A Child's Terror and Play : Play Therapy for Children Suffering from PTSD due to Natural Disasters

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Running Head: CHILD PTSD AND PLAY THERAPY








A Child’s Terror and Play:
Play Therapy for Children Suffering from PTSD due to Natural Disasters
Rebecca A. Schneider
Rollins College, Hamilton Holt School

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Abstract
When the levies broke in New Orleans after Hurricane Katrina had passed, the world
stood in horror. It was a disaster of epic proportions and it seemed as if not only nature,
but man and nature conspired together to cause the destruction of an entire city. This
disaster left families broken and torn apart. The ones who suffered the most through this
ordeal were the children. Characteristic symptoms of Post Traumatic Stress Disorder
(PTSD) are normal reactions to abnormal situations. The symptoms are considered
normal because they are easily understood and predictable based on extreme, abnormal
situations. Comparisons between children’s reactions to Hurricane Andrew and
Hurricane Katrina will show that children were traumatized more by increased violence
in the adults around them than the natural disasters themselves. Brief case studies from
children affected by Hurricane Andrew will demonstrate how play therapy can help
children communicate with adults and counselors about their focus of trauma, how the
traumatic event has impacted them. Finally, play therapy will be examined as a tool
which can be used to bring a sense of empowerment back to the children and aid in the
healing process.
Keywords: PTSD, Trauma, Natural Disasters, Play Therapy, Child Psychology.

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A Child’s Terror and Play:
Play Therapy for Children Suffering from PTSD due to Natural Disasters

The United States of America is experiencing the largest disaster recovery
effort in remembrance. A category 5 hurricane named Hurricane Katrina devastated
Alabama, Mississippi, and Louisiana on September 4, 2005. As a result of this disaster,
many children have experienced and are currently experiencing Post-Traumatic Stress
Disorder (PTSD). According to the “Diagnostic and statistical manual of mental
disorders,” or DSM – IV – TR (2000), PTSD is caused by exposure to a traumatic event
and is re-experienced mentally and physiologically with signs of arousal and avoidance
of associations with the trauma (American Psychiatric Association [APA], 2000). Play
Therapy will be examined as a non-threatening approach to communicating with and
helping children who suffered from Hurricane Katrina and its aftermath.
Traumatic Disasters and Children

Contrary to the DSM – IV – TR’s definition of PTSD as referenced above, a more
practical definition describes PTSD as one’s normal reaction to an abnormal situation
(Schiraldi, 2000). This means that symptoms such as hypervigilance, night terrors, and
even amnesia are understandable and predictable in regards to the extreme situation.
Using this definition with patients helps to alleviate feelings that they may be going
crazy. It also helps them to understand that the situation itself is abnormal and their
reactions are normal responses. Many psychologists agree that PTSD caused by a natural
disaster is easier to recover from compared to man-made traumas (Schiraldi, 2000). The
difference between the two is that natural disasters are based on uncontrollable

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environmental afflictions upon humans, whereas man-made traumas are an affliction
from one human upon another.
Matsakis, disagrees with this belief based on two aspects of natural disasters,
man-made elements and recovery environments (1996). Using Hurricane Katrina as an
example, one of the man-made elements contributing to the disaster was the levy system
that broke down in New Orleans causing the devastating flooding all over the city. The
recovery environment in New Orleans also included man-made traumatic events.
Evacuees who were in New Orleans’ Convention Center, including children, have come
forward with multiple accounts of gang rape, murder, and thievery. Starvation,
dehydration, and an overall claustrophobic environment enhanced violence, crime, and
terror.
According to Miller, the Latin roots of the word disaster, dis meaning ‘against’
and astrum meaning ‘stars’, translates to “the stars are against us” (1999, p. 24). Miller
observes that after disastrous events where parents, teachers, caretakers, and adults are
coping with their own stress, some children are often quieter and more subdued than
normal and others act out with crying, clinging, and aggression. Though it is often
believed by caretakers that the quiet children are coping well with situations, the quiet
and subdued responses indicate deep turmoil and should not be ignored at the expense of
helping children who exhibit more external behaviors.
Shelby and Tredinnick, observe that after Hurricane Andrew swept through
Miami, FL, some children found that their parents were unable to provide for them
physically and mentally (1995). Many children observed their parents reacting to the
devastation with screaming, crying, and even domestic and child abuse. Children were

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forced into parent-like roles and lost confidence in their parent’s ability to provide for and
protect them.
Just like these children in Miami, children affected by Hurricane Katrina will
have shattered illusions of their parents. Some children were separated from their parents
in the flooding of New Orleans and The Center for Missing and Exploited Children is
still working to find children’s missing parents and parent’s missing children. When
counselors and therapists are working with children affected by natural disasters a
common assumption is that the children are traumatized by the natural disaster itself. To
the contrary, Shelby and Tredinnick found that many children traumatized at the time of
Hurricane Andrew were more traumatized by increased abuse, rapes, and witnessing
violence.
Brief Case-Studies of Children with PTSD

During Hurricane Andrew, Shelby and Tredinnick encountered numerous
children who suffered from PTSD from the natural disaster and secondary traumas that
occurred as a result of the hurricane (1995). In one example, an eight year old girl from
South America was believed to be overcome with grief because she lost her toys. During
play therapy involving puppets, Shelby and Tredinnick found that the girl was more
saddened by the fact that her friend was moving back to South America. This was her
primary issue and had to be treated before the healing started for dealing with the storm
and the loss of home.

