Creative Psychotherapy by Prendiville Eileen; Howard Justine;

Author:Prendiville, Eileen; Howard, Justine;
Language: eng
Format: epub
Publisher: Taylor and Francis

The impact of adverse experiences

Perry (2008: 93) defines trauma as ‘an experience or pattern of experiences which activate the stress-response systems in such an extreme or prolonged fashion as to cause alterations in the regulation and functioning of these systems’. He defines neglect as ‘the absence of an experience or pattern of experiences required to express an underlying genetic potential in a key developing neural system’ (cited in Prasad, 2011: 2). He argues that the brain develops sequentially and is organized in hierarchical sequence, and that neurons and neural systems are use-dependent, that is, their development is driven by experience.

Therefore, developmental trauma or neglect is hardwired into the neural system at the time it occurs and becomes more embedded every time it reoccurs. The child will have an altered baseline homeostasis and will rarely experience an internal state of calm and rest. Even when removed from chaotic, violent or neglectful circumstances, the traumatized or neglected child may continue to perceive constant threat from the environment and will be unable to modulate the intense arousal of the stress response. Overreactive and hypersensitive, they may be extremely tense, with an increased startle response, disturbed emotional regulation, generalized or specific anxiety and abnormal cardiovascular regulation (Perry, 2004).

The stress-response state can manifest on a hyperaroused through to dissociative continuum, and different children have different adaptive styles to threat. Much depends on the characteristics of the original adverse circumstances, the degree of agency of the child and the degree of perceived threat: the hyperaroused child will respond from somewhere on the continuum of vigilance, resistance, defiance and aggression; on the other hand, the dissociative child will respond on the continuum of avoidance, compliance, dissociation and fainting (Perry, ibid.).

Neural systems can be repatterned precisely because they are designed to change in response to activity. Developmentally appropriate therapeutic interventions can make a difference, although some neural systems (brainstem and midbrain) are harder to influence than others (cortex). However, the impact of trauma and neglect on the lower brain regions can be mitigated through therapeutic relationship that addresses core regulation, replicating healthy early attachment experiences and giving the child, adolescent or adult repeated opportunities to experience internal rest and calm. Safety, predictability and nurturance are the key principles of core regulation (Rothschild, 2000; Perry, 2004), normally established in utero and in the earliest relational experiences of attachment during the first 2 years of life, when the brain is developing faster than at any other time.

Therefore, in cases of early developmental trauma or neglect, there is a need for carefully targeted therapeutic interventions that understand the nature and timing of the adversity the child has suffered, provide a secure and trustworthy relationship and a safe, predictable environment over a significant period of time, and use responsive, attuned movement, prosody and reassuring safe touch as primary modes of communication.

In play therapy, the child repatterns the nervous system by visiting a safe, undisturbed developmental stage previous to the trauma or neglect experiences, so that another way forward can be imagined and experienced in the safety of the metaphorical play environment and the therapeutic relationship.

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