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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What a Rubber Duck and Empathy Have in Common

In a recent commentary “What Makes Sense?” in the June 2010 TLC Practitioner, Bill Steele remarks, “the full utilization of one’s capacity to learn is predicated upon being in an environment where one feels above all safe and valued.” He goes on to say that feeling safe includes the following: being connected to adults who believe in us and who take the time to become our mentors and guides; exposure to multiple opportunities to engage in meaningful activities; and experiencing environments that encourage our potential to learn and grow.

Feeling personally responsible for our homes, schools, neighborhoods, and communities and those who live in them is another important experience– one that fosters empathy. Not surprisingly, many children who are traumatized by abuse, neglect, loss, or separation from a parent feel disconnected from those around them and often lose their capacity for empathy or concern for both people and their environment. As Steele observes, dignity comes from learning to care about others and how one’s actions impact everyone – and everything – around us.

The capacity to develop empathy is thought to be innate and is commonly seen in children who grow up with strong attachment to an adult and in healthy, safe homes and neighborhoods. We see examples of empathic behavior early in a child’s life when he or she brings a toy or blanket to another child who is in distress or cries in response to the discomfort of another person. Not surprisingly, the environment in which one is raised makes a difference in whether or not empathy develops.

So how do we help children develop empathy and concern for others and for their environments? First, early intervention is key; as most helping professionals know, it is essential that young children have a secure attachment to another person and exposure to empathy from others. Young children who are abused or neglected are particularly vulnerable because in place of positive attachment, these individuals experience misery, abandonment, and punishment that create distrust for others and the environment. Understandably, they also rarely experience empathy.

As children get older, they also need experiences that teach them how to go beyond themselves and learn to care for and about others. In brief, anything that helps children learn to respond effectively to the emotions and circumstances of others can enhance and strengthen empathy. If you attended the opening session of the recent 5^th Annual National Institute for Trauma and Loss in Children Assembly of Practitioners in July 2010, you learned at least one intervention to help begin the process of developing empathy with children. Participants were given small rubber ducks and asked to use some simple art materials [colored tissue paper, feathers, chenille stems, paper plates, scissors, and glue] to “create a safe place for your duck” [some photos of this intervention are included with this blog]. This is an activity I have used many times with children to not only explore what a safe environment is, but also to help them learn how to take care of someone needs outside their own.

Caretaking the rubber duck [or similar toy animal] is a way for a child to explore personal needs for safety, love, and respect and capitalizes on art therapy and play therapy as sensory methods to provide the child with an experience of empathy for another entity. For children who have experienced chronic trauma, it’s not enough to just talk about empathy; children must practice what empathy is through activities that teach self-care and care for others.

When children (and adults) lack empathy, the consequences are serious not only for the individual, but also for family, schools, neighborhoods, and communities. Children without the ability to feel empathy not only suffer isolation, frustration, and anger, they may be anti-social or become capable of violence, even murder. More often, they act without regard for the health, well-being, and feelings of peers, parents, siblings, and everyone they encounter. As helping professionals, we have the unique opportunity to help traumatized children replace worry with calm, fear with safety, and punishment with nurturing—and by doing so, introduce the experience of empathy and the sensory experience of just why helping others matters.

Be well,

Cathy Malchiodi, PhD, LPAT, LPCC

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Supporting Children of Deployed Parents: Voices of Experience Teach Valuable Lessons

The National Institute for Trauma and Loss in Children Annual Practitioners Assembly is in progress this week at Macomb Education Center, Clinton Township, MI. On Tuesday, July 13, 2010, a seven-member panel with varied personal and professional experiences with military service, military families, and military family life opened the event and told their power stories of the challenges of war, deployments, reintegration, and ultimately, dedication, courage, and hope. This dynamic panel represented the “voices of experience” and provided attendees with a unique view of the multiple challenges confronting military parents and particularly their children. These “voices of experience” included:

Debra Casolari who is serving as the current Child Life Program Director for Walter Reed Army Medical Center; her previous experience includes serving as the Director of Child Life at an inner-city academic medical center and over two years as a Staff Child Life Therapist at the Children’s Hospital of Philadelphia. Debra served as volunteer Child Life Services coordinator for Operation Smile International’s medical missions to Romania, China, Russia, Ecuador, Philippines, Africa, Thailand and Cambodia.

Retired Brigadier General Don Scott who is a US Army 30 year veteran who had two tours in Vietnam. While away on duty, his wife Betty raised their three sons. General Scott also served as the Founding Director of AmeriCorps National Civilian Community Corps established in 1993. His decorations include the Distinguished Service Medal, the Legion of Merit, six Bronze Stars and the Combat Infantryman’s Badge. He also received his MA in Counseling and Human Development back in 1982.

Margaret Dellio Storey, a retired Major from the US Army where she served from 1982 to 2003. She was a deployed mom and held such positions as Field Combat Officer, Field Combat Medic among others. She also served in Operation Desert Shield, Desert Storm and currently works for Perry Schools in Ohio.

Christopher Sullins, a Military and Family Life Consultant with the Joint Family Support and Assistance Program (JFSAP) in MI. He provides counseling to service members and their families. He deployed to Iraq as a combat stress control prevention team officer and supported military, federal and contract personnel in various locations throughout central Iraq.

Maryann Williams who works for the Department of Defense as a teacher and counselor. She has worked directly with the children of military families stationed at Fort Bragg, NC for the majority of her career.

Josephine Zutell, a Licensed Marriage and Family Therapist from Arizona. Jo has been providing assistance to military families in both off and on base schools (Luke Air Force Base) for many years. Her spouse was also deployed up to one year in length several times at a time when almost no help was available which unfortunately today still remains a challenge for many guard families who do not live near bases or are in smaller communities with no support.

In addition, the conference includes a variety of courses and workshops on how we can help children and families of the military as well as practical strategies and activities to help all children move from being just survivors to thrivers. But most importantly, attendees at this week’s event are privileged to hear about “lessons learned” first hand from our nation’s military, military wives, and mental health professionals who are dedicated to helping US service men and women and their families and children. Those of us in attendance are indeed fortunate to be in the presence of these “voices of experience” and to learn more about the ways we can be helpful to military personnel and their families.

Be well,

Cathy Malchiodi, PhD, LPCC, LPAT

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