Bruce D. Perry M.D., PhD and Senior Fellow of the Child Trauma Academy was back in Columbus Ohio this week to continue to share research findings of CTA about NMT which is the Neuro-sequential Model of Therapeutics, a developmentally sensitive approach to clinical problem solving. In layman’s terms, each human develops in stages over time. If something occurs (mental, physical, sexual, emotional abuse or neglect for example) to interfere with healthy development, the brain does not develop in healthy ways -with long term effects. A side note: everyone processes experience differently.
There are also the NMC- Neuro-sequential Model in Caregiving and NME-Neuro-sequential Model in Education. A key component of the Neuro-sequential model is to recognize and describe the role of the brain and brain mechanisms in mediating human perception, response and interaction with the world. By understanding how the brain works and how development occurs, we can find better solutions in raising healthier, better adjusted children. In recognizing that human development is sequential and that the brain processes things at a very basic physiological functioning level -all the way up to a more sophisticated cognitive level, we can begin to understand and develop new ways of positive, therapeutic, educational and healing experiences. Dr. Perry said however that no single frame of reference can capture the full complexity of the human brain and behavior; everyone is individual.
Speaking largely to a therapeutic group in prior workshops, this presentation seemed broader and more philosophic. Dr. Perry does not follow a linear format, reading his PowerPoint slides in sequential order as the un-initiated might expect; his presentations are more organic- almost like a stream of consciousness tailored to each audience. For example, Dr. Perry interjected, “The human brain is not designed for the modern world.” He explained that for thousands of generations, humans lived in small multi-generational ratios of 4 adults to 1 for each very young child. “Human beings are living in conditions that we invented. Our complex brain stores more bits of information than any other species. We invented ourselves away from the natural world. We invented the child welfare system, the nuclear family versus the concept of family thousands of years ago-which included adopted and extended family members including slaves. Some of our inherent biological gifts include malleability of the brain in early life. We have largely raised a generation of kids with unrealized potential.”
A second key point was that we’re disrespectful of the gift of being relational. Relational enrichment was 20x greater in the early neurobiological setting of the hunter-gatherer clan with that 4:1 ratio of caregivers to each child to protect, nurture and educate. What heals our kids is relational continuity. The brain is designed for a different world than we’re living in. [Coincidentally 93.3 WODC morning show 4/17 cited a recent study that families are spending less than a half hour together each day-just minutes really; less than 90 minutes over the weekend and seldom without television or other electronic devices present.] Applied to a young mother with depression for example, in today’s model, our culture demonizes and extrudes the depressed mom and removes her child. Interventions further damage mother and child. In ancient settings the extended clan or tribe would embrace her and step in to care for the child.
It would be impossible to cover all that was in the half day presentation in a short post, but two key points stand out. One is what Dr. Perry called ‘differential state reactivity’. Responses to stress occur on a continuum from perceived challenge to distress to extreme stress on the X axis in response to states of calm to alert to alarm, to fear and terror on the Y axis. A child might exhibit arousal or di-association as a protective mechanism. Responses to stress, distress and trauma include changes in cognition, affects, behavior, neurophysiology and physiology. It is inherent that a fight or flight response might move to a dis-associative response when faced with the threat of a saber toothed tiger.
Because of how a healthy versus traumatized brain processes information, the optimum therapeutic dose is more likely to occur in 30 second bytes not 45 minutes of unbroken therapy. ‘The therapeutic change often happens outside therapy because the child is using their protective mechanism to tune out; their window is narrow. They want and need to control how long they deal with trauma,’ he explained. “It’s a case of the correct dosing of challenge vs. tolerance. You turn a big transition in a lot of little ones.” [It might be a 3 minute encounter with someone completely unrelated to the situation, later.] “Controllability is something we must give a child and the therapeutic web is where the healing takes place,” Perry explained. Therefore the janitor is a therapist; the cook . . .
A second key point is that there are different forms of self-regulation. Traditional models assume kids are driven from the top down, but it’s actually from the bottom up. For example if a child is hungry or has a full bladder you can’t establish meaningful connection. You have to first regulate, then relate before you can proceed to reason. Dr. Perry explained that the NMT model suggests one take advantage of somatosensory regulation or self-soothing approaches which are ‘bottom up’. The signals come from the diencephalon. Translated in lay terms, exercises with breathing, rocking, running, swimming, dancing, doodling, humming, swinging, jumping or bi-lateral tapping in predictable doses help a child to re-discover rhythm, healthy touch. “We have a relationally impoverished culture which almost forces kids to promiscuity, alcohol, opiates. The more we have healthy, rhythmic relational environments, the less a tendency to unhealthy behaviors,” he said.
Perry urged his audience of over 400 to share their learning with others and begin to initiate change. The Building Better Lives Changing the Cycle of Child Abuse and Family Violence program was made possible through the Ohio Children’s Trust Fund and Franklin County Family and Children First Council including partners Ohio Mental Health and Addiction Services, Nationwide Children’s, and Mount Carmel. All program material is copyrighted by Bruce D. Perry who is quoted here. For further information visit The ChildTrauma Academy at http://www.ChildTrauma.org. The Pomegranate Health Systems clinical team continues training in NMT.
submitted by Patricia Rodemann, MA, MTS
[photo credit: Pomegranate gym wall-teens & art therapist, titled: ‘Be your own hero’]