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Dr. Athena Drewes, past president and member of the New York Association for Play Therapy, delivered this speech as the one year anniversary of 9/11 approached. It was the keynote address to the participants of the New York APT annual conference held June 8, 2002. It is, unfortunately, a message that is still timely, relevant, and, still, can give us hope.
Anne Stewart, VAPT President

If Ever We Needed Play Therapy, It is Now!
by Athena A. Drewes, PsyD, RPT-S

If ever we needed play therapy, it is now. The world around us seems to be moving at lightening speed, with events occurring that will have profound impact on ourselves and the children and families we work with for a long time to come.

The work that we do should not be underestimated. It is difficult work, but very necessary. Although very rewarding, it can be stressful; growing more stressful over time due to events, often beyond anyone’s control. The statistics are staggering.

For example: Homelessness

One of the fastest growing segments of the homeless population is families with children, which constitute approximately 40% of people who become homeless. In 1998 children accounted for 25% of the homeless population, and homelessness among families is increasing. Between 1997-1998 the rate increased by an average of 15%, yet 32% of requests for shelter by homeless families were denied in 1998 due to lack of resources.
Homelessness severely impacts the health and well being of all family members. Compared with housed poor children, homeless children experience worse health, more developmental delays; more anxiety, depression and behavioral problems; and lower educational achievement. A recent study of the health status of homeless children in New York City found that 61% of homeless children had not received their proper immunizations; 38% of homeless children in the City’s shelter system have asthma, a rate 4 times higher than all New York City children; and that homeless children suffer from middle ear infections at a rate that is 50% greater than the national average. These illnesses have potentially devastating consequences for educational and emotional aspects as well, if not treated early.

Deep poverty and housing instability are especially harmful during the earliest years of childhood. Alarmingly, it is estimated that almost half of the children in shelters are under the age of five. School-age homeless children face barriers to enrolling and attending school.

Parents also suffer the ill effects of homelessness and poverty. One study of homeless and low-income housed families found that females in both groups experienced rates of depressive disorders higher than the overall female population and that one-third of homeless mothers (compared to one-fourth of poor housed mothers) had made at least one suicide attempt. Think of the emotional impact this has on the children we serve.
The Homeless Children’s Network reports that the trauma of homelessness is often compounded by problems of child abuse, domestic violence, parental substance abuse, chronic instability, poverty and mental illness. Without early intervention, these conditions can become perpetuated in a family through generations.
If ever we needed play therapy it is now! For we also deal with children and families of domestic violence.
In a national survey of children between the ages of 12 and 17, 3.9 million respondents said they have been victims of serious physical assault and almost 9 million have witnessed serious violence (Kilpatrick and Saunders, 1997). There are approximately 1 million incidents of violence against women a year at the hands of a domestic partner, and slightly more than one-half of the female victims of domestic violence have children under the age of 12 (Craven, 1996 and Bureau of Justice, 1998). Even very young children are at risk of developing emotional and behavioral problems when exposed to violence in the home (Osofsky & Fenichel, 1999). Many children develop symptoms of post-traumatic stress disorder or develop other emotional problems.

If ever we needed play therapy it is now to especially help infants and preschoolers.

Just five years ago, the White House convened a special conference on early child development. It reported that the neurological foundations for rational thinking, problem solving and general reasoning appear to be largely established by age one. Furthermore, new studies are showing that spoken language has an astonishing impact on an infant’s brain development. In fact, some researchers say the number of words an infant hears each day is the single most important predictor of later intelligence, school success and social competence. There is one catch…the words have to come from an attentive, engaged human being. As far as anyone has been able to determine, having an infant just listen to the radio and television does not work. The constant patter of a voice may be the single most important factor in early brain development. This has profound implications on the birth to three population that many of your serve, as well as obvious political and social implications. It suggests that infants and babies need not only loving caretaker but also a talkative and articulate caretaker. And, that a more verbal family will increase an infant’s chances for success.

