January 7, 2025 • 38 mins
Join us as we explore the complex landscape of adoptive families, particularly those who face the unique challenges that come with raising adolescents with severe attachment issues with Dr. Norm Thibault, a leading expert in adoption and attachment. Dr. Thibault is the founding owner of shares groundbreaking insights from scientists like Dr. Nim Tottenham and Dr. John Balin, revealing how early developmental factors can shape a child's life well before they've taken their first breath.
Parents of adopted children often find themselves on an emotional journey, reconciling their expectations with their current reality. Our discussion touches on controversial topics like the "primal wound" and challenges the notion that adoption is inherently traumatic. We also venture into the enigmatic world of epigenetics, using historical examples to illustrate how prenatal conditions influence future behaviors. With references to polyvagal theory, we emphasize the power of creating safe, nurturing environments to help reverse these effects, advocating for trauma treatments that prioritize nonverbal communication and healing.
Finally, we tackle the significant hurdles within the DSM-5 when diagnosing and treating complex developmental trauma in adopted children. Dr. Thibault underscores the urgent need for systemic changes in insurance practices to ensure mental health care is accessible and effective. We also confront the profound theme of loneliness, exploring the innate human desire for connection and the metaphorical journey some undertake to find their true "home." This episode is a heartfelt exploration of the intricacies of adoption, attachment, and the search for belonging in a world that often feels disconnected.
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:00):
Hello folks, welcome back to Mental Health Matters.
On WPVM 1037, the voice ofAsheville Independent and
Commercial Free Radio, I'm ToddWeatherly, your host,
therapeutic consultant andbehavioral health professional.
With me today, I'm thankful tosay, is another Carolina boy.
Speaker 2 (00:19):
Yes, sir.
Speaker 1 (00:20):
Dr Norm Tebow is the founding owner and chief
executive officer of Three PointCenter residential treatment
center exclusive to adoptedadolescents.
Dr Thiebaud is the recipient ofthe 2017 Bilardi Humanitarian
Award of the American AdoptionCongress and is the former
two-term president of the UtahAssociation of Marriage and
(00:42):
Family Therapy.
Now I'll say that Three PointCenter not only has a program in
Utah, but right here in thesouth, just outside of Raleigh,
north Carolina.
Dr Thibault is a clinicalfellow of the American
Association for Marriage andFamily Therapy and is an
AAMFT-approved supervisor.
He is a certified clinicaltrainer of attachment and
(01:03):
trauma-focused family therapy.
He's been taught extensively byDr John Gottman and has
presented polyvagal theory foradoptive families with Dr
Stephen Porges, and he iscompleting his second term as
president of the board ofdirectors of the Association for
Training and Trauma and theAttachment of Children training
and trauma and the attachment ofchildren the A-T-T-A-C-H dot
(01:27):
org.
Norm utilized all of theseskills and he needed everyone,
I'm sure, to marry the girl ofhis dream, meg.
Together, they have fivechildren and two granddaughters.
How does that feel?
And being a grandparent like?
How does that feel, norm?
Speaker 2 (01:40):
No, you know what, todd?
I love it.
I'm telling you, they were overat the house last night and
goodness it's just they justfill you up.
There's some fantasticneuroscience studies now on the
relationship with grandchildrenand how our mirror neurons get
in sync with them.
And just fills you up.
It's beautiful.
Speaker 1 (01:57):
Yeah, it's good, it's good to witness.
Well, you know, norm, thank youand welcome to the show.
You get introduced often as theprestigious Dr Tybo, but you
know, I'm really grateful justto know you as Norm, as a decent
guy that knows something aboutCarolinas back in the 80s.
Speaker 2 (02:16):
Can I get an?
Amen brother, Can I get an?
Speaker 1 (02:18):
amen, yes, and I tell you, you know we hit this topic
a little bit.
You and I have worked together alittle bit with a mutual client
who, I'm grateful to say, justcame out of your program and is
doing exceptionally well thesedays, now a young adult herself.
And this is a family thatstruggled with the topic I think
(02:41):
you and I want to hit on.
You know they were often quitedistraught at the fact that, you
know you got a child.
They were adopted at birth,they were loving parents, they
provided her with everythingfrom nutrients to resources to
education, everything that agrowing child would need to be
(03:02):
what we would say you know, welladapted and able to go out in
the world.
But came away, despite all ofthat, with lots of attachment
challenges, lots of behavioralhealth challenges, you know,
getting kicked out of school,getting in fights, doing all the
kind of outwardly expressivebehaviors and even and we're
(03:23):
we're also talking about a childthat even in treatment, went to
multiple treatment programs andgot kicked out of a couple, you
know, assaulted staff.
You know like she had, she hada history and came into your
program and I think that one ofthe things that you were able to
address with his family is thatone of the things that you were
(03:47):
able to address with his familyis, you know why, why, why is
she rejecting our love.
You know what is it about.
What is it about having had herand being an adoptive child
from an environment and, ofcourse, her particular situation
.
There's a brother involved.
They were not, didn't getco-adopted, um, and so you know,
there are elements ofseparation that can still occur
in those scenarios.
But just adopted from birth andstill with all these kind of
(04:13):
you know, specific to adopteesattachment disorder and
attachment symptomologychallenges that wreak havoc on
this family system, like you say, we don't talk about this
enough and I think lots ofpeople want to know.
The big question is why, whydoes that happen and where does
(04:34):
it come from and what can we doabout it?
So I'm more than interested tohear your answer to some of that
question at least.
Speaker 2 (04:42):
Thanks, todd, and let me just say what a delight it
is for me to visit with you andto be on your show and to
partner with you in helping kids.
You are so well-respected and Iam so grateful for this
opportunity.
From the bottom of my heart,thank you for allowing me to
visit with you.
Speaker 1 (04:59):
Pleasure's mine Again .
Carolina boys got to sticktogether.
Speaker 2 (05:03):
So you ask a great question, and it's a common
question we get, which is youknow, for example, my child was
adopted at birth.
Why might they afford food?
Why might they be so reactive?
And they've had everything theyneed.
One of the things that we'relearning through wonderful
research from some colleagueslike Dr Tim Nimtottenham, who is
(05:24):
the director of theNeuroaffective Psych Lab at
Columbia University, or Dr JohnBalin, who is a psychologist and
author in neuroscience theresearch that we're getting
speaks to the idea that ourpre-birth environment plays a
much larger role in theexpression of our DNA than we
(05:45):
ever thought.
And so what does that mean?
You know, when I was in graduateschool and I won't say how long
ago it was, todd, but when Iwas in graduate school you know,
we talked about neuraldevelopment and sensitive
periods, right, and thesensitive period for neural
development and attachment,which we thought about three
months prior to birth to aboutage five.
(06:06):
By the time I graduated, someonehad said three months prior to
birth to age four.
Well, a couple of years ago Iwas at the Congress of
Attachment and Trauma inManhattan and they brought in
leading researchers all over theworld to discuss this.
Some are positing that thatsensitive period begins as early
as five weeks post-conception,when you're first learning that
(06:28):
you're pregnant, when you firstmiss a period up to about 20 to
24 months post-birth.
Now, it's a sensitive period,which means optimally, things
happen during that period oftime Doesn't mean they have to,
but what we're learning aboutepigenetics is that very
sensitive period of time plays asignificant role in the way
(06:49):
that our DNA is expressed.
And so you know, we know, thatmom and dad come together, have
a baby, dna is set, but the wayit is expressed excuse me that
is influenced by the environmentthat the birth mother carries
the baby in, carries the fetusin.
Speaker 1 (07:09):
And, if I may, because I'm what you might call
an armchair expert onepigenetics, which means I read
a lot but don't participate.
So you know, just for theaudience out there, and because
I think the world might not havea clear definition.
