You say you want a revolution
Well, you know … we all want to change the world
You ask me for a contribution …
Well, you know we are doing what we can
We all want to change the institution
Well, here’s the plan …
– Inspired by the spirit of
John Lennon (Imagine album)
We have chosen the words “guerrilla warfare” for the title of our final chapter with a bit of tongue-in-cheek. We are by no means implying sabotage, such as a “taking by force” of our existing establishments. The Spanish word “guerrilla” literally means “little war,” and those who engage at this level are an independent group fighting to make vital changes. Our founding fathers were true guerrilla heroes when they fought in the Revolutionary War for the freedoms we enjoy today.
We conclude this book with an optimistic look toward the future. We are hoping that what you, the parents, have learned so far will provide an impetus for taking your new knowledge out into your own communities, becoming genuine revolutionaries. Little changes in our society’s institutions can make a huge leap forward in the prevention and healing of childhood trauma. Parents can conduct this battle for transformation on two fronts to make our world a healthier and more child-friendly place:
Hospitals and Medical Centers
Community and School Crisis Intervention
Parents might, for instance, become activists organizing grassroots campaigns in hospitals, neighborhoods and schools to make them “kid-centered.” This means that the emotional and spiritual needs of children and their families become central to the medical mission of these institutions. Certain overwhelming events such as injuries and illnesses, natural disasters, terrorism and school crises cannot be avoided. However, traumatic symptoms and debilitating stress for our kids can be greatly reduced, and sometimes even prevented. This chapter makes suggestions for you, the “parent warriors,” to bring to your local hospitals, community centers and schools. Keeping our kids resilient is the best antidote for taking the “terror” out of terrorism, regardless of the origin of our children’s terrifying experiences.
Models for Change in Hospitals and Medical Centers
My “career” in developing Somatic Experiencing® began in 1969 when I was asked to treat a woman named Nancy who suffered with a myriad of physical problems including migraines, a painful condition that would now be called fibromyalgia, chronic fatigue, severe PMS and irritable bowel syndrome, as well as various “psychological” problems including frequent panic attacks. During this session (described in Waking the Tiger: Healing Trauma) Nancy began to tremble, shake and sob in waves of full-body convulsions. For almost an hour she continued to shake as she recalled terrifying images and feelings from age four. She had been held down by doctors and nurses and struggled in vain during a tonsillectomy with ether anesthesia.
As I worked with more and more people with symptoms like Nancy’s, I was shocked at how many had similar experiences as young children, during which they were overwhelmed and terrified by invasive medical procedures. As I began to train people in the method I was developing, I also got to confront my own terrifying tonsillectomy. Like Nancy, I struggled against the doctors and nurses who held me down. Desperately I tried to escape the terror of suffocation, but was overpowered and overwhelmed with panic and utter helplessness. As I worked through this experience, feelings of fearfulness, “tummy aches” and betrayal that had plagued me throughout my adult life loosened their grip. Both Nancy and I re-owned an innocence and vitality that had been cruelly, though unintentionally, taken from us during early childhood.
It was at that point I felt propelled to do what I could to prevent children from becoming unnecessarily traumatized. And while hospitals have come a long way since the 1940s and ‘50s, when Nancy and I had our tonsillectomies, even simple medical procedures performed on children are still often experienced as frightening, painful and overwhelming—as we learned with Sammy in Chapter III.
The “war on terror” can begin by reducing the suffering endured by children unnecessarily and inflicted inadvertently by the health care system. Doctors, nurses and allied professionals are in the business of saving lives. Devoted staff members often suffer “burnout,” or vicarious trauma, as they deal (day in and day out) with catastrophic illnesses, injuries and what is often a chaotic, frenzied environment. Add to that the “managed care” bureaucracy that can bury both health care providers and patients in paperwork. Is it really surprising that precious little time has been given thus far to consider a different approach that might reduce, minimize or eliminate traumatic reactions after the operation is over?
Medical and surgical procedures are supposed to resolve patients’ health problems—not create new ones. Whether interventions are urgent or planned, dealing with them can be difficult, even for adults. More often than not the procedures are tricky and frightening, not to mention potentially harmful, as one can see when asked to sign the cautionary forms prior to treatment. Ideally, with the suggestions presented in this final chapter, you, the parents, will be motivated to participate in creating positive change.
Although the responsibility to provide care that prevents unnecessary suffering, facilitates quicker recovery time, prevents future trauma symptoms and saves money lies in the hands of medical personnel and administrators, we live in a business-driven environment. Therefore, you, as the consumers of health care for your family, often have the power that comes with patronage. Any health care facility can readily implement the ideas presented here. Parents and medical staff together, united in their vision to improve pediatric medical care, can be powerful allies in bringing a new consciousness to our systems of care. This new direction would be best if it added a stress prevention program to its existing model. With humanistic practices incorporated system-wide, the following benefits can be expected:
Children who might otherwise suffer following terrifying medical procedures will have a chance to grow up healthy and resilient.
These same children as adults later in life may be less saddled with anxiety and other psychological, physical and medical symptoms of trauma. They may be more likely to rebound in the aftermath of overwhelming experiences, because a predisposition for hopelessness and helplessness has not been imprinted.
Children who are surgical patients would have the possibility of a quicker recovery time.
Serious health problems, and even some violent acts, might be averted.
The needs of the body, mind and spirit could share more equal weight in patient planning decisions, giving children the respect and dignity they deserve.
