Conversations on Healing

Introduction Welcome to the Conversations on Healing podcast, where host Shay Beider speaks with renowned healthcare leaders, practitioners, and thought leaders to explore the world of wellness, the incredible powers of self-care, and what it truly means to heal today. Join us on this journey to become more whole, healed, and connected.

Shay Beider Hello, everyone. My name is Shay Beider, and I’m the host of the Conversations on Healing Podcast. Today we have an extra special guest with us, Dr. Bruce Perry. Dr. Perry is a renowned expert in children’s mental health, trauma and neuroscience. As principal of the Neurosequential Network and adjunct professor at Latrobe University in Australia, he has pioneered research on how trauma affects the developing brain. Dr. Perry’s Neurosequential Model is used globally to guide clinical practice, education, and caregiving, impacting millions of lives. He is the co-author of several bestsellers, including the book, “What Happened to You”, co-written with Oprah Winfrey. A sought after consultant for crises like Hurricane Katrina and Sandy Hook, Dr. Perry has been featured on 60 Minutes and also in the New York Times. He’s received numerous prestigious awards for this groundbreaking work. In today’s episode, Dr. Perry dives into his Neurosequential Model and describes the impact of trauma on child development. We discuss the three Rs framework- Regulate, Relate, and Reason- unpacking how these concepts can profoundly affect healing and resilience. Together, we explore the power of somatosensory practices to support healing, and the ways that also tools like rhythm, dosing, and spacing can be used to maximize positive outcomes and develop new neural networks. Dr. Perry also highlights the importance of relational health and community support in fostering growth and recovery, particularly for those who are overcoming trauma. Join us for this enlightening conversation about how innovative therapeutic approaches- and really understanding the brain- can transform lives, including your own.

All right. Well, Dr. Perry, I’m delighted to welcome you to the Conversations on Healing podcast. Thanks so much for joining me today.

Dr. Bruce Perry Thank you for having me. I’m looking forward to our conversation.

Shay Good. So, we are absolutely going to delve into so many fascinating aspects of your work, but I have to say that for me, this is both a personal and a professional conversation. I’ve worked in the field of trauma for more than 30 years, but I myself am also a trauma survivor, not unlike some of the kids that you wrote about in your first book, “The Boy Who Was Raised as a Dog”, that addresses the profound impacts of trauma on children. And the fact that I am alive to be able to even have this conversation with you is a remarkable thing. I am going to be approaching this conversation with both of my hats today- the part of me that has lived, the part of me that has really spent my entire adult life not only healing from my own trauma story, but supporting others on a similar journey that’s unique to them. So, I just wanted to kind of kick it off with that as a starting point and framework for us today.

Bruce Well, thank you very much for being open about that, and actually, for your work. I think one of the great gifts of the work that we’ve done over the years is it really comes from the people that we’ve met who are on their journey, their healing journey. It’s the courage of people to share what they’re feeling, where they are now, and where they’ve come from that really has helped us understand some of the things that we use now to help others who are at a different point in that journey, earlier in the journey. So, thank you.

Shay Absolutely. And so, there were two things, because we’re going to go through a number of pieces of your work that I think are so fundamental, and foundational, and important to understand as it relates to trauma. But I actually did want to start with two things that I find aren’t discussed as much in the world of trauma, but that have been enormously important to me in my own path and also with now thousands of people that I’ve worked with to support. And so, I thought just for fun, I would start with a couple of things that I’ve found to be incredibly valuable and get your take on those. So, the first one is kind of a concept that I think of around wholeness. So, one thing I- early on- came to feel is like you can easily feel broken after you’ve had a number of years of very significant trauma.

You can feel broken, but in my own life, as I started to identify with the part of me that is never- and never could be- broken, right? The part of me that’s fundamentally whole, kind of no matter what. And as I started to identify that not only in myself but then also in others, I found I could actually imprint off of that. That there’s kind a potential within us to imprint off of this wholeness that we all fundamentally carry inside of our cells, perhaps? I’m not sure exactly how we carry it, but we carry it. And every day, I intentionally move myself into that place of wholeness and connect with that, and that’s been enormously valuable. And then the second thing- and then I’ll let you respond to both of these- is something that I call inner intelligence. And I’ve seen this in working with children in the hospital.

I’ve seen this with working with people who’ve had accidents, serious traumas, all different kinds of disability- that there is an inner intelligence in everybody. It’s not just some people get it, but there is an inner intelligence in everybody that actually knows how to heal. Just like our system knows certain things about homeostasis, and we have an inner knowledge and intelligence around how to heal. And that, in many ways, in my experience, the clinician’s role- and even my own role in my own life- has been to listen to that inner intelligence and to utilize that as a guiding force for where you go next. And so, I’d be very curious about your take on both of those things, the idea of wholeness and inner intelligence as it relates to trauma and healing.

Bruce There is a lot in there as you said.

Shay That was a big starting point.

Bruce So, one of the things that we see all the time- and I say “we” a lot, because I am part of a working group and we are always talking about all kinds of things- and sometimes I’ll bring the primary thought into the group and we’ll do editing and we’ll come out with some working version of the way we think things are. But we’re always, as a work group, we’re always learning, and growing, and changing, as we get more input and learn about what other people are discovering and other people are thinking about and so forth. So, what has come up again and again and again in all of that process, starting with me as a really young developing neuroscientist before I became a clinician, was that everybody is really working from their own frame of reference about how to understand the world. And one of the most important aspects of our work currently is learning more and more about how people create that initial set of primary associations that serve as the base- the core- from which you end up growing.

