Dr. Bruce Perry: How Childhood Trauma Shapes Your Entire Life

Summary

Podcast Summary

We're Out of Time – "Dr. Bruce Perry: How Childhood Trauma Shapes Your Entire Life"

Host: Richard Taite | Guest: Dr. Bruce Perry
Date: May 19, 2026

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Overview

In this profound episode, addiction recovery expert Richard Taite sits down with renowned psychiatrist and trauma expert Dr. Bruce Perry. They dig into the enduring effects of childhood trauma on brain development, behavior, and mental health—exploring why healing must be relational, what modern science reveals about stress and connection, and practical steps for recovery. Drawing from Perry’s decades of neuroscience research and clinical experience, along with insights from his bestselling books, the conversation urges a rethinking of how America treats mental health, addiction, and recovery in a fractured age.

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Key Discussion Points & Insights

The Enduring Relevance of Trauma Science

• Relational Healing over Technique:
  Dr. Perry highlights that the updated edition of The Boy Who Was Raised as a Dog reemphasizes the essential role of relationships in recovery—something that has become even more urgent in a "screened-up" society.

  “[The book] re-emphasizes the power of connection and the importance of integrating quality relational time and space into all of our systems and everything that we do—parenting, education, mental health, and so forth.” (03:06, Perry)

• Modern Relational Poverty:
  Routine, rituals, and shared meals are under threat, diminishing life’s predictability and safety. Such lost cultural practices have clear negative consequences for mental wellness (07:57).

Understanding Trauma’s Impact on the Brain

• The Brain Develops from the Bottom Up:
  Perry explains how stress and adversity during key developmental windows can permanently rewire the foundation of the brain, making later self-regulation, reflection, and learning much more difficult.

  "The brain develops from the bottom up and the inside out..." (32:54, Perry) "Sensory input...goes into the lower part of your brain, and there's an initial processing...then it gets up to the top part of your brain." (33:15, Perry)

• Timing and Sensitivity:
  Early life is when the brain's systems are most dynamic and sensitive to experience. Even brief stressors can have outsized effects if they occur at peak periods (11:55–14:21).

  "When is the brain most dynamic? In utero and early in life." (13:44, Perry)

• Trauma and Expectation:
  The brain creates fixed expectations based on early experience, defining how we interpret—and often misinterpret—later relationships and safety.

  "Once your brain creates this worldview, it acts as a prediction machine… It’s predicting that I’m going to be disappointed because people suck. And what will happen is you’ll get 3, 4, 5, 6 little examples of that… and then the first person that is rude to you or dismisses you, your brain goes, see? I told you so." (29:16, Perry)

From Neuroscience to Therapy: Rethinking Treatment

• Sequence Matters—Regulate, Relate, Reason:
  Before behavioral change or insight can occur, stress must be reduced and a sense of connection made—mirroring the three-level house model of the brain (05:49–06:59).

  • “You cannot take someone who's activated and tell them anything. Right. It's calm down, connect... then we can talk about behavior change.” (05:49, Taite)

• Customization over Rigid Models:
  Perry’s Neurosequential Model doesn’t mandate ‘one size fits all’ treatments but asks therapists to meet clients where they are developmentally and emotionally:

  "You have a higher probability of recognizing where you should start with your therapeutic work. Is it time to talk, or is it time to back off and kind of make sure there's co-regulation?" (38:32, Perry)

• Therapeutic Presence Over Credentials:
  Outcomes often depended less on techniques and more on the depth and consistency of relationships outside the clinic—such as time with a caring parent (55:38–56:42).

The Limits and Ethics of the System

• Low Ceilings, Untapped Ceilings:
  Sometimes progress is genuinely limited (e.g., severe genetic/developmental issues). But often, children and adults hit "ceilings" only because others stopped believing in (or investing in) their growth.

  "We don't always know what the ceiling effect is until we provide adequate, effective repetitions...and sometimes the win is to keep them stabilized." (41:11–47:44, Perry & Taite)

• Medical Economic Model—A Systemic Trap:
  Both agree the insurance-driven, diagnosis-focused system fragments care and undercuts real recovery, especially for the trauma-addiction overlap.

  "The DSM needs something, a code so that people can bill it. That's all it is." (22:56, Taite)
  "Our mental health systems are so overwhelmed and under-resourced that we’re not able to meet the needs of the majority of people that have trauma-related issues." (61:36, Perry)

Trauma, Addiction & the “Therapeutic Womb”

• The Trauma-Addiction Overlap:
  Trauma alters the brain's reward circuitry, making substances and dissociation more appealing; regulation and healthy rewards are necessary for change (64:46–67:36).

• Integrated Care is Essential:
  Separation of addiction from trauma or behavioral health ignores the clinical realities of patients, dooming many to be “bounced around like a pinball machine” (67:50–70:24).

Shifting the Healing Question

• From “What’s Wrong With You?” to “What Happened to You?”:
  The new framework, from Perry and Oprah, validates the individual’s past and reframes healing as a process of understanding, not blaming.

  "If you understand what’s under the hood, you’re going to be a much better mechanic..." (70:43, Perry) "What’s wrong with you puts you in the victim role; ‘What happened to you’ creates space and perspective." (71:50, Taite)

Practical Steps for Healing

• Prioritize Structure and Connection:
  Sleep habits, routines, movement, meal times, and being intentional about connection are simple but powerful steps toward regulation and health.

  "If you have external structure and predictability, that helps build in internal structure and predictability." (73:13, Perry) "Connect with a group of people who can kind of become your people." (74:27, Perry)

• Be Selective With Community, Especially Digital:
  Cutting ties with digital and in-person relationships that undermine self-worth is healing.

  "Getting rid of the digital community that makes you feel like you’re not enough. That’s the first step." (75:31, Perry)

• Grace for Imperfection:
  Aspiring to perfection in healing or relationships is unrealistic; instead, embrace rupture and repair as a central part of growth.

  "Relationships always involve a little rupture and then repair... this aspiration towards perfection—I think we need to just accept you can't be a perfect parent, supervisor, or therapist. Just keep learning, keep trying..." (76:42, Perry)

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Memorable Quotes & Moments

• On Old Wisdom and Modern Amnesia:

  "There are things that are so important about creating health and wellness that were integrated into cultures for centuries, that we've lost." (07:57, Perry)

• On the Power—and Danger—of Early Experience:

  "Dynamic systems are much more sensitive to experience... When is the brain most dynamic? In utero and early in life." (11:55; 13:44, Perry)

• On the Self-Fulfilling Prophecy of a Traumatized Brain:

  "Once your brain creates this worldview, it acts as a prediction machine... and then the first person that is rude to you or dismisses you, your brain goes, see? I told you so." (29:16, Perry)

• On Systemic Failures:

  "You bounce around like you’re in a pinball machine and nobody wanting to literally create sustained, invested help." (69:21, Perry) "There’s so many bad actors in my field. It’s really the economic driver that is doing this." (63:01, Taite)

• On Hope, Grace, and Incremental Change:

  "Give yourself a little grace and remember that relationships always involve rupture and repair. Get back in the game, keep learning, let people teach you..." (76:42, Perry)

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Timestamps for Key Segments

• Opening and Relevance of Relationships in Healing: 03:06–04:34
• Understanding Trauma’s Impact on Brain Development (the three-level house, regulation/connection/thought): 05:49–06:59
• Personal Roots: Perry’s Scientific Journey and Family Influence: 15:03–19:54
• The Sequence of Healing—Regulate, Relate, Reason: 32:54–36:14
• Case Example—Ceiling Effect & Systemic Failure: 41:11–47:44
• Rewards, Regulation, and Addiction: 64:46–67:36
• Integrated Treatment & Systemic Flaws: 67:50–70:24
• Shifting from “What’s Wrong With You?” to “What Happened to You?”: 70:24–71:50
• Practical Steps for Healing and Cutting Out Toxicity: 73:13–76:10
• Embracing Imperfection and Grace: 76:42–77:37

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Final Thoughts

Dr. Bruce Perry and Richard Taite deliver a nuanced, compassionate, and brutally honest conversation on trauma, healing, and the failings—and hopes—of our mental health and addiction recovery systems. Their exchange is packed with science, personal stories, and practical wisdom for clinicians, parents, survivors, and anyone interested in how we might build a more connected, humane future.