Society might save incalculable sums of money in health care costs, not to mention the alleviation of much human suffering.
Currently, many hospitals and medical centers provide excellent treatment, saving lives that previously would have been lost. The next step is to provide immediate, effective interventions to address mental, emotional and spiritual issues.
One such hospital that is beginning to examine the value of services that address the emotional aspects of a patient’s experience is the Children’s Hospital of the University of California at San Francisco Medical Center. In an exciting collaboration with both the Pediatric Rheumatology and Rehabilitation Medicine Divisions along with two members of the Child Life Department, Karen Schanche (a pediatric social worker) has developed and implemented an innovative treatment program for pediatric patients. This program is designed to reduce symptoms associated with various medical treatments.2
Karen, a former student of ours, has been using Somatic Experiencing® principles with both outpatients and inpatients under her care. She prepares children (four to eighteen years of age) who are in the rheumatology outpatient program to successfully cope with multiple painful joint injections during regular clinic visits without having to undergo general anesthesia. In addition to showing them how the procedure will affect them, she spends time with the children to determine what they need to feel safe and comfortable, introduces them to sensations, role-plays with making boundaries and helps them find ways to access inner resources in order to maintain a sense of some control. Part of this process includes empowering the children to make decisions about who they want with them and how they want that person to be involved in helping them manage the sensations of pressure and pain during the procedure.
As these young patients use such techniques as switching their focus from painful sensations to pleasurable (or at least less painful) ones, they are more prepared to endure the pain with minimal discomfort. This allows them to surrender to their sensations, reducing the pain and anguish of the injections while maintaining a sense of control and larger purpose. Karen reports the almost magical result that the majority of children are much more cooperative when receiving these injections with support, compared to when they have to undergo general anesthesia. She said that kids have made comments like “I’m not feeling nauseated and I don’t have to throw up!” The children, generally, are amazed at how much better they feel without the anesthesia.
The biggest bonus is that the children are free of the psychological and physical complications that come from being restrained and drugged. Embla numbing cream and freezing spray are applied locally instead of sedation. Rather than the children feeling helpless as they are held down to experience excruciating pain, Karen empowers the children by helping them to feel their protective responses and strength by using “push hands” or “push away” games. Some of these pushing and pressure exercises can be done during the injections to distract the young patients as they focus on the sensations of using their own powerful muscles. Karen often integrates Somatic Experiencing® with techniques that use the child’s own imagery and metaphor. To date, she has prepared twenty-seven children who are in treatment in the outpatient Rheumatology Program and seven inpatient rehabilitation patients. The child patients are appreciative, and the doctors appear impressed by the improvement in their pediatric patient satisfaction and ability to handle stressful medical procedures with less distress.
While much more research is needed on approaches such as the one at UCSF Medical Center, we (the authors) have noted from anecdotal reports that individuals who receive Somatic Experiencing® treatments before and after medical procedures usually testify to rapid recovery. This includes symptomatic relief and an ability to return to a “full life,” even after serious procedures.
A Peek at a Model Family-Centered Children’s Hospital
Although few in number, attitudes and environments are being created that are sensitive and humane. Some hospitals working to minimize pediatric trauma are those funded by the Make-A-Wish Foundation.3 Let’s look at what they are doing to prevent trauma and make a child’s hospital stay more pleasant and less scary.
One such forward-looking hospital is Miller Children’s Hospital at Long Beach Memorial Medical Center in California. Directions given by Rita, the manager of the Child Life Program, to find the Center were heartening: “Enter by the blue dolphin and go straight to the boat, where you will find a receptionist to give you a visitor badge.” Her warm welcoming tone gave a feeling of comfort and nurturance even before starting the tour of this remarkable pediatric unit. This hospital’s commitment to the total care of each child extends to the whole family. Both child and parents are oriented about what to expect before, during and after the medical procedures. When appropriate, the Sibling Program prepares brothers and sisters for their first hospital visit as well.
The Child Life Program was developed with the sole purpose of making the hospital experience a positive one for both outpatient and inpatient kids. Child Life Specialists plan individualized and group programs that familiarize children with what to expect from their hospital experience in a way that helps lessen fear and anxiety. They use simulated equipment, books and “Jeffrey,” the life-sized doll dressed in child-friendly hospital pajamas and blue surgical cap. “Jeffrey” has a special box with EKG stickers, a pulsometer, an IV, a blood pressure cuff and a syringe that children get to look at, feel and play with. Next, each child is shown a book with photos that orient her to the hospital experience step by step. Kids get involved at the start by picking out the color of some very cool pajamas (with little bears and stars) and slippers that they can keep.
I got to witness the program in action with Daniel, a little boy who was about to have a mass removed from his neck. He listened spellbound to the story that the Child Life Specialist read to him. Next, Daniel got to touch the EKG stickers that the Specialist said were “sticky on the outside and gooey in the middle.” After he played with them, she demonstrated for Daniel exactly how they would be placed on his chest and showed him a photo of another child getting the same stickers.
This orientation took place in the playroom, which was equipped with carpeted climbing stairs, a slide and a television theater featuring shows like “Bear and the Big Blue House.” The episode playing while Daniel was being prepped was about “Doc Hog’s visit to the big blue house to examine bear and all of his friends.” After the preparation, Daniel got to play on the slide with his mom and dad until the doctor came to meet his family. When the doctor arrived, he played a few minutes with Daniel so that he would not be a stranger. Next, he patiently answered any questions the family had. He also explained the sequence of events in simple language.