One implication of the new knowledge about infant brain development is that intervention programs, like Headstart and Special Education Preschool, may be too little, too late. In 1999, results of the Abecedarian Project, a federally funded, long-term project on early intervention for at-risk children showed profound results. Poor children enrolled in high-quality day care from infancy do better academically and economically than low-income children who don’t that get initial boost, according to the results of the Abecedarian Project. Throughout their school years, the day care group had higher IQ scores, better language skills and higher academic achievement than the other group. As adults, the children who received the intervention were more than twice as likely to attend college and be employed. The results clearly indicated that if you wait until age 3 or 4, you are going to be dealing with a series of delays and deficits that will put the children into remedial programs, and for many kids that’s too little too late.

Home-based play therapy intervention programs and the Primary Mental Health Programs are more essential than ever. If ever we needed play therapy it is now to help deal with the impact of environmental traumas infants and children experience. Experience may alter the behavior of an adult, but it literally provides the organizing framework for the brain of a child. If the brain’s organization reflects its experience, and the experience of the traumatized child is fear and stress, then the neurochemical responses to fear and stress become the most powerful architects of the brain. If you have experiences that are overwhelming, and have them again and again, it changes the structure of the brain. Trauma elevates stress hormones, such as Cortisol, that wash over the tender brain like acid. As a result, regions in the cortex and limbic system are 20 to 30 percent smaller in abused children than in non-abused children.

Even relatively short periods of stress may cause changes that leave brain cells hypersensitive for weeks, as reported by an Israeli scientist in the January 2002 issue of Science. The scientists are trying to uncover the molecular root of post-traumatic stress disorder. The experiments with mice found that by exposing them to the stress hormone cortisol, and then forcing them to swim, a rare, abnormal version of acetylcholinesterase or AChE was produced that left the mice’s neurons hypersensitive. Brain scans found higher levels of electrical activity that last for weeks, which was a surprising length of time.

Trauma can leave you nervous, and easily startled. It is one way the body protects itself from future harm, by learning from a bad experience. But in some people, this protective mechanism goes too far, leading to high anxiety, nightmares, and flashbacks known as post-traumatic stress disorder. No one knows just what happens to switch a normal stress response to an abnormal, hyper response. Scientists are struggling anew to unravel traumatic stress in the aftermath of the terrorist attacks.

High cortisol levels during the vulnerable years of zero to three in human infants increases activity in the brain structure involved in vigilance and arousal. As a result, the brain is wired to be on hair-trigger alert. Regions that were activated by the original trauma are immediately reactivated whenever the child dreams of, thinks about or is reminded of the trauma. The slightest stress unleashes a new surge of stress hormones resulting in hyperactivity, anxiety, and impulsive behavior. Children exposed to chronic and unpredictable stress will suffer deficits in their ability to learn. A piece of the child is lost forever.

These are the children we work with. These are the children who need play therapy. These are the young children who experience that caregivers are violent, cruel, rejecting, and unpredictable. They cope through silence and constant vigilance over their environment. The child sees him or herself as bad, selfish, stupid, incapable of and undeserving of enjoyable experiences and loving relationships.

Weak attachments may occur from infancy when the parent may be drug or alcohol addicted, depressed, overwhelmed by lack of supports or limited in child care skills or education. These children may have had to endure losses, abandonment, and neglect and sometimes abuse. Survival becomes their most important goal. One minute they can be superficially charming, but then will quickly attack you when their wants are thwarted. When a child with a weak attachment interacts with a caring and giving adult, the child assumes that it is his own successful manipulation that is causing the adult to act in a caring way. Rather than any nurturing quality of the adult, or any intrinsic worth of the child. When the adult disciplines him or her, the child interprets the discipline or limit setting as abuse, rejection and humiliation. Further proof that caregivers are not to be trusted, and the need to rely on manipulative control of others becomes greater. The child does not see that the limit setting is directly associated with the child’s behavior nor that it is in his or her best interest. Rather the discipline is further proof that this adult too is cruel, and the adult’s other “nice” behaviors were deceitful. Reasonable demands are often frustrating for the child who wants to control the session or the adult. Often they may resort to violence in an attempt not to comply. Hitting, kicking, spitting and even biting are frequently used by such children to avoid revealing their inner feelings of hurt and sadness.