And as you were thinking about that internal whole, it reminded me of the way we think about that primary foundational set of associations in every domain- in every sensory domain. And as you mature, that becomes essentially the framework for emotional domains, where you connect a sensation to a set of incoming sensory inputs. And then, as you get even a little bit older and mature more, there are inevitable cognitive fragments that will arise from that. So, you have this integrated hole that can be very fragile and very- it’s almost like an image you see through fog. But the image is there. Sometimes it’s not absolutely clear, but every once in a while, the fog will blow away and you see it. So, when your brain is developing, and when you are developing in utero and in the early in life, when all of these foundational systems that will ultimately allow you to think and have complex ideas and experience humor and joy and all that kind of stuff, that the core of that is present- not fully developed, not fully functional, but the core is there.

And so, as you were talking about that- finding that sort of inner whole, that’s what it reminded me of. And I don’t know if that’s a reasonable way to think about it or not, but I do think that there is a reset and a re-anchoring that is foundationally a place of safety and familiarity for somebody. That really helps you begin to experience the world and find new ways to add to this frame. So, I do think the healing process involves that. It involves kind of a reset and then an exploration, and then a retreat, and then a reset and an exploration and a new experience. Where do I put that, and which one of these three directions I kind of could go, should I go? And sometimes you don’t know- you might go down the wrong trail a little while- but ultimately, in order to get the right way, get to what is ultimately the healthiest, most mature functional growth, you have to always go back to your core and reset.

And I think of it- I mean, I use visual imagery all the time and the way I think about stuff. So, I think about it sort of as base camp. You’ve got to go back to base camp, and you got to do route finding. You don’t know the best way up the mountain. This looks like a promising route- it’s a big, big valley- but it turns into a canyon, and you can’t climb the canyon. So, you’ve got to go back to base camp, you’ve got to get replenished, you’ve got to get rest a little bit, and then you’ve got to go back out and sort of keep exploring. And I think that that’s what I thought about when you talked about wholeness.

Shay Yeah, that’s great. I want to give you an opportunity to talk about- you’ve developed a whole approach that’s now very well-known and widely used, called the Neurosequential Model of therapeutics, and it addresses the impact of trauma on child development. But you’re using in a lot of different domains now. So, for our listeners who haven’t heard about that or don’t happen to be familiar with it, can you explain the fundamentals of the model and its contributions to our understanding of brain development and healing?

Bruce So, the Neurosequential Model kind of grew out of my aspirations to do research with human beings. I got my PhD in neurobiology working with simpler models- tissue culture- and then with animal models, rats. But even with those systems, the complexity was like mind-boggling, and the number of things we had to control to actually ask and answer a question the proper way so that you actually got a decent answer required a level of, if you will, sort of rigor that was not possible to do with human beings. And so, when I got into, and started to learn about the clinical world, and particularly I was frustrated with the DSM because it was trying to use a paradigm to organize and categorize human beings that was fundamentally disrespectful of the biology- the complexity of the biology of the human being- and not just the human being, but the complexity of family, community, culture- like all of the things that we know influence how people live and function. Really were not incorporated or controlled for by the DSM.

So, using the DSM to actually do research was crazy- and it still is- but people are doing it anyway. So what I realized was if we were going to be able to really ask and answer really important questions- what’s the difference between a really bad thing that happens when you’re two and a really bad thing that happens when you’re seven? And are there things that we know will help protect somebody who is going to have some sort of developmental adversity? And are there things that we can do that will make healing easier for people? I knew that there were pretty unsatisfactory answers about all of that when I started- that people were just not even thinking that much about childhood trauma. They were studying trauma in adults, mostly adult male combat veterans, and that dominated the field- still does actually. But all the research, all the research money, all the clinical programs were focused on adult males who’d been in combat.

And there were a few people that were studying victims of domestic violence or rape, but it was really nothing compared to the funding for veterans. And so part of what I had to do- and I’m still kind of doing this- is I had to resist the temptation to be overly influenced by my peers, which is a very hard thing to do. Human beings are social creatures. We’re very contagious to the thoughts and the feelings of the people around us. So if you go to a professional meeting, a guild meeting, whether you like it or not, you’re going to start thinking like those people. And when you have an idea or a thought that is in opposition to the dominant perspective, you are going to ignore it, you’re going to minimize it, you’re going to take the edge off of the outrage you feel because people are doing stupid things.

And over time, you’ll end up making excuses for the dominant paradigm, and you’ll end up practicing the way you have to so that you can actually get reimbursed, so you can pay the mortgage, so you can have the life that you wanted. And so what happens is the inertia of that process essentially allows for the transgenerational replication of stupid ideas. And so now, I fortunately was kind of a little bit- I don’t want to say a rebel, but that’s giving me a little too much credit- but I used to sit in the back of class and I’d go like, “Is that right? I don’t know if I believe that.” I just was always questioning, “Where did that come from?” And so I had a little bit of that in me, just sort of the- I just did not want to believe authority figures. So that helped me step away from the traditional paradigm and actually embed my thinking mostly in the developmental neurosciences, where I felt that they were being… now, they have their own problems, right?

