Note: To protect the privacy of our members, e-mail addresses have been removed from the archived messages. As a result, some links may be broken.

Lesson Plans


resolution scrapbook

[ Thread ][ Subject ][ Author ][ Date ]
Larry Cox (L_J_Cox)
Sat, 24 Apr 1999 16:47:45 -0600


The resolution scrapbook, a therapeutic technique where traumatized children
complete treatment activities and compile them in the form of a scrapbook,
facilitates the children's resolution of traumatized impacts.
Copyright Transaction Inc. Jul 1995

Full Text:

Children are traumatized in different ways, and when treating traumatized
children, the clinician must assess the nature of the trauma and its impact
upon the individual child. Most significantly, the child's experience of
the traumatic event must be understood, so that the clinician can devise
a treatment plan that best responds to the particular effects of the trauma.
Childhood trauma can be defined as the "mental result of one sudden,
external
blow or a series of blows, rendering the young person temporarily helpless
and breaking past ordinary coping and defensive operations" [Terr 1991:
11]. Various factors determine whether a child will experience an
overwhelming
situation as traumatic. These factors include the severity of the situation;
the child's genetic predisposition, preexisting personality, and
developmental
phase; available social supports; and previous trauma [Gil 1991: 19].

Research into childhood trauma as well as trauma assessment models have
been emerging in the past decade [Eth & Pynoos 1985; Kluft 1985; Scurfield
1985; Van der Kolk 1987; Hindman 1989; Terr 1990; Kordich-Hall 1993]. These
conceptualizations have provided clinicians with a better understanding
of the impact of trauma on children, and the behavioral sequelae that
children
bring to treatment.

Once a trauma assessment has been conducted, the therapist can build a
treatment plan aimed at directing the child toward trauma resolution.
Working
through a traumatic experience involves the process of "sorting, dissecting,
resolving, returning, undoing, and freeing the child within" [Hindman 1989:
375]. It is important to note that trauma resolution does not mean that
the emotional pain disappears. Traumatic experiences are continually
reworked
at various points in time. Ultimately, however, a positive trauma resolution
evolves when the child has been able to:

1. Work through the trauma in a realistic way.

2. Experience whatever levels of pain, anger, or loss are elicited by a
clear memory of the event.

3. Perceive the traumatic event accurately.

4. Recognize that he [or she] is not responsible for having caused the
event.

5. Understand that the experience occurred in the past.

6. Function without feeling devastated by the memory of the event.

7. Refrain from the need to repeat the event, either on a conscious or
unconscious level. [Gil 1991: 21].

In facilitating the trauma resolution process, clinicians have a wide
variety
of child therapy methods from which to choose. The selection of a
therapeutic
method will depend on the clinician's background, interest, and skill,
and on the unique needs of the client. This article offers a description
of the resolution scrapbook technique, originally developed by Hindman
[1989] in her innovative work with sexually abused children. The technique
has been modified and adapted by this writer so that it could be used with
children struggling with various forms of trauma, including family violence,
divorce, and bereavement.

The resolution scrapbook is a therapeutic book that the child completes
with the assistance of the clinician. The therapist provides the child
with various treatment activities, which, once completed, are placed in
the scrapbook. The scrapbook allows the child to participate in a "wide
variety of doing activities" [Hindman 1989: 437]. Indeed, this is a
structured
and experiential approach to treatment, which is used in order to "elicit
material from the child that is unlikely to emerge spontaneously, and to
demonstrate that the issues need not be shameful and can be dealt with
directly" [James 1989: 3). Thus, the clinician structures the therapy
sessions
by selecting scrapbook activities that facilitate or lead the child in
directions that are seen to be beneficial. The number and variety of
therapeutic
activities are wide and are described later.

As children tend to develop strong defense mechanisms to cope with psychic
pain, significant portions of personal history and memories of traumatic
events may become repressed. It is important for the child to have a correct
memory of the trauma and to document the details in the scrapbook before
defenses and blocks in memory distort the reality of the event [Hindman
1989].