They hear epigenetics and theyconfuse it with genetics.
It's like, well, as you know,genetics is you've got this vast
(07:31):
amount of material that'sstored in your genetic code.
Why does your grandmother havegreen eyes but you came out with
blue eyes?
Well, epigenetics is the thingthat's the picker.
It's like what part of the codeam I going to read?
And the thing that we'relearning, that that you know the
(07:51):
addictions the addictionstreatment world can echo in the
same way that you're echoing ithere is that you know
environmental influences andchemicals and substances and you
know, and the availability, theavailability of nutrients and
resources in the whole nineyards that are occurring while a
baby is in the womb are havingan impact on the picker, the
(08:14):
epigenetics, the thing that says, hey, what part of the code am
I going to read?
You can have a real impact onthat thing in the womb
environment.
And continues, there's evenevidence to suggest that you can
have an impact on theepigenetics of an individual,
even when they're in adulthood,and that sort of thing, which is
(08:36):
that we won't go down therabbit hole in the science
that's being done about thatstuff.
But this is really fascinatingto me and explains a lot of this
question.
In terms of treatment, though,what is it like?
You're going to get this kidand maybe you know something
about their, their, the wombenvironment in which they were,
(08:56):
you know, birth?
carried yeah carried, carriedand eventually birthed.
And you probably see a lot offolks that you know.
Mom gives birth, adoptionhappens at that time, sometimes
it happens after, but at thevery least the mother and the
child, the birth mother and thechild, for the, for the, you
know incubation period, thepregnancy period, they're in
(09:19):
charge of that environment.
And you know the other thingsthat impact the chemistry of a
person is are you experiencingpsychiatric symptoms?
Are you experiencing highlevels of anxiety?
Are you experiencing highlevels of stress?
These are all chemicals, youknow, neurochemicals, that are
having an impact on the baby'senvironment.
And when you get a kid, how muchdo you?
(09:41):
You know they're going to bepresenting, but by the time they
get to you, they're presentingwith behaviors and things that
you you can see from thestandpoint of having a clinical
profile might do an assessment.
How do you start working with achild?
You know the environment isepigenetic or it's it's prior to
the parents being involved.
How do you work with a child onthose behaviors to help shift
(10:04):
how they address and see theworld?
And then families, because Iknow that family work is a huge
piece of what you do work withfamilies to kind of come
together on creating somethingthat is new and different and
adaptive to the world they'regoing to go into.
How does that work start andhow do you do it?
Speaker 2 (10:22):
You know, a part of it is getting a real, as much as
possible accurate, assessmentof the background.
Todd, you know we really haveto understand the layers and
complexities that we're dealingwith and, as you mentioned, a
lot of it's work with theadoptive parents, because
there's a few different layersand a few different variables
(10:43):
that we want to reallyunderstand.
One is the sense of loss thatour adoptive families have dealt
with.
It's been said that one traitthat distinguishes all adoptive
families from every other is thethreat of loss.
There's not an adoptive familywho hasn't suffered loss at some
(11:04):
level, be they the adoptiveparents or the adopted child,
and so understanding loss andhow they grieve that loss and
how they're managing that loss.
In addition, understanding theadoptive parents' attachment
style themselves, because weknow that their attachment style
is going to inform andinfluence the way that they
parent an adopted child.
(11:26):
For the kids that you and I workwith, you know most adoptions
are quote-unquote successful.
The majority of adoptions turnout very, very well and most
adopted kids are cognitively,emotionally and physically
caught up to their peer groupwithin two years post adoption.
But for the kids that you and Iwork with who have suffered
some level of developmentaltrauma, either pre-birth or
(11:48):
pre-verbal or post-birth.
Those challenges can beenormous, and so understanding
that adoptive parents, theiranxieties, their attachment
insecurities, their unresolvedtraumas, can be really activated
by parenting these kids.
Speaker 1 (12:08):
Like mirrors, those kids.
Speaker 2 (12:10):
Yeah, yeah, and a neurobiological.
We don't say what we don't sayunconscious level anymore,
because it sounds too Freudian,right?
So now we say neural at aneurobiological level,
parasympathetic level, yeahexactly, exactly.
So.
So understanding those parts ofit that that you know these
parents need a lot of support,because we know adoptive parents
(12:31):
have typically have highereducation status than
non-adoptive parents, but theyalso have higher anxiety levels
than non-adoptive parents and sobeing there as a support to
them, adoptive parents getjudged so often by others who
don't understand the challengesthat they're dealing with, and
so there's shame, there's innershame, there's a lot of layers
(12:52):
to it that we have to examineand we have to be there for
those adoptive parents.
I say for those parents.
If they're dealing withdevelopmental trauma and real,
significant challenges, there'sthree bridges they have to cross
and we have to support them incrossing.
The first is they are not thechild I thought they were going
(13:14):
to be.
The second is I don't get to bethe type of parent I thought I
was going to get to be.
And the third is this is notthe experience I thought it was
going to be, and really beinghonest in those moments and
really taking a look at whatwe're dealing with is absolutely
crucial in the work we do withthese wonderful, wonderful
(13:36):
parents who, you know, kind offeel let down at times, feel
insecure themselves.
One other thing I would sayabout that, if I might.
Nancy Verrier published a booksome years ago called the Primal
Wound, and Nancy is a wonderfulclinician and she's so kind and
(13:56):
generous.
There's been recent research bysome wonderful and just stellar
researchers.
Some colleagues Dave Brzezinski, who is probably I would say
he's denied this but I say he'sprobably studied adopted
children in treatment more thananybody but David Brzezinski,
megan Gunnar at the Universityof Minnesota and Jesus Palacios,
(14:18):
who's out of the University ofSeville in Spain they did a
foundational research onmeta-analysis on adopting kids
and treatment, and they foundthere was no support for a
primal wound, that adoption inand of itself is not traumatic
unless that child has been witha caregiver long enough to form
(14:41):
a secure attachment prior toadoption.
So you know there's a lot oflayers there as we work with
adoptive families and try to,you know, understand the
complexities that have gone into.
Why is my child acting this way?
If I can touch on theepigenetic piece again, there's
two research studies that I lovethat kind of really explain
(15:02):
pretty clearly how epigeneticscan inform the way our kids are
responding today.
The first one is and you'reprobably familiar with it, todd,
during World War II, the Dutchhunger winter.
And that was toward the closingmonths of World War II, when the
Nazis had blockaded theNetherlands, and so there were
(15:25):
people starving and there weresome brilliant researchers who
decided to understand and studywomen who were pregnant during
the blockade, so during a famine, but who gave birth after the
Allies had liberated Holland.
So these kids were carried in afamine but born right after the
famine ended, and in studyingthose kids they have
(15:47):
statistically significantlyhigher levels of heart disease,
obesity and othercaloric-related issues.
The theory is that in uterotheir DNA was expressed in such
a way to prepare them to survivein a famine, so that every
calorie count.
And when you're not born in afamine and your body digests
(16:08):
food differently, then it'sgoing to process it differently
and people like you and I giveit a diagnosis.
Now another more recent studythat goes along the same
principle there wereapproximately 1,700 women in the
New York metro area diagnosedwith PTSD as a result of the
9-11 terrorist attacks.
Studying their children, whoare turning 23 this year, those
(16:32):
kids have statisticallysignificantly elevated levels of
PTSD and anxiety, even thoughthey were not born at the time
of the attacks.
And when you take a look at it,the theory is that their DNA
was expressed in utero toprepare them to survive in a
hostile environment, because youand I know nobody wants PTSD
(16:52):
and anxiety.
But from an evolutionaryperspective it keeps us alive
right.
But when you're not born in ahostile environment and you have
those traits, then again wegive it a diagnosis PTSD and
anxiety when, in the context inwhich it was developed, having
(17:13):
your head on a swivel, notrelaxing, being hypervigilant
and hyper alert would keep youalive.
