A Tool to help Traumatized Children
The facilitation of adaptive resolutions to a child’s internal conflicts and to struggles with experiences in the external world, is at the core of child psychotherapy. Children come to therapy with symptoms that reflect their inability to resolve their psychological dilemmas unassisted.
Traumatized children are often particularly limited in psychological resources, secondary to the effects of trauma on their ego functioning and object relationships. In trauma, children endure unbearable fears, feelings, losses, sensations, cognitions, and often physical pain. The dreaded expectation of reoccurrence of traumatogenic experiences is at the core of symptom formation for traumatized children. Terr refers to this phenomenon as “Traumatophobia”, a term introduced in 1942 by Sandor Rado (See Terr, 1990). Krystal (1978) used the term “Pseudophobia” to describe “the continuing capacity for memory fragments to evolve intense affects” (p. 107), explaining, “the cognitive and affective elements of the memories are, like the rest of the trauma memory, unintegrated, and therefore experienced as dangerous by virtue of their acting like a trauma screen” (p. 107-108). The concept of traumatophobia dovetails well with the psychobiological mechanisms associated with extreme stress, such as disrupted hippocampal functioning causing intrusive sensations and feeling states (van der Kolk, Hostetler, Herron, and Fisler, 1994).
Traumatophobia can begin to be resolved only when children feel safe in the present and have hope for safety in the future. The metaphorical world of play, art, and stories is an arena wherein therapists can guide traumatized children toward adaptive resolutions to psychological dilemmas expressed in their creative products.
If a child’s dramas depict no escape from omnipresent threats, as is common in posttraumatic play, the therapist must help the child develop and maintain a safe place, a place where no danger can intrude. Representation of a safe place in the symbolic world of play and art facilitates the internalization of safety and hope to the inner world, including conveying hope for safety to dissociated parts of the psyche that experience themselves stuck in the sites of their trauma.
Safe places ideally have three features:
1) a protective perimeter, perhaps including people, strong animals, or fantasy or spiritual protectors around the perimeter or at doorways, and for very frightened children, a means of concealing the safe place from outside detection,
2) internal allies; nurturers, friends, pets, spiritual healers, etc.,
3) soothing and reparative things, such as soft bedding, stuffed animals, healing baths, things of beauty from nature, etc.
One child made my life-size wooden jail her safe place. She draped cloth over the bars to hide, built a wall of pillows, curled up in a blanket, and sucked on a baby bottle. Another child lay on the couch shielded by a circle of weapons. Many children create a hide-out under a chair for good guy figures.
Our playrooms should include potential safe places, such as toy forts, boxes that can be made into safe dwellings, or an empty shelf in a cabinet. Their presence symbolically serves to suggest to the child’s psyche the option of a safe place as a resolution to trauma in play, and in the child’s inner world.
Children who do not spontaneously incorporate safe places in their dramas need our help in doing so. If the child can not be encouraged to create a safe place, the therapist should help the child to create one. The therapist should also ensure the survival of the safe place, to the point of physically preventing the child from destroying it, symbolically fighting for the child’s psychological and physical integrity. The safe place remains close by in the therapy room as ongoing dramas are portrayed, a constant reminder that there is a place to go to, either now or in the future, for protection, support, comfort, and healing.
As therapy moves into the phase of processing of trauma, dolls and animals representing the child during the trauma, and any dissociated personality fragments trapped in memories of the trauma, can be taken to the safe place as they are rescued out of the sites of their trauma. Once there, play dramas can include the provision of psychological, physical, and spiritual healing from the internal allies and soothing and reparative things.
Stephen Prior, in his book Object Relations in Severe Trauma (1996), beautifully describes the psychological struggles of sexually abused boys, and their resolution in psychodynamic play therapy. He presents a case of a sexually abused boy who initially enacted violent and sexual dramas with “a complete lack of safety, restraint, or relief from the onslaught” (p. 144). Prior writes of his treatment of this child;
A central event in the first months of treatment was my introduction of the “Safe Place.” This small plate with three tiny animals on it was the only place in the universe safe from sex and violence. To maintain its safety, I eventually had to physically restrain Damon from destroying it. My willingness and ability to protect the Safe Place meant a great deal to him.
Prior concludes this case; “Two years or so after ending treatment with me, I asked Damon what he remembered most about our work, and he said, “The Safe Place, that little dish” (p. 164).
The following safe place was created by a 9-year-old girl who already has the wisdom of an old soul. The safe place is created in a large box lid. It has a door that flaps open and closed, cut in one long side of the box. Small paper hearts are glued around the perimeter. There is a bed made of popsicle sticks. A shield is made of aluminum foil. A fish made of paper swims in the middle.
The door has rules on it that say; Devil Out, Angels Allowed.
The house is made so I can hide out.
The person is my friend and he means friendship.
The butterfly means Mother Nature.
The shield is so if anybody bad comes in, it will push it back out the door. The shield says, Angels Rock.
The Beta fish is a Chinese fighting fish, and he will fight the bad guys.
The heart means love and it will love, love the bad guys out.
And all those things I said is my safe place.
As we work with the child’s play, we work with the child’s imagination, the inner world where psychological resources reside, the source of security, hope, and dreams. As we can impact the imagination, we facilitate the development of deep resources in the inner world. Through safe place imagery and play, the imagery of trauma that once held reign of the child’s imagination can be overcome, contained and understood as of the past, as we lay seed to a present and future sense of safety and healing.
Krystal, H. (1978). Trauma and affects. Psychoanalytic Study of the Child, 33, 81-116.
Prior, S. (1996). Object relations in severe trauma: Psychotherapy of the sexually abused child. New Jersey: Aronson.
Terr, L. C. (1990). Too scared to cry: Psychic trauma in childhood, New York: Harper and Row.
van der Kolk, B.A., Hostetler, A., Herron, N. & Fisler, R.E. (1994). Trauma and the development of borderline personality disorder. Psychiatric Clinics of North America, 17(4), 715-730.