What Happened to You?: Conversations on Trauma, Resilience, and Healing

by Bruce D. Perry

But if as a child you’ve experienced chaos, threat, or trauma, your brain organizes according to a view that the world is not safe and people cannot be trusted. Think about James. He didn’t feel “safe” when he was close to people. Intimacy made him feel threatened. Here is the confusing part: James felt most comfortable when the world was in line with his worldview. Being rejected or treated poorly validated this view. The most destabilizing thing for anyone is to have their core beliefs challenged. As psychologist Virginia Satir puts it, we feel better with the certainty of misery than the misery of uncertainty. Good or bad, we are attracted to things that are familiar.

In fact, if you get into a relationship with somebody who’s not treating you poorly, you may find yourself feeling increasingly uncomfortable. And then, unconsciously, your mind might seek a “predictable” response. You may try to provoke a bit of response. Maybe I’ll do X and it’ll piss him off. If this elicits the behavior you’re most familiar with—he gets angry and treats you poorly—it can actually be validating. The worldview has been confirmed. Even though the result is chaos and conflict, it’s comforting in the sense that it’s familiar.

It’s interesting—most people think about therapy as something that involves going in and undoing what’s happened. But whatever your past experiences created in your brain, the associations exist and you can’t just delete them. You can’t get rid of the past. Therapy is more about building new associations, making new, healthier default pathways. It is almost as if therapy is taking your two-lane dirt road and building a four-lane freeway alongside it. The old road stays, but you don’t use it much anymore. Therapy is building a better alternative, a new default. And that takes repetition, and time; honestly, it works best if someone understands how the brain changes. This is why understanding how trauma impacts our health is essential for everyone.

We often use our belief in another person’s “resilience” as an emotional shield. We protect ourselves from the discomfort, confusion, and helplessness we feel in the face of their trauma. It’s a kind of looking away; it lets our worldview go unchallenged and lets our life continue with minimal disruption.

We are always changing. We change from all of our experiences, good and bad. This is because our brain is changeable—malleable. It’s always changing.

You can demonstrate resilience and, as we’ve said, you can build resilience. But it’s not resilience in the Nerf-ball sense. And it’s not an automatic property of childhood. The capacity to get back to “baseline” after a trauma is influenced by many factors, primarily your connectedness.

The concept of resilience is used in our field. But if you look carefully at our biology after a traumatic experience—all the way down to the way genes are expressed—trauma will change everyone in some way.

ACE studies have demonstrated: Adversity impacts the developing child. Period. What that impact will be, when it may manifest, how it may be “buffered”—we can’t always say. But developmental trauma will always influence our body and brain.

Now, brain scans have shown us that each of us has a unique brain—which, considering everything we’ve been talking about, is not surprising. And because each of us has a unique brain, we will experience stress, distress, and trauma in a somewhat unique way. Two people who experience the same traumatic event can respond differently—and recover differently. When a person is able to “recover” emotionally—returning to a pre-trauma level of functioning—we refer to that as demonstrating resilience. And the capacity to do that is malleable. In other words, the ability to cope with stress, distress, and trauma is changeable. It’s something that we can help build in people. You can make your coping machinery stronger and more effective.

Your connectedness to other people is so key to buffering any current stressor—and to healing from past trauma. Being with people who are present, supportive, and nurturing. Belonging.

Let’s go back to the start of our conversation, back to our core regulatory networks. The CRNs comprise a set of very important neural networks that collectively reach every part of your body and brain. We know that when these systems are well-organized, flexible, and “strong,” we have the capacity to cope with all manner of stressors (Figures 2 and 3). We also know that controllable, predictable, and moderate challenges can make the CRNs even stronger. Our stress-response capabilities expand when they get “practice.” So if a child has had the opportunity to have predictable, moderate challenges as they grow up, they will be more capable of demonstrating resilience in the face of a challenge.

All development involves being exposed to novelty, which in turn activates our stress response. With a safe and stable relational foundation, thousands of moderate doses of stress help create flexible stress-response capabilities.

Every school year, meeting new classmates and a new teacher and studying new content provides moderate, predictable stressors. Participating in sports, music, drama, and other activities creates more opportunities for the controllable, predictable stress that helps build resilience.

And through all of this, relationships are absolutely key. For the infant, the relationship with primary caregivers is the foundation of their capacity for all future relationships. It is in the context of nurturing and caring relationships that the child can meet a challenge; in the face of any new challenge, an adult can model, encourage, and provide a helping hand. And the relational reward—the smile, word of encouragement, congratulations for progress during and after the challenge—motivates the chi...

It’s a Goldilocks situation. Just as the challenge shouldn’t be too big, it also shouldn’t be too small; it has to be novel enough to cause the child to leave the comfort zone of their known experiences and already-mastered skills. If the challenge is going to build resilience, it has to be moderate—just right. Finding the “just right” is a major issue with children who have had trauma. Remember, they frequently live in a persistent state of fear. And fear shuts down parts of the cortex—the thinking part of the brain. In a classroom, what may seem to be a moderate, developmentally appropriate challenge for many children may be an overwhelming demand on a child with a sensitized stress response (see

So children need challenges to build resilience, but the stress of the challenges has to be just right, and the scaffolding of support has to be in place or the child can get dysregulated and fail. In which case, rather than building confidence and resilience, you risk eroding self-esteem or worse.

