So I started this book
emotionally guarded, due to the amount of sadness our professor had mentioned
in class. I was genuinely curious to hear about Dr.Perry's first client. I was
rather surprised and upset that he somehow didn't know what the child was doing
when she climbed into his lap. When I worked at the in patient home for
children who had severe behavioral and emotional difficulties, that was one of
the first things addressed in training...boundaries. We were instructed to not
immediately give children physical comfort (hugs, back rubs, holding their hand
etc.) due to many of the children being groomed from sexual abuse. I can fully
agree that the child is not consciously making the decision all the time to act
the way he/she does. The patterns that the brain finds and sees, wear down a
familiar track that the child definitely follows along.
While my former work
place functioned behind TBRI (Trust Based Relational Intervention), it did not
teach about a lot of the neurological pieces Perry delves into. If it was
mentioned, it was very basic. I was familiarized very well with the brain stem
having the "fight or flight" response. I would have loved to
have known how he planned to address each dysfunctional behavior by treating
the portion of the brain that it stemmed from.
It did worry me that
after 3 years of working with the child, she relapsed on her behavior. I think
of my work with children who had similar issues. I worry about them relapsing
as well. It was comforting to think of how he only spent an hour a week with
this girl, whereas the children had 24 hours, 7 days a week of therapeutic
intervention. Dr. Perry also seemed very opposed to medicine. I both agree and
disagree with how he handled the situation in regards to this.
On one hand, I believe
that children are way over medicated in today’s world, and that it is important
for children to learn how to cope etc without the help of certain types of
medication. However, medication can also help with certain symptoms so that the
main problem can be addressed easier. I do wonder if he had prescribed
medication for his client, if her impulsivity could have been buffered, and her
relapse have been potentially avoided.
I empathized with Perry
wanting to give the family a ride home. I worked with individuals who were
experiencing homelessness during my first field, and would find myself wanting
to give them rides places (social security office, food stamp office, VA, a
potential housing opportunity, etc). I discussed this with my supervisor on a
few occasions, and it was determined to be outside of my role. I was very
surprised that he did not receive any disciplinary action. While I understand
it was for the benefit of the client, it crossed some boundaries of professionalism.
I’m glad it broke the resistance with the mom, but I would be interested in
other ways to break the parental resistance. I would be interested in the work
Dr. Perry did with the mother to help break down the stress hormones at home.
I found it very interesting that you mentioned being surprised that Dr. Perry didn’t know why Tina climbed onto his lap. The thought didn’t cross my mind when I read the first chapter, but it sounds like something that would normally pop into my brain. I could have just been shocked by the sadness of it. I worked at an inpatient hospital that had an adolescent wing and we also heavily emphasized boundaries. I cannot begin to count the number of times I simply said “boundaries” in a very motherly tone; I’m not sure how helpful it was. Boundaries between patients was the main dilemma, but we also had to ensure we maintained boundaries between ourselves and the patients. I am a master at hand hugs.
ReplyDeleteI think working in an inpatient setting conditioned me to have certain responses and feelings in specific situations. Since boundaries were so heavily enforced, I felt weird having an individual counseling session alone with a client in a room the first few days at my first field placement. At the inpatient psychiatric hospital, it was a huge no-no to be in a room alone with a client if there wasn’t a camera. The setting dictates the boundaries we have to instill. I am by no means saying that Dr. Perry should have continued to let Tina sit on his lap; I just find it interesting how the setting affects what is considered ethical.
I appreciated that you pointed out the child is not always consciously making the decision to act the way s/he does. I think it’s easier to remember when a child displays sexualized behavior after sexual abuse. However, if a child acts aggressively after sexual abuse, it’s not viewed the same way. This child can be labeled the “bad kid” and people are often less likely to help the “bad kid”.
Sam, I too wish I had a basic knowledge of the neuroscience Perry offers so helpfully in the book when I was working as a mental health tech with youth and as a caregiver for three children. Interestingly, the education mission (the Neurosequential Model in Education) of the ChildTrauma Academy (Perry’s not-for-profit organization in Houston) has developed an assessment tool for teachers and other school-based staff that helps these professionals identify where students might need focused care or some extra help on a neurological/developmental level. I have a relatively limited understanding of this tool, and learned about it through a discussion with an NME trainer in AISD who has begun the NME rollout process at the elementary level. This tool is certainly still in its nascent phase but would help teachers identify neurological target areas of struggling students who have had traumatic experiences based on the information teachers input about what problematic behaviors students have exhibited, tasks they struggle with, how they relate to and interact with their peers, and how they emotionally present in class. Based on this data, the assessment tool would explicitly identify symptoms of neurodevelopmental trauma and any neurocognitive, psychomotor, sensory, etc. delays in their students that they could work on directly with them or have another school-based professional (e.g. school counselor or social worker) focus on with them. This is such exciting news, and I’m sure there is a similar tool for therapists/clinicians developed by Neurosequential Model in Therapy branch of the CTA. While we have exposure to this information as social work students and emerging professionals, I so often think about those that are still “in the dark” (and I find that I often still am, too) about trauma and its effect on development and the ability to function in everyday life.
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