At Miller, children are given their own doll to dress up in pajamas, along with a medical play kit containing a mask, syringe, gloves, cotton, alcohol swab, band-aid, tongue depressor and a medicine cup. There are coloring books with titles such as “Tommy’s [the Turtle] Trip to MRI” and “My Hospital Book,” as well as a library of videos, books and medical Internet access for parents and teens. Children are given a tour of the playrooms they will get to spend time enjoying after their treatments in order to tantalize them with something to look forward to while recuperating.
Miller Children’s also incorporates state-of-the-art pain-reducing technology. For example, they have “patient-controlled analgesic” machines that operate by a push of a button. It is so safe and simple that children as young as five years old can operate one! They are controlled in such a way that it is impossible for a child to overdose on the medication while at the same time getting sufficient pain alleviation.
A non-drug pain reliever is the mobile “Fun Center” complete with TV, VCR and interactive video games. The Child Life Program manager shared that a study conducted by the University of Southern California in Los Angeles using these play stations monitored physiological reactions of young sickle-cell patients experiencing a pain crisis. Research results were conclusive in finding significantly reduced pain responses in children who were given the opportunity to use the “Fun Center.” A benefit is that it can be used by both children and adolescents. Another program that works especially well with teens (and children of all ages who may not have actively involved parents) is “The Grandparent Program.” This core of volunteers plays cards, sits, talks, listens and just spends caring time with the kids, keeping them from getting lonely and bored.
In addition to the Child Life Program, great care has been taken to make Miller Children’s Hospital a delightful environment for kids. Each room has a colorful mural with an ocean theme. Little kids get to be surrounded by lots of sea creatures, while teens have scenes like surfboards in the sand. There are bedside games, pet visitations and elaborate playrooms. The playrooms offer everything from arts, crafts and imaginative play to special video conferencing through “Starbright World,” a health care organization that connects children interactively online to other children, internationally, having a similar medical condition. As if that were not enough, the “Giggles” TV studio broadcasts live daily, with reception available in every room. This show features a child patient, a Child Life Specialist and, of course, “Giggles the Clown”! Other child patients can call in with questions, and everyone who calls wins a prize. The TV “guest” can expect peer visitors who are eager to get an autograph from the patient “star” of the day.
In addition to Child Life Specialists who prepare children and walk them through procedures, there are social workers and psychologists available to help children emotionally who, despite best efforts, may still be having traumatic reactions. Staff is also on the alert to identify children needing specialized help during their recovery period. If this kind of care seems too good to be true, well, maybe this is exactly how it should be; furthermore, with our book in hand, you might just find that your local hospital is interested in incorporating some of these very same ideas.
Enhancing Trauma Prevention Efforts
Although there are growing numbers of conscious medical centers doing their best to increase the comfort level of children and create an appealing environment, often the simplest but most important practices to prevent trauma remain unknown or overlooked.
The good news is that pediatric trauma prevention does not require fancy or expensive equipment. The skills to prevent trauma can be made available to everyone. The first step is to educate pediatric medical personnel regarding the physical dynamics that underlie trauma. Because trauma symptoms come from immobility, helplessness and the energy bound in the thwarted flight-or-fight response, it is essential to make absolutely sure that no child is strapped down and subjected to being anesthetized in a terrified state.
Doctors, nurses, social workers and Child Life Specialists need to be alert to a child’s feelings and strive to lessen anxiety. The child’s reactions should be closely monitored. Body language and facial expressions often tell the story of a child’s fears better than words (i.e., with a “deer-in-the headlights” frozen expression). Frequently, children are terrified “speechless.” It is usually best if the orientation to the hospital routine and the role-playing can happen the week before, rather than on the day of the surgery, so that parents can be taught to play “hospital” at home until the child is comfortable enough to cooperate.
Another very important point in trauma prevention, mentioned earlier in Chapter IV, cannot be overstated. When a child must undergo surgery, it is important for a local anesthetic to be administered along the line of incisionwhenever possible. Currently this is not routinely done despite a growing body of research indicating that the local anesthetic improves the rate of recovery and lessens complications.4 Many times a local can be given without the potential risks of a general anesthesia; however, a general should not be given without a local in many cases. In addition to quicker recovery time, there is another benefit of administering a local anesthetic. Because the body still registers the point of surgical incision as an invasion when only a general anesthesia is given (perhaps no different than that of a vicious animal attack), adding a local anesthetic along the cut can aid in leaving a child feeling less vulnerable, therefore less susceptible to later psychological symptoms.
Taking Good Programs to the Next Level of Trauma Intervention
Miller Children’s Hospital at Long Beach Memorial Medical Center is one of a network of ninety model hospitals in the United States that are family-friendly. By adding the simple but crucial recommendations described above it would be very easy to initiate change in programs such as these that put children’s needs first. All it would take is for parents to educate their local hospital staff regarding the principles of trauma prevention outlined in this book. Be sure to choose a facility that understands the crucial importance of preventing medical trauma through sensitive practices, orientation and preparation. It is also vital to choose a medical center or hospital that is willing to work as a team with parents. Contact www.ChildLifeCouncil.org to learn more about bringing programs such as Child Life and Make-A-Wish to your community. Be pro-active in reminding them, however, that sophisticated equipment is not the essential ingredient of a trauma-prevention/stress reduction program. Understanding and alleviating children’s fear, worry and pain is the true hallmark of prevention. Remember that the medical staff is supposed to serve your child and family—not the other way around! Know, and insist, on your family’s rights. Ultimately it is up to you to make choices that make change happen!
