Contemporary Theorists

Insights into trauma recovery and impact on treatment

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Daniel Stern (1934-2012) revised psychoanalytic ideas and recognised that there was an important dance of gestures, tone of voice and facial expression of the “stimulus world’ of playful interaction between an entertaining baby and a loving mother”. He introduces “a new conception of the mother’s role and her experience of being with her baby, which in time became a model for a different way of conceiving psychotherapy for adult patients”. (From biography ref below)

Further quote from Trevarthen on Stern:

“This is a psychology to build not only practices to strengthen care for those in distress, but also encouragement for education of the young, and the development of laws and social industries and institutions of government that will benefit more people and reduce injustices. Dan Stern’s thoughts are with us, and will last”.

Biography by Colwyn Trevarthen:

https://blog.oup.com/2014/01/remembering-daniel-stern-developmental-psychologist/

Books:

The Interpersonal World of the Infant: A View from Psychoanalysis and Development Psychology Karnac 1985

The Motherhood Constellation: A Unified View of Parent-infant Psychotherapy Routledge  (1998)

Forms of Vitality Exploring Dynamic Experience in Psychology, the Arts, Psychotherapy, and Development OUP 2010

The work of Allan Schore, Bruce Perry, Bessel van de Kolk and Stephen Porges are key to this developing understanding as it has given us much clearer insight into the impact on the brain and the ability of traumatised children to regulate their emotions, impulses and behaviour. An understanding of brain development is key to helping us understand how we respond to facilitate recovery. Evidence suggests that relationship is central in supporting recovery in traumatised children.

 

Perry and van der Kolk write of how the developing brain organises and internalises new information in a use- dependent fashion which demonstrates that the more children live in a disorganised physiologic state (hyper-arousal or detachment), the less they are capable of dealing with stressful experiences and the more likely their development is thrown off course by exposure to traumatic experiences.

 

Bruce Perry (echoes the idea that the therapy (healing) takes place in doses both within therapy and the therapeutic environment (school and home). Given the idea the brain forms (and therefore repairs) from bottom (brain stem) to top (neo-cortex) and to bottom, he explains that there are core elements of positive, developmental, educational and therapeutic experiences:

 

Relational (safe)

Relevant (developmentally matched)

Repetitive (patterned)

Rewarding (pleasurable)

Rhythmic (resonant with neural patterns)

Respectful (child, family, culture)

It is important to add

➢Reciprocal (taking turns, which will happen once a child begins to feel able to be in relationship)

 

Perry continues this theme by asserting that children are most likely to reach their full potential if they experience consistent, predictable, enriched, and stimulating interactions in a context of attentive and nurturing relationships. He explains that the brain can change through the repetitive relational experiences due to plasticity of the brain.

"It is important to understand that the brain altered in destructive ways by trauma and neglect can also be altered in reparative, healing ways. Exposing the child, over and over again, to developmentally appropriate experiences is the key. With adequate repetition, this therapeutic healing process will influence those parts of the brain altered by developmental trauma. Unfortunately most of our therapeutic efforts fall short of this".

Perry (2006)

Contemporary research that supports the notion that prolonged alarm reactions alter limbic, midbrain, and brain stem functions through ‘‘use-dependent’’ modifications. Chronic exposure to fearful stimuli affects the development of the hippocampus, the left cerebral cortex, and the cerebellar vermis and alters the capacity to integrate sensory input. Current research is beginning to demonstrate the underlying pathophysiology of the difficulties with cognition, impulse control, aggression, and emotion regulation commonly seen in severely traumatised children. (Van der Kolk. 2003).

 

“In trauma survivors, Van der Kolk notes, the parts of the brain that have evolved to monitor for danger remain overactivated and even the slightest sign of danger, real or misperceived, can trigger an acute stress response accompanied by intense unpleasant emotions and overwhelming sensations. Such post traumatic reactions make it difficult for survivors to connect with other people, since closeness often triggers the sense of danger. And yet the very thing we come to most dread after experiencing trauma — close contact with other people — is also the thing we most need in order to regain psychoemotional solidity and begin healing”. Van der Kolk writes:

 

Being able to feel safe with other people is probably the single most important aspect of mental health; safe connections are fundamental to meaningful and satisfying lives.

 

 

Quotes from

https://www.brainpickings.org/2016/06/20/the-body-keeps-the-score-van-der-kolk/

Videos and books by Bruce Perry

Dr Bruce Perry ‘Born for love – why empathy is essential and endangered’

Bruce D. Perry: Social & Emotional Development in Early Childhood