In
Perry's first chapter he introduces us to his first adolescent patient,
Tina. In this chapter, Perry recounts his initial encounters with trauma
exposure at those formative ages and their effect on the bio-physio-emotional
development of a person. We are invited along Perry's inquisitive journey
through his neuroscience framework to get a better understanding of how Tina's
sexual abuse and stressful living environment has impacted her nascent
brain. Perry starts to connect what he knows about the biology of the
brain into explaining the missing pieces of the puzzle to help explain the link
between these adverse events and their effects on a child.
What
made me do this 🙌🏽was the when Dr. Bruce Perry refused to accept
the supervisory consultation of this first supervisor, Dr. Robert Stine. It
would have been very simple for Perry to simply place an obsolete diagnosis on
Tina and prescribe her medication and move one. However, for Perry, doing so
would have ignored the blatant environmental factors/stressors that we know as
social workers are crucial to a client’s assessment. It was encouraging to read
that Perry, a doctor/psychiatrist, was more interested in understanding Tina as
a person and all of her history than simply putting a label on her and 'treating' her with medication, which we know at times in the medical world can be used a
band-aid for treating underlying issues. 😩
Another 🙌🏽
moment came when under the poor supervisory feedback of Dr. Stine, who
interpreted Sara’s tardiness to Dr. Perry’s sessions as “resistance” (Perry,
2006, p. 14). Again, Dr. Perry could have taken the misguided feedback as certainty,
yet Perry, who in those moments (with Dr. Stine) thought more like a clinical
social worker, was really trying to understand the barriers that Sara faced in explaining her being late to sessions....and he acted
more like a LCSW (in doing the ‘home visit’) to realistically understand this
families circumstances which gave the client the benefit of the doubt.
The word 'resistance' really creates resistance in me 😤. This word is too often used with adolescents and more specifically African-American and Latinx youth that don't conform to an adult society and a majority European American culture. Using this word does not invite anything but blame, shame, and judgment towards clients whose lives are complicated by the many "isms" that are woven into our society and institutions. If Dr. Perry, had continued this treatment with this mentality then he would have never had the chance to see for himself the sacrifices that Sara was taking for her family. He saw firsthand her courage, adeptness, and tenacity to take care of her family which would have been misinterpreted for a false assumption that she was envious of Dr. Perry and didn't want Tina to improve 😡.
I hear this narrative all the time in the school setting (where I am employed) in the relationship with teachers and students. Many of them are not aware of the complicated and detrimental experiences that the students sitting in their chairs have faced or are facing day in and day out. A lot of what I hear is, 'I understand that they have been through rough things, but that doesn't excuse their behavior in class.' I bet their relationship and their approach to working with those students would be a lot different if they were to actually sit down with students and/or do home visits to get a better understanding of their story.
I too was thrilled when Perry decided to make up his own mind about whether Sarah was "resisting!" In my work with PTSD, when a soldier is "resisting" we often have to look to see if there are other things going on (are they going through a divorce, does their partner not see any improvement, etc) and see if we can use the therapy techniques to address those concerns as well as the PTSD symptoms. I hadn't really thought about how the "resistance" label was inherently biased towards people of color. I would agree that Psychology and particularly Psychiatry has an extensive "western" and Caucasian Male background to it, and understanding that often what is considered "normal" is actually based on a stigmatized system. I do with that every provider could go and do "home visits" to see what their client actually experiences. Unfortunately, home visits are pretty rare outside of social work, and usually its because the client is in "trouble."
ReplyDeleteOne thing that spoke to me about Perry and Stine's interaction was that it seemed that age was playing a factor. Stine, while I'm sure a good doctor, also seemed to be stuck in his ways and was unwilling to look beyond his own biases. I know that for me, it can be hard to look inward and to change what needs to be changed. I also know that as we go through our careers as social workers, we are going to run into a lot of people like that who simply want to continue the status quo, and having the personal strength to take the client's needs first is going to be very important.
I really appreciated you mentioning medication being used as a “band-aid” for treating underlying issues. I fully believe in the efficacy of medication in the treatment of mental illness, but as someone who worked in an inpatient psychiatric clinic, I witnessed first-hand its use as a quick fix. The typical stay for a patient was 3-7 days and the goal was stabilization. Over a typical stay, a patient might see a licensed therapist individually 1-2 times for a short stay or 2-3 times if they were there for a week. All other sessions were groups led by the therapist or a mental health tech. I always wondered how anyone’s underlying issues could be solved in 3 days. This acute model of care is designed to stabilize people with medication and stick them back out there. From what I understand, aftercare was supposed to be setup during the discharge process, but I never knew if patients continued with therapy.
ReplyDeleteAdditionally, when patients would start demonstrating aggressive behavior, the psychiatrists often ordered strong sedating medications (e.g. Haldol, Ativan) before we had enough time to try to verbally de-escalate the patient. I often wondered if the psychiatrists fully took into consideration the severe- potentially long lasting- side effects the medications could cause each time they ordered the shots.
Lastly, I completely agree with you on the use of the word “resistance”. When clinicians start thinking of clients as “resistant”, they are less likely to actively establish a therapeutic alliance. I can easily see it becoming a “they aren’t trying, so why should I put forth the effort” moment. I admit to having these moments during my first field placement at a high school. I would keep those thoughts in check by remembering everything that was happening in my clients’ lives.
Your post brings up some very interesting points. What if the child just isn’t okay? IF the assumption is that they are resilient and will be okay, how much support is given to them once that assumption is made? How much are we actually doing to help the child be “okay”? What constitutes as okay? You mention how observable everyday behaviors could be going just fine, but we have no idea how much the child is really experiencing. How would we know when therapy has helped if we couldn’t see the storm? The World Health Organization’s definition of health definitely gives us a challenge is determining if a child is healthy and whether or not they are as resilient as many assume.
ReplyDeleteI find it interesting that you brought up the topic of children who are perceived as manipulative, and how they are trying to meet a need. I think this is so important for professionals and parents to understand. By you giving the child control, the opposite reaction of what many others have appeared to have done, and most likely benefited the child. It begs the question of how to work with manipulation from a healing perspective, to not engage in power struggles, and how to not get caught up in it.
I like how you mentioned that therapists capitalize on the word resiliency. It’s what we all would like to be able to label a child and to see form children going through hardships right? It’s what you want to be able to tell parents. I think it is so important that to contrast this, empowering the child builds them up to be able to work through their trauma.