Lalaki: Working with Male Survivors of Abuse

“It is easier to build strong children

than to repair broken men.”
- Frederick Douglass

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About the Facilitator 3

Module 1: Unspoken Darkness: Trauma and Abuse Among Boys 4

Module 2: Assessment of Abused and Traumatized Boys 11

Module 3: Developing an Assessment Module and Intervention Program for Boys 13

Module 4a: Introduction to The Drawing and Writing Exercises for Children: A 17
Psychosocial Processing Approach

Module 4b: Basic Principles and Considerations in The Use of Drawing and Writing 18
Exercises for Children

Module 4c: The Various Drawing and Writing Exercises 20

Module 4d: Processing of The Drawing and Writing Exercises 21

References 22

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ABOUT THE FACILITATOR

Renz Christian Argao, MA, RPsy, RPm, DAAETS

Renz is a Licensed Psychologist and a Licensed Psychometrician, a part of the pioneer

batch of examinees, he passed both licensure examinations in 2014. He is the Community
Development Coordinator of the UST Graduate School, the Supervising Psychologist of the
UST Graduate School Psychotrauma Clinic, and an Instructor at the Department of
Psychology of University of Santo Tomas. He is completing his PhD in Clinical Psychology in
the UST Graduate School where he also finished his MA in Clinical Psychology, magna cum
Laude.

He holds the status of a Diplomate of the American Academy of Experts in Traumatic

Stress and is listed in the International Registry of Professionals and International Deployment
Directory of the National Center for Crisis Management, based in New York. He is the National
Adviser of the Youth for Mental Health Coalition, the Youth Coordinator of Religions for Peace
Philippines, and the Philippine Representative to the Religions for Peace-Asia and the Pacific
Interfaith Youth Network. He is also the Co-Founder and Chief Product Officer of SmarterOne
Philippines, an educational technology start-up. Renz is the Director and Chief Psychologist
of Argao Center for Psychological Services.

His work as clinical psychologist has been devoted to the psychosocial rehabilitation
of communities affected by calamities and the armed conflict in the Central Mindanao Region.
He advocates for community-based mental health services and the integration of mental
health program in schools.

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UNSPOKEN DARKNESS:
TRAUMA AND ABUSE AMONG BOYS

This module presents the complexity of the nature and effects trauma and
abuse among boys and young males. At the end of the module, the participants
will gain a better understanding on how trauma, violence, and abuse affects
boys and young men psychologically, socially, biologically.

Important Terms to Remember:

Trauma – (Gk. τραῦμα; n.) wound; physical injury.1

Psychotrauma – emotional ‘wound’; a result of a traumatic event which may
involve experiencing, witnessing, or learning about serious physical injury,
assault, sexual abuse, or facing a threat to physical and psychological integrity
(Vitzthum, Mache, Joachim, Quarcoo, & Groneberg, 2009).
Stress – psychological perception of pressure; body’s way of responding to
pressure; can be a result of physical or emotional challenges, resulting in
positive adaptations (McEwen, 2007)
Traumatic Stress – encompasses exposure to events or the witnessing of
events that are extreme and/or life threatening (Volpe, 2018)
Sexual abuse – Unwanted and non-consensual sexual activity where the
perpetrator/s use force, treat, or intimidation (American Psychological
Association, 2018).
Sexual violence – “any sexual act, attempt to obtain a sexual act, unwanted
sexual comments or advances, or acts to traffic, or otherwise directed, against
a person’s sexuality using coercion, by any person regardless of their
relationship to the victim, in any setting, including but not limited to home and
work” (World Health Organization, 2002)

What is psychological trauma or psychotrauma?