The resolution scrapbook is a written record that gives children a permanent
memory of their life story and an opportunity to master the trauma. The
resolution scrapbook technique bears some similarity to the lifebook concept
wherein children in long-term out-of-home care compile a book with mementos,
snapshots, drawings, and memories to capture their life story [Aust 1981].
Resolution scrapbooks differ from lifebooks, however, in that they are
focused on a therapeutic process aimed at alleviating the emotional distress
of the traumatized child and on improving the child's level of psychosocial
functioning. Moreover, as children reach various developmental stages,
their traumatic experiences take on different meanings. The scrapbook
provides
the child with a tangible record so that traumatic experiences can be
processed
at later developmental stages. This helps to prevent the potential for
future maladjustment. The resolution scrapbook provides the child with
an opportunity to work through treatment issues, and then have a lasting
record to keep when the therapy is completed. In addition, resolution
scrapbooks
can be an effective and valuable tool, as they guide the client through
the various phases of therapy and "provide immediate physical reinforcement
of each therapeutic success" (Hindman 1991: 224]. The scrapbook is therefore
a tangible illustration of the child's progression through the stages of
treatment.

GUIDELINES FOR THE USE OF RESOLUTION SCRAPBOOKS

As with the use of other therapeutic techniques, the resolution scrapbook
should not be used unless the reader is well trained in child therapy theory
and practice. Moreover, scrapbooking is a process and several key guidelines
should be considered when using this technique within therapy.

Like the use of other therapeutic techniques, the therapist must determine
whether the use of a resolution scrapbook will meet the needs of the child's
situation. Some children may have needs not appropriate for this technique.
For instance, children who have difficulty focusing on one activity for
periods of time may need a more physically active treatment approach. In
general, however, it is felt that the resolution scrapbook is a technique
that can be used with a wide range of children. In fact, because it is
an appealing technique, the scrapbook may be successful in engaging
otherwise
resistant children.

Effective treatment must be based on a thorough assessment. The clinician
must first assess the impact of trauma upon the child before a treatment
plan can be developed. The trauma assessment should be comprehensive, and
ideally, should involve the child and the child's significant others. Once
an assessment has been completed and a treatment plan has been formulated,
the resolution scrapbook can be used as an instrument to fulfill treatment
goals. In some cases, the scrapbook can be incorporated into the assessment
phase, because scrapbook activities can provide valuable diagnostic
information.

The resolution scrapbook can be used in individual therapy as part of the
child's larger comprehensive and multidimensional treatment plan. As James
asserts, "Trauma may assault the child physically, cognitively, emotionally,
and spiritually, and therefore treatment strategies must deal with each
of these dimensions" [1989: 14]. For the child struggling with poor
self-esteem,
a referral to an extracurricular activity that reinforces the child's
interests
and abilities may be beneficial. Group counseling and family therapy may
also be necessary adjuncts to individual treatment. The therapist can
incorporate
various kinds of material elicited from group or family sessions into the
child's scrapbook activities.

The selection of scrapbook activities should be tailored to meet the child's
distinct treatment needs. The interventions should also be developmentally
and culturally sensitive, and aimed at gaining and maintaining the child's
interest and motivation. Art activities, bibliotherapy, and games can be
incorporated into scrapbook exercises. The practitioner may wish to create
activities for the child, or activities can be chosen from existing
therapeutic
workbooks.* Treatment should also be competency-based, and activities should
be chosen according to the child's strengths and abilities. As an example
for children who have creative writing skills, story writing and letter
writing can be part of the scrapbook. Similarly, for children who enjoy
arts and crafts, painting and collages may be suitable.

The activities should be appropriately sequenced, moving from beginning
engagement interventions to activities more specific to trauma resolution.
Ending activities celebrate the children's achievements as progress through
therapy has been made. Activities are sequenced to move along a continuum
of "nonthreatening activity to threatening so that the child gradually
becomes desensitized to the problem area" [Gumaer 1984: 67]. The pacing
of the therapeutic process must therefore be in accord with the child's
sense of psychological safety, and of his or her integrative capacity.
As the scrapbook moves into emotionally laden material, the therapist may
encounter some resistance from the child, whose initial enthusiasm in
treatment
may turn to passive or active resistance once sessions provoke anxiety.
If this occurs, it may be necessary to change to neutral activities until
the child's behavior is stabilized.

