Basketball and Feelings Skills

Several boys were playing basketball outside their residential dorm. Marcus made a basket despite Jeff’s guarding him. Jeff began to taunt Marcus, saying the basket was luck, he didn’t know how to play, he was too short and too ugly. The insults expanded to include racial slurs and comments about Marcus’ mother. Marcus was flustered and missed his next shot. Jeff started to laugh. Marcus went over and punched him, hard. The staff stopped the game and brought the boys inside. Marcus and Jeff were bother restricted, and Marcus’ punishment was seven days of unit restriction because he had used physical violence.

This incident happened at a place I was training. This provided a great opportunity to put these theories into practice.

There were many men in the training, all shapes, sizes, ages, and races. I asked the men to consider that they were in a pickup basketball game with some friends and someone started insulting them, including using racial slurs. I asked for a show of hands of those who thought they could get through this situation without hitting anyone. All the men raised their hands. I then asked what they would do. Their answers included:

I would just stop the game and walk away.

I would say “hey, man, stop talking like that.” And if that didn’t work I would stop playing.

I would play better and better and wipe the person out in the game.

I would use that event as a reason to practice and make my game better.

I would remind myself that this was not very important; it’s only a game, who cares what he says.


Then I asked: what would you have to know, believe, or be able to do in order to respond like that?

After some discussion these ideas emerged:

You’d have to be confident enough of yourself not to take his words to heart.

You’d have to know you were getting upset and have some ways to calm down.

You’d have to have other good things in your life, other friends, other skills in order to know that this game was not that important and that it did not represent all of who you are.

What we want for these kids, what we are trying to achieve, is that they become these men. The taunts will always be painful. Anyone would be upset. But we want them to have what these men have- the skills that enable them to walk away and not hit someone.

And we also want to think about Jeff- how can he learn to handle someone else’s success or maybe even lose a game without resorting to racial taunting? Both the taunting and the hitting come from the same place: a deep feeling of inadequacy that results in this small game feeling like a measure of total worth.

So what will develop these skills? How can we increase confidence, self awareness, an ability to notice and modulate your own feelings, and the ability to turn bad experiences into motivation? Unit restriction will not accomplish any of those things, in fact may decrease some. Instead, if the boys do something constructive together (maybe raise money for some new sports equipment?) they will discover that relationships can be fixed, and that they have something to contribute to the world- whether or not they can always make a basket.

New Friend In Colorado

I have just returned from completing a Risking Connection in Denver, Colorado for Devereux Cleo Wallace. I met many great people who are caring, compassionate and thoughtful about children. I look forward to participating the the agency’s continuing evolution.

We were fortunate to have Dr. Jerry Yager, PsyD. participate in the training. Dr. Yager is a consunt to the agency, as well as working at the Denver Children’s Advocacy Center (DCAC). He has studied extensively with Dr. Bruce Perry. Dr. Yager has a blog at: http://www.drjerryspeaks.blogspot.com/ . Dr. Yager is a Clinical Psychologist with more than 25 years of experience in the assessment and treatment of traumatized children and adolescents. He specializes in working with adolescents who exhibit self-destructive behavior and who have severe mental illness such as clinical depression, bipolar mood disorder, post traumatic distress disorder and psychosis. Before joining DCAC as Director of Education and Training, Dr. Jerry was the Executive Director of the Denver Children's Home.

Jerry taught me some concepts that add depth to the thinking I have been doing about how brain development knowledge can improve our treatment.

First, he pointed out that all information enters our brain through the lower brain, because of course we get all information in one way or another through our senses. Thus, if the lower brain is scrambled or under developed, this will impact the processing of all information. This relates to sensory dysfunction. It also may explain some of the mis-interpretations our clients make. If the lower brain is operating in an aroused, danger state, all information is filtered through a danger/safety categorization.

Dr. Yager said that most psychotropic medications target functions in the lower brain, attempting to provide regulation. We seek regulation through relationships, through self soothing, and, when necessary, through drugs (prescribed or self chosen).

An important and underused concept is the idea of association. The brain forms neural connections between things that occur together. This is how memories are created. In good-enough parenting, the presence of an adult is associated with relief of distress (the diaper is changed) and with pleasure (food, closeness, attunement). In more difficult situations, the presence of an adult is associated with pain and increase of distress. Our kids come to us with these templates about adults: that they don’t care, can’t be trusted and hurt you. They dare not accept relationships at first. But we can use the power of association to begin to change that. At first, all we need to do is be near by when as child is experiencing pleasure. So, we provide the child with positive experiences: a regular meal, rhythmic pleasurable activities, needs met, safety. And we are nearby. We are right there, paying attention, attuning and smiling. After many repetitions, the child begins to associate adults with pleasure. And then….he may have to courage to form a relationship.

One more reason that having fun with our kids turns out to be the most powerful thing we can do!

I Have Received an Honor!

Pat Wilcox was honored with the 2011 Social Worker of Year Award by the Connecticut Chapter of NASW. At the awards banquet, Pat was recognized as a national leader in the area of trauma treatment, especially in congregate care treatment settings that work with the most psychiatrically complex children. At Klingberg Family Centers, she initiated and oversaw an organizational transformation process from a traditional, control oriented token economy treatment approach to one that is based on state-of-the-art knowledge of trauma and attachment. She is the primary creator of the Restorative Approach, a trauma-informed alternative to point-and-level systems in child congregate care. She helped bring the Traumatic Stress Institute and Risking Connection to Klingberg and has grown the programs to national and international status. She accepted the award among family, friends, and her many Klingberg colleagues and mentees. 

Rhythmic Activity

As I discussed in previous posts, I am very interested in Bruce Perry’s Neurosequential Model of Therapeutics (http://www.childtrauma.org/ ). I am thinking about rhythmic, rewarding, repetitive activities that we could add to or emphasize in our programming. These activities should be done with an engage, happy adult. I will list what I have so far. Please consider both your programming and the lives of your own children or children you have known, and give me any more ideas you can think of.
• Dance

• Wii dance

• Music

• Rapping

• Clay

• Throwing balls

• Rocking

• Swimming

• Pets

• Gardening

• Exercise

• Children’s games

• Jump rope

• Peek a boo

• Hand clapping activities

• Hopscotch

• Side by side walking

• Bouncing on "swiss ball" (exercise ball)

• Tossing a tennis ball back and forth

• Throwing wadded up paper in a garbage can repeatedly like shooting baskets

• Quick shoot basketball setups where you can repeatedly shoot baskets over and over

• Toy where you put 1 foot in a ring, whip it around as you jump over with other foot

• Hoola hoop

• See saw with another person

• Swings with two person possibilities -- seats opposite each/see saw-ish seats

• Throwing ball against the wall

• Two square game with another person

This demonstrates what a large role rhythm plays in the life of the average child.