Candi is a young Child Life Specialist intern whom I met when I visited Miller Children’s Hospital. She was especially curious about our work in trauma prevention and captured my attention with her enthusiasm for her career. I listened intently to her story. Candi described her younger self as an outgoing, friendly little girl who was also a dancer. When she was seven years old she noticed a mysterious and debilitating pain in her knee requiring medical attention. Candi said that she will never forget her dreadful and terrifying hospital experience. The doctor was “digging and poking” around her knee until an embedded sewing needle was discovered. But embedded even deeper in her memory were the insensitive words she thought she heard the doctor say to the nurses: “If we can’t get the needle out, we may have to cut off the leg.”
As an adult Candi said, “I understand that they saved my life—the needle could have traveled to my heart—but I was SO scared. Nothing was done to comfort me. When the ordeal was over, the nurses said, ‘Be sure to tell your mom what a great job the nurses did!’ But they didn’t.”
I asked Candi how her hospital experience had affected her life. She told me that she has been shy and anxious ever since that day. She shared that this was her motivation to devote her life to the prevention of medical trauma in children so that no child in her care has to endure that kind of suffering.
Many people experience hospitals and medical clinics as foreign, threatening and even dangerous places. This perceived threat is heightened when a person seeks medical care for a serious health challenge that is actually life-threatening. Medical trauma is particularly significant for children. Many adults recall fears of suffocation, immobilization and terror they endured as a result of medical treatment received in childhood.
Fortunately, as you have seen, much can be done to bring more humane care into the medical setting. Through simple modification of approaches, hospital staff can dramatically influence the degree of safety or degree of threat that our kids experience. Orientation, preparation with the use of role-play, help in processing “the bad-news diagnosis” as it is happening and intentional use of positive language are key examples of powerful tools that health care workers can easily employ to improve outcomes for our littlest patients.
Obviously, pediatric professionals need to be trained so that they understand, like you now do, the nature of trauma. Our hope is that in the foreseeable future, all hospitals and medical centers will understand the importance of preventing or minimizing stress and shock-trauma in all patients—but particularly our most vulnerable citizens, our children. In the meantime you, the parents, can play a pivotal role in changing the current system by becoming constructive, revolutionary, peaceful warriors of healing, armed and ready with knowledge and compassion.
Community Crisis Intervention
The last several years have brought a quickening effect of tragedy, due in part to increased natural disasters caused by extreme weather, the threat of new diseases, school shootings, pervasive media coverage of violence and the advent of terrorism on American soil. This section is for parents who wish to be fortified with more skills to help kids cope in the wake of community catastrophes and mass fatalities. The ideas and activities described in this section can be used by grassroots community organizers with groups of children. They are appropriate for a variety of events that can shake a neighborhood, from the atrocities mentioned above, to accidental multiple deaths such as a mining disaster, to a classmate’s suicide. The principles of emotional first aid that you have learned thus far can also be applied equally in the case of natural disasters such as fire, hurricanes, earthquakes, tornadoes, floods and tsunamis.
Before disaster strikes it is important for ordinary people to come together as a core of volunteers with a school or neighborhood plan that can be implemented when necessary to comfort and help one another and assist those children and adults who remain numb with shock and terror. If you, the parents, have an action plan it is less likely that you will give in to the temptation to stay isolated at home, perhaps being mesmerized into watching the horror repeatedly on the news in your own state of shock. Together, parents can help their kids bounce back as quickly as possible from the disruption of their daily routines.
Our New Reality
On September 11, 2001, the collective reality of safety was shattered in the United States. It is likely that similar events will occur again. We were left with profound, unanswered questions and fears about what might happen next and what to tell our children. In fact, more important than what we say is how we speak with them about such horrible things and how we listen to their feelings and concerns. Children take more from the feelings of their parents than from their words. Their needs have less to do with information and more with security. Children need to know that they are protected and loved. The words “I love you and will protect you”—spoken from the heart—mean more than any kind of explanation. Young children need to be communicated with through physical contact, holding, rocking and touch.
In families where both parents work, it is important to take time to phone your young child so that she knows you are still there. Predictability and the continuity of keeping a routine are important for children of all ages. The making of plans together to give them a sense that life will go on and that they will have fun again is another important thing we can do to alleviate distress for our children.
Because the media use graphic fear as a selling point, it is important to minimize children’s TV news exposure—particularly during dinner and before bedtime. Of course, it’s best to watch the news after they are asleep. Kids three to five years of age may ask questions about things that they have heard or seen on TV. At these ages children are beginning to be able to put feelings into words, and you can let them know that it is OK to have these feelings. Drawing pictures and talking about what they have drawn and how it makes them feel can be helpful, as can the telling of stories where the hero/heroine has overcome difficult situations and been made stronger by meeting and mastering an ordeal.
In addition, children will often draw some new creative element in their pictures to help them contextualize what has happened. For example, one child who witnessed the planes crash into the World Trade Center and then saw people jumping out of the windows drew the scene but with one significant addition—he drew a small round object on the ground. When asked by his parents what it was, he replied, “It’s a trampoline to help save the people falling out of the windows.”
