INTRODUCTION

(Jarero et al., 1998).

Group therapy is a well-proven form of treatment for traumatized children and adolescents (Meichenbaum, 1994; Cemalovic, 1997; Kristal-Andersson, 2000; Samec, 2001) Butterfly

Our protocols were designed following a psychotherapy integration model (Stricker & Gold, 1996). Integrative models call for developing more effective forms of psychotherapy by creating a synthesis of traditional concepts and methods with new theories and practical approaches to treatment.

The protocols were structured in a play therapy format following the principles of Creative Art Therapies (CAT). They have been applied successfully to close to one thousand children (ages 1 to 16) suffering from posttraumatic stress due to natural or human provoked disasters in Mexico, Central and South America, as well as over five hundred rescue and front line personnel.

We would appreciate your comments and suggestions as well as your reports following the replication of these protocols. OBJECTIVES:

The protocols are designed to accomplish eight main tasks as follows.

• Identify children with PTSD or Acute Stress symptoms in order to assist them individually.
• Confront traumatic material.
• Bring to conscious awareness those aspects of the trauma that have been dissociated.
• Facilitate the _expression of painful emotions and or shameful behaviors.
• Offer the patient appropriate support and empathy.
• Condense the different aspects of trauma into representative and more manageable images.
• Increase patient’s perception of mastery over the distressing elements of the traumatic experience.
• Facilitate adaptive congruence in relevant areas of the patient’s intra and interpersonal experience.

Before applying the protocols, we recommend that the team meet with teachers, parents and relatives to educate them about PTST and Acute Stress Symptoms and to identify any affected children.

We believe that these protocols should be applied to facilitate the identification of the children that require individual attention (Emotional Protection Team Task).

We recommend that the team does not leave immediately at the end of the protocols but rather that sufficient time be allowed for individual work with the most affected children.

We also recommend that, whenever possible, individual work is provided on a different day or at least a few hours after group work has been completed.

Note: We do not use written psychological tests before applying our protocols because we have observed that Latin American survivors have fear of being stigmatized by others from their own groups. We also observed that survivors reject people when they believe that those persons only want to obtain something of them (test data) without offering them any help.

That is the reason why in the EMDR Integrative Group treatment Protocol we use a Modified Form of the Impact of Event Scale (Horowitz, 1979). In this modified form the mental health professional who is leading the protocol asks: “Please raise your hand if you have nightmares. Who feels scared? Who feels sad? Who feels angry about what happened? Who has trouble sleeping? Who remembers the hurricane often?” The children who raise their hand at each instance are counted for other team members and if possible (if they are still in the shelter), the questions are repeated to the same group one or two weeks after the application of the protocol; the variations are then registered.

ABBREVIATIONS

CISM: CRITICAL INCIDENT STRESS MANAGEMENT.

ICISF: INTERNATIONAL CRITICAL INCIDENT STRESS FOUNDATION.

EMDR: EYE MOVEMENT DESENSITIZATION AND REPROCESSING.

NLP:NEURO LINGUISTIC PROGRAMMING.

EPT: EMOTIONAL PROTECTION TEAM.

SUDS: SUBJECTIVE UNIT OF DISTURBANCE SCALE.

CAT: CREATIVE ARTS THERAPIES.