How can we utilize the amazing new discoveries in brain science to deliver more effective and powerful treatment?

1. Create safety.

Signature:baed3687aecc9fc02b05e033f52ab04b5ac34144c6f0702c4e0cfe36f9d34041When any person feels danger, their ability to relate, learn and relax disappears. People with trauma histories are over sensitive to danger, often sensing danger when others do not.

When the brain experiences danger it focuses alertness, concentrating on the danger and possible sources of safety. The person becomes more vigilant and more concrete. Their heart rate and blood pressure increases, as blood sent to limbs to be ready to fight or flee. The person becomes hypersensitive to social cues- is help available? Their muscle tone increases. Hunger and digestion are disregarded. Complex cortical thinking disappears.

When unable to fight or flee, a person is left only with the option to freeze. If action does not seem possible, the brain sends a “freeze” response to the body.In the freeze response (dissociation) the person curls up, makes her self as small as possible, and prepares for injury. Blood is shunted away from the limbs, and the heart rate slows to reduce blood loss from wounds. The body is flooded with opioids (“brain’s heroin”) to protect against pain which produces a feeling of calm and a sense of distance from what is happening.

During this danger response, the person cannot learn, play, relate or relax. They miss much of what is going on around them if it is not related to danger or safety. If this danger response is common in a child’s early years it becomes their default state.

How do we create safety?

This is a complex question. It involves the physical plant, the program culture, the staff tones of voice, the kindness in the environment, the response to problems. One place to start is to ask the clients about areas of safety and danger.

2. Assess the child’s brain development and utilize this information in treatment planning.

With each new admission, consider these questions:

At what age was this child hurt? How persistent was neglect and abuse in his early life? Did he have a consistent caretaker?
Then, evaluate bodily management such as toileting, sleeping and eating problems, awkward gait, inability to be still, underdeveloped physical skills, and startle response, ability to use words. The more of these problems you observe, the more body-based the interventions must be.

Click here to get a framework for assessing brain development and utilizing your assessment in treatment planning.

Your tool is here 

3. Emphasize narrative in your treatment. The human ability to observe ones’ self and notice patterns, and to utilize that information in decision making is essential to aproductive life. This ability develops from loving caretakers noticing the developing child and commenting on her life, including her emotions and her actions.Many of our clients did not experience this as their care takers were absent, preoccupied or angry. Therefore their self awareness skills are under developed. We can help with this.

How to use narrative: Talk. A lot. Comment on what you are doing and what you just did. Share memories. Have photobooks. Do lifebooks. Describe what is happening what you are seeing. Identify emotions in movies, tv shows, books. Read aloud. Encourage the kids to keep journals and write back and forth with them. At the end of a day go over it and describe what happened. (NOT in a treatment, what-could-you-have-done differently way but in a pleasant, reminiscent way.) Talk with families about their stories. Keep up a running commentary on what is happening, and ask the child to tell her story.

4. Provide executive functions The pre-frontal cortex (thinking part of the brain) is created by a caretaker doing cortex-functions (care taking, safety, meeting needs, figuring out problems) as the child develops. If no one has done these things, the cortex will be under-developed. The cortex is responsible for complex thinking, analyzing, and using cognition to control emotional impulses.

How to build a cortex: Actively teach problem solving rather than punishing. As you go through your day, verbally describe what you are doing and how you are making decisions. Structure the child’s life for safety and success, gradually giving them decision making opportunities as they can handle. Make lists for them. Make posters showing the steps in a task (have the youth make and illustrate these). Teach strategies that you use, like breaking a big problem into smaller steps.

5. Sooth and calm in times of crisis In times of danger a person cannot think. When someone is dysregulated they cannot utilize a thinking response. At that time the only useful intervention is to help them calm down, at which point their brain will become available again.

How do we help a dysregulated person calm down? Stay calm yourself- children become regilated in the presences of regulated adults. A calm body is our strongest tool to help someone else become calm. Reassure, don’t get into power struggles, don’t back child into corner. Validare. Then validate more. Don’t discuss consequences or how they could have handled things better. Do not rely on verbal planning. Use chit chat, or carefully timed humor. Get on their level. Talk about sensory information in the present (It sure is hot in here).

6. Use rhythmic physical activities…. which will be the subject of the next post.

Let me know in the comments how you have used these ideas in your treatment.


Click here to get a framework for assessing brain development and utilizing your assessment in treatment planning.

Your tool is here

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