If Ever we Needed Play Therapy It is Now! For it is through the unconditional positive regard, and emotional availability of the play therapist using specialized techniques that the young children we work with can achieve improved emotional development and attachment. Through the use of developmental play therapy techniques developed by Viola Brody, or Theraplay by Ann Jernberg (1979) or Filial Therapy by Louise Guerney, children as described above can be helped to move forward and connect to others. Play therapists, like yourselves, are able to make significant differences in the lives of the children and families you work with. Through body and eye contact, focus on intimacy between children and therapist, emphasis on the here and now helps heal the child’s wounds of the past. Through Developmental Play, Theraplay and Filial Therapy it is the relatedness between child and adult that allows for the development of self and personality within the child. The capacity to soothe and nurture oneself in later life depends on early experiences of being soothed and nurtured. Through the directive work that you do with these children and in turn their parenting figures you offer a corrective experience through clear boundaries, and your empathic and reassuring presence. We know these techniques work; we have experienced the healing power of play therapy first hand.

If ever we needed play therapy it is now in working with children and families who suffer from learning disabilities and attention deficit disorder. Estimates suggest that approximately 6 million school-age children (about 10 percent of all school children) suffer from learning disabilities, two-thirds of whom are never diagnosed or receive remedial training. In addition, it is estimated that more than 10 percent of school-age children suffer from ADHD or attention deficit disorder and 50% of them also have a learning disability. LD and ADHD can result from genetic factors or various environmental factors, including damage at birth, fetal alcohol syndrome, and drug use during pregnancy, lead poisoning in the infant or young child, head injury or malnutrition. Because symptoms of these disorders may resemble each other, the diagnosis is often confused. Problems in reading, writing and organizing thoughts can result which correlate with school failure, illiteracy, substance abuse, and juvenile delinquency. Some youth become withdrawn, shy and depressed. Ironically, it is widely regarded as better to be thought bad than stupid in our society. So many of the children may conceal their difficulties behind defiance, and misbehavior, causing havoc in the classroom, rebelling at home and encountering rage and/or disappointment from the adults around them.

To add to their misery, many of these children are vulnerable to abuse, not only because they are lonely and feel unlovable, but because they cannot adequately read and process the cues that signal danger from a potential abuser.

A learning disability may be the central underlying factor in alcohol and drug abuse, violence and sexual abuse, depression, anxiety and chronic work-related problems not just in the children we work with, but in their parents. Their parents who may have an undiagnosed learning disability or attention deficit disorder. These problems may help to explain the chronic sense of chaos and disorganization, which make it almost impossible for the parent (which is usually the mother) to set priorities in any area of their life, from organizing thoughts when speaking or writing, to keeping a schedule. At times drug abuse may result, using cocaine, which paradoxically helps to mellow out the person. Cocaine, an intense stimulant can have the same calming effect as Ritalin or Concerta, prescribed for ADHD children.

Getting through each day for the parent may become an endlessly repeated, desperate struggle, like climbing the same steep mountain over and over, leaving one feeling exhausted, frustrated, helpless and ready to explode in rage.