Scientists are just- they’re human beings, and they do the same bullshit that it happens in every other discipline. But I did feel more comfortable with the science. And so I started to use a neuroscience lens when I was thinking about what I was seeing. And over time, a couple things happened. One, was I finally recognized that a lot of the things that I was seeing clinically were related to the stress response systems in the body, and that they were overactive- they’re overly reactive- and that influenced physical signs and symptoms in the people I was seeing. And it influenced the way they would think and feel. And it was called ADHD or chronic disorder or depression or whatever. But it really had, or you could see, that the physiological origins were in these networks that were involved in the stress response. So, I started to think that we need to have a better way to look at how somebody is functioning, as opposed to just getting a checklist of behaviors and then putting them in a box. And then, from that point forward, “Oh, you have a ADHD. ”

That’s the way we’ll formulate everything we do from this point forward. So that was the one thing. The second thing was I realized that we needed to, in order to kind of deal with the research issues, we had to have an end number that was like 10,000 or 25,000, which is just not done in conventional human research. And so I thought, well, the only way we’re going to do that is if we come up with an assessment approach that measures the stuff. We think these are important things, but the process of doing this assessment actually is helpful to the clinician and gives them information that will help them in their work. So that’s what we did. We tried to develop an assessment that would have enough of the important elements that we wanted to follow, and we were measuring the things that we thought were meaningful- not everything, but enough of the things that we thought would be important.
And at the same time, doing it in a way that was going to not be overwhelming for clinicians. It was going to result in a report that helped clinicians think developmentally and think clinically in a way that should help them. And we realized that the only way to manage all that information was if it was a web-based assessment. So, way before this was a big thing, we were doing web-based clinical assessments in this structured way. And we now have 150,000 individuals who have been evaluated the same way. Now, it’s not an in-depth assessment, it’s kind of a broad assessment where we look at all kinds of things, like the developmental experiences that are good and their timing, and developmental experiences that are bad in their timing. And then we get information about how they appear to be functionally organized, and then we create basically a visual image of the way their brain appears to be organized.
And we don’t say that, “Hey, you have this disorder.” We just put this picture down and we go, “Hey, look at this. This looks how you’re organized.” And they’ll go, “Why is that red?” And I go, “Well, you’re not very coordinated.” They go, “I know it’s terrible. I run into stuff all the time.” And I said, “That’s okay. There are things you can do to help with coordination. What do you like to do? Do you like to dance?”

“No, I hate dancing.”

“Do you like sports?”

“No.”

“What do you like to do?”

“I like to sculpt.”

I’m like, “Okay, well, let’s think about bringing that into your daily activities so that you give those systems practice so they get better.” And that’s what we do. And we use this map to help identify areas where you can collaborate with a person, even a very young child, to come up with experiences that will plausibly create the nature and the frequency of activities that will influence the part of the brain that you want to get to.

Shay And it’s fascinating clinically. You’ve come up with these simple kind of frameworks and models to help clinicians to be able to easily anchor into this and have tools that they can work with. An example of that is the Three R model that you talk about: you regulate- so, there’s self-regulation and co-regulation. Then there’s the relate, which also relates to Stephan Porges’ work around polyvagal theory and social engagement. And then you move into reasoning, or more prefrontal cortex, where we have more opportunity to function out of that part of the brain. But that there’s a sequence to that, that the order is very important. And obviously you can speak much better to that as a neuroscientist, but clinically, to have a map of: you have to get here before you can go here, before you can go here, because that’s kind of the design of how our brains work. So yeah, I think it’s incredibly valuable as a clinical tool.

Bruce Thank you. I have to say, I spent years- and I think most clinicians have spent so much time talking with either a parent, or a teacher, or a parole officer, or somebody who’s trying to understand their client. And the issue that comes up all the time is like, “Well, I told them what to do.” You’re like, “Right.” And when they were sitting there quietly with you and they felt reasonably safe, they could hear and process what you’re talking about. But if you understand how the stress response system works, soon as somebody’s dysregulated, the top parts of your brain start to get less efficient; they go offline.

And so all that stuff that they knew- they knew the rules- but they had no access to that and that didn’t influence their behavior after somebody pushed them in the lunch line. And so that was not an intentional, aggressive act; that was an elicited aggressive act, and they need to be interpreted in very different ways. And the irony is that the law understands that, if you kill somebody in the heat of passion, you’re sentenced differently than if you intentionally planned and had premeditated intent to go shoot somebody. And so there’s just a universal recognition of state- dependent functioning, but we rarely think about the implications of it or the nuances of that understanding.

Shay And you’ve written about this. So, you co-authored a book with Oprah Winfrey called “What Happened To You? Conversations on Trauma, Resilience and Healing”. And in it, you talk about developmental trauma. One of the key things of the book is embedded in the title itself. Instead of thinking of someone as “what’s wrong with you?”- which is very often the case when we see kind of dysfunctional behavior- there’s an instinct to be, like you said, those teachers, those adults are like, “What’s wrong with you?” But really, the question that we should be asking first is “What happened to you?” And even in your prior book, your first book, “The Boy Who Was Raised as a Dog”, you share this story of this young girl- I think you call her Tina. It’s the very first story you share in the book. I’m sure that’s not her real name- but that you worked with, and you thought you were making such great progress, and on some levels you were. But then there were certain things that she defaulted to, which kind of came to your awareness after you worked with her for a few years, that were unhealed and unresolved. And that way that we can default to the places that haven’t yet been healed or resolved inside of us.

This understanding of how you get to those deeper layers- what is your current approach on how you get to the deepest layers of resolving that? Which, in some cases is- because I work with this so much with the people that we serve- it’s nonverbal, it’s symbolic, it’s not in the prefrontal cortex. It’s not in where, “Hey, I can talk to you easily about it and we can have an interesting dialogue.” It’s in other aspects of who we are. So, I want to give you an opportunity to talk about that.

Bruce Well, I mean, and you would understand this better than most, that that’s one of the major, I think, gaps in our current mainstream dominant medical model treatment of trauma. There’s a tremendous undervaluing of nonverbal therapeutic approaches, and there’s an overvaluing of verbal approaches for the kind of problems that we’re talking about- that we work with a lot: early life attachment problems, early life preverbal trauma, and sprinkled in with a little bit of neglect. I mean, you cannot do TF-CBT to make that go away. And again, we’re struggling with this like everybody else, but what we have learned is that- again, here’s my neuroscience hat- whenever we run into situations like this, I say, all right, let’s back up. What do we know about, first of all, where are those systems? What was happening in the pre-verbal time? What was happening in the first months of life when things appear to have gone wrong?