Psychotrauma is a term we use to refer to an emotional wound or injury caused

by experiencing, witnessing, or learning about a traumatic event. The term ‘traumatic
event’ encompass a broad range of events such as physical injury, assault, sexual
abuse, domestic violence, natural calamities, accidents, crimes, or facing a threat to
life. An event may be traumatic to one person, and it may not be the same for another
as various factors affect how a person will experience psychotrauma. (This will be
discussed later). Generally, an event that causes a person to feel intense fear,
hopelessness, and helplessness, may be considered as a traumatic event.

1
(n.b.: In this lecture, trauma and psychotrauma will be used interchangeably, both to refer to psychological trauma)

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In the past, a person must have experienced the event

before it can be considered traumatic, recent literature, Characteristics of a
such as changes reflected in the diagnostic criteria for Post- Traumatic Event:
Traumatic Stress Disorder (PTSD) in the Diagnostic and
Statistical Manual of Mental Disorders Fifth Edition/DSM-5 • Life Threatening
(American Psychiatric Association, 2013), now consider the • Unpredictable
exposure to or witnessing of the event as a criteria for • Uncontrollable
diagnosis. Likewise, learning or hearing about the event can • Meaningless
also cause trauma.

A traumatic event may be a single event or a

repeated experience. What characterizes these events is
that they are overwhelming because they are outside the range of human
experiences.

Psychotrauma has seven stages:

1. Sudden occurrence of traumatic event (victimization)
2. Physical sequelae
3. Shock or disbelief
4. Destabilization
5. Psychological sequelae (trauma symptoms)
6. Coping / normalizing
7. Recovery

What are the effects of trauma?

Trauma affects various areas of functioning which we will summarize in the

acronym “BASIC”: behavioral, affective, somatic, interpersonal, and cognitive.

Trauma affects our behaviors as it leads to changes in the way we react or

respond to situations. People who experience traumatic events may develop an
avoidance for places, people, or even memories of the incident. There are also
changes in the way they live their life, like changes in routine or lifestyle.

Our affective functioning or emotional functioning is also affected by traumatic

events as these events can change the way we feel emotions. Some people become
numb to emotions, while other suffer from debilitating emotions such as depression
and anxiety.

In terms of our somatic functioning, this refers to our biological processes.

Traumatic events can cause sleep disorders, eating disorders, or developing higher
risks for physical illness.

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In the interpersonal aspects, our relationships are also affected because

traumatic events may change the way we interact with other people.

Lastly, in the cognitive functions, traumatic events change the way we think
and process thoughts. Some people experience negative alterations in their
cognitions like having irrational beliefs, loss of memory, or changes in the way they
recall the event or its details.

What factors determine the impact of trauma?

Figure 1: Trauma Impact Model (Decatoria, 2009)

All of us react differently to traumatic events. For example, one person may be
traumatized because of a minor car accident, while another person may not. This is
because there are various factors that determine what the impact of a traumatic event
to a person will be.

In the Trauma Impact Model (Decatoria, 2009; see Figure 1 above), there are
three main factors that can determine how a traumatic event will affect or impact a
person. These are: Support, Coping Skills, and Personality.

Support pertains to social and emotional support that a person has. Several
studies (Demirtepe-Saygili & Bozo, 2011; Trickey`, Siddaway, Meiser-Stedman, Serpell,
& Field, 2012; Feng, et al., 2007; Dai, et al., 2016) have reported that social support is
an important factor that moderates the impact of stressors to the individual.

Coping Skills pertains to how an individual manages and deals with stressors
and stressful situations. An effective, healthy, and adaptive coping strategy can be a
protective factor against the effects of traumatic stress.

Personality refers to the set of characteristics that make an individual unique.

Certain personality traits may make an individual more susceptible to traumatic stress.
Studies like that of Pos and colleagues (2015) show that trauma and personality a
more complex dynamics.

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According to Dr. Decatoria, these three are important to mitigate the impact of
traumatic events on an individual. Having a weak personality or coping skills or social
support can be a risk factor to traumatic stress. Just the same, not having the three
can make a person more vulnerable to the impact of trauma.

What is the difference between stress and traumatic stress?