Click on comment and add your ideas!

Hawaii Trip

I took a long trip to Hawaii to teach Risking Connection Train-the-Trainer. The people are great, exemplify the aloha spirit. The diversity seems a source of richness appreciated instead of a source of conflict. We had some fruitful discussions on culture and VT. The thirteen hour flight and the six hour time difference really messed up my body. If I ever go again I won’t fly there, work three days, leave the night of the third day, and fly all night to get home. Thankfully I did get a little chance to drink in the beauty.



VT, Culture and Complaining

I have just returned from completing a Risking Connection® Train-the-Trainer training in Hawaii. I taught some great people who are going to be very good trainers and leaders in their agency.

We were discussing imbedding discussions of VT within their agency. First we had a very interesting discussion of the role of culture in staff willingness and comfort with discussing VT. Cultural rules such as not sharing one’s feelings, trying not to stand out or be noticed at all, and never complaining are hard to overcome when trying to discuss the effects of the work on the person. As one person said: “Why should I squeak? I don’t see anyone else around here squeaking and they are all working as hard as I am. Better to just keep on going.” A therapist stated: “If the staff see the therapist being affected by the work, what are they going to do? As the therapist I am expected to be able to handle my emotions.” I believe that many of us have one form or another of these beliefs, and our agencies take advantage of this. We just keep doing wore and more, and not complaining, taking pride in how much we can do. When we urged the supervisors to model talking about their feelings, they were afraid this would be scary to their staff, who rely on their strength. How can we encourage sharing the way the work effects us without feeling we are showing weakness, scaring our staff and betraying our culture?

When I asked what the current practice was about sharing feelings about the work, these supervisors described that staff constantly talked about their feelings, both on the job and afterwards. And their feelings were anger at a certain kid, hopelessness about another, complaints about management, discouragement about the system, and general pessimism. So this provoked a lively discussion about what the difference is between sharing VT and what I will euphemistically call a complaint session. We have all had the experience of negative complaint session that spirals downward and leaves everyone feeling worse. What is the difference between that and a productive sharing of the effect of the work on us? We came up with the following ideas for what would make such a discussion healthy:

1. A willingness to look at ones’ self and the role of one’s own history in the emotions.

2. A spirit of compassion towards the clients and an understanding that their symptoms are adaptive, and that our feelings are not their fault.

3. An acknowledgement that VT is an inevitable part of our work, as we share the pain our clients’ experience

4. Looking towards positive action: how can we take better care of ourselves and each other? What can we do to make our workplace more sustaining?

5. Understand that the pain of our work is also the source of our growth and change as people

6. A consideration of possibilities for transforming the pain.

There are times when one just needs to complain. But the addition of these elements could help to turn the conversation into a healing experience.

Still, I think there may be more to this. Any ideas? Click “comment” and let me know.

What We Say Matters

I was recently participating in a training at which we were discussing the function of cutting. One participant said:

“We had a girl named Megan who was cutting to be manipulative. She was doing it to get discharged and go to a place like detention where she wouldn’t have to work on her issues.”

What are the assumptions behind this statement? How does it differ from this statement?

“Megan has been working on some difficult issues recently. This has brought up some painful feelings and she has begun cutting for relief. Sometimes she doesn’t even want to work on her issues and wishes she were in a place like detention where she wouldn’t be in treatment.”

Same facts, different assumptions, leading us to different responses.

Another place I visited I noticed how often staff made statements about how bad the children were. Examples are:

“You’d better watch out putting that in your pocket. These kids will steal it from you in a minute.”

“These kids don’t care what we say as long as they get what they want.”

“You always have to watch your back around these kids.”

The staff tended to bond with each other around how awful the kids were.

Or, consider a staff member talking about a child who says mean things: "There is nothing you can do about Jesse. We have tried everything. Jesse just likes making other people feels bad. He admits it. It makes him happy to hurt others.”

Someone describing the cutting of a foster daughter: "she just wants the foster mother to feel sorry for her."

Do you agree that the phrase "feel sorry for her" connotes an illegitimate need, something that she shouldn’t want or need? Doesn’t it imply that she is trying to get some kind of unwarranted or excessive response? Also, this phrase implies that we should resist feeling sorry for her- and by extension resist coddling her, fussing over her, or being sympathetic. Yet some cuddling and caring may be just what she needs.

We make these casual comments constantly in our many discussions about the kids. Yet by each comment we are expressing a theory, an understanding of why they are doing these things. And at times it is a theory that blames the child and implicitly accuses him or her of doing the behavior deliberately to annoy us.

When we make these comments we forget that the child is doing the best she can, that her fears and needs are legitimate to her, and that she is using the only means she has to meet them. She will only be able to change when she feels safety within committed relationships, and when she gradually learns new skills.

Try monitoring the conversation where you work, and see what assumptions are expressed in the casual comments about the children. Click on “comment” to let me know what you discover.

it is important to stop and challenge ourselves. One comment can lead to an entire attitude that will infect our response to the child and interfere with the child’s healing.

Rethinking Restorative Tasks

At a recent presentation I did for the MAAPS conference, a question from a participant and a response from my friend Bob Davis crystallized some thoughts I have been exploring about learning restorative tasks. The participant asked: “We have a girl who is constantly saying mean things about others. As a restorative task we had her do research on peace movements and on Martin Luther King. She does this well- but it doesn’t affect the behavior. She keeps doing it.”

Let’s begin with the assumption that we are trying to create a response to a behavior that will decrease the likelihood of the behavior recurring. We must start by forming a theory about why the girl, let’s call her Kathleen, is saying mean things about others. What feelings is she having at those times? What need is she responding to? How is this behavior adaptive for her?