If ever we needed play therapy it is now. We have the play therapy tools through 101 Play Therapy Techniques and 101 More Play Therapy Techniques edited by Heidi Kaduson and Charles Schaefer, giving us techniques to use with these children. We have the expertise and years of working with ADHD children that Heidi Kaduson offers, as well as our own NYAPT member Susan Hansen, who works extensively with ADHD children through the Kids Together Program in Ulster Co. Mental Health. We have seen first hand how we can offer coping strategies and alternatives to help these children develop social skills and improved peer interactions. We know the results of offering through child-centered play therapy as developed by Virginia Axline and furthered by Dr. Garry Landreth that unconditional positive regard helps in developing a more positive self-concept in these children. We’ve seen the success of using play therapy techniques to help these children become more self-accepting, experience a feeling of control, and become more trusting of themselves and others.

If ever we needed play therapy it is now to deal with the myriad of diagnosable mental disorders.
An estimated 22.1 percent of Americans aged 18 and older, about 1 in 5 adults, 44.3 million people, suffer from a diagnosable mental disorder in a given year. In addition, 4 of the 10 leading causes of disability in the US and other developed countries are mental disorders, including major depression, bipolar disorder, schizophrenia and obsessive-compulsive disorder. Unless things change dramatically, the World Health Organization predicts that, by 2020, depression will jump to become the second greatest cause of death and disability worldwide. But we have the tools through Cognitive-Behavioral Play Therapy and other modalities.

If Ever We Needed Play Therapy It Is Now. For violence in our society and the world has had tremendous impact on all of us. The average American child spends more than 21 hours per week watching TV (Nielsen Media Research, 1998). Sixty-one percent of TV shows contain violent scenes. The research data strongly suggests that children are vulnerable to repeated exposure to the portrayals of violence that have become a staple of entertainment and recreational activities. Reviews of the research have found that children and adolescents exposed to media violence are more aggressive (Villani, 2001). What happens when children are exposed to violence? Strong feelings of terror, helplessness, guilt, anxiety and rage kick in, even for very young children. These feelings become a standard response and their intensity can either immobilize or arouse children, even when the threat is fantasy and packaged as entertainment. Violent scenes on TV, in movies and in computer or video games can trigger old memories of abuse or domestic violence, create intense fearfulness and anxiety and reinforce the belief that violence is everywhere. We live in a society that is fascinated by and glorifies violence. Many people enjoy vicariously experiencing violence as entertainment. Nevertheless, for those who have been damaged by violence in real life, fantasy violence poses a threat to the healing process.

The periodically reported school violence, such as happened at Columbine to mention just one, with students shooting peers or teachers staggers us each time. But school violence knows no territorial boundaries. Even as recently as April 27th of this year, 17 people were killed in a German school by a 19-year-old expelled student. U.S. Statistics report that 37% of high school students were in fights last year, 80% engaged in some form of bullying. 1% of the homicides and suicides among school-age children occurred in schools, with the other 99% were highest after school. While schools are still the safest place for kids to be, exposure to perceived threats of violence, and actual bullying erodes the feelings of safety and significantly impacts on the child’s ability to learn and concentrate. If ever we needed play therapy it is now with the tools and techniques available for school-based play therapy.

An estimated 300,000 children in more than 80 countries are participating in armed conflict, carrying guns, fighting, becoming suicide bombers and serving as spies as reported in June 2001 by the London-based International Coalition to Stop the Use of Child Soldiers and printed in the APA Monitor in September 2001. The article reports that exposure to violence and participating in it has severe consequences. Many children exposed to horrible acts of violence during key developmental years come to accept violent acts as a normal part of life. It puts young people at risk for continuing cycles of violence. Violence is the way they will use to discipline their children or deal with a conflict with their spouse reported Dr. Mike Wessells, a Randolph-Macon College psychology professor with extensive experience in war zones. He also found that one of the greatest effects he sees on a day-to-day basis is a loss of hope. Once young people feel hopeless, they really do give up. They don’t take the steps that might build a constructive future. He found in many refugee camps, children grow up feeling as if they’ve lost everything and can’t do anything to make things better for themselves. In other regions, children’s war experiences can give them a cynical view of adults and society. Further when parents are emotionally affected by war that alters their ability to care for their children properly. War stresses increase family violence, creating a pattern that gets passed on when the children become parents. We need to learn from the lessons of others countries dealing constantly with war and terrorism.

