Billy is eight, he is adopted. His early life was categorised by neglect, emotional and physical abuse, he frequently moved and at one point lived in a house with a pack of dogs amongst which he would crawl, dodging excrement and looking for food.

Billy was referred for dramatherapy, the hope was that a creative, non-overwhelming, more symbolic and playful intervention might help him make sense of his past experiences.

At the beginning of our work together Billy took the rubber brain off the shelf and began kicking it around the room. He told me that his brain was ‘stupid,’ ‘dumb’ and ‘didn’t work’. It deserved a ‘kicking’.

I asked in what ways it didn’t work and reflected that he seemed pretty angry with his brain. Billy told me that it couldn’t pay attention in class, it couldn’t think or remember things and that it made him feel bad.

Billy’s early experiences were of a frightening and unpredictable world around him. The absence of a consistently safe and trusting other meant that Billy’s attachment pattern was insecure in nature, moving between a desire to be in control of those around him as a way of avoiding feeling vulnerable; to an embodied sense of fear and anxiety.

Billy’s sensory, implicitly held memories were intense and this makes complete sense when we think about brain development. Billy’s early trauma and neglect experiences will have been remembered… just not through words.

The first part of the brain to come on line is the brain stem which begins development in utero, it is the part of the brain responsible for keeping the child alive when in danger and for basic functions such as heart rate, respiration, swallow reflexes etc. The limbic brain starts to come on line at the age of nine months and is responsible for the development of emotional maturity, behaviour control and the ability to have healthy relationships. The emotional centre of the brain, the amygdala, lies deep in the limbic brain, and relies on signals to manage potential threat. If the signals received indicate threat, then powerful stress hormones including cortisol and adrenaline are released to increase the heart rate, blood pressure and rate of breathing, this all prepares our body to have a fight, flight or freeze response to the perceived danger. In normal circumstances once the danger has passed the body returns to its normal state. But when recovery is blocked, the body is triggered to defend itself from that which makes it feel agitated and aroused. Cortisol is a stress hormone, the amounts that are produced in infants who have been abused and/or neglected can become toxic to their developing brains.

The third part of the brain to come on line is called the cortical brain, it is responsible for learning, language, reflection, morality, processing information and planning.

The development of an integrated brain is blocked in circumstances of prolonged trauma and in the absence of a safe other to protect the child and to enable them to regulate their responses and construct a narrative to explain the danger and support their recovery from it.

Billy’s brain was still operating from a hyper-aroused sense, alert to sensory triggers of traumatic memories that meant that he could not relax or be too open to new learning experiences. Billy’s brain had not found a way to regulate and to make a coherent sense of overwhelming sensory experiences and triggers.

I felt that we needed to work on extending his window of tolerance.

Each child has a unique window of tolerance, when they are within it they can think, love, learn, empathise, be playful, explore, reflect and use words to describe their feelings. When they are pushed out of their window of tolerance either to the upper level, hyper arousal or the lower level, hypo arousal the thinking brain, goes off line and disconnects from the other parts of the brain leaving the limbic and brain stem experiencing neuro chemical changes, swinging into distress, fear and activating the move into hyper-arousal and trauma responses of fight, flight, freeze, flop or flail.

The nature of our work together, was how to encourage Billy and his brain to be more integrated and operate more from within his window of tolerance. To do this we had to focus on

• the quality of our therapeutic relationship to support Billy’s experience of me as a safe and trusting other
• develop a narrative to organise and make sense of his early experiences.
• To respond to Billy’s controlling, shame based behaviour through empathic relational and attuned responses
• To encourage joy and delight in Billy’s exploration of himself through dramatherapy

 

At the end of our session Billy said that he needed to keep his ‘brain on a lead so that it did not run away from him’. I thought Billy and his brain needed help making friends…. I asked if he would like to explore this in his sessions with me he nodded and grinned.

 

Look out for my next blog which will explore some of the ways we worked together to support Billy’s brain’s integration

 

Sarah Mann Shaw

January 2018