While reading Bruce Perry's accounts of his work with Sandy
and other children that he encountered at a residential treatment facility, I
was struck by how much he pays attention to the physicality of the brain and
how trauma literally molds the brain into a completely new structure if the
trauma is out of the control of the child.
This fact is not something that I am unfamiliar with as I have
encountered similar thinking when working with adults as a clinician. Many clients
I have encountered through my work as a student have experienced trauma,
especially during the earliest years of their lives. I find this difficult to swallow because many
of these people are still dealing with the aftermath of traumas that happened
5, 10, 20 or even 40+ years ago.
I
appreciated that Bruce Perry is willing to think outside of the box and consider
medication that would treat the physical affects of hyperarousal due to stress
with the medication, Clonidine. I
believe this could have an extremely impactful effect on the children’s
physical health far into their adulthood (as we know that trauma and stress can
significantly impact someone’s health and wellbeing). However, my question is, would treating the symptoms
with medication require the client to be on the medication as a lifelong
treatment?
An
alternative therapy that I have recently gained knowledge of is EMDR. EMDR aids a client in physically healing their
own brain through processing the memory of a trauma while engaging in bilateral
stimulation, which activates both sides of the brain. Bilateral stimulation could be movement of
the eyes back and forth, using a vibration device in both hands, tapping on
each side of the body, etc. This
activates the brain similarly to REM sleep.
A person can then can be susceptible to changing beliefs about themselves
based on the memory.
Reading this particular chapter made me interested to know what
effects EMDR might have on a child vs an adult.
My thinking behind this has a few different factors. First, as mention before, many of the people
I have encountered as a clinician experienced trauma as a child and I wonder if
EMDR would have a greater impact closer in time to the traumatic
experience. Second, I am curious to know
if children’s brains are more susceptible to the positive effects of EMDR
purely due to the fact that their brains are more mailable than an adult
brain. Additionally, when working with children
such as the ones that Bruce Perry encountered, could EMDR eliminate the use of
medication?
Hi Taylor,
ReplyDeleteYour blog post brought up some great food for thought! I’ve also found it really interesting to read about Perry’s discussions regarding how trauma can impact the physicality of the brain. It is a sad reality that childhood trauma can have such a negative long-term impact on a person’s life if the child is not given the help they need. I have not worked with many clients who have experienced trauma, so I would be interested to learn more about your experiences. I will be interning with Austin Child Guidance Center next year and they are very focused on trauma-informed care. While I will be working with children, I would be interested to learn more about what interventions have been successful in your work with adults.
I also had some questions regarding Perry’s use of the medication to deal with overactive stress responses in children. While I believe medication is completely necessary in some cases, I also worry about the negative long-term effects medication could have on a child’s developing brain. I would think Perry’s ultimate goal was to wean the children off the Clonidine and help them develop alternative coping skills. However, I do not believe this was explicitly stated in the chapter.
It would be interesting to further explore the usage of EMDR instead of medication. I did a brief search in the UT library to see if there was any research comparing the efficacy of EMDR versus pharmacological interventions. While I did not thoroughly read through all the results, there appeared to be plethora of studies analyzing the effectiveness of EMDR. I will definitely have to revisit this subject when time permits!
-Elizabeth “Izzy” Sterling
Hi Taylor,
ReplyDeleteI loved that you mentioned EMDR as an alternative therapeutic approach. The thought crossed my mind in both the chapter about Sandy and Tina. EMDR is only recently being accepted as a recommended form of treatment and some people still consider it controversial. Naturally, it would not have been an option for Sandy and Tina at the time, but I would think Dr. Perry would at least consider it an option now. Despite the controversy, people have amazing stories of its success and I have heard it described as a “miracle”.
I think you also bring up a great point about the timing of EMDR. During my substance use disorder class yesterday, my professor described EMDR as a method of bringing the traumatic memories out of the subconscious, integrating the different aspects of the memories, and dampening the arousal the memories create. I am purely hypothesizing, but I would imagine that it would be “easier” to bring memories out of the subconscious and integrate them if the traumatic event occurred recently.
My professor also discussed the implementation of EMDR when the trauma occurred over time, such as in the case of Tina. She said it can take more sessions to integrate the pieces since there are many different memories. My question in response to your question is, would the timing of EMDR or the duration of the trauma have more of an impact on the effectiveness of EMDR? Based on Perry’s explanation of how the brain responds to trauma, I would hypothesize that the duration might play a larger role in the effectiveness.
The aftermath of trauma is something I feel like as clinicians we all hear about, and yet I feel like sometimes we fail to recognize what all the aftermath actually is. You mentioned the aftermath lasting 5, 10, 20, 40+ years ago, and still not recovered. Dr. Perry takes what many of us see as an abstract concept (feelings, emotions, experiences) and connects them to something actually physical inside of the brain. He explains the operations and how the child is functioning from the limbic system or the brain stem, how the frontal lobe is not engaging due to stress. It’s really quite wild to think about where all the emotions and everything come from, and why after all of those years, they don’t seem to leave.
ReplyDeleteYour point about whether medication would be a lifelong treatment begs us as clinicians to think about the implications of that. What does it mean to need medication for treatment across the lifespan? Is it shameful? Is it to be discouraged? In cases such as Sandy, and the 200 boys at the treatment center, it’s hard to imagine or stomach putting children on medication. We may ask ourselves, “Are we just treating the symptoms and not the core? Does this medication provide escapism in some form or fashion from actually processing through the problem?” I personally would like to think that medication in cases where trauma is the main factor effecting the brain, would be used at the start of treatment up until when the child has learned more coping skills and is ready to work through the symptoms. I don’t like to think of medication as a lifelong endeavor. I completely agree that alternative treatments should be explored, especially when maintaining brain homeostasis should the child be brought off the medication.