For more, visit Dr. Perry’s work at the Neurosequential Network: neurosequential.com (78:01)

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Transcript

[A]

You get a number of experiences where you're sort of the balance of good starts to overcome the experiences where people didn't weren't there and they did let you down and they kind of disappointed you. It's a lucky person that has that relational catalog that allows them to then take advantage of the people that want to help you in the future.

[B]

If someone has a problem with substance use disorder, please call one call placement. That's 888-831-1581 and if we can't help you, we'll make a referral to someone who can. One call placement is affiliated with Carrera Treatment Wellness and Spa and One Method Treatment Centers. We have someone very special here today. Dr. Bruce Perry is one of the world's leading experts on childhood trauma, brain development and resilience. A psychiatrist, neuroscientist and clinician with over 40 years of experience, his work has transformed how we understand the lasting impact of of abuse, neglect and adversity and how healing actually happens. He is the principal of the Neurosequential Network and the creator of the Neuro Sequential model, a brain based approach to therapy, education and caregiving now used in over 26 countries impacting millions of children and families worldwide. Dr. Perry is the co author of the Boy who Was Raised as a Dog with Maya Salavitz, a best selling book built on real clinical cases that reveal how trauma shapes development and how connection helps repair it. A newly updated 2026 edition of the book is being released bringing fresh insights and relevance to to a new generation. He is also the co author of the number one New York Times bestseller what Happened to you with Oprah Winfrey which has spent over 100 weeks on the bestseller list and helped bring trauma informed thinking into the mainstream. Dr. Perry has consulted on some of the most high profile traumatic events in modern history including the Waco siege of Oklahoma City bombing, 911 Sandy Hook and major global disasters. Bruce, it's an honor to have you with us today. We just had Maya Salavitz on the show last week. You and Maya have an updated 2026 edition of the Boy who Was Raised as a Dog coming out. What feels most important or newly relevant in this edition for today's world?

[A]

You know, it's, I think as Maya probably taught this, the book has kind of long legs. It's got a long shelf life. We wrote this 20 years ago and the real focus of the book and in all of the iterations since has been the importance of relationships. And I think, I think in this modern era where we're all so screened up, so to speak, that the importance of being with somebody in relational interaction is as important or probably more important than when we wrote this 20 years ago. And I think that that's something that we. I think a lot of people are becoming aware of this and we're struggling with how do we act on this at the same time that we take advantage of some of the new technologies that also have some benefits. And the key, of course, to a lot of this stuff is moderation and balance. And I think that that's the important thing about the book is that it re emphasizes the power of connection and the importance of integrating quality relational time and space into all of our systems and everything that we do. Parenting, education, mental health, and so forth.

[B]

You know what's funny is it does have legs. This is tried and true, and it's almost embarrassing because it should be common sense, right? I mean, absolutely. I mean, I'm the guy who talk. I'm the blame the parent guy. But only to the extent. No, no, no, no. Only to the extent that. And I think we're aligned in this. First of all, we're the most aligned thinking of anybody I've ever been around. Okay. But I want to know where I get it wrong. Okay. Because I'm the blame the parent guy. But only to the extent that you didn't get your basic needs as met as a child. Right. And then. So I'm all about that. I mean, I've been doing this forever, right? Treating addicts and alcoholics. I don't treat people with substance use disorder. Okay, but that's another story. But what you deal with with the major abuse of these kids, I mean, just unthinkable. I mean, you think about it too long, start to well up, right?

[A]

Yeah. That's brutal to not Brutal to not

[B]

expect these people to move on into addiction is unreasonable. And what I loved about your. Your process is it's like. And I think I read this. I don't think I'm smart enough to come up with it on my own, but I think it was like a three level house, right? And it was survival, and then it was emotional connection, and then it was critical thought. And the beautiful part, and this is why it's so common sense and why really I've been doing this forever. And you know, I talked to Patricia, my, my clinical director before I got on this, and she said, oh, yeah, Bruce and Danny Siegel are what our program's based on. Right. So it's. That's why it appeared to me as common sense, how you cannot take someone who's activated and. And tell them anything. Right. It's calm down, connect. Right. And then we can talk about behavior change.

[A]

Yeah. You know, and the interesting thing that you said earlier is that when we talk about some of these things to experienced and insightful adults of all sorts is just kind of obvious. I mean, it's. They have learned through experience that if they want to be an effective leader, they need to have an environment where there's a sense of safety. Right. People aren't going to hear me if I'm angry and threatening. Good coaches, good teachers, grandparents. I mean, I can't tell you how many times I've had the experience of giving a presentation, a public presentation, where it's kind of an interdisciplinary audience and the public's invited, and afterwards a grandparent will come up to me and go, but we've known this forever. I know, I know. I'm like, I'm sorry. I know it's embarrassing. You're right. You have known it forever.

[B]

Do you tell them that the population got dumber?

[A]

Well, we forget. That's an important point. We do forget. There are things that are so important about creating health and wellness that were integrated in multiple cultures for decades and centuries and so forth that we have seemed a lot. We've lost. I mean, one of them is the power of relationships. You know, that the. The power of having meals together, the importance of rituals and routines to bring some sense of predictability to our week and to our month and to our lives. All of that stuff helps us all feel safer. And when people feel safer, they have access, as you. As you pointed out, to systems in their brain that allow them to be reflective and to be creative and to think about the future as opposed to being more reactive and focused on the immediate moment.

[B]

So you've spent your entire life studying trauma and the brain. What first made you realize how much early experiences shape who you become?

[A]

Well, it's interesting, kind of hearkening back to what I just said is that I think if you're a good observer, you pretty much begin to connect the way somebody is acting right now to something that happened beforehand. And, you know, I remember even being a kid and we. We had some friends that were, you know, they were bullies. But then we would see their parent yell at them and scream at them and, like, they wouldn't put their bike away, and they would just, like, get literally to the point where some of them would. And then I would look at my best friend and we Kind of go, that kind of makes sense that he treats us that way. Right. Because that's the way he was treated so early on, you just. I think if you observe behavior and you're curious about it, you begin to see it. But the real, for me, the real point where I realized how powerful early developmental experiences are was when I was a freshman in college, I was in a freshman seminar, and there's kind of a pioneer in the neurosciences guy named Seymour Levine who was studying how early life stressors that were very brief influenced the development of systems in the brain involved in the stress response. And some of these experiences could be up to minutes long. And if you. That was the only difference between one group of animals and animals that were stressed, they're stressed for five minutes at the right time in early development, their brains would be very different as young adults and they would function differently. And I just kept thinking, wow, that's a powerful leverage point. And then once you start to learn about sort of the neurobiology of development, it makes sense. You know, this is you've got these incredibly rapidly moving systems that, you know, you're making millions of new cells within, in a minute, you know, in utero. And after, in the postnatal period, you've got literally hundreds of thousands of synapses that are waiting for certain activations to decide, am I going to really connect? Am I going to stick or am I going to resorb? And so all of these kind of micro architectural processes were, as I was learning this, they were very sensitive to these experiences that were very brief.