As defined in the notes earlier, Stress is the psychological perception of

pressure. It is also the body’s way of responding to pressure and it can be a result of
physical or emotional challenges, resulting in positive adaptations (McEwen, 2007).
While Traumatic Stress encompasses exposure to events or the witnessing of events
that are extreme and/or life threatening (Volpe, 2018).

To simplify this, stress is caused by anything that life throws at us that may
cause us to lose our balance. Trauma, however, is caused by something that is
beyond our everyday experience. Something traumatic is always stressful, but
something stressful is not always traumatic. Stress is not always harmful, trauma is
always harmful.

Think of a being in a see-saw: stress is something that causes you to lose

balance, trauma is something that takes the see-saw away.

What are the symptoms and signs of traumatic stress?

Common Acute Stress Reactions 2:

Shock
Appetite loss
Fatigue
Nausea/vomiting
Sleep disturbance
Headaches
Breathing problems
Panic reactions
Irritability
Impaired judgment

Common Traumatic Stress Symptoms:

Recurrent thoughts or memories of the most hurtful or terrifying events

(flashbacks)
Feeling as though the event is happening again
Recurrent nightmares

2
Sudden stress responses that immediately follow a traumatic event.

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Feeling detached or withdrawn from people

Unable to feel emotions
Avoiding thoughts or feelings associated with the traumatic/ hurtful
event.
Sudden emotional or physical reaction when reminded of the most
hurtful or traumatic event.
Feeling that people don't understand what happened to you.
Difficulty performing work/ daily tasks.
Blaming yourself for things that have happened.
Feeling jumpy
Difficulty concentrating
Trouble sleeping
Feeling on guard / watchful
Feeling irritable or having outburst of anger
Avoiding activities that remind you of the traumatic or hurtful event.
Inability to remember parts of the most traumatic/ hurtful event.
Less interest in daily activities.
Feeling as if you don't have a future.
Hopelessness/ depression; suicidal.
Feeling ashamed of the hurtful or traumatic events that have happened
to you.
Spending time thinking about why these things happened to you.
Feeling as if you are going crazy.
Feeling that you are the only one who suffered these events.
Feeling that others are hostile toward you.
Feeling that you have no one to rely on.
Feeling that someone you trusted betrayed you.
Survivor’s guilt
Sexual dysfunction
Finding out or being told by others that you have done something that
you cannot remember.
Feeling as if you are split into two people and one of you is watching
what the other is doing.

How does trauma affect the brain? Is there a difference on the effect of abuse
on boys and girls?

Several studies like that of Bremner (2006), Hanson et al (2008), Klabunde et al

(2017) and Shaw et al (2008) already started looking into the effects of trauma to the
brain. Traumatic stress is associated with lasting changes with the brain areas:
amygdala, hippocampus, and the prefrontal cortex. The amygdala is the part of the
brain involved in memory and emotions, while the hippocampus is involved in
memory consolidation. The prefrontal cortex is involved in higher mental or cognitive
functions such as thinking, planning, reasoning, logic, and certain aspects of

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personality. Traumatic stress is associated with smaller hippocampus, increased

amygdala function, and decreased prefrontal function (Bremner, 2006).

Traumatic stress is also associated with increased cortisol levels in the brain
(Bremner, 2006). Cortisol is often referred to as the “stress hormone” as it helps
prepare the body for stress responses.

Figure 2: The Insular Cortex

Klabunde and his colleagues (2017) found out that boys with trauma had larger
insula volume and surface area than boys in the control group; while girls with trauma
had larger insula volume and surface area than girls in the control group. What is the
insula? The insula or insular cortex (see figure 2) is located deep within the lateral
fissure, or the part between the frontal lobe and temporal lobe. It is connected to the
thalamus, amygdala, and the cerebral cortex. Its function includes integration of
sensory, affective, and cognitive components of a painful stimulus to create the
sensation of pain; homeostatic regulation; motor control such as speech articulation;
and internal awareness.