Speaker 1 (17:20):
Yeah.
Speaker 2 (17:21):
So they were prepared to survive in a hostile
environment, but weren't born ina hostile environment.
Speaker 1 (17:27):
Which creates maladaptive behaviors in a in a
right.
Speaker 2 (17:31):
Exactly, exactly, which is what we see from many
of the adopted kids that we workwith.
They're not bad kids at all,but their limbic system and
their amygdala, everything is onhyper alert, prepared to react
to keep them alive because ofwhat they experienced.
Rebirth Exactly Right alertprepared to react, to keep them
(17:51):
alive because of what theyexperienced rebirth Exactly
Right.
And so if you take that andthen you combine it with what we
know about polyvagal theory,the idea of safety is so crucial
to helping these kids right.
In order to form a relationshipwith them, they have to feel
safe.
And in order to feel safe we'vegot to dampen that amygdala,
(18:14):
dampen that limbic system, sothey're not quite so reactive,
so that they can kind of relaxinto our influence and start
trusting us.
Because what we know is if it'sepigenetic, it's influenced by
the environment.
That means epigenetic effectsare likely reversible based on
the environment.
Epigenetic effects are likelyreversible based on the
environment, environmentalenrichment at the right time.
Speaker 1 (18:31):
Well, and you see, there are a lot of aspects of
this in adult care, especiallyas it pertains to PTSD and other
things and something I thinkand I'd love to hear your
thoughts about this have reallyadvised the sophisticated trauma
(18:54):
treatment approach that we have, um, because you know it used
to be.
It's like well, they suffer,let's say it's ptsd, so there's
this, this, they, they called ita can of worms, I call it
trauma trunk.
Um.
And you know, if you, if youwalk in on a person who, like
you know, who, doesn'texperience safety as a result of
the neurobiology that's goingon, for whatever reason, and you
try to go in trying to addresstrauma, well, what's the
(19:17):
traumatic issue?
Let's go address this issue.
Let's go dig it up.
The chances are incredibly good.
What you're going to do isre-traumatize that person, not
address the trauma issues thatare coming up as a result of a
specific event.
And so you it's not somethingthat you can hit head on, as
they say, like it's somethingyou've got to be careful about.
You've got a lot of use ofnonverbal strategies.
(19:39):
You've got to, you've got tohelp that person learn how to
regulate first, before they canprocess anything that's that's
anywhere close, anywhere closeto triggering material.
And so you know, just and withkids, of course, I think for
parents who have adopted a childwho has these symptoms or has,
(20:00):
you know, had that in uteroenvironment and came out and
starts to and is on edge and hastheir head on a swivel and has
high anxiety and is is fearfulfor their life, even though
they're not in a situation thatwould require them to be that
their, their, their amygdala hastaken over.
Um, it's very hard for them toeven set what I would call
(20:22):
regular limits.
It's like you know this it onlymakes sense that you would put
away your dishes after you'reasked, or you don't make sense
that you would clean your roomor all these other things, and
this person decides that it'snot important that they clean
their room, and being asked todo something is a threat to
their life.
And then you get all thesebehaviors that come out and the
parents are just dumbfounded,first of all, as to what to do
(20:43):
with this, and they don't knowwhat to do.
Eventually, they'll either findsomebody like me and I send
them to you, or they'll findsomebody like you who knows how
to work with their child andteach them.
Let's work on safety first,then let's train some behaviors,
Then maybe we can address someof these other issues.
But even that is a much longerterm kind of thing.
(21:03):
What message would you give toa family that has you know?
If somebody happened to belistening to this podcast, I
think there's a lot of greatinformation here already.
What message do you have forfamilies that are struggling
with all of this?
Speaker 2 (21:19):
Well, and there's a few different things that I
might say.
One is the self-care piece,because these kids have to be
able to borrow serenity, and youcan't let someone borrow your
own serenity and you can't.
You can't let someone borrowyour own serenity if you don't
have it.
And our parents, our parents,have to be able to find find
(21:39):
that serenity I mean truly sothey can, they can share it with
their children.
There is a there's a goodportion of the research that
says that one of the significantvariables for the successful
outcomes of these kids is aparental capacity to manage
their own dysregulation whentheir kids are not managing
their regulation, and so aparent's ability to stay
(22:02):
centered, to stay calm when it'shitting the fan with their kids
is really, really important.
And the only way, the only wayTodd that adoptive parents can
do that is if they have a goodsupport network, because it's a
Herculean task we ask, we'reasking parents to to take okay,
so so a little background, right.
Being from North Carolina, dadwas a Marine for 36 years, right
(22:26):
, when I got out of line when Igot out of line, I knew it was
coming right.
I knew I needed to stay in lineif I didn't want to get whooping
.
Okay, well, that doesn't workfor these kids.
That cause and effect, verysimple response doesn't work for
these kids.
(22:47):
And you can take all the toysaway.
You can take everything away.
Traditional parenting does notwork for complex developmental
trauma.
Therapeutic parenting is whatwe've got to do, which is a real
shift, because it feels likewe're just coddling kids and
we're letting them get away withstuff.
The goal in therapeuticparenting is not compliance.
(23:09):
Compliance is not to get themto behave.
Our goal has to be and this isour goal at three points
neurodevelopmentalattachment-based healing, which
means we're focused on healingthat, that neural substrate
between the midbrain and thelower prefrontal cortex, so that
they're operating andcommunicating.
(23:30):
Our parents, oftentimesadoptive parents, struggle with.
Why do I have to keep repeatingmyself over and over again at
this child?
Well, the reality is, theircapacity to retain information,
to listen and learn really isgreatly reduced if they've had
some kind of complex traumaprior to birth.
Speaker 1 (23:50):
It never passes the threshold of the reactive
amygdala.
It never goes into the brain.
Speaker 2 (23:55):
Exactly so.
There's no capacity for causeand effect thinking.
But because they look their age, we assume that they're their
age, when in fact, cognitivelyand emotionally, they're so much
younger, so much younger, andso it's.
It's a real challenge for forprofessionals and parents
working with these kids toreally kind of go.
(24:15):
This isn't a choice they'remaking.
The behavior makes sense in thecontext when it was originally
developed.
Speaker 1 (24:23):
Right.
Speaker 2 (24:24):
And that's what we've got to put it in Um so so,
living in an environment, andthat's what we've got to put it
in.
Speaker 1 (24:27):
They're living in an environment you can't see
Exactly.
Speaker 2 (24:32):
Exactly, and so for these parents it's a Herculean
task, and so we say you've gotto have a support network,
you've got to take care ofyourself and educate yourself on
what's behind this, because formost of these kids, these
behaviors were in place beforethey took their first breath.
Speaker 1 (24:48):
Oftentimes it's not about you, it's about what
needed to happen, but then inutero, yeah, I think we're
seeing a lot of that in general,with just the new generations
of kids, you know, adolescentsand young adults, whether
adopted or not.
We're you know, we have thepandemic, we have all these
other periods of time that arehaving an impact, and what I'm
(25:10):
telling you, norm, is that youneed to open a program that's
not just for adolescent, adoptedadolescents.
Speaker 2 (25:16):
Yeah, I think you're right.
We are seeing it across thespectrum, aren't we?
And the impacts, the rippleeffects of post-COVID, the
shutdown and everything else.
It's going to be a tsunami, Ithink, unfortunately, on the
impact of these kids.
Speaker 1 (25:31):
Yeah, I couldn't agree more.
I think that one of the thingsI've been discussing with not
just families but otherprofessionals of late and that
came up, I was recently atSilver Hill for a conference and
they were talking abouteducation and everything else
Knowing resources that exist outthere is one of the greatest
(25:56):
challenges, and even when youknow about them, navigating the
one it's.