[B]

Yeah. Depending on the impact. Right. I mean, if the impact is big enough, then it doesn't matter the duration. And it would seem. And that's why they talk about. Or it's. If it's hysterical, it's historical, right?

[A]

Yeah, yeah. And the thing for me that I. Again, you know, just maybe this is because I'm a weird thinker, but I just kept getting reminded in different classes I was taking, physics and chemistry and biology, that a major determinant of the impact of a period of time or an experience was whether or not the system itself was rapidly moving, had a lot of energy in it, actively moving, or whether it was slowly moving. And the example that I think most people can connect to is the difference between water and liquid form, which has a certain amount of energy. And if you want to move water molecules 6 inches, you just can push it, put a little bit of energy into it. But if you, if you sort of went on water, you couldn't really move it six inches. But if it was in gaseous form, if it was fog, you go a little bit of energy and it goes that six, you know, it'll go six inches. And then when it's slowly moving. So when it's a gas, it's moving more than when it's liquid. But ice is liquid. It's water, but it's not moving at all. The molecules are not moving. And it takes a lot of energy to move that six inches. And so when you understand that dynamic systems are much more sensitive to experience, and then you look at when is the brain most dynamic? When is the most change happening in the brain of a person? In utero and early in life. Right.

[B]

I don't know. When is it?

[A]

Yeah, it is early in life. Yeah. You make like right now, you probably on a good day, somebody our age. Well, my age, we're the same age.

[B]

Go on.

[A]

Yeah. Well, you will make maybe a few hundred cells in our brain. Maybe a few hundred, if we're lucky, if we kind of are active in the brain of a third trimester fetus.

[B]

Oh, okay.

[A]

There'll be a million cells made in five seconds.

[B]

Okay. Right. I was talking about when you're alive. Doctor, when you're alive. What age? Like is it infancy? Is it toddler? Where, where are we? It's got to be infancy.

[A]

The younger you are, the more active the dynamic processes. And as you get older and older and older, the, the dynamic activity changes. It's a little bit like imagine all of the energy and effort going into building. Let's say you were remodeling an entire block in an urban environment. You're going to build a bunch of skyscrapers. In the beginning, they're scurrying, scurrying, scurrying. Collecting things, collecting things. Build, build, build, build, build, build, build. And then five years later, the only thing that really changes. Oh, you know, redecorate the fourth floor. You know, you just bring in a little bit, a little furniture. But it's, the activity's nowhere near as much as it was when you were building the infrastructure for the building.

[B]

Your path wasn't traditional. Amherst, Stanford, no degree then into a top MD, PhD program. What did you believe about systems at that age that made you bet on yourself like that? Because we are about the same age and we could probably get away with that back then, but that don't fly today.

[A]

Right, right. I, it's interesting. I'm trying to think. I, I now I haven't thought about this for a while, but Man, I had all of my friends and my family telling me I was stupid to do some of this stuff. And I. I don't know, I just. I just thought, listen, you know, if I'm really going to learn something about how things work, I need to become a scientist. And. And I, like, I want to be a physician, so I need to take this crazy pathway. I'll never forget. I mean, the. The formal department that I was in was pharmacology. They don't really have those departments much anymore, but that's where a lot of the neuroscience was taking place. And I came back and I. It wasn't actually an MD PhD program. I took a leave from. Absence from medical school and said I need to go become a scientist and get my PhD. So the medical school was great. You know, they were very supportive. My family was like, my mom said, why do you want to be a pharmacist?

[B]

Right. Because it's not a real doctor. You're Jewish, right?

[A]

No, I'm Presbyterian. But she had that same thing where

[B]

they beat you with a stick if you're not a lawyer Doctor.

[A]

Yeah, well, that's. That was sort of the expectation. It was. Anyway, she. But she. I was like, mom, I'm not going to become a pharmacist. You know, I'm not going to open, you know, go work at Walgreens. This is actually studying how nerves work. And. Oh, took me. It took her a while to figure it out, but ultimately they were supportive.

[B]

But that's such a romantic path, isn't it? When you look back at it, there's a romance to that, isn't there?

[A]

Well, you know, I used to go back and I would get. I got into my 30s and all of my friends had jobs and were, you know, like. And I was just. I'm still in school. It was embarrassing.

[B]

Yeah, well, at 32, I was on the corner of Crack and Pipe street, so. Don't worry about it. You were doing great. I would have given. My parents would have given anything for me to be in school.

[A]

Yeah. Yeah, well. And I. So I was just lucky. I had a lot of people that were very supportive mentors. I had, you know, I had had one mentor, sort of my major mentor in science was kind of, you know, they have these academic pedigrees. He was that one of Solomon Snyder's first postdocs. And you may not know of Solomon Snyder, but he was like, a pioneer in psychiatry and neuroscience. And he, along with Candace Pert, discovered the opiate receptor. And. And he had worked with Julius Axelrod, who got the Nobel Prize. So there's this very sciency pedigree that I was part of, and the person that David U. Pritchard, who's passed on now. But he let me kind of do what I wanted to do. In fact, I. When I was doing my dissertation and I was accepted into his lab, I didn't know him very well. He came up to me for maybe the first week I was there. He came up to me once and he sat down and said, listen, we just got this new compound. I think that it binds to alpha 2 receptors. Can you find out how, if that's true? And then he left. I didn't see him for like a month. And I'm like, what are you talking about? I don't even. I don't have any idea what you do. I don't even know how to. How to. Where the test tubes are. It was unbelievable. I was completely left to my own. And that style of supervision, I just stumbled through and figured stuff out. And I. You know, I would call people up, and they were very patient, actually. And. But David knew that, you know, if I figured it out myself, I would be able to be more independent. And so because of that, by the time I got my PhD, I'd published a ton. I'd had the opportunity to. I felt so much more comfortable leaving my comfort zone, trying something new, failing, going back, kind of figuring it out again. And it really made me a much better thinker. And it. It reminded me of how important during growth and development it is to fail. And it just. It's so important.

[B]

Do you know how lucky we were growing up at the same In. In around the same time, to where people would just throw us in the fire and say, sink or swim. There's a. There's again. I hate to bring up the word romantic, but there's such a romance to that. There just.

[A]

Is. It just.

[B]

I love that.

[A]

Yeah. And. And I was very lucky that. That I had. He was a great supervisor in that regard. And then I had this like, True Confessions, but give me the gay.

[B]

Hey, this ain't the normal talk show, dude. Let's. Let's get in here.

[A]

Sort of. I don't want to say antisocial, but I just had a really hard time with authority. So even in, like, in. In high school, you'd get. You know how they used to give you your reading assignment and then you read this for the class? And it's like, I never read, but if the lecture was interesting, I go back and read It. I'm like. It was sort of like, proved to me that I should waste my time on this chapter. And I just kind of maintained that whole skeptical perspective in medicine. I think it really helped me in psychiatry because psychiatry, the. That they were spoon feeding us. It was terrible, you know, the way they were just. Even the, the, the. The concepts about how to cluster people into.

[B]

But you know what's great about that. What's great about that is it's not. You just separated the wheat from the chaff, Right? So you had. I don't like the looking at it as you didn't pay attention or you were obstructionist or whatever. I like the fact that you are intellectually curious about something that you cared about. And the rest of it was just like, this is nonsense. You didn't even have an ear for it. You didn't want it in your consciousness. You heard it. It was stupid. And you're like, okay, let's. Let's figure this out.