Most likely Kathleen is feeling small and vulnerable, lonely and unloved. She has no sense of inner connection to others. She does not have any friends, is sure none of the other kids like her and that she will never have any friends. At other times in Kathleen’s life when she has felt small and vulnerable, people have hurt her. Saying mean things and getting a reaction gives Kathleen a feeling of power, of strength and control. She does not know any other way to get that feeling.

Do we think that Kathleen is mean because she does not intellectually understand that meanness hurts other people? She has received a lot of meanness in her life, and knows exactly how it feels. Do we think she does not want friends and is just not motivated to be nice to others? We know how desperately she wants friends; it is not motivation that is the problem.

Therefore Kathleen will be most likely to decrease her mean behavior when she feels better. If she feels safe, loved, strong, connected, accepted, noticed, and appreciated she will have no reason to be mean. When she learns how to make and keep friends, is absorbed in her own interesting and successful activities, and trusts adults to care for her she will be more generous and kind. Our overall treatment plan and our response to each individual event should be planned to achieve these conditions.

Another way to look at this is to consider what happened right before Kathleen was mean. The most recent time was when two other clients were playing a game together and laughing. The time before that was when she was in math, could not solve a problem, and noticed that Maria was already done with the assignment. In both cases Kathleen felt inadequate and stupid, and spiraled quickly into despair and hopelessness.

What would we like Kathleen to do when she sees two girls playing and wishes she were part of it? What would we like her to do if she feels stupid because she cannot do her math? What would you do in either of these situations?

In the first case we would like her to approach the girls gently and ask if she could play too, or find another girl and engage her in some kind of activity. This is hard to do, requiring both social skills and courage. Another option would be to approach an adult and ask for help finding an activity. This requires trust in the adult. Or, she could absorb herself in a solitary pursuit like drawing, which requires that she has some solitary activities that she know she likes.

In math, we wish that Kathleen would ask her teacher or another student for help when she can’t do a problem. This requires having enough confidence to expose a weakness, and a trust that the other will not ridicule you and will pleasantly help.

This analysis leads us to a lot of ideas of areas in which we can help Kathleen grow. To recap, she needs:

• Social skills
• Courage.
• Trust in adults
• Discovering some solitary activities that she likes
• Confidence to expose a weakness
• Trust that the other will not ridicule her and will pleasantly help.

So what can we do?

• Use a curriculum like DBT to teach Kathleen the skill of joining in or proposing a play activity
• Be trustworthy our selves, do what we say we are going to do, and create opportunities to strengthen our relationship with Kathleen
• Teach Kathleen activities she can enjoy; build on any strengths and interests she has; celebrate her work
• Help Kathleen feel confidence in herself through activities in which she teaches others, leads groups, gives to social causes, and excels
• Treat Kathleen with gentleness and compassion. Make sure she experiences many instances of friendly, non-shaming help.

What if our response to Kathleen being mean to others was to build up her skills in one of these ways? We can look at the event that triggered her meanness and give her practice in another way of handling it; we can have her teach a game to some of the younger kids; we can have her work with a staff member to use her strength to make something for others; for example if she likes to cook she and a favorite staff could make a delicious dinner for the other kids.

Which brings me to my friends Bob’s comment that Kathleen could be an expert in the Civil Rights movement, and if she still felt small and scared inside, she still will need to make others feel bad.

I really, deeply, honestly feel that when kids feel better they will act better. Yet I wonder if we could actually act from that philosophy. It is so deeply engrained in us that the kids will change if we make them feel BAD after they do something that hurts others. If we acted from this belief we would have to see their harmful actions as an expression of how horrible they feel inside, and choose responses that make them happier. And I can just hear the responses now: you are going to reward her hitting me! How are they going to learn if they don’t pay? How will they take responsibility for their actions?

What do you think? Do you agree with my assumptions about the causes of Kathleen’s meanness? Could our programs move in this direction? How can we facilitate this transformation? Please click on comment and share your thoughts.

One Hundred Names for Love

I would like to call your attention to a book I am reading. It is One Hundred Names for Love: A Stroke, a Marriage, and the Language of Healing by Diane Ackerman, (W. W. Norton & Company 2011). The author Diane Ackerman and her husband Paul West are both authors, and their marriage included much loving word play and exploration of literary connections. Sadly, Paul West, a retired English professor and the author of 50-plus books, survivor of diabetes and a pacemaker, was struck by a massive stroke that left "a small wasteland" in his brain, especially in the key language areas. At first he could not talk at all. The book chronicles the story of his recovery through their love, creative and imaginative word play, and the help of others. Ms. Ackerman, who had already written books about the brain, researched his disease and tailored a program for him that utilized his unique strengths and interests. The book is very moving and demonstrates the power of love to heal. Ms. Ackerman also shares honestly the stresses of being a caretaker and trying to keep some hold on her own work and identity.


How is this book relevant to our work? It deeply increases the reader’s understanding of and faith in brain plasticity. It demonstrates without a doubt the way that when one part of a brain is damaged, the rest of the brain can develop alternative routes to achieve the same functions. Ms. Ackerman also teaches us many specifics about how the brain works, particularly in the area of language.

Furthermore, I think that what this couple learned about how to facilitate healing applies directly to our work. The first speech therapists that worked with Mr. West used straightforward exercises using child like words and simple sentences. The process felt demeaning to Mr. West and he was increasingly frustrated and depressed. His wife noticed that larger and more obscure words were in fact easier for him to recollect. She began to build on his strengths and interests to develop playful, silly games for him. She walked a fine balance between helping him and still letting him struggle on his own. She supported his growing independence and abilities even when it meant he was in situations which were not completely safe. She sometimes felt worn out and discouraged; she sometime felt exultant because of a small gain. I think our work also goes best when we are creative, playful and engaging our clients’ strengths.

This book is an interesting and absorbing read that both teaches and inspires. I recommend it.

Crew Rowing and Repairing the Brain

I have just returned from Sacramento, California where I did a recertification for the Associate Trainers of Victor Services. It was very moving to reconnect with these skillful practitioners and experience how they had made Risking Connection their own and used it to transform their treatment programs.
While I was there I visited a local lake and saw some teenagers practicing crew racing, the sport with those long thin boats and many people rowing together. And it occurred to me that this might provide a useful metaphor for the task of healing the lower brain.