For older children, six to twelve years of age, more direct discussions can be held. It may be important to find out where they got their information and what their specific fears are. Then you can have the family brainstorm ideas for things that they can do to help the people who have been affected, such as sending letters to the children who lost loved ones or organizing a fund-raiser to collect aid money. Mobilizing helpful activity, rather than being a spectator, can make a big difference.
Mass Disaster Assistance Lacking for Families and Communities after 9/11
American Red Cross Disaster Mental Health Coordinator Lisa LaDue (then Senior Advisor for the National Mass Fatalities Institute5) was assigned to the Red Cross Headquarters in Arlington, Virginia, following the 9/11 attack on the Pentagon. Her job was to respond to requests from the metropolitan Washington, DC, community for debriefings, consultations and counseling. This is what she told us during an interview in 2006:
The common cry echoed from parents and community leaders was unequivocally the same: “We need help so we can help our children.” It was quite clear that most people were at a great loss to know how to help kids recover from this disaster. Parents were afraid to take their children to school; children were afraid when their parents went to work or even to the store. Whole neighborhoods were afraid to leave their homes after dark. No one seemed to know how to address the effects of terror. These incidents clearly illustrate the need for coordinated services to help children and adults regain their equilibrium in order to recover from both direct and vicarious trauma.
Parents can become community leaders or directors of voluntary organizations that address the terror of terrorism and other mass disasters (man-made or natural). Somatic Experiencing® offers hope in restoring a sense of safety for the children and their families. It provides a fresh approach in recovering from events that shake us collectively as human beings. Armed with new knowledge of how to respond, parents can organize simple games with the neighborhood kids that allow discharge of the traumatic energy. You might also teach them how to integrate art, writing and other expressive forms with body sensation awareness to help calm and settle their nervous systems. Rather than be exasperated with feelings of helplessness because your children are having difficulty sleeping or are afraid to leave home, you can offer these simple somatic tools to restore a sense of balance to their lives.
A child’s fearful face, a classroom with children demonstrating regressive, disruptive behavior and families who find their children lacking the energy to enjoy life the way they did before are all loud warning bells beckoning us to come forth with a grassroots plan for neighborhoods and schools that addresses the crux of trauma in order to restore resilience as rapidly as possible.
Restoring the Resilience of Kids after Natural Disasters: Lessons from Thailand
Using the tools of working with trauma described in this book, the Trauma Outreach Program (TOP) team, made up of a group of Somatic Experiencing® Practitioners, worked and played with school children in Thailand after the historic December 2004 Indian Ocean earthquake caused a devastating tsunami. Another group of Somatic Experiencing® Practitioners, Trauma Vidya, led by Raja Selvam, helped survivors in southern India. Both teams worked to help kids, parents and teachers recover from the horrible shock and grief of watching families, homes, sources of livelihood and animals suddenly being swept away. Workshops were given on the principles of trauma first aid to build the capacity of local people to continue the relief work long after our teams returned home. The following guidelines and games will prepare you to help groups of children in your own community bounce back if a disaster were to strike.
Because trauma overwhelms the nervous system, kids who have experienced trauma often have difficulty feeling confident, balanced and in control of their behavior. They may be hyperactive, demonstrating poor impulse control, or they may be lethargic, spacey or depressed. In order to help these kids, any familiar game such as “capture the flag” and jump rope can be adapted to incorporate the simple principles of body awareness that you have already learned. The excitement and competition provoked by these physical activities arouse a similar energy to those used for fight/flight responses. The group activities will also help you to see how your child and other neighborhood kids you care about are coping.
Activities need to be structured so that highly energized periods of excitation are interspersed with equal periods of rest to give kids sufficient time for settling down. During the time set aside for settling—which can be accomplished by having them sit quietly in a circle—the parent leader does a sensation “check-in” to see how the kids are feeling. In groups it’s easiest to ask for a show of hands, using questions such as: Who feels strong now? Who feels weak? Who has energy? Who feels tired? Who feels hot? Who feels cold? Who feels calm? Who feels sick? Who feels excited? Whose heart is beating fast? Who feels power in their legs? Who has a headache or bellyache? Who feels happy?
During both phases (the excitement and the settling), excess energy is automatically discharged. As children “chase,” “flee,” “escape” and feel vigor and power in their arms, legs and trunk, they are strengthening the centers in the brain that support resiliency and self-regulation. Sensory experiences through play help kids to regain their confidence and stamina. When children are encouraged in this way to heighten awareness of their body states, it is much easier to restore resilience after a mishap.
Suggested Group Activities that Foster Connection and Resilience
We used several games with school-aged kids in Thailand to help them regain confidence and resilience after the devastating tsunami altered their lives forever. The “Coyote (or Tiger) Chases Rabbit” game, “Pretend Jump Rope” and several other activities were successful in helping children discharge some of their anxiety while having fun. Some who complained of headache, weakness in their legs and/or stomachache (or who appeared depressed or anxious) started to recover their vitality as they began to experience mastery through team play. Watching the children’s limp bodies come to life and their sad faces light up with laughter and joy was a sublime experience. Some of the kids, more traumatized than others, needed individualized adult support in order to fully participate. Instructions are provided later in this section on how parents can give each child the extra assistance he or she may need.
