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Oct 2007 Jul Jun May Apr Mar Feb Jan Dec 2006 Nov01/07/2007: SACCS 2007 International Conference hailed a success
Dr Bessel van der Kolk and Dr Bruce Perry, two of the world’s leading authorities on neuroscience and the impact of childhood trauma, were keynote speakers at an International Conference held at the Barbican Centre in London on 13/14 June, to celebrate SACCS 20th anniversary as a provider of therapeutic services for traumatised children. The timely subject of the conference was 'Working with Child Trauma and Recovery’.
Bruce Perry MD, PhD, is a Child Psychiatrist and Developmental Neurobiologist, and has been recognised worldwide for his contribution over the last 20 years to understanding the impact of trauma and neglect on children. Dr Perry is Senior Fellow of the Child Trauma Academy (www.childtrauma.org) in Houston, Texas, and surprisingly, given his international profile, this was his first trip to the UK.
Similarly, Bessel van der Kolk MD is a Researcher and Teacher in the areas of posttraumatic stress and related phenomena in children and adults, and has been active as a clinician, researcher and teacher since the 1970s. He is Clinical Director of the Trauma Center (www.traumacenter.org) in Brookline, Massachusetts, and Professor of Psychiatry at Boston University Medical School.
On the first day of the conference, delegates had the opportunity of attending a master class, either with Dr Perry on the subject of ‘Introduction to the Neurosequential Model of Therapeutics: clinical work with maltreated and traumatized children’, or with Dr van der Kolk on ‘The Body Keeps Score: integration of body and mind in the treatment of traumatised children’. These talks were fascinating and explained how the brain develops in infancy and childhood, including pre-birth; how trauma and neglect can impact on that development, and the interventions that can provide healing for the traumatized child.
One hundred and thirty delegates attended the full conference, which was opened by Graham Allen, MP for Nottingham, and a leading campaigner for early intervention. He described how Dr Perry’s work on understanding the developing brain had helped him to fully appreciate the impact of the first The timely subject of the conference was ‘Working with Child Trauma few years of life on a child’s future development and prospects.
Graham Allen talked about wanting all children to be school ready by the age of four, and this began a theme that emerged throughout the day – the irrational way in which we continue to neglect investment in early emotional wellbeing, which is the cornerstone of a healthy and economically strong society.
Working through a local strategic partnership with ‘One Nottingham’, Graham Allen’s focus is on early intervention through primary supportive work, and putting resources into this area so that pressure is reduced on services later in life to deal with the breakdown of normal healthy development.
Mary Walsh, Chief Executive of SACCS, then took the conference on a brief and inspiring journey through the organisation’s development over twenty years, which also helped to set the context for the heart of the conference. SACCS began its work with sexually abused children in 1987 by providing therapy, consultancy and training. This was pioneering work at the time, as sexual abuse was only just beginning to emerge on the national agenda.
SACCS went on to open residential homes for children who needed long term therapeutic care, and continued with its pioneering work
by developing many new innovative services, including the Mary Walsh Institute which was launched at Conference. The mission of the Institute is to deliver education, vocational training, consultancy and research to improve outcomes for traumatised children.
The keynote addresses by Dr van der Kolk and Dr Perry examined the effect of trauma and neglect on the self, particularly in relation
to neurobiological development. They showed how the brain develops at four different levels, advancing from the brain stem which manages emotional and physical regulation. So for example, if we are faced with a threat, the brain stem manages our physiological reactions such as increased adrenalin to produce the ‘fight or flight’ response. Where the brain stem has not developed effectively, these responses may not be managed so well; this is manifest when a child over-produces adrenalin and feels excessively anxious about relatively minor threats, or where there is a lack of response and the child literally ‘freezes’.
The most intellectually advanced part of the brain is the cortex, which manages thought processes such as abstract thinking. Where
severe traumatisation has occurred during infancy, both speakers powerfully demonstrated how the cortex will be significantly underdeveloped, and how talking therapies that require thinking on the part of the child can be largely or completely ineffective.
What is needed are therapies to support and improve the functioning of the brain stem, operating on a physical level to calm, soothe and steady the child. Therapies including movement, dance, drama and massage can be especially effective. Dr van der Kolk
showed very moving video clips of young people involved in a drama group, enjoying the experience together and then moving on to use
this as a way of working through their trauma – but the starting point was just to get involved in the physical experience.
In cases where the brain has not developed properly, while medication may create a level of stability that allows some recovery work to take place, medication in itself cannot reorganise
damaged neural systems – the cells and structure will remain the same. Neural systems will only change when subjected to repetitive
actions and interactions. Dr Perry in particular emphasised this, saying that the brain develops through ‘repetition, repetition, repetition’.
The way in which trauma and neglect impact on brain development can be seen by comparing the size of a neglected infant’s brain alongside that of a nurtured healthy infant, where the neglected brain is noticeably smaller and less complete. Interestingly, this
image is one that Graham Allen uses to sign off his emails – a powerful message that early intervention is critical to growth and wellbeing.
The quality of presentation by both speakers, both in content and delivery, was so rich that it is not possible to do it justice here,
so I will leave you with a few brief themes:
• The remarkable malleability of the human brain, especially in the first three years of life
• A brain is more active when asleep than when watching television!
• Relational health is key to the effectiveness of treatments – movement, touch, music, rhythm, smiling, being with another person and doing something positive together
• Imagination is necessary to transform trauma
• The most important thing we have to do is to remain hopeful
• The most powerful reward is the attention and approval of other people – we all need to be seen, heard and valued for who we are
The messages from Dr Perry and Dr van der Kolk were delivered in a way that was clearly linked to neurobiological research, supported by evidence-based practice to demonstrate the outcomes of treatment
programmes. Their inescapable conclusion was that beside the benefits to wellbeing, for every one dollar spent in infancy, nine dollars would be saved on further interventions during the lifetime of a victim of unresolved trauma. Early intervention and support simply makes sense.
Patrick Tomlinson, Director of
Strategic Development