You know, our treatment andmental health world is not a
user-friendly environment.
What is it it you're doing withyour families to help grow this
kind of consciousness around,not only the kind of care you're
trying, the kind of parentingyou're referring to, but also
kind of the kind of care thatThree Point Center is able to
(26:18):
provide?
Like, what do you, are youseeing it being a little more on
the stage, both nationally andinternationally, and that sort
of thing?
What's, what's going on in thefield that gives you hope, I
guess, is my question.
Speaker 2 (26:30):
Well, great question.
A couple of things.
One is because people arebecoming more aware of it.
There's so much frustration.
You know, and as you know, todd, you know, in NATSAP, the
National Association ofTherapeutic Schools and Programs
, I've spent time in CapitolHill working with senators and
members of Congress to educatethem that, look, these parents,
(26:50):
these families need help.
They really do.
One of the challenges and I'mgoing to geek out and get a
little technical here, but oneof the challenges we have is in
the Diagnostic and StatisticalManual of Mental Disorders, and
do you know what that is?
Many of your listeners may beaware of it.
Speaker 1 (27:07):
The DSM?
Yes, we are familiar.
Speaker 2 (27:10):
The DSM.
You know the fifth edition.
You know most of us, as mentalhealth professionals around the
world, use the DSM but it'swoefully inadequate to
conceptualize the experience ofadopted children with complex
developmental trauma.
Because we get all thediagnoses right we get ADHD, we
get oppositional, defiant orconduct disorder.
(27:32):
Uh, intermittent disruptivemood repulite yeah exactly and
and you know transparency Icontributed to the DSM five.
You'll find my name in the book, but I'll be the first to say
it does not do any service toadopted children.
Speaker 1 (27:48):
It does not do any service to adopted children,
bessel van der Kolk, who youknow is just wrote, keeps the
score Right no-transcript, whichdoes a much better job of
conceptualizing what these kidsexperience.
Speaker 2 (28:06):
It's different than PTSD and it's pretty simple to
understand why.
Because PTSD is described, youknow it hasn't changed much
since it was battle fatigue inWorld War.
I right, it's about an eventthat challenges your safety and
your sense of self, whereascomplex developmental trauma is
a chronic.
The person who's supposed to betaking care of you not taking
(28:29):
care of you trauma and itrewires the circuitry of the
brain.
So PTSD doesn't do a good jobof it.
Adhd doesn't, because they'rehypervigilant it's not that
they're lazy and don't want tofocus.
Exactly, exactly.
So all that to say, more andmore people are becoming aware
that we need this diagnosis inthe DSM, the next iteration,
(28:51):
because if it is, then we'llteach it in graduate school, and
as long as it's not in there,we're not talking about it in
graduate school.
I wasn't talking about any ofthese things.
And secondly, insurancecompanies will then have to take
a look at it.
Speaker 1 (29:05):
Yeah, I was going to say there's a elephant in the
room there with the diagnosticcode, right?
Speaker 2 (29:14):
Yeah, and if we are talking about complex
developmental trauma, then we'retalking about neurological
healing which takes longer thansimple behavioral changes.
Right, yeah?
And insurance companies.
My own opinion, this is justnorm.
But my own opinions oninsurance companies don't want
to look at that, because nowwe're talking about really
long-term stuff.
Speaker 1 (29:35):
Well.
Speaker 2 (29:36):
Because we're talking about rewiring the circuitry of
the brain.
Speaker 1 (29:40):
Well, and I think that you probably agree with the
statement, I think neuroscienceis the treatment science of the
future and not to dismiss goodtherapy and good medication
management when necessary andall these other pieces.
But I want to hear what youthink about this.
I was at Silver Hill and it wasa big discussion and their CEO
(30:10):
was like you know, you'll neverget insurance companies to sign
on because the averagesubscriber never stays a member
with their insurance from one totwo years.
So interesting, and in orderfor there to be this
incentivized health dynamic andbe in behavioral health and I
(30:33):
would say, in medical care ingeneral, you have to you know a
person who is going intotreatment.
What we know is that you'relooking at two years worth of
care.
You're looking at, you'relooking at two years worth of
care You're looking at two yearsworth of.
You know there's a residentiallevel of care and there's, you
(30:55):
know, a variety of levels ofclinical care that exists past
residential and then evensupport when a person goes back
into the home or an independentenvironment or what have you.
So you know, I tell familiesall the time you're looking at
one to two years worth ofvarious levels of care.
And the point that I made tothis group I said, look, they're
going to save money.
The point made back was thatwell, they won't save.
(31:15):
The company itself won't savemoney because they're
subscribers.
They only last for two years.
I said, yeah, but if you can getthem all to sign on at the same
time, the savings can be heldacross the board.
So while maybe this company'ssubscriber may not save, by the
time they switch, that person'sgoing to go into another care
(31:38):
environment or another you knowsubscriber membership
environment where they no longerneed the same level of care
because they got adequate carethe first time.
If everybody does it at thesame time, you'll get this mass
effect where the care does notcost as much.
Therapeutic care can beeffective because we know we
(31:58):
know how to do good treatment.
Good treatment exists, butlargely only exists for people
who can pay for it so expensiveit so expensive.
It's very, is it, though?
I mean, you know my point tothat.
When people say it's veryexpensive, it's like well, yeah,
for an average family, anout-of-pocket expense of
anywhere from $18,000 to $40,000a month could be an
(32:19):
out-of-pocket residential careexpense.
But if you went into thehospital for a heart attack or
any other major illness let'ssay you had a diabetic attack or
you had severe liver disease orkidney disease or you had any
of these other things and all ofa sudden an insurance company
is responsible for caring for it, you'll pay that money for sure
(32:43):
to handle any of these majormedical conditions.
I would say that behavioralhealth conditions are no
different than the severity thatyou apply to any major medical
condition and, by and large, ifyou talk about what I would call
appropriate levels of care,what we're doing we're doing
(33:04):
fairly economically when youthink about it.
Speaker 2 (33:07):
You know, in that context, what you're saying
makes perfect sense, todd, itreally does, and you're
absolutely correct.
Speaker 1 (33:13):
You know, I only get people on the show that are
going to agree with me.
Speaker 2 (33:19):
So, uh, yeah, no Carolina boys again.
There you go, that's right Well.
Speaker 1 (33:24):
Norm, I man, I tell you we, I tell you we could sit
here and talk about this forquite some time.
I'm so grateful that you agreedto join me in my ramblings on
the show.
The information that youprovided for us is just going to
be valuable.
I'm going to play it severaltimes just so I can dig out all
the resources.
I'm going to play it severaltimes just so I can dig out all
the resources.
(33:45):
But I'm grateful for you as aperson, as a Carolinian, but
most importantly, as a resourcefor families out there
struggling with these challenges.
Thank you so much for foundingthe Three Points Center and
being involved in the work thatyou're in.
It's a pleasure and an honor tohave you on the show.
Speaker 2 (34:00):
Well, thank you, todd .
The pleasure is truly all mineand I appreciate the work you do
and the esteem you hold in thefield.
Thank you.
Speaker 1 (34:07):
Well, I'll look forward to being with you again
here pretty soon.
This has been Mental HealthMatters on WPVM 103.7, the Voice
of Asheville.
We'll see you next time.
I feel so lonely and lost inhere.
(34:30):
I need to find my way.
Thank you, bye.
Outro Music.
I need to leave.
I found the other day I need toleave.
I found the other day I need toleave.
I found the other day.
Speaker 2 (36:32):
I need to leave.
I found the other day I need toleave.
I found the other day I need toleave.
I found the other day I need toleave.
I found the other day I need toleave.
I found the Indian.
I found the Indian.
I found the Indian.
I found the Indian.
I found the Indian.
I found the Indian.
I found the Indian.