How does abuse affect boys?

Understanding the differences on how abuse, violence, and trauma affects

boys requires an important recognition of the gender differences in the rates and
impact of, as well as responses to trauma. Boys and girls have differences in the type
of trauma they experience. Boys are more likely to experience non-sexual assaults,
accidents, illness, injury, and witnessing death or injury (Tolin & Foa, 2006). Girls, on
the other hand, are more likely to experience sexual abuse, physical punishment,
psychological distress, and sexual assault (Hennessey, Ford, Mahoney, Ko, &
Siegfred, 2004; Tolin & Foa, 2006).

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Both boys and girls respond to trauma with anger and dissociation, but girls are
more likely to experience depression and anxiety (Foster, Kupermine, & Price, 2004).
Boys have difficulty admitting the traumatic experience (Briere & Scott, 2006). While
boys often do not have a typical emotional or psychological response to trauma,
responses can range between calmness to near complete breakdown (Tewksbury,
2007).

Studies such as the work of Elliott et al (2004) reported that a childhood

experience of sexual abuse among boys is associated with subsequent adult sexual
victimization. This means that boys who are sexually abused as children are more
likely to be re-victimized as adult men.

In addiction to physical and psychological effects, trauma also have effects on

sexuality and sexual activities. Boys who are sexually abused report questioning their
sexuality, or if being raped makes them gay or if they have characteristics that caused
them to be perceived as gay (Tewksbury, 2007).

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ASSESSMENT OF ABUSED AND TRAUMATIZED BOYS

This module presents current trends and techniques on the assessment of

boys who are victims of abuse and violence. It aims to equip participants with
the knowledge and skills needed to assess the survivors and how to address
challenges that they may encounter in the process.

Are there gender-based factors that affect assessment of boys and girls?
What are the factors that affect the way we deal with boys?

Since trauma affects boys differently, we need to understand how boys view
the experience of abuse. One important point to consider is how boys attribute self-
blame in the experience of abuse. Boys may start to think of reasons why they were
sexually abused and that may focus on blaming the self for what happened. Thoughts
like “I was weak”, “I should have stopped it”, “I should have fought it”, “I was
effeminate”, “I am being punished” may be present to put meaning to the traumatic
experience.

We should also focus on how relationship issues are affected by the traumatic
experience. Boys have difficulty in accepting and disclosing the experience and this
can lead to withdrawal or isolation. Such internalization of the anger or denial may
lead to inward and outward hostility. Sexual abuse affects issues on masculinity and
questions about sexuality. This also leads to changes in their behavior to maintain
social roles and status.

Hence, the key factors to consider in the assessment of boys focus on

disclosure or reporting of the traumatic experiences, identity issues, emotional and
cognitive processes, and coping strategies.

Guidelines in assessment of boys

1. As boys have difficulty in disclosing experiences of abuse, the approach

should be non-threatening to them.
2. Boys benefit from emotional and cognitive expression when they feel
safe and do not fear being stigmatized.
3. Assessments should lead to interventions where boys are assured of
safety as they open their feelings of vulnerability.
4. Avoid victim blaming or inciting feelings of self-blame.
5. Assessment can focus on the impact rather than the actual experience.
6. Consider cultural and religious perceptions on sexuality and masculinity.
7. Assessment should look into social support and coping skills.

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Assessment techniques and tools

Fable Assessment
The use of story-telling activities to assess experiences of trauma,
violence, abuse, or neglect.