And then when you realize that, well, there were really major organizational shifts that were taking place in very low parts of the brain- brainstem, those are kind of lower in the brain. And so you think about what networks are likely to be involved. And then you think about, all right, what does neuroplasticity tell us? And there’s some really very, very, very positive and hopeful things that sort of the fundamentals of neuroplasticity tell us. First of all, and I love this part, is that neuroplasticity tells us that the signal required to initiate change in neural networks only has to be moments long. It doesn’t have to be 45 minutes long. It’s moments. And here’s the kicker: it has to be in the networks where the abnormality or the inactivity, their abnormality in organization, resides. So you cannot change these lower parts of the brain easily by expecting that you will be able to get to those really deeper areas through the cortical, top-down routes.

It’s very hard. Now, again, good news: we have a number of routes to those networks that are interoceptive- that sensory input from our own body, where we are in space, the things that will be activated when we take a deep breath, things that will be activated when we’re hungry, thirsty, cold. We have all of those things that are going up into those parts of the brain that are feedback from your body. And all of our sensory input goes into the lower parts of the brain. There’s no direct input to the cortex from any of our senses. Not one. Every sensory input has intermediary processing in middle and lower parts of the brain. So the easiest, most direct route to those networks that we want to change, that were impacted by early developmental problems are somatosensory. Somato means body and other sensory routes. And again, I mean, this is your bread and butter, right? You know all about this.

Shay This is. This is my bread and butter.

Bruce But if you talk to most physicians who have become psychiatrists, they don’t know shit about this- and excuse my language- it’s eternally frustrating. That the irony is that they’re the ones that are supposed to have learned about the physiology of the body, and they are the ones who have the hardest time connecting the dots and really appreciating the power of somatosensory activities and somatosensory therapeutic approaches. Now, we’ve actually, one of our major initiatives has to do with looking at what are the culturally embedded somatosensory activities that have given people, historically and currently, people who are in a healthy cultural environment- what are those things that have actually been protective and that have helped groups of people buffer some of the adversities that they experience? And furthermore, what are those things? What are the specific elements of those culturally embedded activities that are the natural healing environment for individuals who have had either developmental or other kinds of trauma? And when you look carefully, you see it everywhere. You see it in rituals and routines around meals, rituals and routines around belief systems. You see rituals and routines that integrate somatosensory things all the time. And it really is the best collection of evidence-based intervention in history, because these are centuries-long practices that would not be maintained if there was not some element of efficacy.

And the fact that the core activities, these somatosensory elements and elements of ritual routine- sort of relationally rich practices that permeate a week, as opposed to having one hour a week- that those things actually independently arose on seven continents is the best evidence I can think of. So I think the work that you guys do, even though you probably have a really hard time getting insurance companies, and hospitals, and people to understand that this is as valuable as prescribed, it’s probably way more valuable than prescribing most of the medications we prescribe. Our world just doesn’t quite understand that yet.

Shay Yeah. Yeah, it’s so fascinating because I remember- so I started out at UCLA, I did both of my degrees there, and I was doing some work at Children’s Hospital Los Angeles very early in my career and a lot of research. And the frameworks at that point, I already knew enough about healing not only in my own life, but with others that I was working with, to understand that at a deep level, healing involves a lot of listening. And I remember working with a lot of physicians in the neonatal intensive care unit. We were designing a study for the babies in the NICU, and it was around gentle touch and what they would call massage, but it was really about listening and attuning to their system and body. And I remember they wanted me to design this exact protocol with every single baby. This is the gold standard, right? It’s like every single baby…

Bruce The whole concept of attunement goes out the window, right?

Shay Everything goes out the window. And God, I don’t know how I did it. I came up with a protocol. They really needed that protocol, but I was able to write it in a way that kept it still very open-ended, because I just couldn’t give them what they wanted exactly. But I still needed to honor the medical system, and I understood it. I understood why they wanted what they wanted, but you reach those challenges when you’re approaching healing from a different perspective, which is that fundamentally your job first is to listen and understand. And that can then lead you in a lot of different directions. And in my own work, the therapy that we design, that we call “Integrative Touch”, it’s all the things I needed essentially. So it’s done in a group so you can co-regulate with multiple nervous systems. And so if you’ve got someone who’s highly dysregulated, we can bring in three to five people who are highly regulated, who are going to set a framework that’s powerful. And that’s one of the first things I learned in my early hospital work, was: one of me wasn’t enough.

I needed a team because I needed to outweigh the stress in that nervous system that was so highly activated. And because, as you do, and you know when you work with children, you’re not only working with their nervous system, you’re working with their parents, you’re working with their aunts, their grandmothers, and so now you’ve got a room full of people who are highly dysregulated, and you’re way outnumbered. And so one of my first things was get groups. So I developed our hospital models around- you bring in teams of people. And then when we moved into community-based work, I designed everything in teams of people and in our therapeutic approach, it’s a whole team of people. And then as I continued, I did a lot of things like so many of us do from the heart, like intuitively. But then because I love to learn and read and research, I started to understand more was happening. So…
As an example, interviewed somebody recently who’s also a neuroscientist, understands a lot about the brain. And he was saying how the first three years of life were much more in the right hemisphere of the brain, and that’s more dominant in the beginning of life. And also, that when we experience trauma, it’s affecting more the right hemisphere of the brain. And so we’re in kind of this different landscape. And what I saw in healing from deep trauma is I had to get into that landscape. I had to get into the nonverbal, I had to get into these very symbolic spaces that are not necessarily languaged easily, but that allow people- and that I’ve got to keep the nervous system in a parasympathetic state- but allow enough activation that whatever has occurred has an opportunity to rise slightly. And you see this in Peter Levine’s work, Somatic Experiencing; others have identified this.

