Therapeutic tools: “every creative solution you could imagine”
Treating complex trauma histories, particularly with an eye towards reducing high-level interventions or imprisonment, requires tireless experimentation with different modalities based on each individual’s needs. Referring to her work at Vermont’s Juvenile Detention and Rehabilitation Center, Dr. Steward explains: “I want the kids to get better, so eventually you have to try everything—every creative solution you could ever imagine.”
Dr. Steward says her myriad approaches fall into two buckets: trauma therapies and alternative therapies. In large part, these therapies are utilized differently based on cost. “Insurance companies may reimburse for certain trauma therapies, but it can be incredibly difficult for them to reimburse for alternative services,” Dr. Steward explains. Alternative therapies like nature therapy and mindfulness-based stress reduction have been recognized as effective modalities to treat mental health disorders like anxiety, depression, or PTSD. A study in Psychosomatic Medicine concluded that mindfulness meditation produced better immune function and reduced cortisol levels in participants. But significant data does not yet exist to support the efficacy of these therapies.
Further, medical providers may feel pressure to prescribe medications that correct for chemical imbalances in the brain, even though there can be disturbing side effects to long-term use of certain drugs. According to CNN, lobbying activity for the pharmaceutical industry hit $27.5 million in 2018. “Medical providers are often thinking: what’s the next pill? What can I prescribe? And they don’t always think of prescribing walks outside, or swimming in a lake,” Dr. Steward says. “But nature can be the best medicine we have.”
She speaks from experience. Dr. Steward was born and raised on a tiny farm in Vermont. In recent years, she has reinvigorated her study and practice of nature, animal, and wilderness therapies, and she is interested in how nature might be reintegrated into medical care. “I spent the majority of my early years outside,” she says. “Those nature experiences got me through a lot of the trauma that was around me.”
The potency of her own nature experiences, and her drive to find success with alternative therapies, led to the opening of a bird program at a juvenile rehabilitation center. When a friend offered to teach a lesson on birds to Dr. Steward’s patients, she says, “the youth dove deeply into it, and began bird-watching in the rec yard on a regular basis.”
“I was able to see that some kids, who can’t talk to people or don’t want to be around people, can find peace and comfort and be in the present moment if they are in nature,” Dr. Steward explains. “This is so important with the trauma brain because trauma makes it really difficult to be in the present moment. This is one of the hardest skills to learn, because for people with trauma the present is frightening.”
Work with animals may function as nonverbal healing therapy. “There are so many reasons why people may not be able to put words to why they’re acting out,” Dr. Steward says. “Language development is not on board with a lot of early childhood trauma or adolescent trauma. When your limbic system is activated—the survival part of your brain—then executive functioning is shut down. Sometimes when we look at a patient and ask them why they are acting out. Often that person also does not have the capacity to understand or articulate.”
Some youth are so acute that they can be a challenge for a whole team to manage. “I worked with a kid who had a very harmful and traumatic history, and this youth’s self-harm was so serious, but they had no words to describe their choices or their sadness,” Dr. Steward explains.