Thoughts on Japan, Disaster Relief and Resilience

The recent and ongoing disaster in Japan once again brings up the question– just how do helping professionals assist children after an acute traumatic event like an earthquake or tsunami? Here are some recommendations:

Establish and maintain close relationships with trusted adults. Even under the most adverse circumstances, most children and adolescents can cope as long as they have connections to adults, including helping professionals and caregivers. Young people who have someone they know is concerned about their well-being, provides them with guidance, structure and information, and spends frequent time with them do better than those who do not have such relationships. While parents are usually the source of support, others (counselors, teachers, childcare staff) can also supply a sense of meaningful connection.

Insure a sense of safety. All children need to feel safe, but particularly those under stress. In acute trauma situations like disasters, sharing knowledge of what is being done to help everyone be safe and secure is important. Many individuals have a tendency to worry more than usual after a catastrophe or negative event; for example, some children believed that airplanes could hit their homes after the events of September 11, 2001. Helping professionals and caregivers can assist them by providing age-appropriate and realistic information to reduce undue fright, anxiety or obsessive thinking. Monitoring children’s exposure to violent images or reports of death or disaster will also reduce feelings of vulnerability and the sense that “it is happening again” when, in fact, there may no longer be a threat.

Practice self-regulation techniques. Knowing a method or two to relieve emotional and physical tension can enhance and build resilience over time. Play is a natural form of self-regulation if it calms and relieves the individual. Talking, drawing, making music or physical activities or sports can help, too. For children and adolescents who are anxious or showing signs of hyperarousal, many of the more well-known self-regulation activities and strategies (breathing, mindfulness, and muscle relaxation) are useful; mastery of a “resilience-building” skill also is positive resilience factor, in and of itself.

Encourage optimism. Traumatic events like disasters make it difficult to feel positive about the world; even children and adolescents who have a natural tendency to see a positive future can be emotionally shaken by certain events. Those individuals who believe that these events are temporary will do better than those who obsessively belief that things will not change for the better. It is extremely important that helping professionals and parents help children and adolescents develop a sense that they can effectively deal with stress.

Identify values and beliefs. Commonly used lists of resilience factors include several concepts that underscore the importance of values and beliefs in trauma informed practice. Individuals who are altruistic, for example, and seek to help others in need build personal resilience and reduce depression and anxiety in the process. Values that involve connection to others are particularly important because they reinforce connection to a larger group and emphasize the welfare of others. After a traumatic event, beliefs about religion or spirituality are also a source of resilience for some individuals; trauma informed practitioners can help identify these beliefs within a framework of cultural sensitivity for individuals’ and families’ preferences for sharing information on religious or other practices.

Practice all of the above. This list of recommendations began with the importance of relationships in resilience-building after a traumatic event, underscoring that one of the most significant factors in resilience and trauma recovery is a meaningful relationship with either a parent or a helping professional. In order to make that possible, parents and professionals must be able to be available and supportive. Practitioners must make sure that they are feeling safe, calm, well-rested, and in good emotional health in order to implement the resilience-building strategies in this list. Practitioners can also help parents/caregivers understand and practice these same principles so that they can be available and supportive to their children.

Finally, it is important to look for any trauma reactions even months after exposure to an acute event; it is common for individuals of any age to begin experiencing symptoms 2 to 3 months after the occurrence. Anxiety, depression, avoidance of certain situations, problems with cognition and concentration and irritability can signal that some resilience-enhancement is in order. If reactions persist, professional assessment may be appropriate to make sure children and adolescents retain the ability to function at home, school, and with peer groups.

Be well,

Cathy Malchiodi, PhD, LPCC, LPAT

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Using Art Therapy to Address Bullying

Safran and Safran (2008) note that victims of bullying can benefit from opportunities to express themselves in a safe, creative way. In particular, art expression offers opportunities to communicate and explore more deep-seated feelings about being bullied, emotions that may not be addressed in school-based anti-bullying programs. Fear, worry, confusion, and rage toward the perpetrator and some well-meaning teachers and counselors who fail to protect the victim may emerge in a drawing or collage before articulated with words.

Safran and Safran recommend individual and/or group art therapy for bullying victims; they emphasize that drawing can be one way to eventually explore self-image, perceptions of bullies, and a trauma narrative. The latter is particularly important with those children who can benefit from telling their stories and sharing their images with either the helping professional (Malchiodi, 2001) or with peers who may be able to empathize with the victim.

Collage is another medium I frequently use with older children and adolescents. To begin any collage activity, do some preparation work by collecting colored paper and many magazines; pre-cut a variety of images from the magazines to put into a “picture collage” box (Malchiodi, 2006). Be sure to include a wide range of images of people, environments, objects, and phrases/text and of course, remember to ensure that cultural diversity in present in these magazine photos. Avoid just handing out magazines to your client or group; pre-cutting the images will prevent your young clients from wasting time flipping through magazines rather than engaging in the activity of creating a collage.