Healthy development involves a series of challenges and exposure to new things. And failure is an important part of the process. We try, we fall, we get up, we try again. And again. All developmental success comes after failure, and typically many failures will occur before mastery is achieved. The key is to have challenges that are achievable—close enough to your current capabilities that you will succeed with some encouragement, practice, and repetition.

A child in an environment where they feel loved and safe will choose to leave their comfort zone. Safe and familiar is “boring”; a safe and stable child is a curious child—they want to explore new things. A child who feels unsafe, however, won’t want this. It’s an essential rule of healthy development: A sense of safety and stability provides a foundation for healthy growth.

It’s very difficult to meaningfully connect with or get through to someone who is not regulated. And it’s nearly impossible to reason with them. This is why telling someone who is dysregulated to “calm down” never works.

Yes, it’s best if you can simply be present. If you do use words, it’s best to restate what they’re saying; this is called reflective listening. You can’t talk someone out of feeling angry, sad, or frustrated, but you can be a sponge and absorb their emotional intensity.

her own time. In her own way. Because, as you’re saying, if you control when and how much a traumatized person talks, it can be retraumatizing rather than healing.

Controlling when, how much, and which aspect of a traumatic event they share allows a person to create their own therapeutic pattern of recovery.

We’ve talked a lot about patterns of stress activation that create “sensitization,” which is essentially the opposite of resilience. But when we activate trauma memories and our stress-response systems in ways that offer controllability and predictability, we can begin to heal a sensitized system. Healing takes place when there are dozens of therapeutic moments available each day for the person to control, revisiting and reworking their traumatic experience.

For thousands and thousands of years, humans lived in small intergenerational groups. There were no mental health clinics—but there was plenty of trauma. I assume that many of our ancestors experienced post-traumatic problems: anxiety, depression, sleep disruptions. But I also assume that they experienced healing. Our species could not have survived if a majority of our traumatized ancestors lost their capacity to function well. The pillars of traditional healing were 1) connection to clan and the natural world; 2) regulating rhythm through dance, drumming, and song; 3) a set of beliefs, values, and stories that brought meaning to even senseless, random trauma; and 4) on occasion, natural hallucinogens or other plant-derived substances used to facilitate healing with the guidance of a healer or elder.

It is not surprising that today’s best practices in trauma treatment are basically versions of these four things. Unfortunately, few modern approaches use all four of the options well. The medical model overfocuses on psychopharmacology (4) and cognitive behavioral approaches (3). It greatly undervalues the power of connectedness (1) and rhythm (2).

Her ability to heal and continue to demonstrate resilience was related to ongoing safe and stable relationships through which she could “make sense” of horror and put it in the context of her beliefs.

Social connection builds resilience, and resilience helps create post-traumatic wisdom, and that wisdom leads to hope.

A healthy community is a healing community, and a healing community is full of hope because it has seen its own people weather—survive and thrive.

Think of the diversity within a small multifamily, multigenerational clan. Children growing up had numerous adults and older children who could model, teach, nurture, discipline, and care for them. Each person in the clan had a unique set of strengths—the right person at the right time. No single person was expected to provide all of the emotional, social, physical, or cognitive needs of the developing child.

We expect a single working mother to be the one to throw the baseball with her eight-year-old, rock the newborn, read to the three-year-old, and, by the way, cook a nutritious meal, help with homework, do the laundry, get everyone to bed, then wake up and get them all ready for childcare and school so she can go work all day, only to rush home to do it all again. All alone.

We are meant to distribute caregiving among the many adults in our “band”—our community. In a typical hunter-gatherer clan, for every child under six there were four developmentally more mature individuals who could model, discipline, nurture, and instruct the child. That is a 4:1 ratio: four developmentally mature individuals for each child under six. We now think that one caregiver for four young children (1:4) is “enriched.” That is 1/16th of what our developing social brain is looking for. That is relational poverty.

Imagine that your annual review at work goes badly. Your supervisor gives you some negative feedback. You feel really upset. You keep thinking about it. You run it through your head again and again. You go back and talk to one of your colleagues. “Can you believe he said that? I don’t think that’s true!” And your colleague listens and reassures you: “No, that’s not true. He’s full of it.” You feel soothed for a bit. Then you call another colleague and run it by her. And you go home and you go over it with your partner. You’ve engaged in three, four, or five “doses” where you controlled how and when you talked about the distressing feedback. As your perspective is heard, you become regulated, reassured. The next day, you feel better. You have created a controllable and moderate revisiting of the distressing review, and that has changed your reaction to it. It is no longer as distressing. Originally you were dysregulated, you shut down the “rational” part of your head, distorted the comments, magnified them. But now you can reflect more accurately on the feedback, and maybe see some truth in the comments. That wasn’t possible until you could use your many relational interactions to revisit and regulate.

