Inside the Bruce Perry Show

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Dr. Bruce Perry uses humor to punctuate and bring relief to what is otherwise the most serious subject matter: how trauma interrupts human development.

“I don’t mean to sound ungracious, but I hate the term ‘trauma-informed care,” Perry said, in his opening remarks for the Southern Texas Trauma-Informed Care Conference, which was held this month in downtown San Antonio.

The audience tittered, briefly thrown off balance by his candor. They laughed harder later on as the man who was recently interviewed by Oprah Winfrey on 60 Minutes did his best infant imitation.

By the end of the day, and several swear words later, most people seemed to be on board the Perry train. Day one of the conference was devoted entirely to the work Perry and his colleagues have done to better understand what therapists, social workers and others can do to actually help kids who have experienced trauma.

“This is the true achievement gap,” Perry said, after describing a hypothetical child who lives with an unreliable caregiver, experiences violence in his home, and then has trouble taking a test at school the next day.

“That gap is not about race, shitty teachers or bad curriculum; it’s about a sensitized stress response system, by and large caused by poverty, not trauma,” Perry said.

Perry hates using “trauma-informed care” partly because, over the course of his career, he has found that effective treatment for the impact of trauma on development is more complex than the phrase implies.

It’s as complicated as the human brain.

The threshold of actually helping kids is important, as Perry will explain, because evidence supporting much of the services offered to this population – and probably to adults in public mental health systems – is thin.

“You can’t have a kid who’s lived with daily humiliation and neglect for six years and think your authorization for 20 sessions [of therapy] is going to fix the problem. It’s not, and it’s bullshit,” he said.

How to recalibrate someone’s stress response is only recently understood. The human stress response system can become unhelpfully sensitized when it is repeatedly exposed to stressors, such as chronic hunger, violence or emotional abuse, and is never given the time or support it needs to recover from those exposures.

For boys, Perry said, this often looks like hyper-arousal: inability to focus, becoming angry quickly, or showing aggression. For girls, this more often presents as disassociation, which, in a school setting, can look like shyness, or zoning out.

But the big takeaway from Perry’s workshop is that traditional therapy models – some of which are considered “trauma-informed” – might be getting a few key details wrong about how to best help kids heal from trauma.. . .

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