I found the Indian.
(36:53):
I found the Indian.
I found the Indian.
I found the Indian.
I found the Indian.
(37:45):
I found the Indian.
I found the Indian.
Thank you, I'm so lonely andlost in here, bye.
I feel so lonely and lost inhere.
I need to find my way home.
I feel so lonely and lost inhere.
I need to find my way home.
Speaker 1 (38:14):
Find my way home.
Hello folks, welcome back to Mental Health Matters.
On WPVM 1037, the voice ofAsheville Independent and
Commercial Free Radio, I'm ToddWeatherly, your host,
therapeutic consultant andbehavioral health professional.
With me today, I'm thankful tosay, is another Carolina boy.
Speaker 2 (00:19):
Yes, sir.
Speaker 1 (00:20):
Dr Norm Tebow is the founding owner and chief
executive officer of Three PointCenter residential treatment
center exclusive to adoptedadolescents.
Dr Thiebaud is the recipient ofthe 2017 Bilardi Humanitarian
Award of the American AdoptionCongress and is the former
two-term president of the UtahAssociation of Marriage and
(00:42):
Family Therapy.
Now I'll say that Three PointCenter not only has a program in
Utah, but right here in thesouth, just outside of Raleigh,
north Carolina.
Dr Thibault is a clinicalfellow of the American
Association for Marriage andFamily Therapy and is an
AAMFT-approved supervisor.
He is a certified clinicaltrainer of attachment and
(01:03):
trauma-focused family therapy.
He's been taught extensively byDr John Gottman and has
presented polyvagal theory foradoptive families with Dr
Stephen Porges, and he iscompleting his second term as
president of the board ofdirectors of the Association for
Training and Trauma and theAttachment of Children training
and trauma and the attachment ofchildren the A-T-T-A-C-H dot
(01:27):
org.
Norm utilized all of theseskills and he needed everyone,
I'm sure, to marry the girl ofhis dream, meg.
Together, they have fivechildren and two granddaughters.
How does that feel?
And being a grandparent like?
How does that feel, norm?
Speaker 2 (01:40):
No, you know what, todd?
I love it.
I'm telling you, they were overat the house last night and
goodness it's just they justfill you up.
There's some fantasticneuroscience studies now on the
relationship with grandchildrenand how our mirror neurons get
in sync with them.
And just fills you up.
It's beautiful.
Speaker 1 (01:57):
Yeah, it's good, it's good to witness.
Well, you know, norm, thank youand welcome to the show.
You get introduced often as theprestigious Dr Tybo, but you
know, I'm really grateful justto know you as Norm, as a decent
guy that knows something aboutCarolinas back in the 80s.
Speaker 2 (02:16):
Can I get an?
Amen brother, Can I get an?
Speaker 1 (02:18):
amen, yes, and I tell you, you know we hit this topic
a little bit.
You and I have worked together alittle bit with a mutual client
who, I'm grateful to say, justcame out of your program and is
doing exceptionally well thesedays, now a young adult herself.
And this is a family thatstruggled with the topic I think
(02:41):
you and I want to hit on.
You know they were often quitedistraught at the fact that, you
know you got a child.
They were adopted at birth,they were loving parents, they
provided her with everythingfrom nutrients to resources to
education, everything that agrowing child would need to be
(03:02):
what we would say you know, welladapted and able to go out in
the world.
But came away, despite all ofthat, with lots of attachment
challenges, lots of behavioralhealth challenges, you know,
getting kicked out of school,getting in fights, doing all the
kind of outwardly expressivebehaviors and even and we're
(03:23):
we're also talking about a childthat even in treatment, went to
multiple treatment programs andgot kicked out of a couple, you
know, assaulted staff.
You know like she had, she hada history and came into your
program and I think that one ofthe things that you were able to
address with his family is thatone of the things that you were
(03:47):
able to address with his familyis, you know why, why, why is
she rejecting our love.
You know what is it about.
What is it about having had herand being an adoptive child
from an environment and, ofcourse, her particular situation
.
There's a brother involved.
They were not, didn't getco-adopted, um, and so you know,
there are elements ofseparation that can still occur
in those scenarios.
But just adopted from birth andstill with all these kind of
(04:13):
you know, specific to adopteesattachment disorder and
attachment symptomologychallenges that wreak havoc on
this family system, like you say, we don't talk about this
enough and I think lots ofpeople want to know.
The big question is why, whydoes that happen and where does
(04:34):
it come from and what can we doabout it?
So I'm more than interested tohear your answer to some of that
question at least.
Speaker 2 (04:42):
Thanks, todd, and let me just say what a delight it
is for me to visit with you andto be on your show and to
partner with you in helping kids.
You are so well-respected and Iam so grateful for this
opportunity.
From the bottom of my heart,thank you for allowing me to
visit with you.
Speaker 1 (04:59):
Pleasure's mine Again .
Carolina boys got to sticktogether.
Speaker 2 (05:03):
So you ask a great question, and it's a common
question we get, which is youknow, for example, my child was
adopted at birth.
Why might they afford food?
Why might they be so reactive?
And they've had everything theyneed.
One of the things that we'relearning through wonderful
research from some colleagueslike Dr Tim Nimtottenham, who is
(05:24):
the director of theNeuroaffective Psych Lab at
Columbia University, or Dr JohnBalin, who is a psychologist and
author in neuroscience theresearch that we're getting
speaks to the idea that ourpre-birth environment plays a
much larger role in theexpression of our DNA than we
(05:45):
ever thought.
And so what does that mean?
You know, when I was in graduateschool and I won't say how long
ago it was, todd, but when Iwas in graduate school you know,
we talked about neuraldevelopment and sensitive
periods, right, and thesensitive period for neural
development and attachment,which we thought about three
months prior to birth to aboutage five.
(06:06):
By the time I graduated, someonehad said three months prior to
birth to age four.
Well, a couple of years ago Iwas at the Congress of
Attachment and Trauma inManhattan and they brought in
leading researchers all over theworld to discuss this.
Some are positing that thatsensitive period begins as early
as five weeks post-conception,when you're first learning that
(06:28):
you're pregnant, when you firstmiss a period up to about 20 to
24 months post-birth.
Now, it's a sensitive period,which means optimally, things
happen during that period oftime Doesn't mean they have to,
but what we're learning aboutepigenetics is that very
sensitive period of time plays asignificant role in the way
(06:49):
that our DNA is expressed.
And so you know, we know, thatmom and dad come together, have
a baby, dna is set, but the wayit is expressed excuse me that
is influenced by the environmentthat the birth mother carries
the baby in, carries the fetusin.
Speaker 1 (07:09):
And, if I may, because I'm what you might call
an armchair expert onepigenetics, which means I read
a lot but don't participate.
So you know, just for theaudience out there, and because
I think the world might not havea clear definition.
They hear epigenetics and theyconfuse it with genetics.
It's like, well, as you know,genetics is you've got this vast
(07:31):
amount of material that'sstored in your genetic code.
Why does your grandmother havegreen eyes but you came out with
blue eyes?
Well, epigenetics is the thingthat's the picker.
It's like what part of the codeam I going to read?
And the thing that we'relearning, that that you know the
(07:51):
addictions the addictionstreatment world can echo in the
same way that you're echoing ithere is that you know
environmental influences andchemicals and substances and you
know, and the availability, theavailability of nutrients and
resources in the whole nineyards that are occurring while a
baby is in the womb are havingan impact on the picker, the
(08:14):
epigenetics, the thing that says, hey, what part of the code am
I going to read?
You can have a real impact onthat thing in the womb
environment.
And continues, there's evenevidence to suggest that you can
have an impact on theepigenetics of an individual,
even when they're in adulthood,and that sort of thing, which is
(08:36):
that we won't go down therabbit hole in the science
that's being done about thatstuff.