Imagine that you have been asked to coach a crew team. Although you have not done so before, you have seen the lovely boats slipping across the water as the coordinated rowers respond to the call of the leader. How hard could it be? So you agree.

Alas, when you first meet your team in action you find them to be much different from what you had envisioned. There they are, a bunch of rowers in a lovely boat on the water, with a separate boat calling out instructions. But, the leader sitting in the front is terrified, and keeps yelling: “Careful!!! We are going to drown! Oh no we are tipping over! Hold on!” and other such things. This constant stream of fear has all the rowers upset and disabled. Several are rowing frantically, but in different directions. Two have dropped their oars into the water and are sitting with their arms crossed. One is crying. The boat is turning in circles, lurching from side to side. The noise is so loud; no one can hear the instructions coming from the other boat.

(This is the disorganized brain. It results from early trauma and lack of attunement. No parts are working smoothly together, and the fear system is in full alert, drowning out all other input. Movement forward is impossible.)

As the new coach, what do you do? Do you tell them you will give them each $5 if they can do a better job and row from one end of the lake to the other? Or do you tell them that unless they row that distance successfully they will be on restriction for two weeks and not able to see their friends? Do you give them a lecture on how much better everything would be if they would just get it together and row smoothly?

(Our normal approaches to our children.)

I would suggest that the best coach would not start with rowing at all. He would start by doing lots of exercises on land. First, there would be activities to help the team members get to know each other and trust each other. These would start with easy things and gradually increase in difficulty. (Relationship forming) Then, he would begin having them experience physical challenges together. He would use all sort of rhythmic activities such as drumming together, dancing, playing ball to help them experience the feeling of being in sync and interacting smoothly with each other. Other games would increase their strength and confidence. Every activity would include elements of relying on each other, interacting with each other, helping each other to achieve success. When things didn’t go well they would develop a method for working them out. They would practice team coordination through carrying the boat together, lifting it up and putting it down, making turns on land while carrying it.

He would make sure they all knew how to swim.

The team would adopt a name, and begin a narrative of its journey from the beginnings to success. The team members would retell the story, always adding the day’s events, each night around a campfire.

Then, gradually, the team would return to the water. The challenges would be small at first. They would try regular rowboats in pairs. When they started the crew boats again they would be in shallow water. Each of them would practice leading the beat, the rhythm that coordinates them all, until they could feel it deep in their bodies and respond almost automatically. They would try rolling the boat and falling out until they felt confident they could handle any eventuality. This phase would take a long time.

(All the treatment activities of healing the brain.)

And then, the magical day would come when the team would get into the boat, row through the water together in a smooth and effective way. The youth in front would carry the beat. The team would respond in rhythm. The ideas from the second boat would be easily heard across the silent water. When a wave came, or it started to rain, or they had to make a turn, the team would laugh and solve the problem together.

(And thus the brain would become as powerful and skillful as it had always been meant to be.)

My Recent Travels

I have had the honor and privilege of participating in two special events over the last two weeks. The first was the Vermont Foster/Adoptive Family Association 24th Annual Spring Conference: Hope and Healing. At that conference I attended a one day workshop by Dr. Bruce Perry. I was so delighted to finally have a chance to hear Dr. Perry in person, after having read all his work and listened to him on video tape. When I remarked to the conference organizer that he reminded me of Seinfeld she told me I wasn’t the first person to notice that. As I have written in this blog, his ideas are opening new avenues of learning and teaching for me, and I hope to write more about them here in the future. Dr. Perry expanded on the idea that rhythmic, repetitive, rewarding physical activities with another engaged person are necessary to rebuild the brain stem of children hurt in early life.

The next day of the conference I delivered a keynote address and then led two workshops. The subject of my keynote was: What is Trauma Informed Care and What Does It Mean for Foster Care? The workshops were: The Trauma Survivor as Parent and Maintaining your Sanity While Walking in The Minefield: Helping Youth With Challenging Behaviors. I received much positive feedback for all of them.

Vermont has prioritized supporting and training foster parents. They offer this conference to foster parents and those who work with them every year, and it combines education with a break, recreation and connection. They also raise money at the conference through a silent auction and fifty/fifty raffle for a fund that provides extras for foster children. I found the foster parents to be very knowledgeable and thoughtful, tuned in to the adaptive nature of their youth’s behavior, and extremely caring and committed. I was also impressed with the professionals I met such as the conference organizer Karen L. Crowley, System of Care Manager, Family Services Division, Department for Children and Families. Vermont’s governor Peter Shumlin was present, as was the new DCF Commissioner Dave Yacovone. Their presence also spoke to Vermont’s commitment to foster parents. Vermont is emphasizing the concept of co-parenting between the foster parents and the bio parents, which made my “trauma survivor as parent” workshop especially relevant to the foster parents.

One foster parent asked me a question which we agreed we must defer to Bruce Perry. She has a teenage foster son who is very sexually active. She said that it occurred to her that he was engaging in an activity that is rhythmic, repetitive, rewarding and physical with another engaged person. Is he building his brain stem?

On the third day of the conference we watched a movie entitled “Ask Us Who We Are ~. From the program description of the film: “Directed and produced by Bess O’Brien. This documentary film focused on the challenges and extraordinary lives of youth in foster care. The film is a reflection on loss and the search for belonging and fining family. Although the film highlights the heartbreak that many foster care youth carry with them as they move through their lives, the documentary also reveals the tremendous strength and perseverance that grows out of their determination to survive and thrive. The documentary also focuses on the lives of foster care parents and kinship families that open their homes to children. Through small and large acts of kindness these adults can change the course of children’s lives and give them a sense of place. In addition, the film highlights two parents who lose their children.” It was very moving and I look forward to the time that it will be released for greater distribution outside of Vermont.

The following week I travelled to the Change Academy Lake of the Ozarks (CALO), a specialized therapeutic school that I have described previously in this blog. This school was founded specifically to utilize attachment principles to help children heal. They specialize in children who have been adopted. Their canine program allows each child to adopt and learn to care for a golden retriever, and take the dog with them when they leave. This is one of the powerful elements of the healing process.

