Summary
The boy who was raised as a dog by Bruce Perry and Maia Szalavitz is a book which summarizes a psychiatrists’ most important cases for the purposes of learning what the children can teach us about loss, love, and learning (2017). Using case studies, Dr. Perry is able to bring the reader into the world of the children he treated who had been traumatized in unthinkable ways. Along the way, we get an inside look at the thoughts and actions of an experienced therapist determining the best course of action in highly difficult situations. Learning about Tina’s world and her treatment reminds therapists of the importance of getting to know the client rather than the symptoms. Sandy’s case highlighted the importance of allowing the child to re-enact the trauma, putting them in control of therapy, as a key to healing. With the Davidian children, we are reminded that most therapeutic experiences occur in healthy relationships, not necessarily therapeutic interventions. Laura demonstrated the importance of attachment relationships in early childhood. Leon’s story emphasizes the importance of the environment a child grows up in. Justin, the boy who was raised as a dog, demonstrated great ability once someone came along who was willing to look beyond physical reasons. Connor’s treatment calls attention to the need to match approach to developmental period when the trauma first started. The Gilmer children’s abuse at the hands of those who were supposedly offering treatment brings to light the way people can be caught up in a trend without paying attention to the truth. Amber’s story highlights dissociation and helping the client to understand the difference between perception and reality. The story of James is critical to looking deeper at what may be going on and checking in on therapist reactions to the client. Peter’s story placed a spotlight on the power of love in relationships. All therapeutic concepts presenting in this review are expressed in Perry and Szalavitz (2017) unless otherwise stated.
One of the most interesting and therapeutically relevant concepts of the book rests in the realization after much time and effort researching how to help traumatized children, the most important concepts were determined to be patience and relationships. Throughout the book, Dr. Perry demonstrates a wonderful ability to approach the children in a way that diminishes their stress response and allows him to do the necessary work. He accomplishes this by accessing the brain’s mirror neurobiology in being calm and centered himself first, causing the children to become calm and centered. Without the stress response being overactivated, the relationship with the children can be built around patience, attention, and safety. The concepts of use-disuse of the brain and patterned, repetitive experiences were also addressed often. Essentially, it is important to keep in mind that whatever is not used does not develop properly, and in order to help with that development patterned, repetitive experiences must be provided for the healing child.
Lastly, the approach of the Neurosequential Model of Therapeutics (NMT) is described. Four key components make up this approach. First, developmental history is obtained. Important to this model is the time when the trauma occurred, as this determines what area of the brain could have been affected. Additionally, strengths are also addressed. Second, the current functioning of the child is determined paying attention to strengths and vulnerabilities, relational abilities, and cognitive abilities, as well as the therapeutic web, the resources the child has in their environment and his connection to them. Third, treatment is determined in accordance with the individual child’s developmental needs. Lastly, the therapist continually assesses the implementation and effectiveness of the plan in order to make changes that are needed.
With all of this information, the therapist is able to provide a picture of where the child is so that rather than being labeled, the child can learn more about themselves and what they need to accomplish in order to heal. Although the book is not written from a Biblical worldview, I will demonstrate how some of the research in it in fact supports Scripture.
Reflection
Reading this book furthered my understanding of how to address children who have undergone trauma. I have come to realize I learn well with case studies. They give me the ability picture what I would have tried and imagine how it played out. Several questions surfaced for me in response to what I read. For example, what is the best first course of action in the immediate aftermath of trauma? What are the brain-wise developmental milestones for children? According to Uhernik (2017) it is not good to try to elicit an explanation of the trauma immediately after its occurrence. Therefore, it seems simply being present and allowing the child to move at their own pace would be the most beneficial strategy. An important finding with regards to developmental milestones is that since brain plasticity is increased through ages three or four, environmental influences affect it in a greater way during this time (Davies & Troy, 2020). This is great when the experiences are good, but when chronic trauma is occurring, those pathways in the brain get stronger in a very harmful direction (Davies & Troy, 2020). Infancy and early childhood are incredibly important time periods in brain development which have been shown to affect future development through a complex web of attachments, genetics, and environment (Davies & Troy, 2020).
