Case Study: Play Therapy After the Niigata Earthquake

Situation

The series of earthquakes that hit Niigata, Japan between October 23, 2004 (6.8 Richter) and October 25, 2004 totalled over 1,000 tremors. There were 67 deaths (4 children) and 4,805 injuries. In addition, 100,000 buildings were damaged and 103,000 people were displaced. A snowstorm hit shortly after the quake, killing some and sickening others who were forced to live in cars or temporary shelters.

Psychological Context

Play is a natural form of expression for children across cultures. Children that experience mild levels of PTSD benefit from playing out their experiences. It is a natural and self-therapeutic process to deal with trauma that allows a child to integrate the traumatic experience into his or her personal timeline. However, a child with moderate to severe levels of PTSD may frantically exhibit the same play themes over and over again, retraumatizing himself through repetitive and compulsive play. When left untreated, all but the mildest of childhood traumas last for years. To be successful, play therapy must be organized so that the child plays out the trauma a little at a time.

Response

Mental health professionals treated children using cognitive behavioral techniques pioneered by Janine Shelby and the UCLA trauma team with the following goals:

1. normalize reactions
2. assess current coping mechanisms and reinforce healthy ones
3. assess and modify misattributions and cognitive distortions
4. decrease hyperarousal and panic symptoms
5. increase self-soothing
6. identify and change intrusive re-experiencing
7. decrease isolation and withdrawal and reinforce the ability to seek helpful social support
8. decrease regressive behaviors by focusing on strengths and resources
9. identify loss reminders and trauma triggers
10. leave the child with a sense of hope

Activities used include the following:

1. puppet shows to address children’s fears and correct misattributions
2. writing and reading a story about the earthquake while acting out story
3. yoga and breathing exercises
4. making coping bracelets/necklaces as a visual reminder of their support systems and self-strengths
5. building a new village together to instill hope, a sense of community, and a sense of control
6. magazine collages to assess current coping mechanisms
7. changing words to well-known songs to develop new songs about hope and safety
8. blowing bubbles to symbolize blowing away bad feelings
9. having a transitional object like a worry stone to rub away the feeling of being scared
10. blowing up different sized balloons symbolizing different amounts of pent up emotion and releasing the emotion
11. assigning different colors to feelings to identify a range of emotional responses to trauma
12. identifying within a group common thoughts to create a sense of community
13. tinman/ragdoll activity to experience the physical difference between feeling tense and feeling relaxed to learn to control muscle tension
14. group activities to decrease isolation and reinforce the importance of seeking social support

Japanese Rituals

In times of distress, the Japanese have a number of rituals that originate with the Buddhist/Shinto faith but are ubiquitous even among the non-religious. These rituals include lighting incense, placing a paper charm on one’s door, retelling folk tales, attending festivals, lighting candles, building mountain fires, floating dolls and visiting shrines/temples. A common theme among these rituals is the use of an inanimate object (such as a doll or origami figure) to carry away one’s burdens.

Relevance

Natural disasters are traumatic for children. The adults children rely on are often temporarily unable to provide reassurance, guidance and support. The greater the physical displacement and change in routine for a child, the more difficult it is for them to cope. Children need a way to work through their trauma. Parents that try to suppress the memory in their children are doing them a disservice. Play-based interventions can help. Adapting coping rituals (inherent in the cultural context) to children’s games could help adults help their children after a disaster.

Kalayjian, Ani, and Dominique Eugene. Mass Trauma and Emotional Healing around the World: Rituals and Practices for Resilience and Meaning-making. Santa Barbara, CA: Praeger, 2010. 37-54. Print.

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