[A]

That's kind of what. That's kind of what happened. I mean, I just was. It didn't make sense to me, you know, I mean, I. Coming from being trained as a neuroscientist where there's like 86 billion neurons, and we would have these little studies where we were working with what are called monoclonal cell lines, which are all genetically supposed to be the same with just one cell type from the brain. And we would have incredibly challenging studies where we were trying to control for all the variables that influence how this one cell type changed. And then I thought, how is it that with 86 billion neurons, you go into a pediatric mental health clinic, you've got 85% of the kids have one of four disorders that just seemed bizarre. It's like, that just doesn't make sense to me. And I tried to kind of understand the rationale, but over time, I'm like, that's kind of circular thinking.

[B]

Do you want to hear. Do you want to hear the rationale? Since I'm on the ground? Okay, yeah.

[A]

What's the rest?

[B]

The DSM needs something, a code so that people can bill it. That's all it is.

[A]

It's the medical economic model. Yeah.

[B]

On my life. That's all it is. There's a new. There's a new disorder in every edition. Multiple. It's bizarre. Okay. Started with Restless Lang syndrome, by the way. All right. What actually happens in a child's brain when they experience neglect or abuse? And how early does that start?

[A]

Well, part of what we've been trying to figure out, and as have a lot of other people, is how the timing of experience makes a difference on how things impact the developing child. And so let's start with sort of abnormal, excessive patterns of stress. So let's say that you have some experience where your stress response system gets activated to really high level and it stays that way for a long period of time. If that happens in the first couple months of life when your stress response neurobiology is developing, that has very different impact on your whole body, including your brain, than if you and I had a comparable experience at our age.

[B]

All right, well, let's, I mean, let's, let's break that down for a second because I, I want to get, I want to get my head around that. So how could that be caused at that young age? Letting someone cry themselves to sleep where they just can't self soothe for hours? Not getting breastfed? What, I mean, no one's hitting the baby.

[A]

I mean, that's the sad thing, unfortunately. Sometimes people are, you know, it, it's when it, when you're an infant and you're hungry, you will cry out. And that's kind of the infant's variation of the fight or flight response. You know, come and feed me or fight for me or flee with me. But if nobody comes, then you basically will cry, cry, cry. And, and there's something in you that figures out this is not working. So I need to use other adaptations. And you will kind of flip into a different physiology, which is more of that disengage from the external world, internalize, dissociate, you know, sort of do what you can to protect yourself. So with the, the dilemma is that right after you're born, when your brain is still undeveloped in many regards, it's trying to figure out what the world is going to be. And this is one of the great gifts of the human species is that we have incredible malleability. You know, we can be born into dozens of different kinds of cultures with different parenting styles and still be healthy, productive human beings. We can tolerate lots of different kinds of climates. You know, that we're just incredibly adaptive. But the key to that is that we make these really important construction decisions based upon the signals we get when we're really early in life. Like your brain goes, all right, am I going to be in a world that's going to be consistent and predictable? And when I express a little bit of need, I get fed or I get warmed up or I, you know, my, my fundamental stressors are, are moderated by my external Stress regulator or am I going to be on my own? You know, and these human, these things that come around that ultimately I come to know as human beings, they're kind of there, they're not to be trusted. If you get too close to them, they might hurt you. Sometimes they feed you. It's kind of crazy, but I don't really know what to make of all you human beings. And so you develop different neurobiology.

[B]

All right, so what do you do, Doctor, what do you do when, when you've got a five year old, okay, running a 45 year old man, okay, because that's what's, that's what's really happening until, you know, you know, you're, you're traumatized. You've just, you've compensated for what's going on around you, right? And then there's one more disappointment after the next beating, after. And they keep getting reinforced. And pretty soon you're a piece of shit, okay? And you're 45 years old and you have no idea why, right? And that goes back to your genius, which is don't ask what's wrong with you. Ask what happened to you. Because at a certain point, once you get the whole picture, then, you know, after you calm them down and after you connect, now it's about, okay, let's get this thing handled here. Let's, let's have a, let's behavior change here. You know, you've been lying to yourself for 40 years.

[A]

Okay, Richard? You know, one of the hard things there is that that one of the major kind of neurobiological mechanisms that our brain uses as we develop to make sense out of the world is it creates expectations. It kind of creates a set of experience from the experiences we have. It creates your internal worldview. Right? So those two examples I gave you of a child who's got inconsistent relational stuff or consistent, predictable. One worldview is that human beings are decent, predictable. They'll meet your needs, give them a chance. The other one is people are like, cannot be. You cannot trust them. Don't let them get close to you. Intimacy elicits threat. The dilemma here is that once your brain creates this worldview, it acts as a prediction machine. And so your brain goes into the world with an expectation of what it's

[B]

going to meet and it's self fulfilling.

[A]

Right, exactly. It's predicting that I'm going to be disappointed because people suck. And what will happen is you'll get 3, 4, 5, 6 little examples of that. That was nice. That was pretty nice. They didn't suck. They didn't suck. And then the first person that is rude to you or dismisses your brain goes, see? I told you so.

[B]

That's right.

[A]

And that's the problem with this. These early experiences are what create that worldview.

[B]

Which one were you, door number one or door number two?

[A]

I think I was pretty much door number one. You know, that people are pretty predictable, pretty consistent. Yeah, I was lucky. I mean, not everybody in my life was like that. But I think collectively. And again, this is kind of back to our earlier point about sort of the importance of relationships and the risk right now in the modern world, where we have kind of relational poverty everywhere. But, you know, my mom wasn't perfect. My dad wasn't perfect. My granny wasn't perfect.

[B]

Because that's why you were empathetic to when the kids were bullying. Right. You or your friend, and you could sit back and look at it and go, wow, he don't have parents like mine. I get it. He's okay. That's. That's why they're. Your parents are great. All right.

[A]

Yeah. That's right. And then. But see, the. The wonderful thing, human beings, we're all incomplete. We're all. You know, none of us are great at every developmental age, in every interaction, but collectively, you get a number of experiences where you're sort of the balance of good starts to overcome the. The experiences where people didn't. Weren't there and they did let you down and they kind of disappointed you. And it's. It's. You know, it's a. It's a lucky person that has that relational catalog that allows them to then take advantage of the people that want to help you in the future.

[B]

I have to ask you a personal question. I have to keep interrupting you because I just can't help.

[A]

That's all right. Sure, sure.

[B]

Personal question, because I'm a father, right?

[A]

Yeah.

[B]

I just wanted to know, did your parents live long enough to see who you became?

[A]

That's a. That's a great question. And they did. They did. Which was great. You know, it was. It really was. It was. It was good because in the beginning, you know, they didn't quite understand my career trajectory, but over time, I think it. You know, it made sense to them. So I was. I was lucky. I was lucky in that regard.

[B]

How proud were they?

[A]

Pretty proud. They got it.

[B]

Did they get it?

[A]

You know, it's funny. I think. I don't. I think they got different parts of it. So, like, when I was.

[B]

But they didn't get the Full Monty.

[A]

No, no, they didn't get it. I mean, it's so funny, because when I wrote the. That, as you know, from Maya, the title of our first book was the Boy Is Raised as a Dog. And so I'm telling my mom I wrote a book, you know, and she

[B]

thought it was a children's book.

[A]

Well, she thought it was about me talking about how they raised me as a dog. And I was like, mom. She's like, why don't you do that? We never were mean to you. I said, mom, it's not about me. It's. It's about somebody else. I mean, it's. Anyway, it was pretty funny.

[B]

That's so great. That's so great. All right. You said the brain develops from the bottom up, but how should it change the way we treat people?

[A]

So, you know, you mentioned earlier, you know, the ability to talk to people that are not, like, neuroscientists about stuff. And one of the things that I failed at miserably when I first started sharing our work was communicating clearly what we were, what we're doing.