If ever we needed play therapy it is now to help the U.S. children who have been diagnosed as seriously emotionally disturbed/behaviorally disordered (SED) are more likely to be victims of , witnesses to, and commit more acts of violence that their non-SED peers, according to a Research Brief published by the Cuyahoga County Community Mental Health Research Institute. In a study reported in 1998, 146 boys and 20 girls in third to eighth grade diagnosed with SED in two counties in Ohio were compared with a sample of non-SED general education children. SED boys as victims and witnesses of violence reported higher rates of exposure to violence in the school setting. Significant relationships were found between SED status and exposure to violence, violent behavior and psychological symptomatology. Being a victim or witness to violence at home was the most powerful contributor to total trauma symptoms.

SED boys who were victims or witnesses to severe violence were more likely than non-SED boys with similar levels of victimization to be perpetrators of violent and aggressive behavior toward others.

Nearly seven in ten SED girls as victims and witnesses reported they had been slapped, hit or punched at home within the past year, while approximately one-fourth reported they had been beaten up at home or in the neighborhood. Nearly three in ten reported being sexually abused within the past year and nearly one-half of SED girls reported they had witnessed gun violence or had witnessed someone being sexually abused. SED girls reported high rates of aggression toward others, with one in six SED girls reported attacking someone with a knife within the past year.

If Ever We Needed Play Therapy It Is Now. We have the tools to deal with post-traumatic stress disorder caused by violence or abuse through the work of Beverly James, in her landmark book “Treating the Traumatized Child”, in helping the child find a safe place within themselves or learning how to identify and integrate their feelings. Or the directive play therapy approach and use of play therapy techniques by Neil Cabe or in family therapy through the work of Eliana Gil in her book “The Healing Power of Play”.

We have the use of Gestalt play therapy in a process oriented approach that is concerned with the integrative functioning of all aspects of the person by using expressive arts, art therapy, guided imagery, and work with clay through Violet Oaklander’s book “Windows to Our Children”. We have the tools in using prescriptive play therapy as developed by Dr. Charles Schaefer to find the best method to fit the presenting problem. We have the use of sandplay as originated by Margaret Lowenfeld and Dora Kalf, and which Lois Carey practices and extensively teaches in her book “Sandplay Therapy with Children and Families”. We are able to witness the unfolding of the imagery and archetypes of the collective unconscious as the child’s psyche begins to heal itself through the medium of sand as he or she in selecting a variety of miniatures creates his or her own world.

We know that play therapy works. We have been witness to its healing powers. We have been humbled by seeing how a child’s inner psychic force, given the therapeutic holding environment of the therapy room and the skills of you the play therapist, can allow a child to heal him or herself.

If ever we needed play therapy it is now!

No one in New York and even within our nation was left untouched or unaffected by the terrorist attacks on September 11th. We all can remember where we were and what we were doing on that fateful day. Most of us knew someone who knew someone who was directly impacted. And for many the wounds and feelings are still as intense now as they were almost nine months ago.

For many, September 11th stripped away things that most of us consider fundamental to our existence and well being: family, livelihood and a sense that the world is a relatively safe and predictable place. This is what violence does to human beings. This is what it has done to many of the children we serve.

The families and children we work with, as well as ourselves and our own families experienced traumatic reactions to the events of 9/11. Many have been especially hard-hit while others have been more resilient than many people anticipated.