Most people who are in the process of excavating the reasons they do what they do are met at some point with resistance. “You’re blaming the past.” “Your past is not an excuse.” This is true. Your past is not an excuse. But it is an explanation—offering insight into the questions so many of us ask ourselves: Why do I behave the way I behave? Why do I feel the way I do? For me, there is no doubt that our strengths, vulnerabilities, and unique responses are an expression of what happened to us. Very often, “what happened” takes years to reveal itself. It takes courage to confront our actions, peel back the layers of trauma in our lives, and expose the raw truth of our past. But this is where healing begins.

Let’s start with young children. We’ve talked repeatedly about the important role of early-life relationships in the development of the stress-response systems and the capacity to form future healthy relationships. We know that when children experience distress and trauma—including poverty, homelessness, domestic violence, maltreatment—they will have some disruptions in development. Frequently the result is a “splintering” of the maturation of specific skills, as we talked about in Chapter 6 in relation to neglect. So, a five-year-old child may have only developed the language skills of a typical two-year-old and the self-regulation capabilities of a typical four-year-old. Along with this fragmented development, the child will have an overactive and overly reactive stress response (see Figures 3 and 5).

Now envision this child entering a preschool environment with expectations, transitions, rules, and curricula designed for the typical five-year-old. A developmentally uninformed, trauma-unaware setting will expect this child to “act” typical. But that is impossible for the child. The day will be filled with communication difficulties (due to their language development) and intense frustration (due to their self-regulation capabilities). In this overwhelmingly distressing situation, they will shut down or blow up. Either way, they don’t get the full benefit of the social, emotional, or academic learning. They fall further behind. They may be kicked out. More children are expelled from school in pre-K than at any other grade level; children of color, especially boys of color, are expelled at rates three times higher than white children.

This is the start of a toxic mismatch between the child’s capabilities and the unrealistic expectations of an education system that is all too often underresourced, developmentally uninformed, and trauma-ignorant. Even if the child “progresses” to the next grade, they are still behind, and this sets them up to fail. Year after year, they fall further and further behind. Their delays in developing skills, together with their trauma-related symptoms, begin to attract mental health labels (see Figure 6). The hypervigilance from their sensitized stress response is labeled ADHD; their predictable efforts to self-regulate—by rocking, chewing gum, doodling, daydreaming, listening to music, tapping their pencil, etc.—are prohibited. They will be labeled, medicated, excluded, punished, perhaps expelled, and then, all too often, arrested. When they try to avoid the constant ...

A child who is struggling is not going to say, “This poor teacher simply doesn’t understand ‘state-dependent’ functioning and the impact of trauma on my ability to learn. He should be helping me regulate, not conjugate.” They say, “I must be dumb.”

This isn’t just a few children; studies show that between 30 and 50 percent of children in public schools have three or more ACEs. And as we’ve discussed, these adversities have an impact.

These teams know that any “one size fits all” solution does not work. Think about how absurd it would be if everyone who had chest pain and a cough got the exact same antibiotic. That is what happens in many clinics that specialize in a specific “technique.” At a clinic that has learned that trauma-focused cognitive behavioral therapy (TF-CBT) is an evidence-based intervention for trauma, everyone with trauma may get this intervention. But while it is helpful for some, it isn’t for all.

A truly trauma-aware clinical team has a lot of “tools” to use: occupational therapy, physical therapy, speech and language supports, liaisons with the school, good psychoeducation with the family and child, plus access to a range of therapeutic techniques such as TF-CBT, Eye Movement Desensitization and Reprocessing (EMDR), somatosensory interventions, animal-assisted therapies, and many more. Despite being a young field, traumatology does have preliminary evidence of the effectiveness of many of these techniques when used at the right time in the treatment process.

What that means is that an effective therapeutic approach has to follow the sequence of engagement; problems with regulating have to be addressed before you can get results with relational or cognitive therapies. This is why I developed the Neurosequential Model of Therapeutics (NMT) that I wrot...

What we know is that the key ingredient of effective healing involves using your healthy relationships to revisit and rework the traumatic experience.

But remember that therapeutic moments can be brief and ideally are spread throughout your whole week—it’s not just about one hour a week with the therapist.

But what we’re learning is that having access to a number of invested, caring people is actually a better predictor of good outcomes following trauma than having access to a therapist. The therapeutic web is the collection of positive relational-based opportunities you have throughout your day. A therapist can be an important part of healing, but isn’t required. This isn’t to suggest that therapy isn’t helpful, but therapy without “connectedness” is not very effective.

And again, if you look at Indigenous and traditional healing practices, they do a remarkable job of creating a total mind-body experience that influences multiple brain systems. Remember, trauma “memories” span multiple brain areas. So these traditional practices will have cognitive, relational-based, and sensory elements. You retell the story; create images of the battle, hunt, death; hold each other; massage; dance; sing. You reconnect to loved ones—to community. You celebrate, eat, and share. Aboriginal healing practices are repetitive, rhythmic, relevant, relational, respectful, and rewarding—experiences known to be effective in altering neural systems involved in the stress response. The practices emerged because they worked. People felt better and functioned better, and the core elements of the healing process were reinforced and passed on. Cultures separated by time and space converged on the same principles for healing.