Whether a scrapbook or other technique is used, the therapist-client
relationship
is central to the client's realization of particular goals. The relationship
that evolves between therapist and child forms the foundation for
therapeutic
success. According to Sandler et al., the therapeutic alliance is seen
as resulting from the child's "conscious or unconscious wish to cooperate
and his or her] readiness to accept the therapist's aid in overcoming
internal
difficulties and resistances" [1975: 45]. In building the therapeutic
alliance,
the practitioner must create a safe atmosphere in which the child is made
to feel accepted, understood, and respected. Similarly, the therapist must
be sensitive when processing all scrapbook activities so that the child
does not feel that the work is being judged.

Preservation of the scrapbook should be ensured when the child terminates
therapy. A meeting between the therapist, the child, and the child's
caregiver
can be arranged, to discuss a safe, private location for the scrapbook
to be kept.

CREATING THE RESOLUTION SCRAPBOOK

Readers are encouraged to be flexible and creative when using this technique
to create resolution scrapbooks with their child-clients in the therapeutic
context. Each resolution scrapbook will be unique. Hindman states: "As
children are not traumatized in the same manner, scrapbooks and resolutions
are dissimilar. Creativity must occur" [1989: 424]. The steps below provide
a process and structure.

Step One: The Initial Session

When introducing the scrapbook to the child, efforts should be made to
invite the child's enthusiasm in a participatory process. The therapist
might wrap the scrapbook and present it to the child, or a game could be
created in which the child must guess what is in the therapist's bag. Once
the child receives the scrapbook, the therapist explains that all the
child's
work will be kept in the book, and at the end of therapy, the child and
therapist can decide on a safe place for the scrapbook to be kept.

The purpose of the scrapbook is explained to the child. For example, with
a child struggling with divorce, the therapist may say: "All of the
activities
that we work on together in our sessions will be kept in this scrapbook.
We will be working on activities that will help you to sort out your
feelings
about your parents' divorce, and to help you feel better. We'll work on
different kinds of activities in this book, like writing and coloring."

Confidentiality is dealt with at this initial stage. The therapist and
child should discuss who will be permitted to see the scrapbook. It is
also essential that the therapist explain to the child what is done if
concern about safety arises during the course of therapy. The child should
be informed that if he or she discloses abuse, self-harm, or harm to others,
this information must be given to the proper authorities.

The therapist and child (and, if appropriate, the child's caregiver) should
agree on a written or verbal treatment contract. In the therapeutic context,
a contract refers to "a commitment that one makes to work toward the
reduction
or alleviation of treatment issues" [Epstein 1988: 144]. This writer
generally
proposes weekly one-hour sessions. The first 30 minutes of the session
are devoted to "scrapbook time" and the second 30 minutes to "free time"
in which the child can select an activity of his or her choice.

Once the purpose of the scrapbook has been explained to the child, and
a treatment contract has been agreed upon, the child can decorate and title
the cover of the scrapbook.

Step Two: Introductory Activities

Beginning scrapbook activities engage the child in the therapeutic process.
Nonthreatening activities that will help the therapist get to know the
child are employed. For instance, children may be asked to draw
self-portraits
or a picture of their family. A sentence-completion exercise that asks
children open-ended questions about themselves is a simple activity that
elicits personal information: For example, "My name is --." "I am -- years
old." "In my free time I like to -- "If I had three wishes I would want
--. "I hope that by coming to therapy I --."

Step Three: Feelings Activities

Scrapbook activities enable children to identify and express appropriate
affect. Children often need help in understanding that it is normal to
have many different feelings. The "feelings wall" (see figure 1) illustrates
one exercise used with a ten-year-old girl who had witnessed spousal
violence.
This activity is adapted from "The Worry Wall" [James 1989]. For the
completion
of a feelings wall, the child is given an envelope containing adhesive
labels. A different feeling is written on each label. The child's task
is to select labels from the envelope one at a time, identify the feeling
written on the label, and write on the label about a time that feeling
was experienced. Once the labels are completed, the child sticks the labels
on the feelings wall. Stronger or more intense experiences are represented
by sticking them higher on the wall.

