Chico Center for Psychotherapy

Psychotherapy and Counseling services for Children & Adults | Support for Parents

(530)321-2970

Chico therapist An Bulkens, LMFT is psychotherapist and counselor in Chico, California.  An Bulkens specializes in psychotherapy and counseling for young children  (toddlers, preschoolers, adolescents) and support for parents, with a special emphasis on  early childhood psychotherapy, and counseling  for preschoolers and Kindergarten aged child.  She also offers parenting skills support. She offers psychoanalytic psychotherapy for adults.  Her approach is grounded in  Lacanian Psychoanalysis. She was also trained as a clinical psychologist in Europe, Belgium.  Her education emphasized developmental psychology and psychoanalytic therapy. 

Bruce Perry in Chico: Maybe lawyers know something Bruce Perry does not know

On May 8 Bruce Perry spoke about Childhood Trauma and the Brain in front of massive audience of about 1300 people during an event organized by Options for Recovery.  

Bruce Perry’s message is in essence a very hopeful and encouraging one for the treatment of traumatized children and adults. As the brain is a malleable, plastic organ, it can be changed and ‘healed’ by an intentional therapeutic practice that keeps in mind the findings of neurobiological research. Perry regrets that policy makers and current ‘evidence based practices’ are typically at odds with those findings. He advocates a treatment approach that mimics the development of the brain: ‘from the bottom up,’ with the more primitive parts of the brain developing first. The first brain structures to develop are the brainstem (regulating heart beat, respiration, stress response), and the cerebellum and diencepalhon (motor function control, hearing, vision, smell, taste and touch perception), followed by the limbic system (emotional and relational) and then the cortex (cognition, believes).  Traumatized children typically have disorganized lower brain functions, and a fortiori even more disorganized higher brain functions. It is crucial that therapy addresses the disorganization of the lower functions first, with interventions that are specifically tailored to regulating and strengthening the parts of the brain that are disorganized.  A typical Cognitive-Behavioral approach, which focuses on engaging the higher functions in modulating emotions and motor behaviors is ill informed from this perspective.

What approach does Perry advocate for?

Healthy brain development demands that the child’s confrontation with moderate stressful experiences are integrated in repetitive, patterned, rhythmic experiences in the context of an attuned social relationship with a caring person. Patterned exposure to moderate stress, followed by attuned responses that help the child to get back to their baseline level of arousal will help the child become resilient, gain a sense of control. However, early trauma and experiences of neglect or an emotionally unavailable caregiver will not allow for this patterned, rhythmic regulating ability to develop: As stressors are unpredictable, the child does not develop a typical sense of control and the rhythmic return to a safe baseline state in the context of a nurturing relationship. Perry claims that providing the child with patterned, rhythmic experiences in an intentional therapeutic practice, with a non intrusive therapist/caregiver who is able to give some control to the child, and is willing to be patient, will allow the malleable brain to heal. 

Perry gave a beautiful vignette of a schoolteacher who was dealing with a difficult, easily aroused student. This child was not able to sit down at the beginning of the school day, and tended to stay standing restlessly while fidgeting. His teacher started walking in a swaying way to the back of the room (picking up on his restlessness she introduced a rocking, soothing motion in her movement), which he started to mirror, and which calmed him down. She intuitively did not approach him directly but more from the side, as walking straight towards him might have increased his stress response. Once he sat down, his level of arousal had decreased to a level that allowed him to tolerate touch. The teacher put her hand on his shoulder and told him that she would like to know more about his fishing trip with his grandfather during recess, offering the chance of a relationship. At this point the boy was able to engage in schoolwork.  Perry emphasizes in this vignette the swaying, rhythmic, aspect of the teacher, her ability to use ‘touch’ when the child is in an arousal state where he can accept it, and where it can help him calm down further, allowing him to be able to be calm and focus on his school work. This example fits Perry’s theory perfectly. First you address the brainstem (swaying motion), then the diencephalon (touch), the limbic (relational), and then the cortical activities (doing schoolwork) become possible. Perry clearly seems to put the emphasis on the swaying rhythmic motion of the teacher, imitated by the boy, and the use of touch at the right moment, as well as on her invitation to talk to her during recess.  Important for the development of the brain is that the child imitates, mirrors a positive role model, and that this role model provides the child with manageable stress experiences at the right time. The specifics of the content that the teachers offers to discuss with the child do not seem to be emphasized by Perry. My critique of Perry is that he does not emphasize to what extent the ‘relational,’ aspect is already permeated by a symbolic dimension. The reference to the fishing trip with the grandfather is probably not a random reference but is likely to touch the symbolic coordinates of this boy... That his teacher acknowledges and recognizes the importance of his grandfather for him, and offers him a space to talk about it, being able to elaborate symbolically his position as grandson, how he ‘counts’ for his grandfather...