COYOTE CHASES RABBIT
This game and the next one use the principles of Somatic Experiencing® and were designed for groups by our colleague Alexandre Duarte, who did trauma relief work with children in Thailand, India, New Orleans and Baton Rouge. We called this game “Tiger Chases Rabbit” in Asia since the tiger is an animal that local children are familiar with. Obviously you can vary the critters while the essential game remains the same. For this activity all that is needed are two balls of different colors and sizes. This game is designed to simulate the flight response. Parents from the neighborhood or volunteer parents, teachers and counselors at school can rally to help the kids after a disaster.
To start, the adults and children form a standing circle and then sit on the floor in that arrangement. The leader holds up one ball, saying, “This is the rabbit.” Then the rabbit gets passed around the circle hand to hand, starting off slowly. The adults encourage the kids to gradually increase the pace. Soon participants begin to feel their sensations of anticipation grow as the rabbit “runs” from child to child.
A parent then introduces a second ball as Mr. or Ms. Coyote (Tiger, etc.) and starts the second ball chasing the “rabbit.” The pace increases naturally as the children identify with the strength of the coyote and the speed of the rabbit, and as the excitement of the chase escalates. The complexity of the game can be increased for older children by calling out a change in direction. The idea is not to win or lose but to feel the excitation of the chase and the power of the team effort to pass the balls quickly so as not to get “caught.”
Next, the children rest. As they settle, the leader checks in with them, asking for a show of hands to identify the various sensations they may be feeling. After playing this game for a while, have the group participants stand up and feel their legs and their connection to the ground so that they can discharge activated energy through their bodies. Those children who feel weak or lack energy can get the extra support they need from an adult. For example, you might have the less energetic kids pretend they are bunnies; the adults hold their hands while helping them to hop by sharing their stamina and enthusiasm and seeing how high they can get them to hop, first with assistance and then on their own.
At the end of the play period, children need to be monitored carefully to make sure that no one is frozen or shut down. If a child is rigid or spacey, an adult might do a grounding exercise with him until he becomes more present. “Push hands”—where the parent can give a little resistance while a child pushes his own hands against the adult’s—can also be helpful in getting a child settled into the present moment.
THE PRETEND JUMP ROPE
This game gives kids an opportunity to run toward (rather than away from) something that creates activation and to experience a successful escape. No jump rope is needed. This game is done as a pantomime. Two children or adults hold a pretend jump rope while the others line up for a turn just like in regular jump rope. First the rope is swung back and forth at a low level near the ground. You can increase the imaginary height if the child seems to desire more challenge. One by one students jump over the “rope” to safety. The reason for not using an actual jump rope is that the lack of a real one engages the imagination and reduces the likelihood of falling. It symbolizes a manageable threat coming toward them. This elicits spontaneous movements and gives children the satisfaction of a successful escape.
Note: More group activities that parents can use together with neighbors or teachers, such as “The Empowerment Game,” “The Wolf Comes at Midnight,” “Past-Present-Future Hopscotch” and “Parachute” activities can be found in Chapters Eleven and Twelve of Trauma Through A Child’s Eyes: Awakening the Ordinary Miracle of Healing.
Note for Physical Activities
The key to “assisted self-regulation” after a disaster is the presence of adult activity leaders who are able to assess and assist those kids having difficulty. While some youngsters will have trouble settling down (they will not be hard to spot!), others will recede to the shadows or complain of being too tired to continue or having a headache, tummy ache, etc. For the children who are struggling, the adults need to be skillful in dealing with their special needs. Here’s where extra help comes in handy. These activities are best carried out with several other grown-ups co-facilitating to ensure that every child who needs assistance gets it.
When some kids need extra help to feel successful, the leaders model for the whole group how to support each other in learning self-regulation. For example, a student complaining of fatigue during the sensation “check-in” might lie down and rest her head on the lap or shoulder of a friendly teacher or classmate, while another adult helps her explore where she feels tired. If she says, “my legs,” the child can rest the legs for a bit and later be given support to move her legs slowly when ready—perhaps pretending she is moving like her favorite animal. This may include physically helping the child to move her legs alternately while lying on her back with knees up and feet flat on a mat.
For the child who is hyperactive and needing help to settle, an adult or more regulated student can sit next to her, helping her to feel the ground and to inhale and exhale more slowly. A partner or an adult might place a firm hand on the student’s shoulder or back as he grounds himself, communicating calmness through contact. The main idea is to normalize individual differences and teach the group how to help one another as they connect more deeply.
It Takes a Village: Katrina, Rita and Other Natural Disasters
With the comfort of home washed away and families torn apart by the Gulf Coast hurricanes of 2005, school staff were being challenged, perhaps for the first time, to help pupils muddle through the aftermath of disaster. In an article entitled “Helping Students Cope with a Katrina-Tossed World” (The New York Times, November 16, 2005), Emma Daly reported that elementary school students in Gulfport, Mississippi, kept coming to see the school nurse at Three Rivers Elementary School “with vague complaints: headaches or stomach pains that are rarely accompanied by fevers or other symptoms.” (Actually, children will sometimes have fevers in the aftermath of loss and trauma.) Other pupils were quiet and withdrawn. All of these symptoms, of course, are common in post-disaster situations. Most people, however, don’t connect physical symptoms to trauma. Dr. Lynne Jones, advisor to the International Medical Corps regarding hurricane-affected populations, is quoted in the same newspaper story as emphasizing the importance of normalizing symptoms by saying something to the children like, “This is to be expected; if you have been through a very frightening, painful experience, the pain and fear settle in part of your body.” It is precisely because the body does bear the burden that the model throughout this book for the prevention of long-term trauma involves helping kids notice and work through their body’s sensations and feelings painlessly. Games “with a twist” that promote a charge and discharge of energy, together with the sharing of sensations and feelings, restore a sense of pleasure and competency, replacing feelings of helplessness and hopelessness.