You’ve got to get a little bit of a rise, but then you’ve got to also soothe, right? And so you start to see what you need over time, and it starts to take shape and form, and then suddenly you’ve got a therapy that you’re doing, and it’s like helping people. But it’s more than anything that, for me and my work, it’s been a dyad between deep listening and then studying and learning from people like you and others who are deeply connected to trying to figure out how we heal and what actually is happening inside of us. And one of the things I deeply appreciate about your work is you talk a lot about relational health and relational poverty, and the importance of community and how evolutionarily we’re designed to be and work and relate and interact together. And that’s a huge part of how we heal.

Bruce Again, as I was listening to what you described, that phenomenon you’re talking about is basically the way we would talk about it: is that when you take these neural networks that are involved in a traumatic memory or traumatic stress, they make changes. Those systems become overactive and overly reactive. They become what we call sensitized. And this is something that is relayed a lot of the symptoms that we see: because these very widely distributed networks that are involved in many functions, they become overactive and overly reactive. Now we know that you can take these systems and give them a different pattern of activation. In order to change them, you have to activate them. The problem is you have to activate them in tiny little moderate doses, just exactly like you’re talking about: that somebody has to feel safe, and then they have to sort of leave their comfort zone and have a little dose of going there, and then retreating back, and going there, and retreating back.

And when that happens, those systems literally start to become more neurotypically regulated. And then, ultimately, over time, that’s what builds resilience. Resilience comes from activating the stress response system in moderate, predictable, controllable ways. And so the very same process internally that is involved in building resilience is the process that’s involved in therapeutic healing. And the way you described it is a very nice way to talk about it and think about it. And the thing that’s, to me, is very attractive about your approach is that, again, in the community, in sort of the natural world where human beings live together, the presence of people who you felt that you were connected to in some way- these are my people, my aunties, my uncles, my neighbors- they’re basically capable of being the healing backboard for you to have a little bit, one of those little therapeutic moments. You go up and you say, “I miss Mom,” or whatever, and it lasts for a second. They go, “I miss your mom too.” And then you go off and do whatever. That’s a therapeutic moment. But if you have nobody in your life to do that with, you don’t have the healing matrix. And what’s nice about when you bring people together, that quadruples the number of therapeutic opportunities that people can benefit from.

Shay Yeah, it’s so fascinating. And part of what I’ve learned with that is people of all ages, all lives, because you need this really diverse mix because some people are going to feel safe or unsafe with someone who looks like ‘that’, sounds like ‘that’, is ‘that’ age, is ‘that’ skin color, is ‘that’ hair color. So you intentionally need to create high levels of diversity in these communities so you can find points of safety. And so that piece is so fascinating. I want to touch on, because you talk about this in your work, you just mentioned it now, this idea of therapeutic dosing and the rhythm, the dosing, the spacing, and how this was also in some of your books- how we’ve designed therapy. When you started in your career, you were spending an hour a week with a patient, and yet everything you know about the brain, it’s like that’s not how it works at all, right? So it’s fascinating how the early imprints of therapeutic intervention really don’t mesh with what we now know about how the brain works, which is in these small little doses, but much more frequent. And so how are you addressing that now and how you look at the design of clinical models?

Bruce Well, it’s interesting because we’ve been forced a couple of times to think about this very intentionally, when we are brought into these incredibly catastrophic traumatic events. For example, there was an earthquake in Turkey a couple of years ago where there were thousands and thousands of people dead, 4 million people homeless. The destruction was just catastrophic. And we were consulted on what should we do? And of course, every NGO out there was like, “Oh, we need to train people to do more TF-CBT.” And I’m like, I said, “That’s crazy.” I said, “Just look at the numbers.” I mean, if you look at the number of people who will have trauma related symptoms that would benefit from some sort of therapeutic experience, it’s in the millions. So you’d have to take every single clinician in Turkey, and they would have to spend every waking hour doing TF-CBT, and they still would only meet about one third of the need.

So, we have to do something else. And that’s when we said, listen- and I know that this is true. I’ve been involved in a lot of these things- conventional mental health intervention from strangers in the beginning of these events is experienced as intrusive and not helpful most of the time. And when it is perceived as helpful because these people leave, it’s a negative experience later on because you feel like you spilled your guts to somebody and then they just fricking disappeared. Where are they now? Six months later in the middle of the night when I want to kill myself, and I have no idea who to connect with.

We’re doing a lot of things with good intentions, but they’re very stupid. And so we have been really very much focused on thinking about what are natural routes to creating a relationally sensitive environment, where people are capable of doing the listening and the attuned responsiveness that’s required to have a healing moment. And so we work through sport, school, drama- all of these places. And if we build the capacity in educators and coaches, and it is pretty light-touch capacity building, we reassure them that they don’t have to be therapists. They just have to- we want you to understand what you’re seeing as opposed to labeling it as a bad kid and recognize the power of just being present. There’s a few things that you can do. The fact that you guys do pattern, repetitive, rhythmic movement stuff is really good for these kids. So there are healing opportunities in sport and in drama and in music and all of these environments that we’re trying to capitalize on to increase the buffering capacity of a community of a school.

And I guess you could consider that builds the resilience, but I don’t like to think about that in that language. But I just think the more attuned, aware adults there are in the life of a child, and the more aware peers can be about some of this stuff, the more you can magnify the healing opportunities of relational interactions. So that’s a lot of what we’re doing. And it’s interesting, there are a number of really, really active and successful community… I don’t even know what you call ’em. They’re not like community organizers, but there are people like Cormack Russell who have recognized that rather than bringing in these institutional models into a community, you need to go into the community. And like you said, the first step is, let’s listen to them- where their strengths are, what do they need? How do they solve problems? And then help them when they need it, bring in selected institutional strands to support their community capabilities. And I think in the end, that’s going to be a much more effective way to do things: build community, build connection, take advantage of natural mechanisms for regulation and connection, and then there will always be these very, very, very complex challenging individuals where you need some of that expertise. But the vast majority of people, I feel like we really over pathologize people.