Psychological Tests
Various psychological tests can be used to assess the effects of trauma
on children, the experiences of childhood abuse among adults, and to assess
PTSD among children. This includes, but is not limited to:

Acute Stress Checklist for Children

Child PTSD Symptom Scale
Clinician Administered PTSD Scale for Children and Adolescents
Traumatic Events Screening Inventory
Cameron Complex Trauma Interview
Trauma Symptom Checklist for Children
The Child and Adolescent Needs and Strengths Trauma
Comprehensive

Projective Tests
Human Figure Drawing Test
House-Tree-Person Test
Draw a Person Test
Sentence Completion Tests

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DEVELOPING AN ASSESSMENT MODULE

AND INTERVENTION PROGRAM FOR BOYS

This module equips the participants on developing a framework for

assessment and treatment of boys who are victims of trauma and abuse. At the
end of the module, the participants will be able to demonstrate an ability to
construct modules on individualized and specialized assessment of boys.

What should be considered in developing the assessment module?

The purpose of the assessment module: Is it for screening? Is it for

diagnosis? Is it for treatment? Is it for risk assessment?
Who will be assessed? What is/are the age group/s?
How they will be assessed?
Who will assess them?
What will be the focus of the assessment?

What are the important considerations in developing a treatment program

for boys?

Acceptance and disclosure of abuse

The need for control
Minimizing emotions
The use of anger and hostility
Traditional gender socializations
Addressing health and safety concerns
Normalizing post-trauma reactions
Psychoeducation
Adaptive coping strategies
Providing validation
Permission to feel and to have needs
Sexuality and gender issues

What are examples of treatment/interventions?

Stress Inoculation Training: A behavioral treatment to address fear and

anxiety. Composed of three phases: Education, Skill-building, and
Application.
Prolonged Exposure: flooding/exposure therapy; individuals repeatedly
confront fearful images and memories of traumatic events so that the fear
and anxiety decreases.
Trauma-Focused Cognitive Behavioral Therapy

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Eye Movement Desensitization and Reprocessing

Play Therapy
Art Therapy/Expressive Arts

Trauma-Focused Exercises (Assessment and Processing)

Progressive Muscle Relaxation

PMR is a relaxation technique that is used to reduce anxiety and control
stress. Various PMR techniques are available online for various purposes.

PMR will take about 15-20 minutes for children. It should be in a

comfortable place where the child will not be disturbed. It can be
conducted with the guidance of an adult or the child can do it on their own.
It usually involves tension and relaxation of muscles.

Guided Imagery
Guided Imagery is a technique that can be used to manage stress and
reduce tension. It is like a daydream as an individual uses his/her
imagination through the guidance of an instructor or even self-guidance. It
involves the following steps:
1. Choose a comfortable position.
2. Do deep breathing: 4-7-8 technique.
3. Choose a scene and vividly imagine it.
4. Immerse yourself in sensory details.
5. Relax.

Trauma Incident Reduction:

“TIR Traumatic Incident Reduction Therapy involves a very specific but
fairly simple procedure that helps people resolve painful incidents. The first
step is to identify a traumatic incident. Next, we identify when it happened, how
long it lasted and where you were at the time. Then you will be asked to
imagine going to the start of that incident. The starting point is that moment
just before the upsetting event began. Once at the starting point you will close
your eyes, report what you are aware of and then imagine moving through the
incident until it is over. At the end of the incident you will open your eyes and
report what happened as you moved through it.

After the therapist makes a few notes about what you experienced, you will
be asked to repeat the process of going back to the beginning of the incident,
moving through it in your mind to the end and reporting what happened. You
will repeat this process of reviewing the incident multiple times (often 5 to 25).
With each subsequent reviewing:
- you will notice or remember different things,
- you may release pint-up emotions,

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- your feelings and sensations will start to change,

- the incident will become less disturbing
- you'll gain a deeper insight into the experience
- and ultimately you may revise the meaning associated with the event.

This method of reviewing the trauma facilitates the mind to desensitize the
pain, reprocess the event and enables you to move toward recovery. By the
end of the process you should be able to talk about the incident and either feel
completely comfortable or much improved.” (copied from the work of Steve B.
Reed, LPC, LMSW, LMFT)

Butterfly Hug
The Butterfly Hug (Artigas, 1998) was developed initially for the survivors
of Hurricane Pauline in Acapulco, Mexico. It has become a standard practice
for clinicians in the field who are working with survivors of traumatic events.
The Butterfly Hug is a self-administered bilateral stimulation method to
process traumatic material. It can be used for individual or group work.