One thing that did not agree with the author was the evolutionary worldview of relationships. Often, throughout the book, he referenced the development of the need for relationships from an evolutionary mindset. The people needed to work together in order to survive. However, from my Scriptural mindset, we are made for relationships because we were made by a relational God. From the very first chapters of Genesis, corroborated by John) we are introduced to a relational God (Genesis 1-3; John 1, The Scriptures, 2018). As a matter of fact, although the Scriptures often say we have one God, it is interesting to note that the original Hebraic understanding of one, ehhad, is unity, not necessarily singularity (Benner, 2007). John 17:20-23 states “And I do not pray for these alone, but also for those believing in Me through their word, so that they all might be one, as You, Father, are in Me, and I in You, so that they too might be one in Us, so that the world might believe that You have sent Me. And the esteem which You gave Me I have given them, so that they might be one as We are one, “I in them, and You in Me, so that they might be perfected into one, so that the world knows that You have sent Me, and have loved them as You have loved Me (The Scriptures, 2018). Although many study the New Covenant in Greek, a Hebraic understanding provides more depth. In the Greek, the word used for one is heis while the Hebrew would be ehhad. Many believe Yeshua spoke Hebrew, not Greek. Therefore, if we study the verse from a Hebraic perspective, we have our Messiah explaining the unity of the Godhead and praying for us to model that unity as His community. The God we serve is community, therefore we long for and thrive in community.
What excited and inspired me the most in reading this book was the association between the scientific findings and what Scripture states. Dr. Perry stated that patience and relationships are essential for a therapeutic experience in the lives of children who have undergone trauma. Our Messiah exemplified the concepts of patience and relationship when He was on earth and through the Spirit, we can now demonstrate these concepts to those who are hurting.
Application
This book was highly influential for my personal and professional growth. Personal, because I am a mother. In some ways I am already beginning to consider what areas of my children’s brains need to be strengthened. I would call it neurobiologically focused parenting. The knowledge of how the brain develops sequentially, the importance of the early years, and the ability to heal by making new connections are enlightening concepts. I mostly appreciate the importance of relationships. Scripture states that we should train up the child in the way he should go and when he is older, he will not depart from it (Proverbs 22:6, The Scriptures, 2018). This Scripture reveals in depth knowledge about the way the brain works. For example, Dr. Perry described the mechanism by which the brain strengthens the neural connections it uses in persistent and repetitive manner but prunes the connections that are not used. A specific way that I plan to incorporate this knowledge into my parenting is to be consistent in the habits I would like my children to acquire, such as reading Scripture, using kind words, writing narratives, and developing a relationship with God through prayer. I mostly appreciate the importance of relationships described in this book. Not only will I work on building stronger relationships with my children but also on helping them developing a secure attachment with God.
Professionally, I hope to always be trauma informed. Awareness of the genetic and environmental factors will be part of my assessment process. Some genetically influenced factors that can affect children who endured early severe neglect include temperament, intelligence, and timing of the trauma. Timing of the trauma was emphasized in the book as it correlates to brain development. I hope to learn more about the different brain areas such as what they regulate and how they are affected by trauma.
Additionally, I will pay attention to the whole picture, reminding myself that my preconceived notions can cause bias. Many of the cases presented in the book demonstrated two levels on understanding which were basically determined by whether the ones involved in the case were trauma informed or not. I will seek to understand beyond what is initially presented to me.
With regards to therapy, I will look towards approaches that are developmentally appropriate. Sometimes, children’s needs are diverse with regards to the part of the brain that was most affected. Some approaches that can access those needs and were used in the book included massages, music therapy, and socialization. People do not always fit into a list of symptoms for a category of a disorder; people are much more complicated than that. Seeking to develop a picture of what is going on is more therapeutic than stamping a label. Each child is different and is deserving of therapy that is appropriate for where they are in their development, not necessarily their chronological age.
Above all things however, treatment must begin with creating a sense of safety so that the stress response that is so alert in trauma victims is attenuated. Being trauma informed means I will be aware of the need of patience and attunement. With reliance on the Set-Apart Spirit of God, peace and safety can be provided to those most vulnerable.
References
Benner, J.A. (2007). The living words volume one: A study of Hebrew words and concepts from
the old and new testaments. Virtualbookworm.com Publishing Inc.
Davies, D., & Troy, M. F. (2020). Child development, fourth edition: A practitioner’s guide.
Guilford Publications.
Perry, B.D. & 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. Basic Books.
The Scriptures. (2018). Institute for Scripture Research.
Uhernik, J. A. (2017). Using neuroscience in trauma therapy: Creative and compassionate
counseling. Routledge.
Discerning Trauma 