[B]

Right. And.

[A]

And so over. Over the years, you kind of develop what we call heuristics or sort of models to capture some of these concepts. And there. And within, you know, whenever you summarize really complex stuff, there will be some distillation, distortion, inaccuracies. And that's just the reality. And so it is true that the brain develops from the bottom up and the inside out and the. I think one of the things that's so important about that is that as you look at how the brain is organized from the bottom to the top, that there's a mirroring quality to the way we experience the present moment. Because sensory input, what you see, what you smell, what you touch, kind of what you and I, right now in this moment, as we're trying to interpret this and make sense out of it, the first place that all of the sensory input goes is to the lower part of your brain, and there's an initial kind of processing, and then it gets passed into the middle part of the brain, and then it gets up to the top part of your brain. Now, the. And this kind of recapitulates that developmental process that, you know, you organize lower and then middle and then top ultimately. So the. The challenging thing about that for human beings is that if you look at where the networks in our brain are that are involved in kind of reflection and cognition, and kind of the most human parts of what we do, they're not in our brain stem you know, the lower part of our brain kind of is in control of relatively simpler, more primitive functions like regulating your heart rate and blood pressure and so forth.

[B]

And fight. And fight and flight.

[A]

Right.

[B]

And freeze.

[A]

The, the initiator of the fight and flight response, right, is lower in the brain. So. And in addition to that, the part of your brain that can tell time is up at the top. So when sensory input comes into that lower part of your brain and it's matching the present moment against what it's already stored. What's similar to this? Right? Your brain kind of goes, what's similar to this? How do I interpret this? Am I safe? Am I under threat? Is this a good thing? Is this a bad thing? That process is not informed by the capacity to reflect on previous experiences.

[B]

So the, the, the, the. The cortex is not talking to the brainstem.

[A]

Well, it does talk to it, but there's a time delay. There's a time delay, right?

[B]

Passing through the midbrain on the way to the right.

[A]

You have to go through. Right? You have to go through a couple synapses before your cortex can go, oh, this feels like getting yelled at when you're four years old. But I'm 40 years old and I'm in a workplace.

[B]

That's excellent.

[A]

But because the lower part of your brain is able to act on that information before it even gets to your cortex to get interpreted accurately, you may go you to your boss.

[B]

So you're doing this when you're getting yelled at, and if you're reactive, you don't even get to feeling it and then acting on it, right? You just don't even get there.

[A]

Right? You act before you think.

[B]

Great, that was me 20 years ago.

[A]

Such an interesting thing about the way the human brain is organized is we have all of these.

[B]

How long has it been, doctor? Since you've been acting. Since you acted that way? For me, it's been 20 years. Okay, 15. I was lying this morning. That's awesome.

[A]

No, we just. But this is what happens is that that ability to have access to your cortex, it's fluctuant, right? So if you're hungry, sleep deprived, you act less mature. And if you're hungry, if you're. If you're not hungry, you're not thirsty, you're not cold, you know, safe and familiar environment, it's your office. You know what to do.

[B]

You.

[A]

You know what the sort of the routines are. You can look smart, but if you go to a new office, it's a new job, you know, and you don't really know what's going on. And this is your new boss, and they ask you a simple question. All of a sudden you find yourself having a hard time retrieving stuff that you've known for years, and so you kind of stumble it out kind of inaccurately, and you go, oh, well, I start instead of being fluid and articulate and comfortable. You sound like you're a rookie.

[B]

You're unsure, right? You're unsure. You're in a new place. It's. You're not quite safe. You're not good. Yeah, good at a high level. What does your neurosequential model get right. About healing that most approaches miss?

[A]

I think that the value of that. Of that approach is that you have a higher probability of recognizing where you should start with your therapeutic work. Is it time to talk right away, or is it time to back off and kind of make sure that there's a sort of co. Regulation. Regulation. Do you want to walk and talk, or do you want to sit across from somebody and talk? Can you jump right into it and get into this emotional content, or should you use rhythm and regulation and other things to kind of help somebody get regulated that, you know, open up their cortex so they can have access to all that stuff that you really want to work with?

[B]

Yeah.

[A]

You know, the thing that's so interesting about the brain and the way the brain makes. Kind of creates your personal sense of how the world works and your personal sense of yourself is that it's most unique at the top part of your brain. Right. So if you could look at, you know, the way our mind and our. In our brain work compared to other people, the higher you get in the brain and did this analysis, the more you'd go, oh, unique, unique, unique, unique, unique. Everybody would be absolutely unique. And then you start to kind of get into the lower parts of our brain and go, all right, well, the way human beings manage emotional stuff is, you know, we have a few tools in our toolkit, and it gets less unique. And then you get all the way down to the brainstem, and you look at something, some function. Like, we don't have a lot of unique ways to regulate body temperature. You know, we're all pretty much 98.7. And so the range narrows. Right. You know, there are some people that run a little warm, some people run a little cool, but it's pretty narrow. You can't have a huge range and variation. Whereas if you look at the cortex, there's a huge range in variation in language and, you know, understanding of history and capacity for reflection. And that's the cool thing, is that, you know, the human beings are remarkable creatures, and the cortex, which is the most uniquely human part of us, is where we are able to demonstrate the most unique diversity from person to person

[B]

in 40 years of this work. What's a case where your model didn't work the way you expected? And what did that teach you?

[A]

Yeah, you know, it's. You know, one of the things that we try to get some understanding of is what was the developmental trajectory to this presentation? You know, is this genetic? You know, are you having struggles with relatedness? Because there's some genetic or neurodevelopmental thing that we don't understand? Were there intrauterine factors? Were there sort of experiences that were traumatic, Et cetera, et cetera? So we developed this kind of a roadmap of the developmental history that gives us a clue about what we might see. And there are some individuals that we've worked with where there was essentially a ceiling effect. And what I mean by that is that, for whatever reason, we could not provide any kind of plausible experience that will seem to be able to change the functional capability of that certain domain of functioning. And most of that has happened with kids that have some kind of developmental issue, like maybe severe autism or some intrauterine hypoxic event where they just don't have the. The raw material to change. And so one of the things that. That we've seen is that we don't always know, Even if we get a good history, we don't always know what the ceiling effect is until we provide adequate, effective repetitions to activate whether it's a motor or emotional or a social or cognitive area with sufficient intensity and duration to see progress and see change. And there have been a number of times where we've run up against a low ceiling. Now, the interesting thing about that is that what has happened with many of these kids is that because of the. The label, that they have some neurodevelopmental problem. Yeah. People have stopped trying to find that ceiling. Right.

[B]

That's disgusting. Go on.

[A]

And that. But. And again, one of the classic examples from the history of kind of mental health service delivery is what the way we used to treat children that had down syndrome is like many, many years

[B]

ago when I was on the face of the earth, by the way. Go on.

[A]

Yeah, I mean, in there, and. And many pediatricians used to. And physicians and mental health people would just tell families they're better off in an institution because they're scared have you

[B]

ever met a more happy, loving person in your life than someone with down syndrome?

[A]

Yeah, they're so, they're sweet and actually many of them are very, very bright, very, very creative. They do wonderful stuff. But what happened, and this is so classic of the way, of the way things happen in medicine, is that it became a self fulfilling prophecy that people started to say that if you have down syndrome, you have a low iq. And that was because they were, the vast majority of them were put in settings where they weren't given any stimulation.

[B]

That's right.

[A]

And so what happened was it was this really terrible cycle of families struggling. What should I do? Getting recommendations to send them to the state institution for kids that have neurodevelopmental problems. And then these kids wander around without any stimulation. Education, social opportunities and social forth. And so they, they don't have. Their potential is never expressed in ways that would show what they really can do.