Instruction for the Butterfly Hug Method (Artigas and Jarero)

Say, “Please watch me and do what I am doing. Cross your arms over
your chest, so that the tip of the middle finger from each hand is placed
below the clavicle or the collarbone and the other fingers and hands cover
the area that is located under the connection between the collarbone and
the shoulder and the collarbone and sternum or breastbone. Hands and
fingers must be as vertical as possible so that the fingers point toward the
neck and not toward the arms.
If you wish, you can interlock your thumbs to form the butterfly’s body
and the extension of your other fingers outward will form the Butterfly’s
wings.
Your eyes can be closed, or partially closed, looking toward the tip of
your nose. Next, you alternate the movement of your hands, like the
flapping wings of a butterfly. Let your hands move freely. You can breathe
slowly and deeply (abdominal breathing), while you observe what is going
through your mind and body such as thoughts, images, sounds, odors,
feelings, and physical sensation without changing, pushing your thoughts
away, or judging. You can pretend as though what you are observing is like
clouds passing by.”

Superhero Project
This drawing activity helps explore the child’s thoughts and feelings
about what constitutes safety. It is also used to allow children an
opportunity to use their projective abilities to further understand their world
views about safety and security.

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Color Your Feelings

This art activity helps children a way of identifying affective states,
intensity of affective states and show affective states that are person and
situation-specific.

Color Your Life

This art activity has the following objectives:
• To elicit information about children’s history, what they remember,
and what they have experienced;
• To encourage children to view their abuse in the context of many
other experiences;
• To identify their coping strategies and strengths.

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INTRODUCTION TO THE DRAWING AND WRITING EXERCISES FOR CHILDREN:

A PSYCHOSOCIAL PROCESSING APPROACH

This will introduce the Drawing and Writing Exercises for Children as an
approach to processing the emotional and psychological experiences of
children who are survivors of trauma, violence, and abuse. The participants are
expected to be able to identify the purpose and usefulness of the technique in
dealing with children, understand its objectives, and be able to outline its
processes. At the end of the module, the participants will be able to
demonstrate an understanding of the nature and purpose of the drawing and
writing exercises for children.

Background of the Drawing & Writing Exercises for Children

The Drawing and Writing Exercises for Children was developed by Prof. Johnny
B. Decatoria, PhD, RPsy, BCETS to assist professionals and paraprofessionals working
with children (Decatoria, 2004). It was adapted from the work of Kendall Johnson and
was first used with the Montserrat children in the Caribbean who were victims of a
traumatic volcanic activity. It was also used in Asia, the Kosovo regions, in West Africa
with child soldiers and victims of war trauma, and in the Philippines for the survivors
of armed conflict in Central Mindanao and various calamities in the various provinces
in the country.

Based on a model of defusing traumatic experiences, this intervention uses

drawing exercises or writing exercises where the emotions and thoughts connected
to the traumatic experienced are processed. It is composed of 18 drawing/writing
tasks that can be modified into shorter activities depending on the case or profile of
the patient. There are various translations available for the short versions: Cebuano
(Labrador, 2009), Akianon (Sungcang, 2014), Kapampangan (Argao, 2013), and Filipino
(Decatoria, 2004).

Why should we use drawing or writing exercises as a method for assessment?

It is non-threatening
Drawing is a natural part of childhood activities
It is flexible and modifiable
It is a form of psychosocial processing and assessment

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BASIC PRINCIPLES AND CONSIDERATIONS IN THE USE OF

DRAWING AND WRITING EXERCISES FOR CHILDREN

This will introduce important guidelines and skills needed to conduct the
DWEfC. At the end of modue, the participants will be able to describe the
principles and guidelines before, during, and after the conduct of the exercises.

