Disaster Recovery Play Therapy

Susan M. Sikes, M.A. Professional Life Coach Certified in Play TherapyFormerly, Orange County Team Leader, Project HOPE 2005

Helping Children Put the Pieces Back Together

April 22, 2015

What is a Disaster Like to a Child?

Children see disasters in the same way as adults do in some ways.

But in many ways a child sees a disaster in very different ways Children may not understand abstract concepts or

metaphors; need simple, concrete terms Safety comes in the form of significant adults, not

large government organizations Do not yet have the ability to see another’s

perspective – may not understand why someone is upset

More Differences Need protection due to size, lack of judgment, lack

of coping skills May not understand that loss can be permanent Feelings are a total, full-body experience Need adults to meet most of their needs and may

not know how or feel safe to ask May not have vocabulary to express feelings May not have adults who have time or awareness

to ask a child about feelings

Commonly Seen Behaviors in Children During and After

Disasters Reversal of developmental accomplishments

Bathroom problems Fear of strangers Thumb sucking Crying

Stress-induced behaviors Whiney or clingy Listlessness or apathy; boredom Sleeplessness or nightmares Constant motion or lack of energy Aggressive/acting-out behavior Physical complaints – head or stomach aches, flu-like symptoms, generally

not feeling well These are not pathologies – these are normal

reactions to abnormal circumstances

Common Children’s Worries During Disaster and Recovery

~Often are reflections of the concerns seen in the adults around them

Fear or harm coming to absent family members

Worry about pets Money concerns Practical worries –

food, ice, water Intense focus on

weather or similar disasters

Fear of another hurricane Fear of not having a

home Doubt about authorities’

ability to help (e.g., FEMA)

Being ignored or getting in trouble

Increase in abuse

General Assistance to Children in Disasters

Children less than 10 or 12 years of age often benefit less (than adults) by “talking about it.”

When they do want to talk, usually should be child-initiated, not adult-led Make sure the children know that they can talk

about it when they’re ready – significant, safe adults will be available -- and wait for the child’s need.

Most children are incredibly able to express their feelings in play

Why Play Therapy? Play Therapy is a research-based, well-

documented approach to serving the emotional needs of children, based on the following concepts: Play is the natural language of children. (Landreth,

2002) Children have the ability to “play out” their stress. Play therapists use play to allow children to work

through their issues. Play can be rule-directed and organized or child-

directed, both have their place.

And Group Play Therapy

Just as adult therapeutic interventions are designed for both individuals and groups, play therapy can be used in both individual and group settings.

Again, can be organized or free-form, rule directed, or participant-led.

Initial Crisis Phase Needs~Time between disaster event and 30-60

days later

Displaced children may be in shelters, with or without parents and other family members.

Children may see adults’ distress and try to emulate what they think is the appropriate reaction to the situation

Survival needs tend to supercede emotional needs; however, most children continue to play in some form

Limitations on space and supplies Shelter counselors usually are ARC or NOVA,

depending on type of shelter

What happens when the

counselor is recovering? Local counselors

often are victims of natural disasters themselves. We need time to help ourselves.

Parents are focused on providing food and shelter, not the emotional needs of their child

Most shelters for families have trained disaster counselors available.

Shelter counselors are often overworked, burn out quickly, and usually provide babysitting items like books, crayons, and TV.

Disaster Recovery Play Therapy

Begins after the initial 30-60 day crisis period Uses best practices as defined by

professional play therapy associations Creates opportunities for children to express

themselves regarding a recent disaster they’ve witnessed or endured

Focuses on healing and finding ways to return to “normal” rather than re-experiencing the disaster and risking re-traumatization.

Who Does This Type of Recovery Support?

From 2004-2005 Project HOPE – a FEMA grant funded organization, run by the state, to provide emotional and informational support to recovering disaster victims

Only created when Federal Emergency is declared – only in involved counties

In this case, for those recovering from the 2004 hurricane season

Offers many types of recovery support srategies for all those affected.