Shay Yeah, it’s interesting. So at our healing center, we do camps for kids of all abilities. It’s a mix of anything you could imagine- kids who’ve had trauma, kids who’ve had illnesses like cancer, kids with autism, kids with down syndrome, cerebral palsy, genetic conditions, a whole range, a very wide diverse group. And we bring all these humans together. And then we have tons of volunteers, and a lot of our primary principals are around regulation and fun because it’s got to be fun. It’s kids, you’ve got to have fun. And it’s fascinating. So one of the moms was just saying to us recently that her son- he’s probably now 16, at least developmentally younger- and he was at the doctor, and the doctor was like, “He is moving his body completely differently. He’s doing all these things he’s never been able to do before. What changed?” Well, as it turns out, we do these adaptive dance camps for anybody, you can dance, and he loves to dance, loves it. And so that love of dance was getting him to move his body in ways that he hadn’t, but it was through the joy. And that’s that piece that you’re identifying- sometimes it is through sport. It is through honestly just the things that bring people joy can inspire what we’re trying to inspire in the first place.

Bruce Exactly.

Shay Yeah.

Bruce And a long time ago, when we first started moving out of the clinic into more community based activities and opportunities, we would run into situations exactly like you’re talking about, where a kid who had never learned how to read and was struggling- he was like in high school and he hated reading. It was a deficit, but he would go out into the woods and he was really good at telling direction. And then what we did was we said, “Well, listen, you’re so good at this. Look at this map and this N means north and S means south.” And we’d start to talk to him about an explorer who came through this part of Canada called David Thompson, and he wrote these things. And pretty soon he was interested in exploring his strength and he learned to read in context of reading maps, reading about explorers. And it was just one of those things, to your point, that if we sort of step back from your deficit and we give you an opportunity to engage in something that is identifying and celebrating your strength, you can almost always go from a splinter strength and use that as the frame, the beginning of a growth in multiple domains of functioning.
It just takes that kind of attunement and the kind of opportunity that you guys are providing for the people that you work with, which as you well know, is not allowed in the current medical economic model, which is really part of what is the major impediment, I think, to progress in mental health right now in the country- is the economic model.

Shay Yeah, it’s such a, oh my goodness, I spend more time than I would just trying to figure out the financial side of it all, because that is the hardest part. We don’t have a reimbursement structure that is attuned to this way of healing. And so, yeah, the financial and economic model is an enormous part of the day-to-day of trying to figure out how to keep it alive. But you do it anyway, because you love it. I want to ask you about another piece of the puzzle. I had the opportunity recently to interview Dr. Richard Boyatzis, who’s kind of one of the top scientists in the world of how we change, and how do we actually change and how the brain works around change, and also what the research shows. And one of the things he shared that I just think it’s super fascinating is that you- part of how you change is you have to get into certain brain states, and one of those is you really need to create parasympathetic activation.

And so, he had actually done an analysis, because he loves science, and he’d looked at all the studies of what are the things we know scientifically that have been in at least five or more peer-reviewed journals that we know elicit the parasympathetic state. And so we were talking about that, and he kind of gave me a list of things. It’s like meditation and yoga, tai chi, prayer, modest exercise (not crazy, strenuous), feeling hopeful about the future, helping others who are less fortunate, being in a loving relationship, having a pet, laughter and playfulness, playing music or dancing, and walking in nature. These were all ones that had a good amount of scientific study behind them and showed that they elicit that parasympathetic state. And so, I want to understand more about how you see, understand, and are working with that relationship between healing from trauma and eliciting the parasympathetic state.

Bruce Yeah, I mean, it’s interesting. I tend, and I have tremendous respect for the polyvagal theory and Porges and all that stuff, but I tend to kind of view the brain as more than, you know a bigger set of systems. And there’s no doubt about it that when you are in a reflective, the state of safe, which opens up certain parts of your cortex to drift, to do mind wandering, which is one of the most powerful capabilities that the human being has. That’s the state in your brain that allows you to take content that you’ve already put in there and manipulate it in new ways and put it together in new ways.

Shay And this is the default mode network, is that correct?

Bruce Well, it’s the default mode network is involved in this, but it’s a specialized activity that happens when you are basically mind wandering. It’s a dissociative state. Now, we get to a dissociative state all the time, probably every 15 seconds. We have a little bit of drop into this sort of disengaged state, in part when our active working memory dumps out content to a component of short-term memory. And that’s kind of what happens. Think about our conversation: while I’m talking, you’re partially disengaging from all the sensory cues in front of you, including my words, and you’re thinking about, “Oh, that reminds me of Dr. this,” and then “This thing I read, and I wonder about that.” And that’s why you brought up, ‘Oh, default mode network, right?” That was something you got when you were partially disengaged from being fully externally focused. And we do that all the time.
We go in and out and in and out. That’s a natural rhythmic cognitive rhythm that people carry through the day. It allows us to basically take in new content and then play with that new content and put it where it kind of belongs. Now we’re only kind of partially putting it away. It’s like there’ll be times when I actually take an empty milk carton and I’ll put it over by the garbage, but I don’t put it in the garbage. My wife gives me crap about it all the time, or a dirty dish. I put it by the dishwasher, but I don’t put it in the dishwasher. And she’ll go, “What is this?” I said, “I’m not ready. I’m going to wait till I get a few of ’em and then I’ll put ’em all in at the same time.” That’s the way that kind of short version of short-term memory works.

