ladders
RCOT Sensory Ladder

Sensory Ladders in Adult Mental Health and Psychiatry
The first Sensory Ladders were made in 2001 for adults with sensory integration difficulties receiving help with mental health difficulties in Cornwall. Influenced by the paediatric Alert Program, they offered therapists a way to combine Dialectical Behaviour Therapy and Ayres’ Sensory Integration, addressing the development of the person’s self-awareness in collaboration with ward staff on an acute psychiatric inpatient unit.
The need to start with the person where they are at, before introducing learning about new ways of being, including the development of new skills, made it necessary for the Sensory Ladder to remain a very individualised and personalised journey within a close safe therapeutic relationship.
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 – creating and promoting 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 challenging.
The Sensory Ladder facilitates the reframing of behaviour that are a result of sensory integration challenges, providing the first step of acceptance of the behaviour necessary before strategies and therapy support development and change to happen.
Learn more about how to use these in mental health settings across the lifespan.