In natural disasters and other mass-fatality situations, like terrorist attacks and war, the local caregivers are personally affected as well. “Mass disasters produce a peculiar reticence in grief—everybody is looking after everybody else,” continues Dr. Jones. Everybody has lost something, so the tendency is to suffer silently rather than burden your neighbor. In Thailand, for example, a mother who had lost one child had a friend who lost all of her children and her house. The mother told us she felt that she shouldn’t hurt as bad as she did because her friend lost even more! But such inequities of loss don’t mean that one’s own pain or trauma is diminished. Children are especially protective, trying to spare parents any sorrow because they need to see them as able to cope. Kids often keep their pain secret in an attempt to relieve their parents’ distress.
For this reason group support is essential for both parents and children to counteract the tendency toward withdrawal and isolation. If neighbors come together in emergency preparedness efforts such as with their friends from “Neighborhood Watch,” they can practice the skills and the games in advance. This way they can generate a plan for meeting together with their kids to support them and each other following a catastrophe. Neighbors need neighbors. People heal people!
A New Model of Crisis Debriefing at School
Traditional crisis intervention in the schools typically is designed to debunk myths, get everyone on the same page with the facts, normalize traumatic reactions and give the children a chance to talk about what happened. The debriefing team might even ask the kids to tell about the worst parts of what they saw and how they feel; then, off they go!
There is little if any processing (working through) of the awful experiences they were asked to describe! We, the authors, believe that such debriefing with a lack of integration can be re-traumatizing, especially for children. And because children (and many traumatized adults as well) tend to be compliant, the first responder may not be aware that the child is being pushed further into shutdown and dissociation.
Somatic Experiencing® offers a new model for crisis intervention in the school and community. It was used successfully with Thai children in the aftermath of the 2004 tsunami and with survivors of Hurricanes Katrina and Rita in the United States. Those treated in New Orleans, Baton Rouge and Thailand participated in a research study that demonstrated dramatic benefits in both the short and long term. A significant reduction in trauma symptoms was evident after only one to two Somatic Experiencing® “first aid” sessions.
The Critical Difference in Somatic Experiencing® Crisis Intervention
The emphasis in Somatic Experiencing® “first aid” is on symptom relief and in resolving the underlying “energy” that feeds those symptoms. This is accomplished by assisting children to reduce excess nervous system arousal through accessing his or her internal sensation-based resources. This is in sharp contrast to some other methods that focus on gathering and disseminating information and asking kids to describe the catastrophe. Instead, children are asked to share their post-event difficulties—not their memories. Common reactions after a disaster include: eating and sleep disturbances, irritability, spaciness, weakness in the limbs, fatigue, numbness, headaches, feeling dead, flashbacks, worry about the future, panic and survivor’s guilt.
Great care is taken to avoid re-traumatization by refraining from probing for the “telling of the story.” SE® does not ask grief-stricken, terrified children to talk about “the worst thing that happened.” Instead, support is given by observing and listening to each child’s bodily reactions and helping them to move out of shock and distress. Sensations and emotions are processed in very small increments. And the child only reveals bits of the story as they arise spontaneously rather than being deliberately provoked.
In the following example you will learn how SE® crisis intervention is conducted. In this case, a group of middle-school students helplessly watched a drive-by shooting as they waited for their bus. The counselor met with the small group later that morning and a few times subsequently. One boy and one girl, however, continued to have problems and were referred for crisis counseling. After using our somatic approach, both youngsters’ symptoms resolved. Curtis’s story (below) is a poignant example of the details of using Somatic Experiencing® after a crisis.
Restoring Curtis’s Innocence after a Drive-By Shooting
Curtis was a middle-school boy who witnessed a drive-by shooting at the bus stop. He was referred by his counselor because he couldn’t stop thinking about the event. At school Curtis was restless and distracted; at home he was physically aggressive with his brother. When I met Curtis he told me that he didn’t want to act the way he was acting. He “wanted to feel like himself again.” He said that his biggest problem was the angry feelings he had each time he pictured the man who was shot lying on the ground. He also got distracted in class and had difficulty sleeping. But he shared that what troubled him the most were the brand-new feelings of wanting to hurt somebody—anybody, any random target—without understanding why.
When I asked where he felt the anger, he said, “In my legs and feet.” Together we tracked the sensations in his legs and feet. Within a minute or two of noticing his lower body, Curtis was able to tell me that his legs wanted to kick. He also mentioned that he liked kickball and soccer and described feeling strong in his legs (an important resource). As we worked together, Curtis discovered that he wished he could have kicked the gun out of the gang member’s hands. I had Curtis use his legs to kick a soccer ball in the same way he had wanted to kick the gun. He started to kick the ball with vigor.
Rather than have Curtis kick fast and hard, perhaps getting wound up and enraged, I gently showed him how to make the kicking movements in slow motion. I had him describe the sensations in his hips, legs and feet as he prepared to kick (what his body wanted to do to stop the violence). Then I invited Curtis to rest and notice the feelings in his legs. Each time that we followed this sequence, his legs would shake and tremble. Once this activated energy was discharged, Curtis centered himself, took a deep breath and kicked the ball full-out, as he felt his steadiness, strength and confidence return. He got his power back and lost the urge to hurt a random bystander.