You don’t immediately go to long-term memory. You pile up a bunch of dirty dishes, and then when you are in REM sleep or when you have a longer reflective period, when you’re on a walk, walking in nature, then you start to find yourself- you’re putting the dishes in the dishwasher, the dirty dishes, you’re putting them all away. Anyway, we could talk about a lot of different parts of that, but the key is the modern rhythms of most people’s day don’t give us enough time to do that. How many of us have these reflective periods after we’ve gone to a lecture? We don’t sit for 45 minutes and kind of take a walk. We go to the next appointment. In fact, we’re usually, we don’t even have time to think about what the meeting was about until the next meeting starts. We do this with kids.

We take cognitive class, class, class, class, sport, violin, homework, go to bed. We don’t give them the kind of opportunities to get in the state where you optimally absorb the content that was new. And so this is, I think one of the things that active prayer, meditation, certain kinds of low intensity exercise- they allow you to get to this parasympathetic, “I’m calm, I’m safe, my cortex is open.” All these different special parts of my cortex are capable of doing what they want to do. And I think that that’s a major component of a stage of healing in trauma. Now, the other thing- and I think that kind of healing is sort of… I think that you talked earlier about that sequence of engagement. I think that healing from trauma also follows the sequence of engagement. So you can’t really begin to heal from some of the relational ruptures, relational things that have happened until you reach a certain level of regulation.

And then after you get to a certain point- and let’s pretend you’re doing this healing process in therapy, conventional therapy- you work with somebody, you get to the point, you really trust them, you open up and there’s some healing going on. But that’s when you get to that cognitive level where you’re like, “Wow, this pattern- I’ve done this so many times.” And that’s what happens: you reflect on it and you go, “Wow.” Then you bring that back into the office. See that’s sort of in the beginning, your healing’s around regulation, regulation, regulation. Then you get to a certain point of regulation that you can tolerate the relational stuff. Then you kind of work, and then you get to the point where you’re like, “Wow, this is the higher order stuff that like, geez, how do I change that pattern?” So I do think it’s part of it, but I really think that there are, I think the brain follows certain rules. There’s certain… the sequence of engagement tracks during development, it tracks during the processing of the present moment, and I think it tracks with the healing. So I don’t know if that makes sense.

Shay Yeah, it does. It does. And I’m also interested because I was listening to one of your lectures that you had given, and you said that you often are seeing today a delay in social and emotional development among young people, and you’re seeing it fairly consistently. And there’s a lot of- I heard you give a few ideas on what might be underlying to that. I’m curious about what you think we can do to create more healthy development in this modern world with all the things we have in this modern world.

Bruce Shay, honestly, I think one of the most important things we can do is act on some of the list of things that you described. So here’s what we know about the brain: the networks and systems in the brain that are going to get activated and changed, and are going to have basically developmental repetitions are the parts of the brain that we get attention to. So whatever we pay attention to, we internalize. But if you have one-tenth the relational interactions, because you only have a single parent and you don’t have aunties and uncles around, and you live in your little square in a building that’s full of other little squares, but you don’t know any other people… If you have relational poverty, you can’t pay attention to conversations and relational nuances and eye contact, and you don’t learn it. So you get fewer repetitions with practicing nonverbal communication, social communication, and you get fewer… And if your mom- pretend your mom’s raising you and she’s exhausted, because she had to work all day long- her ability to kind of be fully present and interactive with you is going to be a little bit compromised. It’s one person, and I’m exhausted, and I just want to make sure you get your bath and you get dinner and you go to bed, and maybe I’ll get 45 minutes to myself.

We’ve created a brutal, relationally brutal environment. And so I think what is happening is that because our culture values words, and the stuff that our cultural values are the stuff that is going to get stimulated again and again, and again, and again and again in the brain. And because we have decided to teach kids using highly active, visual, quickly changing images on Sesame Street, plus every other thing by the time somebody… rather than having these quiet, relational moments where we learn how to observe and listen and process, where we learn that rhythm I just talked about- where you go, “All right, I’m going to internalize something, then I’m going to sort of partially disengage and process it, and then I’m going to come back out.”- we don’t learn those rhythms, because we don’t have opportunities, we don’t have repetitions. We are put in front of a screen and our brain, which is very visually biased, is pulled to this fast thing, then this fast thing, then this loud thing, then this fast thing. Then, oh, there’s an A, there’s an A, there’s an A, you might learn your A’s, but you don’t learn your ahs. I just made that up. What do you think?

Shay That’s great. I love that. That’s such a good way to say it. Well, and such a reminder of repetition is so key. And even though we know, and you talk about this in your work, that there are so many more changes happening in the brain when we’re very young, that does never stop. It just slows down quite a bit, right? And so you still have the opportunity to create new repetition cycles as an adult. And so it’s like it never ends. There’s still always opportunity to focus on what you want to focus on and put your mind space in a place that you want it to be in and to create change through that simple repetition, even as an adult.

Bruce Exactly. But to our earlier point, Shay, and this is why your work is so important. The adult world overvalues cognition in word, right? So, as we get older, we do not give people the space or opportunity to have those relational repetitions that are going to help grow those capabilities. We push people into cognitive things, and I love cognitive stuff, but we overvalue words and we undervalue relational and touch. So when you’re an adolescent, you have so much less opportunity for learning about healthy touch than you do when you’re young. And if you didn’t get adequate, if you will, developmental repetitions around this, you are basically a 16-year-old walking around with kind of a sensory hunger that you’ll end up trying to fill that bucket in an oversexualized way. The only way you get touched these days, right? There’s… we are not good at non-sexualized touch with adolescents

Shay And all those other parts of us that need to be expressed in sound. Even like how you said, not the A, but the ah, right? There’s these parts of us that need to be expressed through movement, through sound, not necessarily through language. There’s just that going back to that idea of the somatosensory, right? There’s things that we need to experience on other levels, and we certainly are creating deficits in that learning curve for young people today, and it’s so needed. So hopefully that can continue to be recognized.