I am honored to have been asked to be on the Board of Advisors of CALO. On this visit I got to know the program and people even more, and attended a conference CALO hosted. On the Board also are a parent advocate (who is also an adoptive parent), a lawyer who advocates for children and who is an adoptive parent herself, and an attachment specialist in private practice in the Washington DC area. For me it was a great treat to be among people who are so immersed in this trauma informed, relationship based way of thinking. I was soaking it in, being reaffirmed and recommitted to the importance of what we are doing. I learned some new ideas as well. And all this in the midst of the beauty of the Ozarks in the Spring, with many lovely flowering trees.

I feel very lucky to have been able to participate in these events.

Ten Essential Elements of a Successful Transformation to Trauma Informed Care

1. Administrative buy in: The top administration, including the Board, must understand the change and see compelling reasons to make it. They will need to support the change through their actions, financially, by presenting it to the outside world, and by demonstrating patience and hope through the inevitable roller coaster implementation process.

2. An Implementation Committee: A group of people dedicated to keeping the process moving, deciding next steps, and checking to make sure there is follow through.

3. Trainers and Champions: A group of dedicated trainers and champions who are enthusiastic and eager to see change.

4. A training role out plan. This should include who will do the training, what will the schedule be, who will attend and how many trainings will be done.

5. A new behavioral management approach: a plan for moving away from a consequence based approach to behavioral issues which includes what the agency will do instead.

6. Communication: Mechanisms to communicate to the whole agency what the change is that is being made, how is going to happen, why are you doing it, and how will you measure success. Communicate with the families and involve them in the process. Also communicate to the outside world (funders, licensing, donors, the public)the changes you are making and your hopes for improvement.

7. Celebrations of success: Share and applaud ways to share particular interventions that have made a difference, good outcomes, positive feedback, and particular staff who have done a great job.

8. Attention to vicarious traumatization: Time and space for staff to talk with each other about the ways the work is affected them.

9. Measurement: Set some goals that you hope to reach by implementing trauma informed care, such as: reduced restraint and seclusions; less staff turnover; less negative discharges; and more positive outcomes. Measure these and report the findings to the agency.

10. Fun: Make the training g fun. Invent rituals, sayings and games around implementation on the units. Give little gifts and certificates to staff who interact flexibly and warmly. Play more with the kids! Add more fun interactive activities to your daily milieu life, and make sure the staff and kids play together. Make joy your primary daily goal!

The Primacy of Safety

Feeling safe is necessary for relationships, for fun, for relaxation, for sleep, for concentration, for verbal learning, in fact for daily living. I have quoted before the experiment in which baby rats in a cage were playing, and the experimenters introduced three cat hairs for ten minutes. All play stopped. When the cat hairs were removed, it was weeks before the play started again and it never resumed its previous levels.

The kids we work with feel so unsafe. They are constantly on the lookout for the danger that has permeated every part of their lives. A central fact of their existence is that any small indication of danger sends them into full life-or-death alert mode. And the world is full of indications of danger.

So how do we recognize this, make sense of it and work with it? How do we help our kids to feel safer?

Allison talks often about feeling unsafe. And, in fact the other girls do pick on her and at times assault her. Allison comes out of her room and stands in the lounge swearing at the girls, calling them names and insulting their families. She is smart and knows exactly what to say to each individual girl to totally infuriate her, and she constantly does so.

Malcolm runs away two or three times a week. Anything at all that upsets him can trigger him to run away. Often it doesn’t seem that anything has upset him, and the run aways seem planned. He often persuades other boys to go with him. When he runs he puts himself in very unsafe situations. He also does self destructive things, including jumping into the street and using his belt to threaten to hang himself in the middle of a town park.

Both Allison and Malcolm have had very unsafe lives, and now seem to be deliberately courting danger with every ability that they have. How do we understand this?

Maybe it feels safer for Allison to bring the danger and abuse on herself; at least she has some control. It may feel to her like she has the upper hand over others for once, even when it results in her being hurt. Maybe when the unit is calm and quiet Allison feels foreboding, like something terrible is about to happen. So she precipitates it and no longer has to wait for it.

Maybe Malcolm is so used to a life of danger that it feels familiar to him. Maybe the danger of relationships, letting people down, failing, being disappointing others, is so acute that the danger on the streets pales in comparison. Maybe (using a reenactment approach) he relishes leading others into danger instead of being led.

We can look at the patterns, explore with the kids how they feel and what they think just before they do something, and gradually come to an understanding of the adaptive function of these behaviors for these particular kids.

So what can we do to help these children and all the others in our care?

First, of course, we should try to achieve as much actual safety as we possibly can. With staff supervision, schedules, routines, checks, the physical environment, and planning we should create as safe a world as we can.

Then let’s talk about safety in our community. In unit groups let’s discuss what kind of community we want to live in. It is important to acknowledge that everyone there has experienced an unsafe childhood, and has not been protected as they should have been. We can use a psycho-ed approach to teach the youth about how early exposure to danger changes the bio-chemistry of the brain and body, and hence every youth there reacts easily to any sign of danger. We can teach them to observe this in themselves and others, and hopefully over time to feel some compassion for themselves and each other. And we can collaboratively develop some plans for our community by which we will increase everyone’s safety.

And let’s actively address the issue of safety with each individual child. This could include (depending on what fits with the individual) looking at and mourning the ways the child was not kept safe when she was young. We could talk about what makes him feel safe and unsafe. How do you make others feel safe or unsafe? We could be clear that we are trying to be different than adults in their past: we are trying to keep them safe. We can use multi media: drawing, collages, music, movies, all exploring safety and lack of safety. We must surround this investigation with as many experiences as possible in which the youth is engaged in positive, active, physical fun interactions with caring adults. All members of the team should know that the treatment theme is safety, and inquire and comment regularly on their own feelings of safety in a given situation.

Our days in residential are precarious. We are always trying to keep groups of deeply suffering children safe. The more we are aware of this, articulate it, and address it collaboratively with our kids, the better chance we have at succeeding.