After this “first aid” session to move his body out of shock, Curtis’s symptoms disappeared. In a follow-up several weeks later with Curtis and the school counselor, he continued to be symptom-free. He was relieved that he no longer felt pointless aggression. Curtis shared that he felt like himself again. Not only did he get his power back; he got his innocence back! The major shift in this type of crisis work is that the focus is not on the horror of the event; rather it is on completion of the body’s incomplete responses to protect and defend itself and others. This is what led to symptom relief and long-term transformation of trauma for Curtis.
Crisis Relief with Groups
The SE® crisis work done with Curtis could have been done with the entire group of middle-school students had the counselor been trained in working with the principles of tracking sensations, nervous system activation/deactivation and sensorimotor defensive movements. Suggestions that follow are for school-wide trauma first aid after a crisis such as a natural disaster, school shooting or terrorist attack. Parents and educators can partner together to help children calm their aroused states in small groups at school. As the kids assemble, one student usually volunteers. As she is supported to process her symptoms and gets relief, the shyer students gain confidence and ask for their turn. Below are guidelines for working with groups of three to twelve students:
1. Invite as many parents (or other caregivers) as possible to participate.
2. Seat students in a circle so that everyone can see each other. Seat adults directly behind the children in a concentric circle for support.
3. It is very helpful but not necessary to have a child-size fitness ball for the student who is “working.” Sitting on the ball helps youngsters drop into and describe their sensations more easily. These balls are very comfortable and children love to sit on them.
4. Educate the group on the trauma response. Explain what the children might expect to experience both during the initial shock phase and as the shock begins to wear off in order to normalize their symptoms. Use the information that you have learned in this book. (For example, some may feel numb; others may have recurring images or troublesome thoughts, etc.) Explain what you will be doing to help them (i.e., that the group will be learning about inner sensations and how they help to move stuck feelings, images and worrisome thoughts out of their body and mind).
5. Do not probe the group to describe what happened during the event. Instead explain to them that you will teach skills to help lessen symptoms so they might feel some relief.
6. Ask the group to share some of the trauma symptoms they may be having (for example: difficulty sleeping, eating or concentrating; nightmares; feeling that “it didn’t really happen”). At the same time it is important not to over-focus on the symptoms; this can have the effect of causing more worry and may reinforce the feeling that there is something wrong with the person experiencing the symptom(s). Symptoms are only discussed to provide the knowledge that these are normal responses and to help guide children toward balance and equilibrium.
7. Explain what a sensation is (distinguishing it from an emotion) and have the group brainstorm various sensation words. You might even write these down for all to see, if convenient. Explain what to expect: that they might feel trembling or shaking, be tearful, jittery, nauseous, warm, cool, numb; or they might feel like they want to run, fight, disappear or hide. Let the group participants know that these are sensations that can occur as they are moving out of shock.
8. Work with one volunteer at a time within the circle. Have that child notice the support of the adults and other students in the group. Invite him to make eye contact with a special friend or familiar adult for safety. At any time during the session, if the student needs extra support, invite him again to take a break and make contact with a special “buddy” in the group.
9. Ask the student to find a comfortable position in the chair or on the ball. Invite him to feel his feet touching the floor, the support of what he is sitting on and his breath as he inhales and exhales. Make sure that he feels grounded, centered and safe.
10. Begin the sensation work as soon as the child is ready. First have him describe a sensation of something that brings comfort or pleasure. If he hasn’t had any resourceful feelings since the event, have him choose a time before the event when he had good feelings and describe what he feels like now as he recalls those good feelings.
11. The child might automatically describe symptoms, or you may need to ask what kinds of difficulties he is struggling with since the event. Then ask him to describe what he is feeling. The following are sample questions and comments to use as a guide for inviting awareness of sensations:
a. As you see the picture in your mind of “the man behind the tree” [for example], what do you notice in your body?
b. And when you worry that he might come back, what do you notice in your body?
c. And when you feel your tummy getting tight, what else do you notice? Tight like what? What might it look like? Can you show me where you feel it?
d. And when you look at the rock … or make the rock with your fist … what happens next?
e. And when you feel your legs shaking, what do you suppose your legs might want to do?
f. When your legs feel like running, imagine that you are running in your favorite place and your [insert the name of a favorite safe person] will be waiting for you when you arrive.
g. Or, have the child imagine running like his favorite animal. Encourage him to feel the power in his legs as he moves quickly with the wind on his face.
12. The idea is to follow the student’s lead. Help him to explore, with an attitude of curiosity, what happens next as he notices his internal responses.
Note: please refer to Chapter II for detailed information on emotional first aid for coming out of shock. If loved ones have died, see Chapter VII to help children with the grieving process. For more activities and ideas for parents, teachers and counselors to use at school, please refer to Trauma Through A Child’s Eyes, Chapter Eleven.
As we said in the beginning of the book, trauma is a fact of life. No one grows up without encountering at least some of this monster. But the good news is that trauma doesn’t have to be a life sentence. With the simple tools you have learned to support your child’s innate resilience, parents can be reassured that they can promote confidence and joy in their kids. And in this way you can change the world, one child at a time—and, if so inspired, one institution at a time. Thank you, committed parents, for making the effort to learn about these tools. Your children are our hope for the future.