Examples of Project HOPE Outreaches

Special strategies developed for “at-risk” populations Neighborhood support groups in especially

hard-hit areas Community education at festivals and events Resources for physically, mentally, or

emotionally challenged

AND Outreaches to Children Outreaches to Senior Citizens

Children’s Outreach Children are often the “silent victims” in a

disaster Significant adults – even when well-meaning –

may simply overlook children’s needs Outreach to children using the “Heroes of the

Storm” puppet show Created specifically to facilitate children’s

expression of their feelings in relation to their experiences

Uses a safe environment and form to encourage self-expression and closure

Why a Puppet Show?

Research has shown that puppets can be very useful in providing emotional support for children. Puppets have been shown to be extremely

effective in providing a means by which children can talk about fears

Puppets often succeed where other attempts to connect or encourage expression have failed

Allow a means through which children can have the puppets can physically express their feelings for them

“Heroes of the Storm” Format

Animals are native Floridians – ones that children are apt to be familiar with

Animals live in realistic settings – dens, nests, not houses

Animals experience the “before,” “during,” and “after” of a hurricane experience

A discussion of a return to normal is included Community helpers and cooperation in

rebuilding are discussed

Discussion Format After the puppet show, children were offered the

opportunity to: Ask the animals questions about their hurricane experience

in the forest Thank the animals for sharing their story Tell the puppet team about their own hurricane memories

Often, this was the first time a child had been asked for his or her impressions of the hurricane experience by an adult

Children literally leapt at the chance to talk about their own personal “hurricane stories.”

Artistic Expression Format

Follows the discussion section Children were asked to:

“Draw something you remember about the hurricanes last year.”

Nothing is wrong or done badly – emphasis is on the process, not the product. “Tell me about your picture.”

Puppet team processed the drawing using appropriate comments, encouraging expression of feelings associated with the drawing. “What was that like, when that happened?”

Then “Draw something about your first picture that is ‘all fixed’ or ‘back to normal’.”

Allowed children to see that: Disasters do come to an end Things do return to normal Normal may be different than before

Critical in bringing closure to the experience

Assessment and Intervention Steps

The Narrator – someone with training specific to children’s emotional needs -- monitored the children for anxiety or other intense reactions – some had not been able to return to their homes, even 6 months later. Some experienced severe losses or injuries. While activities and discussion took place this person

observed and watched for children who might need further one on one counseling.

If time permitted, we took those children (usually 1 or 2 in a large group) aside for more individualized assessment

Referred these children to individual work with a local play therapist, or in a school setting, to their school counselor.

Other Strategies When working with children in a school or office atmosphere

during the recovery period, other strategies might include: Child-led play therapy in a playroom by a trained play therapist Partnered Drawing – helper begins a drawing and then asks child if

he or she would like to continue, picture changes hands every 30 seconds

Scribble Drawing – helper creates a scribble and offers child an opportunity to finish the drawing into a picture

Modeling clay or dough for pounding or creating All activities should be open-ended with no requirements as to

final outcome – praise the process, not the product. Parents should be educated as to developmentally appropriate

reactions that they might see in their children – normal reactions to abnormal circumstances – and appropriate responses

Play with Seniors Senior Citizens are often (like children)

also marginalized. Unable to do many physical jobs necessary Must delegate to others or rely on

government – loss of independence May be out of their home for extended

periods and in unfamiliar surroundings Better able to identify feelings, but may not

want to, may not feel “safe”

Example: Senior Bingo

Created by another Play Therapist on our team Bingo Card made up of common occurrences

during recovery: Displaced, lived in a shelter, wind damage, lost

transportation, fear, frustration, fatigue, injury, anxiety, PTSD, etc.

Dollar Store prizes awarded for each game As cards were finished, the squares covered are

discussed with the group Return to normal always involved at the end Well received and enjoyed

When have you been involved in a natural disaster?

Can be any type of natural disaster – earthquake, tornado, tsunami, ice storm, etc.

Divide into Pairs – one person who has experienced a disaster, and one active as Play Therapist.

Activity Play Therapist: Facilitate a discussion about

the disaster experience including: Where and when Partner’s personal experience and reactions Ask partner to draw a picture about the disaster Reflect on and discuss what feelings come up

while drawing Highlight successful coping strategies Re-draw the same picture, but with some thing or

things as “back to normal”

Questions? Sunshine is delicious, rain is refreshing,

wind braces up, snow is exhilarating; there is no such thing as bad weather, only different kinds of good weather. Author: John Ruskin

John Ruskin obviously never lived in Florida during hurricane season!