Mental health services will be needed in the aftermath of these events for many years to come. Using the Oklahoma City bombing as a guidepost, the Red Cross Disaster Mental Health Services and American Psychological Association Disaster Relief Network estimate that 5 million people will need services in New York alone. Experts estimate that there will be 10 psychological casualties for every person who was physically hurt. In the New York metropolitan area, at least 1.5 million people will need some form of terrorism counseling, and the ripples of service needs goes out from there, to a projected 5 million people needing counseling including the rescue workers, clean up crews and counselors giving the counseling. A study reported just this past March found 7.5 percent of those living in the southern part of Manhattan suffered post-traumatic stress disorder, with an additional 9.7 percent who reported symptoms defined as depression, for a total of about 150,000 people. As would be expected, PTSD was at 20 percent in the trade center’s immediate neighborhood.

The Red Cross Disaster Mental Health Services is estimating that the need for psychological services to last for as long as the next ten years, and that it will need to include helping the helpers. Helping the mental health counselors who do the debriefings along with the front line rescue workers, their families and children. Years after the Oklahoma City bombing, divorce rates climbed, grades dropped for children and substance abuse increased in teens and adults. We can expect the same and even more fallout over time from the 9/11 terrorist attacks, barring any additional tragedies that might yet come.

More research will be needed on trauma’s impact on children – an area still in its infancy relative to work with adults. Dr. Robin Gurwitch of the University of Oklahoma Health Services Center recently reported in APA’s Monitor that “signs and symptoms of post-traumatic stress may be misunderstood or underestimated by caring adults, leaving many children in need of services without appropriate interventions.”

Moreover, since many children watched the terrorist events unfold on television, “the impact of this must certainly be considered when assessing service delivery and interventions with children. Dr. Gurwitch noted that research conducted after the Oklahoma City bombing indicates that children who watched a lot of television coverage of the bombing were more likely to report post-traumatic stress symptoms than those who saw little television coverage.

On May 2nd, just a little over a month ago, the New York Times reported on a study conducted by the Board of Education in New York City. Results found that tens of thousands of public-school children are experiencing chronic nightmares, fear of public places, severe anxiety and other mental health problems months after the World Trade Center attacks. About 8,300 of the school system’s 1.1 million students participated in the study conducted in February and March of this year, through random sampling. The study, interestingly, surprised researchers because the trauma wrought by September 11th appeared to be quite evenly dispersed through a large geographical area, not limited to the area near ground zero.

The study estimates that 75,000 school children in the 4th through 12th grades, or 10.5 percent of those grades, suffered PTSD after 9/11. Even more, 107, 395 or 15% suffered agoraphobia, fear of public places, including fear of riding public transportation. Hispanic students were disproportionately affected, which mirrored a study of adults that found adult Hispanics suffered mental health problems more than any other ethnic group after 9/11. Researchers estimated 13.8 percent of Hispanic students citywide suffered PTSD compared with 9% of non-Hispanic blacks, 8% non-Hispanic Whites and 9% Asians Girls were more likely than boys to experience psychological problems, and fourth and fifth graders seemed to have more symptoms than older ones.

Also of significant note was that 64% of students surveyed who did not attend schools near ground zero, and 51% of those who did, said they had suffered some sort of previous trauma. As we know, those who suffer previous trauma are more likely to have compound emotional reactions and result in mental health problems related to the terrorist attack.

If Ever We Needed Play Therapy It Is Now. We have witnessed first hand the benefits of using symbolic play. And in the silences hearing through a sandplay creation, block building or drawing, the deafening and heart wrenching impact of a child’s emotional unburdening of the horrific images witnessed that no words could match.
Having been a play therapist for 25 years, I have always believed in the healing power of play and in the effectiveness of play therapy as a theoretical model but also in being a toolbox filled with therapeutic techniques.

I have had cases in the past, as many of you have, where I witnessed first hand the impact of play therapy, and its benefits. But after September 11th, I found myself ever so grateful that play therapy existed.
When a call came just a few weeks after September 11th asking me to volunteer my therapeutic skills with play on weekends, and to help organize people with play therapy experience, at Pier 94 in New York City at Kids Korner, I was ready. In this cavernous, organized yet chaotic environment was the setting where social service providers had established a base to respond to victims of the terrorist attack. Set up in a corner was a respite area among the chaos. Here the children could stay, play and talk with trained, caring people and try to be children again. Meanwhile their caregivers spent huge amounts of hours trying to navigate the maze of agencies to learn of what services they might be able to receive. Several of you present responded and volunteered your time to work with the children. And you helped offer them a safe haven to share their fears and find a supportive ear.