What Administration Can Do to Support Trauma Informed Care

The actions of the agency administration will determine the success of a transformation to trauma informed care. The administration must truly understand and support this approach, or it will not have a chance. Staff are keenly attuned to what is actually expected and rewarded within an agency. Mere lip service will not convince them to make this difficult change.

How can administrators demonstrate their support? First, they can arrange financing for training for all staff on trauma, how it affects people, and how they can heal through attuned relationships. Key members of the administration should attend at least a portion of trauma training themselves (vs. sending designees in their places). The agency must make provisions for the staff to attend the training and be released from their regular duties.

Expectations are conveyed in many ways throughout an agency. Does the administration value control and lack of disruption more than anything else? Can the administration tolerate certain level of organizational chaos in making the transition, including such things as staff confusion, conflict within treatment team, resistance to change, and increased property destruction? Trauma informed practice encourages staff to be flexible and to offer choices to the clients, even when the result is that the client is not immediately brought under control. Can the administrators support this?

In one residential agency trauma informed care champions had been working with the staff to be more flexible. They were teaching staff to ask upset clients what is wrong and to listen and to validate their feelings before discussing consequences or solutions. Maggie, a sixteen year old, had just learned that her mother had relapsed. She was screaming in the main hall on the afternoon of the Board Meeting. The CEO was wondering what Board members would think if they walked in the door and heard a girl yelling about killing herself and running away, and heard staff empathizing with how bad she was feeling. So he went out and said he knew she was upset but could staff please get her to go back to the unit or at least into one of the meeting rooms?

What messages are sent in this two minute interaction? That not upsetting the Board is more important than what is happening to Maggie; that in fact what Maggie is feeling and saying is unacceptable and shameful and should be hidden; and that the job of staff is to get Maggie to quiet down and stop bothering people. Those two minutes can undermine months of training.

Administration should look for every opportunity to praise staff members for their patience and kindness. They should express their sadness about what the children are going through, and acknowledge how real and important the stressors on these children are. A response of compassion to both the child’s and the staff’s experience in an incident will have a very powerful effect in reinforcing the staff’s flexibility with the child.

This example also points out that it is important to share the principles of trauma informed care with the Board of Directors. They need to know why the agency is making this change, and how it will affect agency functioning. Both possible positive and possible negative ramifications must be shared with the Board. If possible, Board members can be invited to attended some portion of the trauma training, or even participate in the over site committee.

Staff members want to do a good job. They want to be seen as competent and successful. If administration makes them feel bad about the children’s emotional outbursts, they will try to stop these outbursts. It administration helps them feel proud of their kindness and flexibility with the children, these behaviors will increase.

Fundraising is a key function of the CEO of any agency. Implementing trauma informed care can help with fund raising. The agency can become a leader in a cutting age treatment modality. Developing sophisticated treatment skills will help the agency survive current economic stressors. Emphasizing the trauma histories of the clients served helps donors understand why they need assistance. Also, using research such as the ACES study will demonstrate the economic benefit of helping people heal from trauma.

Administrative leaders can further set the tone for trauma informed care by celebrating both staff and client achievements. Their concern, kindness and compassion towards issues affecting both staff and clients model the response needed from staff. Their heartfelt joy when a client wins and award or a staff member gets their professional license reminds everyone of the purpose of this difficult work.

A transformation to trauma informed care is not possible without this strong administrative support.

It’s All for You, Mallory

Picture Mallory sitting in the Main Lounge. She is a large sixteen year old girl in tight garish clothes. Next to her is an over turned couch. She is surrounded by glass from the window she just broke. Her legs are swathed in gauze bandages covering the cuts she just inflicted on them, and there is blood on the carpet. The wail of the fire alarm she pulled is giving voice to her pain. Her face is frozen.

Everything we are doing is for you, Mallory. For you, who was abused by a relative repeatedly over five years. Your mother struggled with her own abuse history and depression, and has made several suicide attempts. She is not able to endure your pain, but she cares about you. She has advocated for you as you have travelled between treatment programs and hospitals.

Because of the transformation we have made at our treatment center, someone is holding your hand. No one is talking to you about consequences. There is compassion and caring in the eyes of the staff who look at you.

When you have left for the hospital, the staff discussion will center on your pain, not that you were difficult or annoying. Your team knows that you read an article in the paper today about your molester. They understand how this would be unbearable. They are shaken and disturbed, and they are feeling with you, not feeling angry at you.

Because of the changes we have made, everyone appreciates how hard this incident was on Mallory’s team, and immediately people rush to comfort her therapist, the people who saw her cut, all those who helped. We are aware of how this difficult work takes its toll on us all as we stay present with Mallory’s sadness.

We know we have work left to do when the policemen says sarcastically to Mallory “well, I guess someone’s angry” and the EMT threatens to drag her to the ambulance. And we are working on it through a grant to train the police force and have regular fun activities shared by the police and the kids. This has made great improvements in our cooperation as agencies- but today wasn’t our best day. Still more to do.

Nothing that happened to you was your fault, Mallory. You are not being manipulative and just wanting attention. You are unbearably unhappy, and you have every right to be. We are honored to be by your side, even when it doesn’t go well, even when you are not cute, even when we are exhausted and far from perfect, even when the system lets all of us down.

When Mallory is in the ambulance ready to go to the ER she asks her special staff member Rebecca if she can have a hug. Mallory is covered in blood and Rebecca hesitates. “Here, I’ll put on my coat” Mallory says. They hug.

We are trying to change the world for you, Mallory.

Becoming Naked

Today I would like to ask for a consultation on a certain behavior- namely, taking off all one’s clothes.

Davonte is 12 years old, and is small for his age. He has a history of extreme abuse, and has lived in 19 places. He exhibits many problem behaviors, such as aggression and threatening. However, one of the most common is taking off all his clothes and coming out of his room. He often makes statements about how great his body is and how he will someday be on magazine covers. Sometimes he will respond to and matter of fact directive to get dressed, other times that will lead to a full fledged meltdown.

What is the adaptive function of this behavior? What does it communicate and/or accomplish? What needs does it meet?

We see this behavior quite regularly, in boys and girls, in younger children and in adolescents. Often children take off all their clothes within a crisis, but other do so in every day times and when it is unexpected.

