Revolutionary Ideas about Treatment

In my last two blog posts I have written about incorporating the ideas of Bruce Perry and those of Risking Connection to create a new approach to congregate care treatment.

Let’s see if I can put this all together.

Foundational ideas:

1. Our children were injured early in their lives, therefore their lower brains have been damaged. This part of the brain is involved with bodily regulation, the calmness/alertness cycle, the danger response and the regulation of emotion. It has tendrils into all parts of the brain.

2. Early experiences create templates or patterns of relationships deep in the lower brain. These templates are what the person expects from relationships, their deepest assumptions about what kind of world this is and how people treat you.

3. Brains can change and be healed at any age, and it takes a lot of repetition.

4. Parts of the brain change only while you are using them.

5. Whatever you use in the brain gets stronger; you get better at whatever you do most.

6. Things that happen together repeatedly become wired together, associated with each other and thus in the future the presence of one evokes the other.

7. Human connection is in itself reinforcing because it stimulates our reinforcing brain chemicals. If a person gets inadequate supplies of the reinforcement of connection they are more vulnerable to other activities that stimulate these same chemicals, such as self harm, drugs and risky behaviors.

8. Because of early trauma, neglect and attachment disruptions the biochemistry and brain structures of our clients have been changed. They have become caught in the human danger response, which leaves them hyper-aroused, over responsive, and with difficulty regulating and relaxing. They may also have developed a dissociative, freeze response to stress.

9. Because of early unresponsive and/or abusive caretaking, the children have developed templates or expectations that people are not trustworthy, will hurt you, and do not care about your needs.

10. Change is possible through repetitive healing experiences.

11. People act better when they feel calmer: safer, welcome, accepted, competent and at ease.

What does this mean about what we should do in treatment programs?

Every person in the treatment program must understand that their first and primary job is to help the client feel better. What can I do today to help this child feel safer, more appreciated, welcome, noticed, connected? Feeling better, less afraid, less hopeless will free the child to take the risk of acting better.

Especially at the beginning of treatment, we must deliberately fill the child’s day with activities that are physical, rhythmic, and regulating. This would include rocking, music, drumming, dance, Wii games, throwing and catching a ball, etc. The non-verbal connection with animals is also healing. As the child participates in rhythmic activities his own bodily rhythms and cycles will become more regular.

These activities must be done with active, engaged, hopeful adults. Using the body activates the lower brain. Pairing lower brain activity with positive relationships will gradually change the template the child has about relationships.

Since whatever a person does, they will get better at, we should make sure our children spend their time being successful, having fun, and enjoying positive interactions.

We should make sure every child experiences many positive human connections throughout their day.

What are the program implications of this way of thinking?

We can be much more deliberate and planful about our use of recreation- both recreation therapy and all the recreation/ down time in the day in our milieus. We can make sure the activities are tailored to develop the brains of the children we have, at whatever stage they currently are, and are fun and interpersonally rewarding.

What about therapy? Do we no longer need it? Nothing could be further from the truth. In the early stages of treatment, the therapist can e primary source of reparative connection. He or she can incorporate these principles by having a rocking chair in their office, using art and music, walking while talking, and making sure the appointments are positive and fun. As the child feels safer and calmer, he or she will be more available for cognitive approaches. The cognitive part of the brain inhibits immediate action on impulses, and needs increased strength to successful do so. Any discussion, reading, talking (about anything, like sports or the weather) builds this brain skill. Therapy interventions such as TF CBT or Target are still very helpful, especially after the child has made some progress. Therapists can also incorporate these principles into group and family work. They can assist the family and child in engaging in joyful games that may heal the brains of both. Groups that cook, read and discuss books, do crafts, take walks can build all parts of the brain. And with the team the therapist has an essential role in leading staff to think beneath the behavior, consider how it is adaptive and plan how we can help the child meet his or her needs in a less destructive way.

And perhaps most importantly this theory demonstrates in a new, more urgent way the importance of taking good care of our staff. If a child is playing Dance, Dance Revolution and the staff is at the side of the room texting his friends on his cell phone, the child may be having fun but her templates about human relationships are not being changed. The template that people really don’t notice or care is being strengthened. As an agency we must prioritize keeping our staff happy, hopeful, engaged and energetic. The staff’s ability to offer warm, rewarding, joyful connections to the clients is ultimately the only tool we have to use.

What is your reaction to these ideas? Please click “comment” and share your thoughts.