To enable clients to deal effectively with their feelings, activities
related
to coping strategies are incorporated into the scrapbook. It is important
to equip children with appropriate coping skills in early sessions so that
they can better manage their distress as issues arise in the course of
therapy. For example, as an adjunct to the feelings wall activity, the
child can develop a "strategy list" of coping techniques to use when
experiencing
a particular feeling. For example: "When I am feeling angry, I can punch
my pillow, write in my journal about why I am angry, take a time out, or
talk to my adult helper." This activity will allow the clinician to assess
the child's repertoire of appropriate coping strategies. If necessary,
the therapist can facilitate the child's exploration of effective coping
styles.

Step Four: Trauma Resolution Activities

The body of the scrapbook comprises trauma resolution activities. Whether
the child is grieving a significant loss, struggling with divorce, or coping
with family violence, this stage of therapy is likely to elicit strong
affect. The therapist should be cautious, then, to pace activities, respect
the child's defenses, and carefully process material as it surfaces. It
is best to begin with activities that are general and then progress to
activities that are specific to the client's traumatic experience. For
instance, in working with an 11-year-old boy whose father had been killed
in a car accident, this writer selected several exercises from a bereavement
workbook [Heegaard 1991] to help the child understand the concepts of death
and grief. In later sessions, activities were chosen that were specific
to this child's personal experience of loss. For example, in one session,
the boy used finger paints to express how he felt when he first learned
of his father's death. In another session, the child made a collage of
things that reminded him of his father. In a session dealing with this
child's feelings of guilt about his father's death, the book "I Know I
Made It Happen" [Blackburn 1991] was read aloud to the child to facilitate
a discussion of this boy's self-blame. In a later session, the boy wrote
a letter saying good-bye to his father. Thus, various media including
artwork,
writing, and bibliotherapy were used within the context of the scrapbook
to enable this child to move toward trauma resolution.

Step Five: Empowering Activities

This part of the scrapbook is devoted to activities related to
problem-solving
and self-esteem so that the child leaves therapy with an enhanced feeling
of empowerment and self-worth. To illustrate, figure 2 is a problem-solving
questionnaire that was used with a 14-year-old girl whose parents had
recently
separated. This activity helped this child to master her problem-solving
abilities.

At this point in the scrapbook, mementos affirming the child's
accomplishments
can be included. For example, if a child has taken swimming lessons, a
copy of any badges the child received can be glued into the scrapbook.
Similarly, copies of class pictures can be included to signify a child's
successful completion of grade school. It is important to include these
mementos so that children understand that the traumatic experience was
only one part of their life.

Letters from significant others can also be included in this part of the
scrapbook. Hindman [1989] has asked parents, relatives, police, clergy,
and so on, to write letters to children as important contributions to their
healing process. For example,

parent can write a letter to the child explaining the reasons for the
divorce,
and affirming for the child that the marital breakup was not her or his
responsibility. Having such a letter for the scrapbook is a tangible
representation
of support and it can be of value for the child to refer to in later years.

Step Six: Termination Activities

When working with traumatized children, the termination phase of therapy
must be handled by the therapist with particular sensitivity. The end of
therapy can stimulate much anxiety, as well as feelings of rejection and
abandonment. The child should be given ample opportunity to plan the
good-bye
and to express any ambivalent feelings about ending treatment. In working
with a seven-year-old boy whose parents had divorced, termination and saying
good-bye had particular emotional connotations. Consequently, activities
were chosen to help the boy examine and understand his feelings about
termination.
In one activity, the boy was asked to draw two pictures of times he had
had to say good-bye-one of a time he felt it was relatively easy to say
good-bye and one of a time he found it very difficult to say good-bye.
In the first picture, the boy drew himself saying good-bye to his mother
as he was leaving for school. In the second picture, he drew the scene
of his father packing and leaving the family home at the time of the marital
separation. The boy was then asked to draw a picture of what he thought
it was going to be like to say good-bye to the therapist. By using the
three pictures, the therapist enabled the child to explore and express
his feelings about the end of therapy.