Obviously this same behavior means different things to different youth, but what are some of the possibilities, just to start us thinking?

Some possibilities that occur to me are:

1. To shock and get a reaction

2. To keep people away

3. To test whether someone is going to molest them or use them sexually

4. To determine whether people will accept their real, true self

5. To replicate what they saw in their family

6. Because a child is uneasy about his or her body, they want to see if people are revolted

There must be many other thoughts.

I am sure that Davonte does not disrobe because he is happy about his body and wants to show off how wonderful it is. Instead I feel certain his behavior comes from a place of fear and shame, in which he fears that there is something inadequate, awful and disgusting about his body.

Have you had experience with this behavior in your settings? How have you come to understand it? How have you and your team responded?

Please click on comment and share your experiences so we can all learn from each other.

Responding to Martin’s Threats

In his fifteen years before his admission to residential, Martin has been repeatedly abused by multiple people, including horrifying sexual abuse. When first admitted he was primitive and reactive, unable to trust anyone, easily panicked and always alert for danger. Whenever he felt threatened he lashed out, often physically. Gradually however Martin began to feel safe and was able to form some relationships with staff. His outbursts became less frequent and less severe, and he was more often able to participate in fun activities. He demonstrated an ability to draw and created some amazing cartoons. Both he and the staff are beginning to feel some hope for his future. He and his therapist are talking about a possible move to a group home or a foster family.
It was very discouraging then when the report came from school that Martin was suspended for threatening his teacher. He became extremely agitated, would not go to his next class, threw some books, and told the teacher that he was going to kill her with a knife. He was so intense that the teacher was frightened, and a restraint resulted.

What happened here? How do we understand this behavior? What should our response be?

Martin will not have a life worth living if he often becomes so agitated that he threatens to kill people, destroys property and disrupts whatever is going on. There is no doubt that we need to help him change this behavior. What is our most powerful strategy to achieve that change?

Punishment is the first idea that occurs to everyone. Martin needs to learn that he cannot treat people this way. He should be suspended from school for three days, and not have any activities or fun events during that period. Then maybe next time he will think twice before threatening someone.

But will he? In fact, the problem is that Martin cannot think once when he is agitated, much less twice. The punishment will confirm Martin’s world view: that he is a horrible kid who continually does bad things, and that the world is a place where he has no role, where people do not like or accept him.

Because Martin has formed relationships with his treatment team he was able to tell them several days later what had happened in this incident from his point of view. First, Martin is feeling anxious because discharge is being discussed. He is facing leaving the first place he has experienced any success and formed connections. That day, Martin was scheduled to go to art class. He had been dreading art since the last class earlier in the week. Martin has decided that the art teacher, Mr. Howard, is a homosexual. Mr. Howard has been very nice to him and encouraged his drawing skills. Martin has started to like Mr. Howard. Last class, while helping him with a project, Mr. Howard put his hand on Martin’s shoulder. Martin knows this is the first step towards Mr. Howard molesting him. He is terrified. The only way he can protect himself is to avoid art. But Miss Lesley, his home room teacher, didn’t understand this (nor did he tell her). She kept insisting he had to go to art. Martin was terrified and flooded with feelings of being small, vulnerable and powerless to prevent abuse. So he tried to save his life by threatening people and getting them away from him. He did not have to go to art or see Mr. Howard.

It is quite likely that throughout his life Martin will encounter situations that evoke his previous abuse and make him feel desperately afraid for his life. What do we hope that he will be able to do when this happens?

We hope that Martin will feel safe enough and trust someone enough to turn to them for help. We hope he will have one moment of realizing what is happening to him, one moment of considering that it may not be the truth that the art teacher is going to molest him, it may be related to his past. In that moment, he could say to someone: can I talk to you? I need help.

What would Martin need in order to do this? He would need to trust people. He would need to experience that the world has safety in it, that there are people who will not hurt you, that in fact people may care and want to help. And he would need to develop some self awareness so that he can recognize when he is having feelings related to his past and be able to stop for a moment and consider whether in this case the present is different from the past. This is a very hard thing to do.

When Martin is in the grip of panic related to his past abuse, the thought that he will be grounded if he threatens this person is of no use at all. His cortex (analytical thinking) is not available to him. Even if he could remember that he will be grounded (and he can’t) being grounded would be infinitely preferable to being molested by the art teacher, an event he sees as a complete certainty if he does not get out of going to art.

So what can we do to help Martin?

When he is not upset, his therapist and others close to him can talk to him about these things, teach him about trauma, and help him understand the connection between past events and current behavior. Together with him, they can mourn and deplore the horrible things that happened to him. And they can begin to identify the situations that are most difficult and most likely to bring up feelings of the past. Martin can begin to observe what the first signs in his body are that he is becoming upset. Staff can also learn with him what are the early signs of anxiety, and can identify them to him.

In the crisis, it would be helpful if someone noticed when Martin was beginning to be agitated. There are many more options if we catch this event when it starts and before it has escalated into a full meltdown. In either case, it is helpful if staff approaches Martin asking what’s wrong, what’s bothering you, rather than by telling him what to do. Martin will not be able to tell anyone what is really bothering him when he is agitated. Their faces (even those he likes best) will be the faces of his past abusers. So staff should employ any calming techniques they know. Can Martin go for a walk? Can he draw? Can he play basketball? Does he need to be alone, be with someone? There should be no focus at all on making him do the next thing he is supposed to do. All the focus should be on helping him feel soothed, accepted, and calm.

What if this doesn’t work, and Martin threatens or hurts someone? What can we do afterwards? Remember that once Martin regains his sense of being in the present he feels very remorseful that he hurt someone. He also feels more shameful than ever. So what can he do to make amends to that person? He can talk with Miss Lesley. She can speak from her heart, in a modulated way, and tell him how scared she felt. She can relate that to how scared he must have felt as a little boy when people threatened and hurt him. Together they can plan some strategies for the next time Martin feels scared. Maybe Martin can also do something to make Miss Lesley’s life easier, like clean up the classroom or do some other chore for her. And what about learning? Could Martin draw a cartoon illustrating how the world looked to him right before this happened? Can he start a comic strip about a boy who is learning that the present is different from the past, and make different episodes as the boy learns new things?