I learned something important from the men, women and children with whom I spoke. They helped me appreciate the nature of courage and the power of caring, and of play. By allowing me to help in a small way, they consoled me and lent me purpose and left me stronger by virtue of their personal, private heroism. Here are some of their stories, along with those of the children in Astor’s Therapeutic Foster Home program in Orange County.
Many of the children found they could not discuss their intense and confusing feelings with their parents because their parent was so caught up in their own grief or the stress of looking for a new job. It was as though they were bidding their time, waiting, until the parent could deal with their own feelings and “get it together” before the child could let go and show how they, were really feeling. What was most rewarding was the power of play in allowing the children an opportunity to express what was going on for them, without having to use words. The horrific images seen, fantasies, and fears could be played out safely with distance. Children who witnessed the violence of the World Trade Center attack became captive in a passive role. They had to attend to the full horror of the act. They struggled with vivid memories of the images and sounds of the scene, often focusing in their recollections on one particular worst moment. They become flooded with impressions of both the attacker’s aggression and the anguish of the victim’s emotional and physical suffering. They struggled with their inability to intervene, change the events or save the person.

Here is one story:

Bobby, age 9, took all the large stuffed animals. He began to tape up the various animals. He asserted with great authority that they had various broken bones, and internal damage. We worked together for a while in silence, trying to help mend them. He then looked up at me and carefully commented about one particular teddy bear. “This one is depressed.” Slowly looking into my eyes he said “it has a broken heart”….adding soon after..”it doesn’t have a heart”.. Plaintively he then inquired of me “do you have any other hearts for it?”

Or that of Elliott, age 5, who came over from Surrey, England with his mother and brother, age 7, and his grandparents for a special memorial in November. His father had died in the World Trade Center. Working with pipe cleaners, he decided he would make special goggles for his face, and added some stars to it. He then decided we should wrap each of our fingers with alternating colors of pipe cleaners and add stars to them. We were to create power goggles and power fingers. He stated that with his special power goggles he would be able to see far with them. When I inquired how far did he wish to see, he replied “all the way up, past the stars.” One could only imagine whether his thoughts were of heaven and a wish to glimpse his father. He felt powerful and safe with his power fingers and goggles and we walked together all around showing them to the policemen and others. After a while he decided he could take off his power rings and goggles, and that he could still feel strong even without them.

Jabul, age 10, was from Bangladesh. He drew his repeated nightmares about the World Trade Center being hit by the plane. He is in the building and the building begins to collapse with him in it. He awakens from his nightmare and goes into his brother’s room or living room to sleep. His father was not killed but worked nearby. He remembers the events from the TV. He has lived in New York City for five years and can remember the safety of his country of origin. Utilizing the work of Beverly James in “Treating the Traumatized Child” we identify and visualize a safe place that he can keep within and go to whenever he feels anxious.

Or the drawing of one child, 11 years old, of how it used to be, and now, how it is. The imagery of the mound begins to permeate many of the children’s drawings, and sandtray work both at Pier 94 and in the Therapeutic Foster Home Program an hour north of the city. A smoldering volcano, as the fires continued to burn within the World Trade Center rubble for many months. And for the children the image of the mound came to represent the people and objects buried within.