But this is really fascinatingto me and explains a lot of this
question.
In terms of treatment, though,what is it like?
You're going to get this kidand maybe you know something
about their, their, the wombenvironment in which they were,
(08:56):
you know, birth?
carried yeah carried, carriedand eventually birthed.
And you probably see a lot offolks that you know.
Mom gives birth, adoptionhappens at that time, sometimes
it happens after, but at thevery least the mother and the
child, the birth mother and thechild, for the, for the, you
know incubation period, thepregnancy period, they're in
(09:19):
charge of that environment.
And you know the other thingsthat impact the chemistry of a
person is are you experiencingpsychiatric symptoms?
Are you experiencing highlevels of anxiety?
Are you experiencing highlevels of stress?
These are all chemicals, youknow, neurochemicals, that are
having an impact on the baby'senvironment.
And when you get a kid, how muchdo you?
(09:41):
You know they're going to bepresenting, but by the time they
get to you, they're presentingwith behaviors and things that
you you can see from thestandpoint of having a clinical
profile might do an assessment.
How do you start working with achild?
You know the environment isepigenetic or it's it's prior to
the parents being involved.
How do you work with a child onthose behaviors to help shift
(10:04):
how they address and see theworld?
And then families, because Iknow that family work is a huge
piece of what you do work withfamilies to kind of come
together on creating somethingthat is new and different and
adaptive to the world they'regoing to go into.
How does that work start andhow do you do it?
Speaker 2 (10:22):
You know, a part of it is getting a real, as much as
possible accurate, assessmentof the background.
Todd, you know we really haveto understand the layers and
complexities that we're dealingwith and, as you mentioned, a
lot of it's work with theadoptive parents, because
there's a few different layersand a few different variables
(10:43):
that we want to reallyunderstand.
One is the sense of loss thatour adoptive families have dealt
with.
It's been said that one traitthat distinguishes all adoptive
families from every other is thethreat of loss.
There's not an adoptive familywho hasn't suffered loss at some
(11:04):
level, be they the adoptiveparents or the adopted child,
and so understanding loss andhow they grieve that loss and
how they're managing that loss.
In addition, understanding theadoptive parents' attachment
style themselves, because weknow that their attachment style
is going to inform andinfluence the way that they
parent an adopted child.
(11:26):
For the kids that you and I workwith, you know most adoptions
are quote-unquote successful.
The majority of adoptions turnout very, very well and most
adopted kids are cognitively,emotionally and physically
caught up to their peer groupwithin two years post adoption.
But for the kids that you and Iwork with who have suffered
some level of developmentaltrauma, either pre-birth or
(11:48):
pre-verbal or post-birth.
Those challenges can beenormous, and so understanding
that adoptive parents, theiranxieties, their attachment
insecurities, their unresolvedtraumas, can be really activated
by parenting these kids.
Speaker 1 (12:08):
Like mirrors, those kids.
Speaker 2 (12:10):
Yeah, yeah, and a neurobiological.
We don't say what we don't sayunconscious level anymore,
because it sounds too Freudian,right?
So now we say neural at aneurobiological level,
parasympathetic level, yeahexactly, exactly.
So.
So understanding those parts ofit that that you know these
parents need a lot of support,because we know adoptive parents
(12:31):
have typically have highereducation status than
non-adoptive parents, but theyalso have higher anxiety levels
than non-adoptive parents and sobeing there as a support to
them, adoptive parents getjudged so often by others who
don't understand the challengesthat they're dealing with, and
so there's shame, there's innershame, there's a lot of layers
(12:52):
to it that we have to examineand we have to be there for
those adoptive parents.
I say for those parents.
If they're dealing withdevelopmental trauma and real,
significant challenges, there'sthree bridges they have to cross
and we have to support them incrossing.
The first is they are not thechild I thought they were going
(13:14):
to be.
The second is I don't get to bethe type of parent I thought I
was going to get to be.
And the third is this is notthe experience I thought it was
going to be, and really beinghonest in those moments and
really taking a look at whatwe're dealing with is absolutely
crucial in the work we do withthese wonderful, wonderful
(13:36):
parents who, you know, kind offeel let down at times, feel
insecure themselves.
One other thing I would sayabout that, if I might.
Nancy Verrier published a booksome years ago called the Primal
Wound, and Nancy is a wonderfulclinician and she's so kind and
(13:56):
generous.
There's been recent research bysome wonderful and just stellar
researchers.
Some colleagues Dave Brzezinski, who is probably I would say
he's denied this but I say he'sprobably studied adopted
children in treatment more thananybody but David Brzezinski,
megan Gunnar at the Universityof Minnesota and Jesus Palacios,
(14:18):
who's out of the University ofSeville in Spain they did a
foundational research onmeta-analysis on adopting kids
and treatment, and they foundthere was no support for a
primal wound, that adoption inand of itself is not traumatic
unless that child has been witha caregiver long enough to form
(14:41):
a secure attachment prior toadoption.
So you know there's a lot oflayers there as we work with
adoptive families and try to,you know, understand the
complexities that have gone into.
Why is my child acting this way?
If I can touch on theepigenetic piece again, there's
two research studies that I lovethat kind of really explain
(15:02):
pretty clearly how epigeneticscan inform the way our kids are
responding today.
The first one is and you'reprobably familiar with it, todd,
during World War II, the Dutchhunger winter.
And that was toward the closingmonths of World War II, when the
Nazis had blockaded theNetherlands, and so there were
(15:25):
people starving and there weresome brilliant researchers who
decided to understand and studywomen who were pregnant during
the blockade, so during a famine, but who gave birth after the
Allies had liberated Holland.
So these kids were carried in afamine but born right after the
famine ended, and in studyingthose kids they have
(15:47):
statistically significantlyhigher levels of heart disease,
obesity and othercaloric-related issues.
The theory is that in uterotheir DNA was expressed in such
a way to prepare them to survivein a famine, so that every
calorie count.
And when you're not born in afamine and your body digests
(16:08):
food differently, then it'sgoing to process it differently
and people like you and I giveit a diagnosis.
Now another more recent studythat goes along the same
principle there wereapproximately 1,700 women in the
New York metro area diagnosedwith PTSD as a result of the
9-11 terrorist attacks.
Studying their children, whoare turning 23 this year, those
(16:32):
kids have statisticallysignificantly elevated levels of
PTSD and anxiety, even thoughthey were not born at the time
of the attacks.
And when you take a look at it,the theory is that their DNA
was expressed in utero toprepare them to survive in a
hostile environment, because youand I know nobody wants PTSD
(16:52):
and anxiety.
But from an evolutionaryperspective it keeps us alive
right.
But when you're not born in ahostile environment and you have
those traits, then again wegive it a diagnosis PTSD and
anxiety when, in the context inwhich it was developed, having
(17:13):
your head on a swivel, notrelaxing, being hypervigilant
and hyper alert would keep youalive.
Speaker 1 (17:20):
Yeah.
Speaker 2 (17:21):
So they were prepared to survive in a hostile
environment, but weren't born ina hostile environment.
Speaker 1 (17:27):
Which creates maladaptive behaviors in a in a
right.
Speaker 2 (17:31):
Exactly, exactly, which is what we see from many
of the adopted kids that we workwith.
They're not bad kids at all,but their limbic system and
their amygdala, everything is onhyper alert, prepared to react
to keep them alive because ofwhat they experienced.
Rebirth Exactly Right alertprepared to react, to keep them
(17:51):
alive because of what theyexperienced rebirth Exactly
Right.
And so if you take that andthen you combine it with what we
know about polyvagal theory,the idea of safety is so crucial
to helping these kids right.
In order to form a relationshipwith them, they have to feel
safe.
And in order to feel safe we'vegot to dampen that amygdala,
(18:14):
dampen that limbic system, sothey're not quite so reactive,
so that they can kind of relaxinto our influence and start
trusting us.