Another male child, age three from Cuba, was brought to the counselors because
he had become fearful and clinging with the passing of hurricane Andrew. Because a
child at the age of three does not have the same communicative abilities as older children,

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Shelby and Tredinnick asked the boy to draw a picture of the hurricane. While he was
drawing the picture he said that the picture, meaning the hurricane, was very bad. After
the drawing was complete the counselor told the boy that he could do anything he wanted
with it. He raced across the building and threw it away. This activity was repeated a few
times, with the boy becoming more positive and smiling more and more. It was the first
time he had smiled since before the hurricane.
Play Therapy & Other Expressive Art Therapies

Post traumatic play is considered “the most potent way to effect internal changes
in young, traumatized children,” (Terr, 1990, p. 299). Terr discusses the main benefit of
play therapy in treating traumatized children involves helping patients regain a sense of
control. Because children’s cognitive processes are at different developmental stages,
play therapy is a way to reenact behaviors and emotions the child may have difficulty
expressing. One of the hardest things for a child to regain after trauma is a sense of
control. Play therapy is a way of giving that control back to the child. As the example of
the young Cuban boy illustrates above, by telling the child he can do anything he wants
to the picture of the hurricane, the therapist is giving control back to the child (Shelby &
Tredinnick, 1995).

Play therapy is also a way of reenacting traumatic events as if they’re happening
to someone else (Terr, 1990). As the child looks at the event as something that is
happening to someone else, the child can identify external factors and possible outcomes.
For example, when working with a young girl, a therapist may use a doll named Laura
ask the girl to describe how Laura might feel in a hurricane situation. The therapist may
then ask the child to describe how Laura might react in school the week after the

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hurricane and in the next thunderstorm. Legitimatizing the emotions experienced by
children in traumatic situations is important for helping the child to cope with the
aftermath. Positive reactions and coping skills can also be demonstrated by the therapist
through the doll. Through play therapy children can learn that although they were
helpless in one situation, they might have other options in the future, they can be more
prepared and have more control.

Other expressive art therapies include music therapy, art therapy,
movement/dance therapy, storytelling, dramatization, and poetry, among others
(Schiraldi, 2000). A music therapy technique would be to give a child a drum and tell the
child he/she can play with it however they want. They can play loud, soft, fast, slow,
they can tell the therapist to play the drum loud, soft, fast, and slow, to start and stop.
This gives the child a sense of control back. It is important for the therapist to enable the
child to make individual choices and decisions in the play, music, art, story, drama, and
thus in the therapy itself.
Discussion
As recovery efforts continue and the United States continues to mourn its losses,
it is important to remember that when the waters recede, debris is cleared, and houses are
rebuilt, children will still be struggling to heal. A therapist’s best gift to a traumatized
child is to give back some control that was taken away by floods, abuse, rape, and
neglect. Children who are not able to talk can still express their turmoil through pictures
and play therapy. Future therapists will be needed who are able to empathize with
childhood traumas and who understand that natural disasters occur hand-in-hand with
man-made traumas. The greatest need will be for teachers, parents, and care-givers to

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really listen and see what the children are communicating and to give support,
understanding, and provide help to these traumatized children. Only then, will the
children in America be able to heal.

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References
American Psychiatric Association. (2000). Diagnostic and statistical manual of mental
disorders (4th ed., TR). Washington, DC: Author.
Matsakis, A. (1996). I can’t get over it: A handbook for trauma survivors (2nd ed.).
Oakland, CA: New Harbinger Publications, Inc.
Miller,L. (1999). Treating Posttraumatic Stress Disorder in children and families: Basic
principles and clinical applications. The American Journal of Family Therapy,
27(1), 21-34.
Schiraldi, G. R. (2000). The Post-Traumatic Stress Disorder sourcebook: A guide to
healing, recovery, and growth. Los Angeles, CA: Lowell House.
Shelby, J. S., & Tredinnick, M. G. (1995). Crisis intervention with survivors of natural
disaster: Lessons from Hurricane Andrew. Journal of Counseling and
Development, 73(5), 491-497.
Terr, L. (1990). Too scared to cry: How trauma affects children…and ultimately us all.
New York, NY: Basic Books.







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