Trauma-proofing Children
The distressing images emerging from the war in Ukraine, and a recent discussion with a group of social workers, youth workers, art therapists and play therapists in Lismore, have prompted me to reflect on how to best support children in crisis. Hundreds of children have lost their homes in the recent floods in the Northern Rivers area of New South Wales. Thousands are fleeing the utter devastation in Eastern Europe. Not only are these children displaced and have gone through an overwhelming event, but they have also lost the entire infrastructure of their community, their homes, schools and play grounds. They have lost the connection with friends and possibly family members. Their entire life has been turned upside down in a wave of uncertainty and terror. So the big question is - how can we support these children in a trauma-informed way that is age appropriate and healing?
Safety: First and foremost is to establish a sense of safety. Without a deeply felt sense of safety, we have no basis for any trauma processing. We do this naturally through human connection, physical contact, co-sleeping and hugs. Other implicit resources can be cushions, blankets or stuffed toys to hold. Explicit art therapy exercises can encourage the creation of a safe place, such as a shelter for a small toy animal. In the aftermath of the Christchurch earth quake, art therapist Deborah Green (Green 2012) found children benefitted from building houses out of collage materials and recreating a new town. I found the same art therapy exercise worked well in a Syrian refugee camp, where groups of children and adults built houses on card board squares, then pushed them together and in the process recreated villages from scrap materials. This allowed them to restore a sense of order and community.
Narrative Play: One of the Lismore therapists described a group of children arriving for therapy in the aftermath of the floods spontaneously stripping the covers off the cushions in her therapy room in order to create boats. They had experienced rescue workers and neighbours saving them from the rooftops of their submerged homes, and they re-enacted the emergency response. Somatic Experiencing emphasises the importance of an active response to an overwhelming event. If we can react adequately to something terrifying, life threatening or painful, we may remember it as a bad experience, but it will not cause lasting post-traumatic stress. Levine (Levine and Kline 2007)describes PTSD as an incomplete emergency response. If children can complete their journey to safety in a pillow cover, their nervous system can reset to a renewed equilibrium. (Porges 2011) In the context of therapeutic play, it can be helpful to introduce helper figures such as rescue workers, ambulance officers, fire men, police or doctors; figures who would know what needs to be done. Their expert responses can then be enacted as narrative play, pictured in drawings or in the sand tray.
Rhythmic Movement: Restoring the rhythm of life can be most beneficial for those who remain frozen in fear. Some children may react with constriction, freeze or immobility in their body. They may complain about tummy aches, headaches, asthma or develop digestive problems and bedwetting. Others display postural problems such as raised shoulders, being hunched over or they have trouble coordinating their hands and feet. Some just do not seem to enjoy anything. Their behaviour may become avoidant such as not wanting to go to certain places, or they display repetitive play. Frequently kids become clingy and regress to younger behaviours.
The most effective way to bring children and teens out of dorsal vagal shutdown (Porges 2011) is through rhythmic action patterns. Young children respond to rhythmic clapping, jumping and hopping, preferably in combination with songs or rhymed verses. Peter Levine and Maggie Kline developed a whole range of trauma-informed, body-based songs and plays accompanied by movement. (Levine and Kline 2007) Children enact stories about animals in the wild that are being hunted by predators and they animate the running towards safety with their legs. These songs are designed to enact the fight-flight response, which, based on Levine’s research, are able to complete incomplete action cycles which were interrupted due to traumatic overwhelm. These stories can be easily adapted to the event that needs to be addressed.
For example, after the 2004 tsunami in Aceh, Sumatra, Somatic Experiencing therapists worked with children who had lost their parents, often their entire village by enacting with them through song, movement and imaginative play the flight response. After rhythmic high excitement simulating the flight response - with a ball being ‘chased’ by all the children - they began to billow a large parachute sail mimicking the huge wave that came. Rather than being overwhelmed by the ‘wave’, 50 children now created the wave as an active response. At the highest point they all slipped underneath the parachute sail singing: “I am safe, I am safe.” Having an active response allowed them the end the trauma and to come to an embodied realization that they had all survived, were alive and safe now. None of the children who had participated in the program were found to develop PTSD. They certainly had had a terrible experience, but they were no longer stuck and frozen in it, but could move on.
An art therapist in Israel put a video together to teach the kindergarten and primary school children an active response to the constant sirens and rocket fire from Gaza going off nearby, which kept the children in a constant state of high alert and anxiety. The song has a catchy tune and is enacted by the children with movement patterns. Initially the song focuses on the fear felt in the body. The children then enact an active fight-flight response to avoid freezing in overwhelm, until they all find safety and can discharge the inner tension through shaking. The positive effect on the children is palpable, and many have integrated the song into their recess play routines. The interviewed children all report that they now feel better, because they know what to do when the sirens go off. The video is available on YouTube as the Colour Red song by Tzeva Adom. (Adom 2009)
In recent years Hip Hop Therapy has become a popular approach of giving traumatised adolescents a voice based on rhythmic engagement (Lyford May/June 2021). Teens can also benefit from co-created choreographed dance moves to their favourite music. Capoeira, for instance, is a Brazilian martial art that combines elements of dance, acrobatics, and music. Drumming Circles encourage the healing power of co-regulating the nervous system of even large groups. Trauma is isolating and characterised by loneliness. Rhythmic engagement can support the reconnection with the human tribe, which we need to thrive.
In the event of trauma, the internal sense, our heart rate, breath and digestive system literally holds the body hostage (Van der Kolk 2014). We feel our ears ringing, hold our breath or are in pain. The outside world is perceived as a blur in the tunnel vision of the shutdown nervous system. Initial interventions need to focus on reengaging the five senses. We need to come back online. This can be with a simple cup of tea or a crunchy cookie, if we want to stimulate taste. All the arts are perfectly able to engage touch, sound, sight and smell. Retrieving voluntary control over the muscles through rhythmic repetition and really simple motor impulses such as clapping, jumping and moving around gives agency and encourages empowerment. There are many options for an embodied approach to trauma healing. Given that children feel sufficiently safe, it can be fun to develop programs that are life-affirming and creative. This way they can come back into being and reconnect with life.
Bibliography
Adom, Tzeva. 2009. "Color Red Song." YouTube. January 24. www.youtube.com.
Green, Deborah. 2012. "Clearing a space." ANZJAT.
Levine, Peter, and Maggie Kline. 2007. Trauma through a child's eyes. Awakening the ordinary miracle of healing. Berkeley, California: North Atlantic Books.
Lyford, Chris. May/June 2021. "Hip hop therapy; the healing power of giving kids the mic." www.psychotherapynetworker.org.
Porges, Stephen. 2011. The Polyvagal Theory. New York: W.W. Norton.
Van der Kolk, Bessel. 2014. The body keeps the score. New York: Viking, Penguin Group.
AThR, SEP, ANZACATA, IEATA
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