Bruce Perry’s admits that he simplifies the way the brain works and develops. ‘From the bottom up,’ implies that the vegetative, comes before the relational and emotional, which comes before the rational, ‘language’ aspect of development. This is a gross simplification, as Bruce Perry admits that the development of language already starts in utero.  As the explosion of growth of the right hemisphere, which is sensitive to the relational and emotional components of communication explodes it is clear that the child is from the beginning immersed in a bath of language, a symbolic order, which starts shaping the child - and also the brain of the child.  It is by speaking to the child, by giving it words that address the bodily experiences of the child, by attributing meaning and intention to the child’s cry and expressions, yes by assuming that the child is a symbolic agent from the very beginning, that the child can start carving out his own place in the symbolic world, and can start to use language to gain control over the stressful and traumatic experiences that will shape any human life.  It is unfortunate that language therapies seem to be equated with Cognitive-Behavioral approaches for Bruce Perry. I agree with him that these are not the best and most effective approaches to bring about change in the brain, in the life, especially of traumatized children. However, language should not be immediately associated with ‘cognition’ and ‘left hemisphere’ functions. Bruce Perry seems to gloss over some of the important research by A. Schore and P. Fonagy that shows the value of a psychodynamic and psychoanalytical informed ‘talking cure.’ By truly listening to children, and communicating with them on their symbolic level, which is closely tied to the affective and relational world of the child a ‘talking’ therapy is able to bring about change, increased regulation, that can even be measured at the level of the brain if we feel the need to do so.  So, yes, it is possible to bring about change from the ‘top down.’ Only, this top level: the symbolic, is there from the start in our human lives. It has its own logic, its own rhyme and reason, that cannot be easily reduced to a one on one correspondence with neurons in the brain.

I think Bruce Perry knows this at some level, as is expressed by his puzzlement by, and teasing love towards lawyers. He shares that his wife and son are both lawyers. He jokingly expresses his superiority as he is interested in the brain (‘the real thing,’) and not just ‘the written word’ like lawyers. Lawyers operate purely in the symbolic realm, which clearly has its own principles, logic, ‘reality,’ unconcerned with the material base of neurons that underly it. That the symbolic functions at a different level, and is irreducible to brain functions, is something lawyers know, but not Bruce Perry. 

In this context I would like to refer to the work of Denis Noble, a systems biologist whose research undermines the naive deterministic, and maybe also ‘developmental’ model that underlies also Bruce Perry’s simplified version of the brain development. These models assume that the most simple elements develop first and then determine the next, higher order function. Denis Noble in his book ‘The Music of Life. Biology beyond genes’ exposes the limits of this vision and shows how already at the level of the genes, higher order level of proteins is involved in the gene expression. However, this would be a topic of a different post. But it hints at a phallacy that I think underlies Perry’s work. 

 

An Bulkens    |    Licensed Marriage and Family Therapist    |   MFC 52746

Tel. (530) 321- 2970    |   344 Flume Street, Chico, CA 95928