Please note: This was an assignment for SWO 5377 Advanced Clinical Practice: Children and Families at Baylor University’s Diana R. Garland School of Social Work, Fall 2020.
Abstract
The Boy Who Was Raised as a Dog by Perry & Szalavitz (2017) provides an insight into the impacts of trauma on children and families by considering the individual’s circumstances and diagnoses, reviewing their history, and then considering what their bodies are doing at that time to cause the behavior they are experiencing. This provides insight into how to best tune in to clients and which treatments would benefit them the most. This paper discusses how I felt about the book overall, the points that stood out to me the most regarding the impact of trauma on children and Dr. Perry’s tactic while addressing the client’s issues, how I can apply knowledge gained to enhance the client’s well-being and therapeutic alliance, and briefly discusses religious and spiritual considerations while working with clients.
Keywords: understanding and impact of trauma on children and families, enhancing client well-being and therapeutic alliance, religious considerations, understanding of professional integration of faith and practice in relation to trauma work
Review: The Boy Who Was Raised as a Dog
The Boy Who Was Raised as a Dog was well organized and written to provide an overview of the individual’s medical and mental health issues, a quick lesson on how the brain and body are impacted by such trauma, how treatment helped the individual, and then finally, how the individual was doing at a later time. Each chapter details a new story and a new experience with trauma and the body’s impact. Many of the stories were difficult to listen to but were also inspiring and intriguing. I appreciated the fact that Dr. Perry realized his original tactics did not work and accepted the lessons he had learned from Mama P to realize that even though some children are not actual babies, they do lack the treatment babies receive, and with that treatment, regardless of their age, they can grow. This is meeting the client where they are at—stepping outside of the textbooks and allowing a child to tell you what they need to overcome their struggles. This is truly tuning in to the individual and their needs.
Impact of Trauma on Children and Families
With each story shared, Dr. Perry explained why the body responded the way it did. He began explaining the elevated heart rate and how it “can be an indication of a persistently activated stress response” (Perry & Szalavitz, 2017, p. 22) and how a child’s “attention and impulse problems might be due to a change in the organization of her stress response neural networks, a change that might have once helped her cope with her abuse, by was now causing her aggressive behavior and inattention to her classwork in school” (Perry & Szalavitz, 2017, p. 21). Dr. Perry also stated that “when the brain becomes sensitized, even small stressors can provoke a large response” (2017, p. 38) and “patterned, repetitive stimuli lead to tolerance, while chaotic, infrequent signals produce sensitization” (2017, p. 55). Dr. Perry addressed how each client would disassociate so their brain could prepare for injury, even during treatment. On one occasion, he mentioned a child wearing his heart rate monitor, and the child’s heart rate would significantly increase once he mentioned specific events the child experienced, all while the child would become silent and seem unmoved physically. According to Dr. Perry, “in a classroom setting, both dissociation and hyperarousal responses look remarkably like attention deficit disorder, hyperactivity, or oppositional-defiant disorder” (2017, p. 51).
Each of these examples provided great information and enhanced my learning of the impact of trauma on children and families. Before reading these stories, I had never considered a child’s diagnosis of ADHD or ODD to be from a traumatic experience, and yet, many children I have worked with have experienced traumatic events. Unfortunately, the most recent have had notes that their parents did not want the traumatic events discussed during treatment.
Enhance Client Well-being and Therapeutic Alliance
Throughout the book, Dr. Perry named several professionals he consulted with and learned from, but one specific doctor who stood out to me was Dr. Dyrud. Dr. Perry stated, “Like other teachers, clinicians, and researchers who had inspired me, he encouraged exploration, curiosity, and reflection, but most importantly, gave me the courage to challenge existing beliefs” (2017, p. 14). An example of this is when Dr. Perry gives Tina and her family a ride home, as shown in Chapter 1. He mentioned, “One moment in that tiny apartment had told me more about the challenges facing Tina and her family than I could ever have learned from any on-site session or interview” (Perry & Szalavitz, 2017, p. 13). Stepping into clients’ lives and allowing them to share their day-to-day lives with us opens up new windows of learning and opportunities for us, as Therapists, to build trust and therapeutic alliance and understand their situation more. Although many clinicians will advise against personal favors for clients, Dr. Perry quickly learned about Tina’s circumstances, and Dr. Dyrud encouraged him to continue home visits with his clients.
“To create an effective ‘memory’ and increase strength, experience has to be patterned and repetitive” (Perry & Szalavitz, 2017, p. 40). In each of the stories, Dr. Perry shared how he would tune in to the client before interacting with the client. Sometimes, he would get a brief overview of the client’s situation but not the full opinion of others who have met with the child so that others’ opinions did not skew his judgment. Instead, he would approach the child on their terms. He would often ask permission to meet with the child or, in the case of the boy who was raised as a dog, he made small moves to build trust before approaching the child.
According to Dr. Perry, “relationships matter: the currency for systemic change was trust, and trust comes through forming healthy working relationships” and “people, not programs, change people” (2017, p. 85). As mentioned above, Mama P greatly impacted Dr. Perry, and I appreciated him sharing those experiences in his book. The remarkable way she loved the children in her care and taught one mother how to show love to her child. Instead of judging the children and punishing them for misbehavior, Mama P provided a loving home and positive, patterned, and repetitive behavior the children needed to overcome their circumstances. Mama P formed healthy relationships with these children, and because Dr. Perry was open and receptive to new learning, he also could bond with the children in a way that provided a therapeutic alliance. These examples have assured me that I should consider research and professional opinions but also listen to my instinct while tuning in to the clients I work with in future practice. And like Dr. Dyrud did for Dr. Perry, I should encourage others to do the same.
Religious Considerations
Professional integration of faith and practice allows the client to lead the discussion based on their faith. It includes tuning in to your own beliefs but also the client’s personal beliefs. When working with individuals who have experienced trauma, it is important to allow them to share their own experiences without interjecting their personal opinions or biases, even if they go against their faith and beliefs. This includes allowing the client to use their faith as a strength for them. This is seen with the boy who was instructed to grab one item from his home when he chose his bible. The child chose to use his Christianity as a strength to help him during his traumatic experience. Even though others around him were forcing him to go against his wishes, he held onto his personal beliefs. When talking with Dr. Perry, Dr. Perry noticed the boy’s demeanor change when mentioning this to the child. Dr. Perry also tuned into the act by considering if the child was participating in satanic events he had been accused of, he would not have grabbed the bible as his most prized possession, therefore he was able to ask more in-depth questions that helped return the child home. This amount of tuning into religious and spiritual beliefs is important for the client’s well-being and therapeutic alliance as well.
Conclusion
I enjoyed this book. As mentioned above, I felt as though each chapter was well organized and written to provide an overview of the individual’s medical and mental health issue, a quick lesson on how the brain and body are impacted by such trauma, how treatment helped the individual, and then finally, how the individual was doing at a later time. This allowed me to learn so much, from the effects of trauma to the impact later in life. I find books like The Boy Who Was Raised as a Dog informative. With each chapter being a very interesting story, I am interested in learning more about trauma and children.
References
Perry, B., & Szalavitz, M. (2017). The boy who was raised as a dog: And other stories from a child psychiatrist’s notebook—what traumatized children can teach us about loss, love, and healing. New York, NY: Basic Books.