In the last session, the therapist presents the child with a letter that
is attached to the final page of the scrapbook. The purpose of the letter
is to review the goals that were achieved in the course of therapy and
to validate the child's efforts and accomplishments. Figure 3 is a sample
letter written to the 11-year-old boy referred to previously, whose father
had died in a car accident. (Figure 3 omitted)

The scrapbook can be given to the child as part of a termination ceremony.
Together with the child, the therapist can review the scrapbook and
highlight
the child's progress in therapy.

CONCLUSION

Based on this writer's direct clinical experience, the resolution scrapbook
appears to be a valuable tool that clinicians can use as part of a child's
overall treatment plan. It is a technique that encourages clinicians to
incorporate originality, ingenuity, and skill into their practice. Helping
professionals must motivate themselves to use their creative talents to
provide clients with opportunities for growth through innovative and
experiential
activities. Outcome studies, nevertheless, must ultimately evaluate the
effectiveness of the technique. Currently, there are few systematic
evaluations
of treatment strategies, particularly with children. Empirical research
is urgently needed to identify optimum treatment approaches when working
with traumatized children.

References

Aust, P. H. (1981). Using the life story book in treatment of children
in placement. Child Welfare, 60, 533-560.

Blakburn, L. B. (1991). I know I made it happen. Omaha, NE: Centering
Corporation.

Epstein, L. (1988). Helping people: The task centered approach. Columbus,
OH: Merrill Publishing.

Eth, S., & Pynoos, R. (1985). Developmental perspective on psychic trauma
in childhood. In C.R. Figley (Ed.), Trauma and its wake (pp. 352). New
York: Brunner/Mazel.

Gil, E. (1991). The healing power of play. New York: The Guilford Press.

Gumaer, J. (1984). Counseling and therapy for children. New York: The Free
Press.

Heegaard, M. (1991). When someone very special dies. Minneapolis, MN:
Woodland
Press.

Hindman, J. (1989). Just before dawn. Ontario, OR: Alexandria Associates.

Hindman, . (1991). The mourning breaks. Ontario, OR: Alexandria Associates.

James, B. (1989). Treating traumatized children. Lexington, MA: D.C. Heath
and Company.

Kluft, R. P. (1985). Childhood antecedents of multiple personality.
Washington,
DC: American Psychiatric Press.

Kordich-Hall, D. (1993). Assessing child trauma. Toronto, ON: Institute
for the Prevention of Child Abuse.

Sandler, J., Kennedy, H., & Tyson, R. L. (1975). Discussions on
transference.
The psychoanalytic study of the child, 30. New Haven, CT: Yale University
Press.

Scurfield, R. M. (1985). Post-traumatic stress assessment and treatment:
Overview and formulations. In C. R. Figley (Ed.), Trauma and its wake.
New York: Brunner/Mazel.

Terr, L. C. (1990). Too scared to cry: Psychic trauma in childhood. New
York: Harper and Row.

Terr, L. C. (1991). Childhood traumas: An outline and overview. American
Journal of Psychiatry. 148, 120.

Van der Kolk, B.A. (1987). Psychological trauma. Washington, DC: American
Psychiatric Press.

(Address requests for a reprint to Liana B. Lowenstein, c/o Jewish Family
and Child Service, 4600 Bathurst Street, Toronto, ON, Canada M2R-3U3.)

* A number of mail-order catalogs are available that offer a variety of
treatment workbooks, including Childswork Childsplay (Center for Applied
Psychology, Inc., P.O. Box 1586, King of Prussia, PA 19406); Impact
Publishers
(P.O. Box 1094, San Luis Obispo, CA, 93406); The Safer Society Press (R.R.
1, Box 24-B, Orwell, VT 0576-9756); and Western Psychological Services
(12031 Wilshire Blvd., Los Angeles, CA 9002-1251).

Liana B. Lowenstein, M.S.W. is Therapist, Jewish Family and Child Service,
Toronto, ON.