[B]

Isn't it sad? Isn't it sad?

[A]

It's heartbreaking.

[B]

It's heartbreaking. And what else is sad is the fact that a lot of these neurodivergent kids are so gifted in other areas. They're just challenged in certain other areas. And it's actually a gift. It's not a, it's not a curse, it's a gift. Okay. Interpretation is, is, is not a gift. That's the opposite of not a gift.

[A]

And, and one of the nice things about this model that we've seen so many times is that when we run into kids that have kind of been put in that category of, you know, they've got some neurodevelopmental problems, so why try?

[B]

Yeah.

[A]

When we actually start to give them opportunities, we see tremendous growth. And now there might be some area where that just something just doesn't change, but everything around that function changes. So they may not be the best at some sort of mathematical problem solving thing, but they develop good social skills and they develop an ethic about I want to be on time and I want to work hard and I want to be a good employee. And you're like, wow, that's way better than somebody who knows math and just doesn't want to work. And so this is something that we, we kind of run into a lot of this with kids that end up getting labeled low fetal alcohol.

[B]

Do you know it's, do you know what's the saddest to me though? Talking about the ceiling and the floor? The saddest is when I walk into my treatment center, right. And I've been Involved in a case, and they're not getting better. Right. And I just lose it. And I remember once going to my clinical director, and I was screaming at her, I was like, why the is this person not getting better? Right? I mean, just talk. I mean, okay, so it wasn't 15 years ago. It was, you know, three years ago. All right, Okay. A year and a half. You know what? The longer I keep talking, It'll be like 10 minutes ago. Right?

[A]

During this call.

[B]

During the call, for sure. During the call. But she explained it to me, and she said, babe, sometimes the win people are so sick that sometimes the win is to keep them stabilized. Yeah, to where they're not getting any worse.

[A]

Exactly.

[B]

Get any better, dude. When I heard that for the first time, I'm thinking about it now, I'm about to fall apart. Because if you're anything like me, and I think you are. You think you can fix anything, and so can I. And it's. And when I can't, it drives me insane.

[A]

Yeah, you know, we. One of the things. It's funny because we talk about this a lot because we do work with really challenging populations, and some of the organizations we work with have very limited. Have lots of constraints on the duration of time they can help somebody or the way they can help somebody. And it's kind of heartbreaking for the people doing the work because they know if they had more time or more opportunities, they could see this progress. But I. I just. I do think that. That the lesson of treading water is really important. You know, when you're shipwrecked, you know, you tread water, and if you don't, you're not getting anywhere for yet. But you know what? You don't know which way to swim because it's still dark.

[B]

It feels like kissing your sister.

[A]

Yeah, it may feel like that, but I. I actually like treading water. I think it's good for people to actually not deteriorate. So many of them have a history of failing and failing and failing, of course. So I always try to tell the people, the teams that I work with, that, listen, be patient with them. They're ultimately going to. When the sun comes up, they're going to realize, I need to swim to that island or that island or that island, which one is closest.

[B]

That is a big tread water.

[A]

And until they find a direction, it

[B]

reminded me of something that came up for me. And you're right about that, because I was getting defeatist. And I just remembered one good case. There was one case that was sent to me Believe it or not, Katie Couric sent it to me, okay? And it was for some show. I had no intention of dealing with the show, but I wanted to help the person. And this woman came in. She was brutally abused sexually for years from 14 to 18. She came in and she could not speak. She wouldn't speak. And. And I walk into a clinical meeting. Now, I only went to four a year. So this was a complete accident, okay? I don't micromanage these people. They're. They're way better than I am, okay? And I walk in and I listen to this new therapist. I didn't even hire him, like, maybe the first therapist I personally never hired, right? And he's sitting there holding court, and he's talking about how this woman needs a higher level of care right now. I'm not the same guy I was then that I am now. That felt like the height of disrespect to me at the time. Right? I mean, it just felt disrespectful because I put so much love into this place. Place. I used to call it a love call. Right? And there was nothing we couldn't handle. We are the best level of care that we are going to love this person. Okay? Well, that's what we're going to do, right? And I remember telling this guy, after listening to this, I looked around and I said, is there anyone else in this room that feels this way except for they all know me? So they're like, nope, just that guy. And so I had him go get his check, and I told him he wasn't one of us. Hand to God on my life. The girl spoke the next day. She spent six months with us. She is now a nurse practitioner going to school to be a doctor. And she had two twins, one Mason and one Tate. Thanks for that. Took me a while to remember the good. Okay.

[A]

Yeah.

[B]

You say the relationship. Sorry. Man, I'm such a. I'm so damaged. From all the bad stories that I've heard, it's just like you can't even be a normal human being anymore. I'm so damaged. Does that ever happen to you?

[A]

Yeah, there are moments, absolutely. I mean, I have just been so fortunate that the nature of my work is such that when I get close to the edge, I can go right? Or I can go do research, or I can do other things that kind of feed our organizational mission without sort of being so overwhelmed by the clinical work, which I couldn't do clinical work all the time. It's just so hard. Yeah, it's so hard.

[B]

You say the relationship is the therapy, but have you ever sat with someone so dysregulated that your presence actually made them worse, not better? I know the answer to that.

[A]

Oh, yeah. Oh, yeah? Yeah. I mean, I, I. One of the things that we actually kind of moved us more intentionally down, kind of looking at relationships more carefully was when we were, I don't know, this must have been 25 years ago, we were beginning to believe our own press clippings that we were so good. Oh, yeah, we know trauma. We're so good. And of course, I also had a lab where I was, like, studying, like, real sciency stuff. And then I just sat there in the afternoon listening to people talk about our clinical programs. And I said, you know, we should actually prove that we're good. Let's see what happens to these people. Are we really tracking that? And it turns out that we were not as good as we thought we were. And the most interesting thing was this. And this is, I think, the experience of a lot of people that do clinical work. A very significant percentage of the people that came to us were lost to follow up after 4, 5, 6 visits, they just kind of disappeared. We have no idea whether they got better or worse. I. That's not a great statistic. You know, I'm not.

[B]

Well, that's not. I, I want to interrupt for a second. That's not, that doesn't mean anything in my world, because. No, but if you went into five successions, you can't expect to get better, right?

[A]

Well, and you know that that's not unusual for, like a public mental health clinic.

[B]

Happens all the time.

[A]

Yeah, exactly. So then the people that were, that we looked at, that got better, we started to, you know, we had all this data and I'm looking at. All right, is it diagnosis? Is it the therapist? Is it the combination of therapeutic. We could not find any correlation because there would be some clinicians, they would have clients that just made no progress. Some made a lot of progress, A few got worse, actually. And, but there was no pattern. And so finally I just plugged in zip code, and it turns out that the further away from our clinic, the better they got.

[B]

Wait, wait, you gotta explain this to me. I don't get it.

[A]

I will, I will, but. And I just thought, what the hell is this? Some weird pheromone thing? I mean, it's like we make them worse if they get close to us. And then I started to, I did, you know, of course, the unheard of. I actually talked to them like, why do you think that is? You know, what do you do? What happens when you come and see us? Turns out, not all, but a lot of a majority of these kids were being driven to the clinic by a parent. And because it was far, they would get out of school early, they'd have some special time with the parent. They. Because it was towards the end of the day, they'd, like, go have a meal together and they'd drive home. It was all the time with the parent. It was special time with a parent. In parallel, not face to face. Tell me how your day was. It was in parallel. And these kids would talk much more and they had this special time with their parents. And that turned out to be the most important thing.