The theme here is that Martin will not be less likely to threaten people if we make him feel worse. He already feels about as bad about himself and his life as a person can feel. He will be less likely to threaten people if we help him feel better. He will be less likely to threaten people when he trusts them, feels safe, and is relaxed.

There is a particular opportunity in this situation. If Martin feels up to it when he is calm, it would be great for him to meet with Mr. Howard in the presence of someone he trusts. He could plan this in advance. And of course Mr. Howard would have to be comfortable and at ease in this discussion. Mr. Howard could assure Martin that he will never in any way molest him. He could apologize for putting his hand on Martin’s shoulder, and say that he did not realize how scary that would be for Martin but he can completely understand how it would be given Martin’s experience. He could say that he hopes he and Martin can continue to work together as he sees that Martin has a lot of art talent. But he understands that might be scary for Martin, so could they set up any plan for when Martin gets nervous? Maybe he can leave the art room and go back to home room. Or is there anything else that could help that Martin can think of? This conversation and their subsequent work together can become an extremely important corrective experience for Martin. Maybe there are people in the world that are friendly and want to help you and will not hurt you. This is what we hope Martin can come to believe.

It’s not that we are letting Martin “get away with” threatening the teacher. Punishment is irrelevant here. What we are trying to do instead is to use our most powerful relationship tools to help Martin learn how to identify and cope with his understandable panic responses so he will not feel his life is in danger and thus will not need to threaten others in order to save his own life. It is a long process, requiring many repetitions. We have already seen progress in Martin and with this awareness we feel hope for his happiness.

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.

These Kids Will Act Better When They Feel Better

In May I wrote about what it would mean if we really believed that children will act better when they feel better, and discussed what "feel better" would really mean. Feeling better includes:

• Feeling safer

• Felling calmer

• Feeling more connected:

• Feeling better physically

• Feeling less shame

• Feeling more competent

• Feeling more effective

I am struck with the connection between this way of thinking and our understanding about how the brain changes. The brain changes in a use dependent way: what happens often is strengthened; what is not used withers away. What happens together is associated, which means that one thing evokes the other. Many repetitions are needed to change something previously learned or associated. We also know that human interaction is intrinsically rewarding, and that if humans do not have enough of this reward they are more vulnerable to seeking other rewards such as those available from cutting, drugs, aggression, etc.

We want our children to associate human contact with pleasure and help. We want them to experience that life can be a fun, positive rewarding experience. We want them to know that when difficult things happen, you can turn to others for help and use your own skills to surmount them.

It is true, then, that our main function in treatment should be to help each kid have a great day. (Idea courtesy of Martha Holden, CARE project, Cornell). Because having a great day will establish new patterns and templates in their brains. Having fun with staff, repeated many many times, will begin to change their expectations of interactions with others.

I was talking this over with a friend, and he asked: does this mean we should just let the kids do whatever they want, and sit around and eat candy all day? No, it does not. For one thing, feeling better is a complicated phenomenon, and includes all the aspects above- so it demands many activities and challenges. Felling better necessitates lots of the delicious rewards available through social connectedness. For another thing, we have to consider the group. Each person has to have a great day in a way that does not impede the other people having a great day. And thirdly, there is the staff. In order for the child’s template of relationships to change, there must be a genuine, positive engagement with adults. To do this, staff must be feeling hopeful and caring. So promoting anything that hurts or pushes away the staff does not achieve our brain-changing goal.

Therefore, we should be discussing how to create a milieu containing the most possible highly engaged, physical, rhythmic fun for the staff and the kids. Now that would be an interesting treatment team meeting!

Changing the Brain and Having More Fun

What do we know about how to change the brain?

• •Brains develop and change sequentially. The lower part, which concerns the body, the danger response, and emotional reactions, develops before the higher part which involves words and analytical thinking.
• Brains develop and change in a use-dependent way. If you use a part more, it gets stronger. If you dn’t use it, it withers away.
• What fires together wires together. Things that repeatedly happen together get associated in the brain, and the next time one happens it brings up the other.
• In early years of brain formation, patterns are set in to the brain which determine our assumptions and expectations of life. If a child is hurt by people in the early years, they expect people to hurt them from then on.
• If you want to change a part of the brain, you have to use it. So, if you are talking, you are not changing the lower part of the brain. You are only affecting the thinking part.
• Many repeptitions are needed to change a previously learned association or pattern.

 So what is the radical significance of all this for our work?

Our children in residential have almost all been wounded early in life, during the formation of the lower, bodily, emotional and danger response parts of their brains. And, the early patterns that they have established are that people hurt you and leave you. This is what we need to change, before we can work with the thinking, verbal part of the brain. We want to change their expectations of other humans. We want to pair human contact with positive emotions and good results, to undo that old pairing of human contact and pain.

In order to reach the lower part of the brain to change it, we have to engage it. And how do we do that? We involved the child in physical activities with movement and rhythm. These could include music, dance, drumming, rocking, swings, planting a garden, massage, shoveling snow. And, we pair these activities with positive interactions with other people. We make sure they are fun and engaging and done in connection with adults.

Do you see the implications of this? We have always maintained in our training that the daily life in the milieu and the relationships with the mental health workers are powerful forces for change. Now we can see even more clearly that having fun with the kids in physically engaged, active ways, is the very thing we have to do in order to change their brains. And now we can do this more planfully and with targeted goals.

Another implication is this. As we know, our kids are acutely perceptive about other people’s moods and emotions. This also reflects their earliest brain development. They had to develop this perceptivity to stay alive and anticipate the next dangerous event. So they will know if the adult is actually engaged with them, actually having fun and feeling positive and affectionate. If the adult is distant, sarcastic, punishing or distracted and texting on their phone this will not change the brain. In fact, this will confirm and further strengthen the patterns already established. So, in order to be successful in our change process, we need to take good care of our staff, so that they feel energetic, hopeful and available.

Isn’t this amazing? It turns out that having a lot of playful, energetic, engaged fun with the kids is the best thing we could possibly do! Get out that Wii and play Dance, Dance Revolution, and make sure the staff dance too, and laugh a lot…. Do it again and again. And you will be changing brains.