I know that in your own life, inevitably you’ve experienced trauma because everybody does at one level or another. And I had actually read about one trauma that I know you experienced that’s significant, and there are probably many others that I don’t know about that live inside of you. And so I like to ask everybody that comes onto the show, kind of based on your own life experience, based on your work, based on just what you know about being a human being, how have you come to define or describe what you think healing is? What’s the essence of healing?

Bruce Well, I think about the people that have talked with us and shared with us their experiences. I think about my experiences with growing up and dealing with loss and trauma. I think the very core of it is a recognition that there is an inevitability to disappointment, to challenge, to fear, to pain, to loss. And that the antidote to all of that is connection. And that whether it’s sitting side by side with a friend and fishing, or we’re taking a walk with a grandchild, or just having a meal with people that you laugh with, those are the things that I think are at the core of healing. And different people will have different elements of who they are that get injured. Sometimes it’s an emotional abuse where you felt humiliated and belittled and excluded, and you will heal that in a different way than you would heal a sudden unexpected car accident that left you with a physical injury.

Both of them were traumatic, but they impact different parts of you. And so I do think that for me, going back to your concept of that whole person, I think that even when there are these broken bits and there are these undeveloped potentials and there are these disappointments about where you wanted to be and you aren’t, that if you retreat back to the very core of who you are in connection with your primary caregiver, and I don’t want to get too wacky, but even into all the way into the utero, when you were literally one with another, that’s home base. That’s that safe place that if you go back there, get fed, get bored, that’s the key. Once you get back there, you’re like, all right, this is familiar. And there is this thing. And when you talked about this right at the beginning, there is something in us that pulls us to go out and explore and develop and change and heal.

And you see this with kids all the time. They know what activity is developmentally, what they should be doing. So when little kids turn the light on and off and on and off and on and off, there’s a specific thing about permanence that they’re learning about efficacy of the world and permanence. But three months later, they don’t care about that; they’re doing something different. But if you try to push them to be curious about, “Look what you can do, you can turn it on,” they’re like, “Whatever, I know all about that, leave me alone.” So I do think that the core of healing is going back to this primary relational capability and relational need, being in connection with someone where you were able to tap into that and they can, in some ways, remind you of the importance of that connection. And then you can reset and go back out and keep exploring and changing and growing. But I think one of the biggest things, though, in all of that is that we all have to at some point recognize that, listen, none of us are getting out of this.

Nobody’s getting out of this unscathed. I don’t know anybody that it doesn’t have something. So just be, recognize how important it is to take advantage of that relational part of us that makes us part of a larger whole and be nice to other people, connect with other people. I think one of the most healing things you can do is actually try to help somebody else who’s struggling. This is why in our clinical work, we almost always have as a major treatment component that you mentor or connect with or help somebody who’s earlier in the journey than you are. And so we have lots of kids, for example, that lost a parent who will work with us, and with a child who just lost a parent last month. And those relationships end up being much more therapeutic than what we do.

That’s a long rambling answer. You can see I’m not much of a soundbite guy.

Shay That was a great answer. You made me really think of something very specific about that point of connection. And so there was, this is some years ago now, but there was a moment in the hospital where I was sitting with a father who had accidentally run over his daughter with a motor vehicle, and she was on life support and she wasn’t going to make it, and she didn’t make it. And we were sitting in the room with her body in front of us. And the amount, as you would imagine, the amount of grief and mostly shame, actually, that was embedded in his system in that moment was extraordinary. It was singularly the most shame I’ve ever felt come from another human being. It was just so thick. He couldn’t even look at, he couldn’t make eye contact with anyone. He was just entirely in shame. And I remember I thought of all the gajillion things I’ve learned about healing, what the heck am I going to pull out of this hat? What in the world am I going to do in this moment? And I realized for him, really the only thing I could do was what you just defined, was to connect. And I did it in the most simple way, because I knew he couldn’t tolerate hardly anything at that moment. I just sat next to him and I let my leg touch his leg, and he wasn’t alone. And some part of me was conveying to him that what had happened happened, but it didn’t have to… there was some kind of level- and again, this is nonverbal, so I’m not going to say it in words properly- but that he could be accompanied even in that most horrible thing that had occurred, that he didn’t have to be abandoned or left alone or isolated even in that. And there’s something in that. There’s something about not leaving someone alone, even in their worst moment. That connection that you described, that relational piece, that I think is some kind of a critical anchor to getting us through those really hard things.

Bruce Yeah, no, I agree completely, and I think people underestimate the power of being able to sit in the darkness with somebody. There’s no words, unfortunately. We have a lot of experience working with really tragically heartbroken folks, and the most powerful thing that we do is that we just sit. We’re okay. We can sit with them in the dark and wait, but they’re not alone. Just like you said, we let them know they’re not alone, which I think, in the end, that’s just really the single most important thing about that acute grief and traumatic loss piece. It feels so bleak and so empty that a lot of folks give up.

Shay Well, thank you, Dr. Perry, so much for your incredible work and for…

Bruce Thank you

Shay Supporting people so that they’re not alone in those dark moments.

Bruce Well back at you. I appreciate the opportunity to talk about this, and I just want to make sure everybody, everybody’s listening, people give me a lot of credit, but the people that do the really hard work are the people on my team. I’m just a really lucky guy. So, they do all the hard work. I get all the credit.

Shay That’s unfair isn’t it.

Bruce It is unfair, but it’s all of us, it’s the way it’s going to go, sorry.

Shay All right. Well, thank you so much for having this conversation with me today.

Bruce My pleasure.

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