[B]

That's beautiful. Even if they didn't talk, just sitting there and being together, being with the parent, that's beautiful. I'm sorry, I interrupted the other thing

[A]

that we started to do. Then we said, all right, if it's relationships, let's measure that some way. So we would have kids come in and we would have them fill out a little thing like, did you have a sleepover this week? How many of your friends did you play with? And it turns out there was a linear relationship between, like, social connections during the week and symptoms in the last two weeks.

[B]

Do you publish a study like this?

[A]

Well, we have something kind of like this that we've published. Yeah, but not that. Not that specific one part of what. The reason I didn't want to publish a lot of that stuff was because of the medical economic model. I mean, at the time, insurance companies were looking for anything that they could to kind of.

[B]

Stop. Stop. That is the most responsible thing I've ever heard. That is selfless and responsible. That is.

[A]

Well, are you to say, I want

[B]

to fix you up? Are you married?

[A]

No, I am married. I am married, yes. But I. I just realized that we had another study that showed that if you go in after an acute traumatic event into a pediatric hospital and you tell people about what to expect, you know what you're going to run into. It's very normal for these things to happen. And we don't want to pathologize this, but just expect it. And if things get really, really bad, you can call this. And then that was sort of like the light touch psychoed group. And then we had another group where we said, we know a lot about post traumatic trauma. We want to give you therapy every week. The group that got therapy every week did worse than the group that got the information.

[B]

Sure. Because the people that got the information had had a nightlight and they weren't scared anymore. They knew what was going to happen and so they were okay with it. Yeah, the other people were scared. If they're relying on a human being. Okay. When all they needed was a little direction beforehand. Right or no.

[A]

And what also happened was to your earlier point about whether or not I've made people worse. I've made people worse a lot. What happened was these kids would be okay. I have therapy on Friday afternoons or on Wednesday afternoons. I have to come up with an excuse why I can't go to soccer. And then I know I have to talk about the trauma because they want me to talk about the trauma. So therapy became an evocative cue.

[B]

But wait a minute. You didn't make anybody worse. I can't. And I'm not going to let that.

[A]

Well, that's kind of you to say, but I.

[B]

No, no, no, no, no, no, no, no. You're looking at it wrong. You didn't make anybody worse. Magic Johnson never lost a basketball game. He just ran out of time. Okay. You didn't have the right time with this guy. Okay, is that's fair, right?

[A]

I like that. Yeah, I like that.

[B]

Well, what's true is true. Let's not horseshit ourselves. I mean, you know, you're so self deprecating. I don't want you walking out of here believing it.

[A]

Well, it's. Thank you very much.

[B]

No problem. I'm here all night.

[A]

One of the, one of the things that we ultimately began to realize is that many of the, that the dosing and spacing of conventional sort of medical model, psychotherapeutic stuff was really not giving particularly kids control over when and how they talked about their traumatic stuff. You know, we determined, you know, you're going to come on Wednesdays at 4 and for an hour, that's what we're going to focus on.

[B]

Yeah, but that's nonsense. You would come, they would walk in. You're sophisticated enough where you walk in and you play and you play chess with them. If the kid want to play chess, you play chess for, for.

[A]

That's true.

[B]

For 90 minutes.

[A]

That is true.

[B]

And then it's over. And then that's how you build a therapeutic alliance.

[A]

That's true, that's true.

[B]

Unfortunately, you're one out of a hundred people who would do it. One out of a thousand people that would do it.

[A]

What we've been trying to do is get, is think about ways to provide people in the, what we call the Therapeutic web of the child, help them better understand some of these things so that in the moments that they have interactions with these kids, they can be a therapeutic presence, they can regulate, they can listen, they can be respectful, they can't, you know, they'll learn not to push too much. And then when that happens, you basically magnify the number of, if you will, therapeutic opportunities during the week. And when we do that with much less kind of intensive traditional doctoral level interventions, we get the same outcomes. Which is actually something really important when you're dealing with, you know, communities that have no capacity. You know, I mean, we really, our mental health systems are so overwhelmed and under resourced that we're really not able to meet the needs of the majority of people that have trauma related issues and problems.

[B]

Actually, actually you're not, you're not able to meet anybody's needs because the insurance companies cut you off after three, four weeks. And you know, the only way to get them well, I mean, look, if you're in a pre contemplation stage, right, you need four, four to six months. Very rarely does somebody come in, in an action stage, right? And then they only need 30 days, right? So those people are few and far between. Most people need to come back four or five times, literally. And it's not our fault, it's just you, you know, I can't treat everybody for free. I can't do it. You know what I mean?

[A]

And I think that that's one of the major, that's, I think that's one of the major challenges that we have as a field is just figuring out how to deal with a medical economic trap. Because it is a trap, I think. I mean, I know people that have lots of resources and even with resources, I think it's still hard to find really quality care.

[B]

It's impossible. Especially in my, in my field. There are so many bad actors in my field. And what's even worse now is people are, most treatment centers are operating on skeleton crews. They don't even have nurses at night. Some don't have nurses at all. And the reason is, is because when you, you know, when I was at my last place, before I sold it, I was getting $0.67 on the dollar. For example, today you get about $0.25 on the dollar. So if you're working on, on 25, 30% margin, you're out of business, right? So everybody's going out of business and the only way that they can stay in business is to kind of skirt the system and, and you know, and do that, but, you know, thank God we didn't have that problem. But I would have had that problem had I not sold the first place. Had I not sold the first place, I'd be operating like everybody else. Okay, thank God I didn't have to do that. So it's not, it's not, it's, it's really the economic driver that is, that is doing this. It hasn't, you know, people, you can't even say that people aren't decent because they don't have an opportunity to be decent. Really right now.

[A]

Yeah, it's kind of heartbreaking. You know, the. Yeah, it's a mess.

[B]

No, it is. All right. In my world, I see a lot of adults who did not have language for trauma growing up. How does unrecognized trauma tend to show up later in life, especially in addiction or self destructive behaviors?

[A]

Well, as you well know, I mean they, they kind of run together. You know, one of the major, you know, if you go back to, back up to the neurobiology of trauma, one of the things that you'll see is that the systems that are most frequently impacted are the systems that are also involved in reward. The reward neurobiology. And when you are out in the world and you're feeling distressed and you have sort of poverty of rewards too, because you're sort of, you know, you're not getting great feedback from the rest of the world about great job at work, great job here. You know, sometimes because this vicious cycle of what, what you're doing with the getting high and being undependable and whatever, all that other crap that goes with it, you're just, your life sucks. And so you start wanting to use dissociative strategies to get away from the distress. And drugs will help you do that. And, and so part of what we think, you know, when we do this work, we think about how do you create healthy forms of reward and healthy forms of regulation? Because if you have those, that's really the only way that you're going to be able to sort of create circumstances for somebody to get to the point where they can then in a sustained way act on what they want to do, you know, if they really want to. It's really hard. If you have been struggling with this stuff, it's really hard. Even though you have good intentions in a moment, it's hard to sustain that under tremendous distress.

[B]

That's right.

[A]

And so, and I believe that a lot of the neurobiological vulnerabilities that really relate to making it more likely that somebody will use, and more likely that somebody will use maladaptive ways to get reward and regulation, that those kind of predispose you for overusing substances. And, But I think that if you can, again, if, if in the same way that you would treat somebody who has a predominant trauma related presentation, if you give them opportunities for appropriately dosed and spaced opportunities for success, then that are relationally scaffolded. Right. You've got a relational density where people are around who can be respectful and regulating and aware of all of this stuff. I think that that will go a long way in helping somebody who's struggling with a drug.

[B]

The therapeutic womb.

