Insights

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Siri L. Thorkildsen of RVTS Sør in Norway, interviewed Dr. Bruce Perry and Dr. Stuart Ablon in 2018 about how we can use their research in practice. What they had to say is both important and inspiring.

Two of the world's leading researchers on developmental traumatized children visited the Children's Level Conference (at the child's level, seeing them eye to eye). The evening before the conference started, we were lucky enough to interview both of them.

Dr. Perry at The Child Trauma Academy has worked for years with children who have experienced the most brutal things imaginable. Who have experienced long-term trauma and gross neglect. He has developed a neurosequential model, which is based on what the stresses the child has experienced lead to, purely in terms of development. In this way, you can help the child heal by understanding which brain functions have been disrupted in development by seeing it in the context of when in life the stress occurred.

Dr. Ablon at Think:Kids at Massachusetts General Hospital has researched how problem solving through collaboration helps children, and adults, to create good relationships, create security, and develop the brain. Here, you invite the child to help you figure out the problem, together, through empathetic listening and collaboration. Together, Dr. Perry and Dr. Ablon want to inspire caregivers to meet children who are having a hard time in a way that will be developmental for these children.

You make a big difference

What is their most important message to those who work with children who are having a hard time?

Dr. Perry begins:
– My most important message is that you make a big difference. You play a big role, and it is so incredibly important that you are with these children. The most important thing to remember is that even though it is difficult, these meetings will have a meaning, and this will make a difference for these children. These meetings provide opportunities for brain pathways to be repaired, and new pathways can be created.

Dr. Ablon adds:
– Sometimes this meaning is much stronger than you may realize, even when the meeting only lasts a few seconds. These meetings can have a huge effect on development.

Those who are in the most important position to help these children are those who are with them the most. They are also those who have the least education, the lowest wages, and the most difficult jobs. But they have the most important job.
Dr. Stuart Ablon

Love is the key

Dr. Perry, you have said that love is the most important and powerful agent of change. What does this mean when working with children who are struggling?

– When I talk about “love”, it is because I want to acknowledge the emotionally driven element that goes into being able to stand by them when things are at their worst. Where you are able to acknowledge the child for who he is, even though he may be very challenging.

It is love that enables you to be present, attentive, attuned, and responsive in these healing moments.
Dr. Bruce Perry

“One of the things we know is that being connected is one of the most important things in healing. Ideally, that means someone showing you love. “Love” means so many things in different relationships. But what I think is important in a healing relationship is that you look at the person in a positive way, no matter what’s going on. And that you want to be there for them, even if you don’t understand them or know what to do. You show that you’re there, and that you’re doing what you can to help. It’s love that has a real therapeutic effect,” Perry says.

“And it’s really hard to love a child when they’re behaving at their worst. And that’s the biggest challenge, because those are the children who need it the most. Unfortunately, their behavior makes it difficult, because it’s dismissive and often rude.” Dr. Perry has helped us understand how this behavior is a result of trauma, and it has given people an opportunity to look at these children and their behavior in a new light, change their attitude towards the children they meet and meet them in a much more humane and kind way, which makes it possible to actually help these children with respect – something they rarely experience, but which is exactly what they need, adds Ablon.

Children do the best they can

When you, Dr. Abslon, say: “Skill, not will”, that is, that children do the best they can based on the assumptions they have: How do we combine that with Dr. Perry’s view of love?

– This is incredibly coincidental, says Ablon.

– What Dr. Perry’s research shows is that these children do not behave badly because they want to, they actually do the best they can. If they could, they would have done it. And if they don’t, then there is something that makes them not do it. What Dr. Perry gives us is an understanding of why this is so, developmentally, while collaborative problem solving provides some practical tools to do something about this.

“Yes, they fit together like a glove, because what we are trying to understand about the child is: Where are they, developmentally,” says Perry.

– Too often we have expectations for the child based on age. But because of neglect, trauma, or other things that have stood in their way, they are falling behind emotionally, socially, and cognitively. There is a persistent “mismatch” that creates conflict, so the moment you understand where the child is, developmentally, you can actually meet the child at the right level. And if you then use collaborative problem solving, then we can meet the child where they are. Then we can create small, wonderful doses of challenges that can help them succeed, and get them back on a good developmental path. It’s really beautiful, when you think about it!

Why does the world need Collaborative Problem Solving?

Much of the world still misunderstands why children misbehave, or when they don't do what we want them to do. The result is that we miss out on what we can do to help, and we see this especially clearly when it comes to children and young people who challenge us.
Dr Stuart Ablon

– They have experienced a lot of resistance and they lag behind their peers. We assume that this is something they do on purpose. What our research shows, however, is that challenging behavior is a result of not being able to. It is not because they do not want to. We see this reflected in the child's flexibility, frustration tolerance and problem-solving. But this can be learned. And if we build the ability to manage this, in a loving, understanding environment, then we can facilitate development, and reduce challenging behavior, without having to resort to force and control – something we usually see as a solution when we are faced with challenging behavior, answers Dr. Ablon.

Is it really the case, always, that children do their best? Anyone who has experienced bedtime with young children has probably thought that this must be about as much desire?

Dr. Ablon laughs, and answers that there are probably times when the will is not always in place.
– But I do not trust that we adults understand the difference between will and ability, in the moments when it is most important to understand the difference. Because it is in those moments that we are angry, frustrated, stressed. You are tired yourself, have a lot to do. You are not in the right frame of mind to decide whether the child does not do what you say because he cannot do it, or because he does not want to. So then the trickiest thing is to take the safest solution, namely to assume that the child is not able to do what you ask him.