Guidelines (Decatoria, 2004)

1. Consider the age groupings. It is easier to work with children of same age

group. However, children should be allowed to join any group they feel safe to

be with.

2. If the group of children is so difficult to handle because of the size, consider

breaking it to smaller groups. A group of 5 to 7 children is an ideal size.

3. Creativity and initiative in the part of the facilitators are essential to conducting

the exercise.

4. The exercise can be done in any format, such as:

a. Drawing, sharing, drawing, sharing, etc.

b. Drawing of all exercises first, then sharing.

5. Morning can be used for drawings, afternoon for sharing and reviewing of

exercises.

6. Around 10 minutes per drawing can be allotted for the exercise.

7. Facilitators can go around while the activity is being held.

8. The activity can be modified based on time availability. It can also be

divided/broken into several sessions.

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9. Allow children to work anywhere.

10. Older children may not need supervision.

11. Consider language and cultural factors.

12. Children should have freedom in expressing themselves.

13. Take note of signs and symptoms of traumatic stress.

14. Best not to read instructions. Try to give instructions spontaneously in your own

words and within the understanding level of the children.

15. Avoid giving prompts like providing details or specifications about the drawing.

16. Use encouraging remarks like “good”, “you are doing well”, etc.

17. If children stop drawing and engage in discussions about the incidents, let

them. Join them. But make sure you control the whole scenario and re-focus

on the goal of the session.

18. Take note of abreactions. Use grounding when necessary.

19. Call the exercises as “fun day exercises” or other non-threatening terms.

20. The drawings may be kept by children if they wish to.

Modifying the Exercises

The exercises may be modified to fit the needs and abilities of the children.
What is important is that there should at least be three parts/sections of the exercises:
1. Recall of the incident
2. Expression of how they felt during the incident and how they feel about it now
3. Expression of hopes for the future and lessons learned from the experience.

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THE VARIOUS DRAWING AND WRITING EXERCISES

This will introduce the various drawing and writing exercises included in the
module. The participants are expected to learn the various exercises and how
to facilitate them to the patients/clients.

Materials needed:
Workbook
Pens
Crayons
Mats
Chairs and tables
Paper
Other art materials

The 18 Drawings (Decatoria, 2004):

1. Write or draw a picture that tells about your family or where you live.
2. Draw or list some bad things that happened to you.
3. Remembering the bad thing that happened, where were you?
4. How did you feel? Were you scared? What did you hear?
5. Do you feel safe in this place now?
6. Are there other feelings? Were you sad? Angry? Anxious?
7. Write or draw a picture of the worst thing you worry that might happen to you.
8. Draw or write something that would help you feel safe.
9. Write or draw a picture of any bad dreams or frightening and repetitive
thoughts you have had.
10. What do you do when you have a bad dream or when you have a negative
reaction?
11. Write or draw a picture of a dream you would like to have.
12. Write or draw something how you feel about the incident now.
13. Draw a picture of you before the incident.
14. Draw a picture of you now.
15. Draw or write a list of the good things in your life now.
16. What are you hopeful for?
17. What wishes do you have for the future?
18. Other feelings you wish to express?

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PROCESSING OF THE DRAWING AND WRITING EXERCISES

This will discuss the various ways on processing the drawings and writing
exercises conducted in the activity.

Guidelines in processing the drawings or writings

Set house rules. This should come from the children.
Ask for volunteers.
Do not force children to speak. Let them speak when they are ready.
Assess responses and symptoms.
Allow children to freely express themselves.
Avoid judgmental remarks.
Processing should allow children a form of release where they can express all
that they wish to
Create a safe space

Activities that can be used during processing:

Butterfly Hug
Spaghetti Story
Deep Breathing Exercises (Balloon)
Games
Color Your Feelings

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References

American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders Fifth
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