[A]

Yeah.

[B]

Do you think the field is falling short in how we approach addiction today, especially when trauma is not fully integrated into treatment?

[A]

I do. And I think that part of the. I, I'll never forget when I first went up to, I went up to Canada to work as the director of Provincial Child, Provincial Child, Child and Adolescent Mental Health Services. For a while we were sitting around a, a table with all of these experts and heads of these different divisions, including the folks that worked with substance abuse and people that worked in juvenile justice. And, and they were absolutely rigid about making these boundaries between people that have mental illness versus people that have behavioral problems versus people that have addiction problems. And I'm like, it's the same kid. It's like, what are you talking about? You just. If you don't understand that, then you're going to continually actually create systemic solutions that will make the problems worse, which is what we see all the time. I mean, there'll be a place that says that we work with an adolescent that's struggling with mental health problems, but, oh, if he has any substance use, kick him out and send him over to a substance use program.

[B]

It's disgusting because if you don't treat the, the addiction the same way you treat trauma, then it doesn't, it doesn't work. It doesn't work at all. And that's why. And the public doesn't have any understanding about that.

[A]

I know, and it's heartbreaking because. And I, it's just kind of the experience of somebody in our systems has to be terrible, you know, to kind of be like bounced around like you're in a pinball machine and nobody wanting to literally create sustained, invested help. So I think the programs that understand that these are so intertwined, interrelated issues and create processes that can address both of these things, I think they're going to have much more success and they're the way to Go. But honestly, even the way we set up funding reimbursement models, it's insane. There'll be separate reimbursement models for substance abuse programs, programs or mental health service delivery programs, or trauma informed educational programs. And they're all fragmented. So.

[B]

Yeah, in your book what Happened to you with Oprah Winfrey, you shift the question from what is wrong with you? To what happened to you? Why is that shift so important? And are we really embracing it yet?

[A]

I think it's important because if you understand that sort of the origins or the etiology of a certain presentation, you have a much better chance of intentionally coming up with a solution. And as you well know, you can have somebody come in and you see certain symptoms, and the symptoms could be from any direction, like dozens of different routes to that certain presentation. But if you don't know how they got to you, you'll not be very effective at sort of helping address the problem. So that I think that's the. The major reason is that if you understand really what's under the hood, you're going to be a much better mechanic. You know, it's. It's sort of like when my car breaks down, I pretend I know what's going on. I open the hood and I kick the tires, and I pretend I check the oil. None of it has any. Anything to do with what's wrong, but I think I'm doing something. And that's kind of what our systems do right now. We don't have enough people that understand what is literally under the hood and, and have ways to fix it.

[B]

So the reason I. Another reason I love it is because what's wrong with you? You're in the victim role, right? And what happened to you, you would think you're in the victim role, but there's so much space there that it feels like you're looking at it from 30,000ft. Right. So you don't feel the same victimhood. And therefore, you can. Now, once you have an understanding, you're calm, you've connected, you're ready now for the behavioral shift. I love that. That's great.

[A]

And I think one of the things a lot of people see when they begin to understand developmental things, they recognize that just to your point, they haven't backed up far enough in their own life to look at causality. Right. They might go, oh, I was a bad student. And like, well, why were you a bad student? And then they back that up a little bit, and then back it up. And then you realize, wow, how could the two year Old me have you've been responsible for that and you weren't.

[B]

For parents or even adults trying to heal themselves, what are some practical things they can start doing today that actually help the healing process begin?

[A]

That's a great question. And that, that it's actually there are a lot of things that we can do to make us more regulated and help us function better from whether it's trauma related dysregulation or other reasons that we're, that we're struggling. One of them is, is to recognize that if you have external structure and predictability, that helps build in internal structure and predictability. So I mean, I don't want to sound like, you know, your mother, but like if you go to bed, you develop good sleep habits, you develop good exercise habits, you develop habits to have meals with people, you develop good, good sort of habits around what you eat. And I, we, we actually have looked at and continue to look at a lot of how powerful movement is in helping create health and not just physical health, but sort of mental health. Are we human beings are, you know, we're biological creatures and we are neurobiologically sort of predisposed to seek and to change effectively when we move and when we connect with other people. So that's my main advice about. All of this stuff has to do with external structure, internal regulation and, and then find the people in your life. You know, be intentional about spending time with, with people and whether it's if you like sport or if you like cards, or if you like art or whatever it is, connect with a group of people who can kind of become your people. You know, you need relational connection and you know, the family, friends, community, culture, all of those things are very powerful in helping people heal.

[B]

It's, that's, that's as good as it gets. Your next book will be about how to cut people loose that aren't enhancing your life. Right? Because that's the next, that's the next level of community. Right? Getting rid of the community that doesn't serve you.

[A]

Which is, it's interesting because one of the first steps in that is getting rid of the digital community that makes you feel like you're not enough. Right?

[B]

That's exactly right. How do you do that?

[A]

Yeah, it's hard. But the reality is, think about it. When you and I were growing up, we were lucky that we didn't have literally 700 opportunities a day to see that we weren't as fit as everybody else, or that we were not as good looking as everybody else, or we were not as whatever.

[B]

I know.

[A]

Just the non stop bombardment for young kids. Kids about how they're not enough.

[B]

I know.

[A]

Is got to be brutal. It's got to be brutal.

[B]

It's the worst. And the bullying is the worst. At least when we were kids, if you were going to get bullied, you. They'd say it to your face and you'd fight and you'd move on. Okay, exactly. Today it's just, it's, it's, it's like a mob mentality and it's just, it's. It's so vicious. I feel so bad for these kids. All right, is there anything we missed or I didn't cover today that you want the viewers to know?

[A]

Well, you know, one of the things I think I'd like to say is that I kind of related to what we just talked about is I think people need to learn how to give themselves a little grace and to remember that, that relationships always involve a little rupture and then repair and, you know, this aspiration towards perfection. I think we need to just accept that, you know, nobody is perfect. You can't be a perfect parent, you can't be a perfect supervisor, can't be a perfect therapist. And you just keep, get back in the game. Just keep learning. Keep trying to get better and let people teach you. You know, if you let people teach you, if you tolerate the discomfort of imperfection and learn, you'll just incrementally get better and better and better and.

[B]

Until you're. Until you're a Buddhist.

[A]

Exactly. Exactly.

[B]

I'm sorry. The intimacy was so much for me. I couldn't take it. Did you see what a child that was? I really don't deserve this. I don't deserve it.

[A]

That's good, though.

[B]

All right, good. Where can people find you?

[A]

I think probably if you just. Probably the best thing is just go to the neurosequential network website, which is neurosequential.com, and you might. You may get three or four different spellings of it that won't take you anywhere. But ultimately, keep to trying. Trying. You'll get it. Neuro sequence.

[B]

Did you just call my audience stupid?

[A]

No, no, no. I just called our name stupid.

[B]

No, no. If I can't pronounce it, it ain't stupid. All right, so this was a blessing. What a great time.

[A]

Thank you.

[B]

No, pleasure's all mine. Believe if the pleasure wasn't all mine, I would have told you this was the.

[A]

And I'm. I'm really happy that you talked to Maya. Maya is a really special person.

[B]

She is so special. She is so magnificent. I just. You guys are just great. Thank you. Thank you for blessing the program.

[A]

All right, well, thank you.

[B]

See you next Tuesday, everyone.

[A]

All right. See you, Richard. We're out of time. Please subscribe on YouTube. Click the thumbs up and leave a comment. Please subscribe on Apple Podcast and Spotify and leave a rating and a review and share the we're out of time podcast with others you know who will

[B]

get value out of it.

[A]

See you next Tuesday.