Because what we know is if it'sepigenetic, it's influenced by
the environment.
That means epigenetic effectsare likely reversible based on
the environment.
Epigenetic effects are likelyreversible based on the
environment, environmentalenrichment at the right time.
Speaker 1 (18:31):
Well, and you see, there are a lot of aspects of
this in adult care, especiallyas it pertains to PTSD and other
things and something I thinkand I'd love to hear your
thoughts about this have reallyadvised the sophisticated trauma
(18:54):
treatment approach that we have, um, because you know it used
to be.
It's like well, they suffer,let's say it's ptsd, so there's
this, this, they, they called ita can of worms, I call it
trauma trunk.
Um.
And you know, if you, if youwalk in on a person who, like
you know, who, doesn'texperience safety as a result of
the neurobiology that's goingon, for whatever reason, and you
try to go in trying to addresstrauma, well, what's the
(19:17):
traumatic issue?
Let's go address this issue.
Let's go dig it up.
The chances are incredibly good.
What you're going to do isre-traumatize that person, not
address the trauma issues thatare coming up as a result of a
specific event.
And so you it's not somethingthat you can hit head on, as
they say, like it's somethingyou've got to be careful about.
You've got a lot of use ofnonverbal strategies.
(19:39):
You've got to, you've got tohelp that person learn how to
regulate first, before they canprocess anything that's that's
anywhere close, anywhere closeto triggering material.
And so you know, just and withkids, of course, I think for
parents who have adopted a childwho has these symptoms or has,
(20:00):
you know, had that in uteroenvironment and came out and
starts to and is on edge and hastheir head on a swivel and has
high anxiety and is is fearfulfor their life, even though
they're not in a situation thatwould require them to be that
their, their, their amygdala hastaken over.
Um, it's very hard for them toeven set what I would call
(20:22):
regular limits.
It's like you know this it onlymakes sense that you would put
away your dishes after you'reasked, or you don't make sense
that you would clean your roomor all these other things, and
this person decides that it'snot important that they clean
their room, and being asked todo something is a threat to
their life.
And then you get all thesebehaviors that come out and the
parents are just dumbfounded,first of all, as to what to do
(20:43):
with this, and they don't knowwhat to do.
Eventually, they'll either findsomebody like me and I send
them to you, or they'll findsomebody like you who knows how
to work with their child andteach them.
Let's work on safety first,then let's train some behaviors,
Then maybe we can address someof these other issues.
But even that is a much longerterm kind of thing.
(21:03):
What message would you give toa family that has you know?
If somebody happened to belistening to this podcast, I
think there's a lot of greatinformation here already.
What message do you have forfamilies that are struggling
with all of this?
Speaker 2 (21:19):
Well, and there's a few different things that I
might say.
One is the self-care piece,because these kids have to be
able to borrow serenity, and youcan't let someone borrow your
own serenity and you can't.
You can't let someone borrowyour own serenity if you don't
have it.
And our parents, our parents,have to be able to find find
(21:39):
that serenity I mean truly sothey can, they can share it with
their children.
There is a there's a goodportion of the research that
says that one of the significantvariables for the successful
outcomes of these kids is aparental capacity to manage
their own dysregulation whentheir kids are not managing
their regulation, and so aparent's ability to stay
(22:02):
centered, to stay calm when it'shitting the fan with their kids
is really, really important.
And the only way, the only wayTodd that adoptive parents can
do that is if they have a goodsupport network, because it's a
Herculean task we ask, we'reasking parents to to take okay,
so so a little background, right.
Being from North Carolina, dadwas a Marine for 36 years, right
(22:26):
, when I got out of line when Igot out of line, I knew it was
coming right.
I knew I needed to stay in lineif I didn't want to get whooping
.
Okay, well, that doesn't workfor these kids.
That cause and effect, verysimple response doesn't work for
these kids.
(22:47):
And you can take all the toysaway.
You can take everything away.
Traditional parenting does notwork for complex developmental
trauma.
Therapeutic parenting is whatwe've got to do, which is a real
shift, because it feels likewe're just coddling kids and
we're letting them get away withstuff.
The goal in therapeuticparenting is not compliance.
(23:09):
Compliance is not to get themto behave.
Our goal has to be and this isour goal at three points
neurodevelopmentalattachment-based healing, which
means we're focused on healingthat, that neural substrate
between the midbrain and thelower prefrontal cortex, so that
they're operating andcommunicating.
(23:30):
Our parents, oftentimesadoptive parents, struggle with.
Why do I have to keep repeatingmyself over and over again at
this child?
Well, the reality is, theircapacity to retain information,
to listen and learn really isgreatly reduced if they've had
some kind of complex traumaprior to birth.
Speaker 1 (23:50):
It never passes the threshold of the reactive
amygdala.
It never goes into the brain.
Speaker 2 (23:55):
Exactly so.
There's no capacity for causeand effect thinking.
But because they look their age, we assume that they're their
age, when in fact, cognitivelyand emotionally, they're so much
younger, so much younger, andso it's.
It's a real challenge for forprofessionals and parents
working with these kids toreally kind of go.
(24:15):
This isn't a choice they'remaking.
The behavior makes sense in thecontext when it was originally
developed.
Speaker 1 (24:23):
Right.
Speaker 2 (24:24):
And that's what we've got to put it in Um so so,
living in an environment, andthat's what we've got to put it
in.
Speaker 1 (24:27):
They're living in an environment you can't see
Exactly.
Speaker 2 (24:32):
Exactly, and so for these parents it's a Herculean
task, and so we say you've gotto have a support network,
you've got to take care ofyourself and educate yourself on
what's behind this, because formost of these kids, these
behaviors were in place beforethey took their first breath.
Speaker 1 (24:48):
Oftentimes it's not about you, it's about what
needed to happen, but then inutero, yeah, I think we're
seeing a lot of that in general,with just the new generations
of kids, you know, adolescentsand young adults, whether
adopted or not.
We're you know, we have thepandemic, we have all these
other periods of time that arehaving an impact, and what I'm
(25:10):
telling you, norm, is that youneed to open a program that's
not just for adolescent, adoptedadolescents.
Speaker 2 (25:16):
Yeah, I think you're right.
We are seeing it across thespectrum, aren't we?
And the impacts, the rippleeffects of post-COVID, the
shutdown and everything else.
It's going to be a tsunami, Ithink, unfortunately, on the
impact of these kids.
Speaker 1 (25:31):
Yeah, I couldn't agree more.
I think that one of the thingsI've been discussing with not
just families but otherprofessionals of late and that
came up, I was recently atSilver Hill for a conference and
they were talking abouteducation and everything else
Knowing resources that exist outthere is one of the greatest
(25:56):
challenges, and even when youknow about them, navigating the
one it's.
You know, our treatment andmental health world is not a
user-friendly environment.
What is it it you're doing withyour families to help grow this
kind of consciousness around,not only the kind of care you're
trying, the kind of parentingyou're referring to, but also
kind of the kind of care thatThree Point Center is able to
(26:18):
provide?
Like, what do you, are youseeing it being a little more on
the stage, both nationally andinternationally, and that sort
of thing?
What's, what's going on in thefield that gives you hope, I
guess, is my question.
Speaker 2 (26:30):
Well, great question.
A couple of things.
One is because people arebecoming more aware of it.
There's so much frustration.
You know, and as you know, todd, you know, in NATSAP, the
National Association ofTherapeutic Schools and Programs
, I've spent time in CapitolHill working with senators and
members of Congress to educatethem that, look, these parents,
(26:50):
these families need help.
They really do.
One of the challenges and I'mgoing to geek out and get a
little technical here, but oneof the challenges we have is in
the Diagnostic and StatisticalManual of Mental Disorders, and
do you know what that is?