You lose nothing by treating a child empathetically, understanding that this may be difficult for them. But treating a child as if they don't want to do what you ask them to do sends you down a dangerous path. So it's always safest to assume "skill, not will."
Dr Stuart Ablon

Revolution takes time

We talk about how your research has revolutionized the field and contributed to a paradigm shift, where we are now fundamentally changing how we look at, and relate to, children who are having difficulty. What do you think about this?

– I think people realize that this change in how we look at children who are having difficulty makes sense. But change is really difficult, because how do you make it possible for us to help a child's brain heal and change? Then you also have to change the adult's brain so that we can think and behave differently around children. All these adults are often stuck in a structure, in systems, where we have done things in a particular way for a long time. It takes a lot of courage, work – and frankly, discomfort – for us adults to change this too, Ablon answers.

– We have been talking about these concepts for thirty years, but it is only now that it is trickling into professional life without too much resistance and negative reactions. So it takes time, Perry adds.

Dr. Ablon then refers to his 102-year-old grandfather who used to say: “There’s really no difference between being wrong and being right too soon.”

“Common sense ain’t too common.”

Is this really “common sense”? It’s based on people’s inherent primal power like love and connection. Why haven’t we focused on this before?

Again, Ablon refers to his grandfather.

My grandfather used to say that “common sense ain’t too common.” It’s true. It’s not common. Especially when we encounter challenging behavior.
Dr. Stuart Ablon

The more I work on this, the more I see that what we need to work on the most is helping adults stay calm in difficult situations. Being regulated when things are boiling over. It's about the adults, and their ability to stay regulated, then half the job is done. Most of the time it's our own unregulated behavior that creates escalating behavior - and that's when we don't use "common sense" and we don't have access to our own thinking brain.

- This is where an understanding of the structure of the brain is useful. It helps us understand that our emotions and unregulated behavior "smear" onto others. This results in an unregulated interaction with the child, who is having a hard time and doesn't get any easier because we are unregulated. If you learn problem-solving through collaboration, you will get some concrete strategies that help us to withdraw a little, self-regulate and re-enter the situation in a calmer way, Dr. Perry adds.

Dr. Ablon then praises Dr. Perry's work, in connection with this.
– Something I've always thought you do wonderfully, Dr. Perry, is emphasize that:

If being unregulated is “contagious,” the good news is that being regulated is also “contagious.” So if we adults can stay regulated, we will help our children regulate themselves as well.
Dr. Stuart Ablon

The good helper

Would you say that being able to stay regulated when things are boiling over is the most important quality for a “good helper”?

– It’s a good start, at least, says Dr. Perry flatly.

Ablon nods and agrees.
– It’s absolutely necessary. Is that enough? Well, I think that if you can stay regulated, a lot of other things come naturally. And a lot can also be learned then.

You can actually teach an old dog new tricks, believe it or not.
Dr. Stuart Ablon

– We see that the best opportunity for healing for children who have experienced trauma is positive attachment, and it's all about relationships. What we see from our research is that the biggest influence on how someone who has experienced trauma feels today is not what they experienced, but what kind of attachment and relationships they had when they experienced it. The other thing we've learned is that no matter what has happened to a person, the relationships you have today are also incredibly important for how you feel. This is important for how we look at early childhood and trauma, and how we help those who are supposed to help these children:

If everyone in children's lives understands how trauma can affect them, and we help them be present and relate in a good way, then these children will be much better off.
Dr. Bruce Perry

Violent youth – what about them?

There is a lot of debate in Norway right now about youth who show violent, dangerous behavior towards others, and how we should help them while at the same time protecting others from being harmed. There has been a lot of criticism and questions about limitlessness, while you point out: Consequences and punishment have no useful value for these youth. How do we navigate this landscape?

Dr. Perry begins:
– One of the things we talk about is that there is no “one size fits all”. We have to get to know the youth, and understand who she or he is. They always have a story that will help you understand why they are violent. And the moment you understand why, you have hopefully also built a good relationship with this child. Then you have a starting point for the work. So my message is: Get to know, really get to know, this child, he says and looks at Dr. Ablon.

– Yes. And the more frightening behavior the child shows, the more unregulated we adults become as well. And then we lose the opportunity to find effective ways to help.

I say time and time again: Don't focus on the behavior. If you want to reduce violent behavior, I would argue that the worst thing you can do is focus on the violent behavior.
Dr. Stuart Ablon

– The frightening behavior scares others. And then you turn off your own thinking brain and the response becomes reactive, categorical, simplistic and punitive, says Perry.

Ablon has done research on American schools, and cites an example from there:
– When frightening things happen in schools in the United States, we see exactly this reaction in the form of reactive, categorical, simplistic, and punitive measures. And what we also see is that this leads to less safe schools. When you try to push your will through in situations that are escalated, it leads to insecurity. And there is nothing about this that reduces the chances that this will happen again. The children learn nothing from this, and thus there is a great danger that they will repeat the frightening behavior. That is why it is so wonderful when you change the mindset to build relationships and work to solve problems together, rather than correct and punish. Then you see fantastic results, he says, and is supported by Perry:

– We see from both collaborative problem solving and the neurosequential model that aggressive behavior is reduced – and the use of coercion is greatly reduced – when we use this.

Both emphasize, however, that they do not “excuse” bad behavior:
– The more frightening the behavior, the greater the chance that people will see our message as an “excuse” for this behavior. And it is important to understand that we do not excuse dangerous and bad behavior, but we explain it. Because if you do not understand why they behave this way, you have no way of fixing the problem, concludes Dr. Ablon.