At this point, many helping professionals often say, “create a collage that represents bullying and/or the victims of bullying.” That’s a relevant directive, but try to think about the topic of bullying more globally and create and use themes strategically. When working with adolescents, I like to use this directive—“create a collage that represents what the feelings of powerful and powerless mean to you.” If I am working with a group, I might initiate a short discussion about these two feelings and give them some options for how to construct the collages. I sometime suggest that, “you can fold your paper in half and put the images of powerful on one side and images of powerless on the other. Or, if you want to, you can mix them up in any way that you like.” For this activity, I generally supply 12 by 18 inch colored construction paper or poster board, glue sticks or white, non-toxic school glue, and scissors if appropriate.

After everyone finishes creating the collages, let each present their pictures to the group. Have each participant talk about at least one image in his or her collage that represents “powerful” and one that was chosen to show “powerless.” Depending on how the discussion unfolds, participants may want to share their own experiences with bullies, including whether they have been the targets of bullying (powerless) or been a bully (powerful). Encourage further exploration of how one can be powerful when confronted with bullying and other aspects of powerful-powerless dynamics.

There are many, many variations to this activity; what is important is that you consider your group’s needs and adapt this activity to meet those needs. If you missed the two previous blogs on bullying, see Bullying 101 and What is Relational Bullying for more information; remember TLC has an excellent online course on bullying and cyber-bullying, too. Next up: More creative interventions to help children and adolescents address bullying.

Be well,

Cathy Malchiodi, PhD, LPAT, LPCC

References

Malchiodi, C. (2001). Using drawing as intervention with traumatized children. Trauma and Loss: Research and Intervention, 1(1), 21-28. See National Institute for Trauma and Loss in Children website for a copy of this article.

Malchiodi, C. (2006). The art therapy sourcebook. New York: McGraw-Hill.

Safran, D., & Safran, E. (2008). Creative approaches to minimize the traumatic impact of bullying behavior. In C. Malchiodi (Ed.), Creative interventions with traumatized children (pp. 132-166). New York: Guilford Press.

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How to Raise Resilient Children in a Traumatic World: Start with Family Rituals

Trauma specialists and helping professionals in general often ask, “How do I help enhance resilience in children?” Research tells us that resilience in children is often predicated on attachment and bonding with parents and other relatives and the degree to which social support is present in their lives.

Caelan Kuban, LMSW, Program Director and Clinical Consultant at the National Institute for Trauma and Loss in Children, has a practical suggestion for helping raise resilient children from A Time for Resilience: Raising Resilient Children in a Traumatic World (National Institute for Trauma and Loss in Children, 2009). Kuban says, “Brainstorm with your child about the rituals your family already has in place. Then think of rituals that you would like to start practicing. Write words or draw pictures that represent the rituals. Start practicing these rituals today.”

In my work with children and families, I have adapted this activity, using magazine pictures in addition to drawing. If you are a therapist or counselor working with a family, have a shoebox or small basket of pre-cut pictures ready for everyone to choose from; home-oriented, sports, and outdoor magazines are a good source for images. I recommend cutting pictures from magazines in advance of your meeting with the family to prevent your participants from leafing through too many magazines and getting distracted from the task at hand. It also gives you a chance to create a set of images that represent not only common activities, but also to introduce other ideas for rituals to help the family imagine new rituals for the future. Be sure to include images that represent diversity [ethnicity, gender, and societal], too.

Once the pictures are selected, ask the family to work as a group to glue the images to a large piece of colored construction paper, cardboard, or poster board [available at any local discount store]. After the family completes the task, I often ask each family member to talk about their creation and what rituals are most important to them in their picture. I also ask if there are any activities or rituals missing from the picture, if there are any they would now like to add as a family, and any family mottos or sayings that we can add to their collage. Finally, I recommend that the family hang their final creation in a prominent place at home to reinforce positive actions and rituals they can engage in as a family in the future.

Identifying rituals and activities as a family may seem like a simple intervention, but it is, in fact, an activity that has a potentially important impact on family cohesion, bonding among family members, and children’s sense of safety and security. In their seminal book, Rituals for Our Times, family therapists Evan Imber-Black and Janine Roberts note that, “Rituals have existed throughout time—they seem to be a part of what it means to be human.” For this and other reasons, family rituals ease difficult life transitions, commemorate personal history and relationships, and celebrate life in the most basic sense. The families we see in our work are yearning to recapture, reinvent, or rediscover meaning in their lives; they are also longing to reduce the alienation that trauma and loss often increase among family members. Fortunately, as trauma specialists, we can help them reconnect with each other and in doing so, address the impact of crises on children and enhance their capacity for resilience in what is often a traumatic world.

Be well,

Cathy Malchiodi, PhD, LPCC, LPAT

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Reference

Imber-Black, E., & Roberts, J. (1992). Rituals for Our Times: Celebrating, Healing, and Changing Our Lives and Our Relationships. NY: Harper Perennial.