Oscar, is 8 years old. His father worked in several areas in the World Trade Center complex, with the last in the basement/main area as a food industry worker. Oscar talks as he plays checkers with me, about his father needing to find a better paying job than the little pay he has now. Soon he talks about seeing the bodies of people jumping and falling out of the World Trade Center on 9/11. It is hard for him to get away from this image. He was too far away to really see it, living in Queens, but he saw it on TV. He worried that day that his father was in the building and had died, while he was at school. He draws me a picture of where his father worked. He was relieved when his father came to his school to pick him up. Quickly his talk shifts to his fears of safety, what he’s heard on TV about Bin Laden’s statement that “how no one in America will feel safe” and that the war has begun in Afghanistan. Then after a brief pause, he spontaneously shares something he has been carrying around in his heart unspoken. How he had a best friend whom he played soccer with at school, and how on a Friday he told him they were to play a tournament against each other on Monday. But then Monday came and in school that day they announced his friend had been killed, hit by a bus. It was almost two years ago. He still missed his friend.

So too for many children, as well as adults, the events of 9/11 brought to the surface unresolved grief, loss and traumas of the past. Together Oscar and I talked about grief, using bibliotherapy, we read “Why Dinosaurs Die”, which was donated along with many other books by The Self-Esteem Shop, and slowly begin the healing process for him.

Jay, age 10, living in foster care, utilized the sandtray to express his fears. The separation from and loss of his biological parent and his feelings around it were able to slowly come to the surface after 9/11. His initial sandtray of the dangers in the world, with mounds of buried police and cars, and police around. Then evolving into the inclusion of animal families another day, along with the police and mounds.

We are then able to see his awareness of his feelings and issues around his biological family. Finally, resulting in his mourning for his family and the losses he experiences. But he is aware he has another family (the foster family) able to take care of him now.

Jonathan, age 7, is another child in foster care. We see the chaos played out in his sandtray made soon after 9/11. All the animals are put together, with great concern that each baby have a parent. In the center danger looms and all the animals flee. The next week the animals again are united with a parent, but the theme of death, and the metaphor of the volcano enter more clearly.

After a few weeks, a re-creation of the World Trade Center events and fears. The towers looming high above as police are nearby. Then it collapses, burying everyone in a mound. This child, also has issues related to the loss of his biological family and the severe abuse he suffered by them. Slowly over time the mounds and volcano imagery repeat itself more clearly as he talks about how aliens have come, and how everything is now buried over. But through his figures and dialogue he expresses his fears that the people are buried alive, and will come back up again and haunt. They will be able to come and get him, much like his fear that his parent will come back to abuse him again. We begin to process the issue of death and loss and his fears.

In time he turns to blocks and is able to make a better building, stronger, with protectors and a doorway that is safe in controlling who enters and who cannot. He begins to feel some hope of being safe.

And so too in drawings the children can also envision hope and re-birth. Wanting to remember the way it was and never forgetting loved ones.

Thank goodness we have play therapy and play therapists like you.

We cannot prevent pain and hurt in a child’s life, but we can help soften the blow. We cannot change what a child faces in his or her life, but we can be with the child fully as we are capable, as the child moves fully into the experiences of life.

We cannot make the child’s life relationships less complex and more nurturing, but we can be consistent and predictable in our behavior and genuinely compassionate in our caring.

We cannot undo experiences that have shattered a child’s childhood, but we can establish relationships safe enough. In the relationship that you share, each of you, as play therapists, using the healing power of play, children can begin to feel in control of that part of their lives. Within each of you is the emotional healing power. It is people like you that make a difference in children’s lives. Who have committed your lives to helping children and their families that makes a difference in these children’s lives.

We stand on the edge of tomorrow in our relationships with children. What does the future hold? Will there be more terrorist attacks? What do these relationships hold? I do not know. But I do know who holds the emotional healing power. I believe it is people like you who love children and have committed your lives to helping them that makes a difference in children’s lives. You give priceless gifts to children and their families. You give courage. You give love, self-esteem, and kindness. You give direction. You give time. You give yourself. You give hope.
Again, I say thank goodness for the healing power of play and play therapy, and for you in being play therapists. For if ever we needed play therapy, it is now and for a long time to come.