Many of your listeners may beaware of it.
Speaker 1 (27:07):
The DSM?
Yes, we are familiar.
Speaker 2 (27:10):
The DSM.
You know the fifth edition.
You know most of us, as mentalhealth professionals around the
world, use the DSM but it'swoefully inadequate to
conceptualize the experience ofadopted children with complex
developmental trauma.
Because we get all thediagnoses right we get ADHD, we
get oppositional, defiant orconduct disorder.
(27:32):
Uh, intermittent disruptivemood repulite yeah exactly and
and you know transparency Icontributed to the DSM five.
You'll find my name in the book, but I'll be the first to say
it does not do any service toadopted children.
Speaker 1 (27:48):
It does not do any service to adopted children,
bessel van der Kolk, who youknow is just wrote, keeps the
score Right no-transcript, whichdoes a much better job of
conceptualizing what these kidsexperience.
Speaker 2 (28:06):
It's different than PTSD and it's pretty simple to
understand why.
Because PTSD is described, youknow it hasn't changed much
since it was battle fatigue inWorld War.
I right, it's about an eventthat challenges your safety and
your sense of self, whereascomplex developmental trauma is
a chronic.
The person who's supposed to betaking care of you not taking
(28:29):
care of you trauma and itrewires the circuitry of the
brain.
So PTSD doesn't do a good jobof it.
Adhd doesn't, because they'rehypervigilant it's not that
they're lazy and don't want tofocus.
Exactly, exactly.
So all that to say, more andmore people are becoming aware
that we need this diagnosis inthe DSM, the next iteration,
(28:51):
because if it is, then we'llteach it in graduate school, and
as long as it's not in there,we're not talking about it in
graduate school.
I wasn't talking about any ofthese things.
And secondly, insurancecompanies will then have to take
a look at it.
Speaker 1 (29:05):
Yeah, I was going to say there's a elephant in the
room there with the diagnosticcode, right?
Speaker 2 (29:14):
Yeah, and if we are talking about complex
developmental trauma, then we'retalking about neurological
healing which takes longer thansimple behavioral changes.
Right, yeah?
And insurance companies.
My own opinion, this is justnorm.
But my own opinions oninsurance companies don't want
to look at that, because nowwe're talking about really
long-term stuff.
Speaker 1 (29:35):
Well.
Speaker 2 (29:36):
Because we're talking about rewiring the circuitry of
the brain.
Speaker 1 (29:40):
Well, and I think that you probably agree with the
statement, I think neuroscienceis the treatment science of the
future and not to dismiss goodtherapy and good medication
management when necessary andall these other pieces.
But I want to hear what youthink about this.
I was at Silver Hill and it wasa big discussion and their CEO
(30:10):
was like you know, you'll neverget insurance companies to sign
on because the averagesubscriber never stays a member
with their insurance from one totwo years.
So interesting, and in orderfor there to be this
incentivized health dynamic andbe in behavioral health and I
(30:33):
would say, in medical care ingeneral, you have to you know a
person who is going intotreatment.
What we know is that you'relooking at two years worth of
care.
You're looking at, you'relooking at two years worth of
care You're looking at two yearsworth of.
You know there's a residentiallevel of care and there's, you
(30:55):
know, a variety of levels ofclinical care that exists past
residential and then evensupport when a person goes back
into the home or an independentenvironment or what have you.
So you know, I tell familiesall the time you're looking at
one to two years worth ofvarious levels of care.
And the point that I made tothis group I said, look, they're
going to save money.
The point made back was thatwell, they won't save.
(31:15):
The company itself won't savemoney because they're
subscribers.
They only last for two years.
I said, yeah, but if you can getthem all to sign on at the same
time, the savings can be heldacross the board.
So while maybe this company'ssubscriber may not save, by the
time they switch, that person'sgoing to go into another care
(31:38):
environment or another you knowsubscriber membership
environment where they no longerneed the same level of care
because they got adequate carethe first time.
If everybody does it at thesame time, you'll get this mass
effect where the care does notcost as much.
Therapeutic care can beeffective because we know we
(31:58):
know how to do good treatment.
Good treatment exists, butlargely only exists for people
who can pay for it so expensiveit so expensive.
It's very, is it, though?
I mean, you know my point tothat.
When people say it's veryexpensive, it's like well, yeah,
for an average family, anout-of-pocket expense of
anywhere from $18,000 to $40,000a month could be an
(32:19):
out-of-pocket residential careexpense.
But if you went into thehospital for a heart attack or
any other major illness let'ssay you had a diabetic attack or
you had severe liver disease orkidney disease or you had any
of these other things and all ofa sudden an insurance company
is responsible for caring for it, you'll pay that money for sure
(32:43):
to handle any of these majormedical conditions.
I would say that behavioralhealth conditions are no
different than the severity thatyou apply to any major medical
condition and, by and large, ifyou talk about what I would call
appropriate levels of care,what we're doing we're doing
(33:04):
fairly economically when youthink about it.
Speaker 2 (33:07):
You know, in that context, what you're saying
makes perfect sense, todd, itreally does, and you're
absolutely correct.
Speaker 1 (33:13):
You know, I only get people on the show that are
going to agree with me.
Speaker 2 (33:19):
So, uh, yeah, no Carolina boys again.
There you go, that's right Well.
Speaker 1 (33:24):
Norm, I man, I tell you we, I tell you we could sit
here and talk about this forquite some time.
I'm so grateful that you agreedto join me in my ramblings on
the show.
The information that youprovided for us is just going to
be valuable.
I'm going to play it severaltimes just so I can dig out all
the resources.
I'm going to play it severaltimes just so I can dig out all
the resources.
(33:45):
But I'm grateful for you as aperson, as a Carolinian, but
most importantly, as a resourcefor families out there
struggling with these challenges.
Thank you so much for foundingthe Three Points Center and
being involved in the work thatyou're in.
It's a pleasure and an honor tohave you on the show.
Speaker 2 (34:00):
Well, thank you, todd .
The pleasure is truly all mineand I appreciate the work you do
and the esteem you hold in thefield.
Thank you.
Speaker 1 (34:07):
Well, I'll look forward to being with you again
here pretty soon.
This has been Mental HealthMatters on WPVM 103.7, the Voice
of Asheville.
We'll see you next time.
I feel so lonely and lost inhere.
(34:30):
I need to find my way.
Thank you, bye.
Outro Music.
I need to leave.
I found the other day I need toleave.
I found the other day I need toleave.
I found the other day.
Speaker 2 (36:32):
I need to leave.
I found the other day I need toleave.
I found the other day I need toleave.
I found the other day I need toleave.
I found the other day I need toleave.
I found the Indian.
I found the Indian.
I found the Indian.
I found the Indian.
I found the Indian.
I found the Indian.
I found the Indian.
I found the Indian.
(36:53):
I found the Indian.
I found the Indian.
I found the Indian.
I found the Indian.
(37:45):
I found the Indian.
I found the Indian.
Thank you, I'm so lonely andlost in here, bye.
I feel so lonely and lost inhere.
I need to find my way home.
I feel so lonely and lost inhere.
I need to find my way home.
Speaker 1 (38:14):
Find my way home.
Popular Podcasts
Stuff You Should Know
If you've ever wanted to know about champagne, satanism, the Stonewall Uprising, chaos theory, LSD, El Nino, true crime and Rosa Parks, then look no further. Josh and Chuck have you covered.
Dateline NBC
Current and classic episodes, featuring compelling true-crime mysteries, powerful documentaries and in-depth investigations. Follow now to get the latest episodes of Dateline NBC completely free, or subscribe to Dateline Premium for ad-free listening and exclusive bonus content: DatelinePremium.com
24/7 News: The Latest
The latest news in 4 minutes updated every hour, every day.