Transformation of mental trauma in children using the Hibuki-therapy method

Аспірант Університету менеджменту освіти НАПН України Ма Соціологія освіти, Єврейський університет в Єрусалимі, Ізраїль; Мед педагогічна психологія, Університет Дербі, Англія

Трансформація психічної травми у дітей методом Хібукі-терапії

Анотація

У статті аналізується поняття «психічна травма» як життєва подія, що зачіпає значні сторони існування людини і призводить до глибоких психологічних переживань. Підкреслюється, що психотравму, отриману в результаті стрес-реакції, дитина дошкільного віку не в змозі трансформувати самостійно, тому в більшості випадків це призводить до тяжких психічних руйнувань. Проаналізовано різні наукові підходи до розуміння психічної травми та відзначено достатню складність і багатоаспектність цього психологічного феномену, відсутність єдиного підходу до його розуміння.

Зазначається, що застосування іграшки в трансформації психічної травми особистості сприяє встановленню емоційного контакту, зняттю емоційної напруги, розширенню світогляду про навколишній світ, профілактиці дезадаптивної поведінки. Іграшка спонукає дитину до ігрової діяльності і психолог використовує терапевтичний вплив гри, щоб допомогти дитині у трансформації психологічних та соціальних труднощів, що перешкоджають особистісному та емоційному розвитку.

У статті розглядається проблема трансформації психічної травми у дітей, отриманої внаслідок природних катастроф та бойових дій на території їхньої країни, за допомогою Хібукі-терапії. Описується сутність і роль Хібукі-терапії як методу терапії іграшкою у роботі з дітьми, які пережили сильний емоційний стрес.

Досліджується процес становлення терапевтичної моделі Хібукі-терапії. Підкреслюється, що авторська модель ґрунтується на принципі, згідно з яким діти, які активно протистоять пережитим стресовим ситуаціям, можуть трансформувати свої страхи і краще адаптуватися до життя після будь-якої психічної травми. Запропонований метод дає дитині стимул зосередити увагу на почуттях та потребах іграшкового песика, а також на ролі дитини як опікуна, тим самим пропонуючи відволікання від власних страхів і тривоги. Дбаючи про м'яку іграшку, дитина може розвіяти свої страхи та за непокоєння. Важливо, що дитина починає себе почувати компетентним опікуном, а не неспокійною людиною, яка потребує допомоги.

Нині Хібукі є важливим інструментом, який допомагає українським дітям упоратися із травмою війни. До цього процесу також підключають батьків дітей, які отримують інструкцію про те, як треба дбати про Хібукі.

Ключові слова: арт-терапія, ігротерапія, трансформація, емоційний стрес, хібукі-терапія, лялькотерапія, психічна травма, терапевтична модель.

Introduction

Problem statement. Emotional states of children suffering natural disasters or local wars is a global problem of our time, characteristic for many countries and peoples, in particular Israel, Bosnia and Herzegovina, Syria, Japan. Currently, this problem has become particularly acute in Ukraine, whose residents are forced to endure difficult trials, including genocide, mass extermination of people, destruction of ordinary life and family ties.

During the war, children experience many different mental traumas. They witness murders, violence and destruction of houses. Together with their parents, they run away from their place and this travel is often dangerous and dramatic. That is why children should have a developed ability to overcome experienced stress. The stronger the stress, the more vital resources a child needs to overcome it.

As work experience shows, art therapy is an effective mean of working with children's mental injuries, which helps children build an adequate system of psychological protection (Valdes, 2005).

Art therapy as a special direction of psychotherapy was formed at the turn of the 19th and 20th centuries. The psychoanalytic theories of Z. Freud and K.G. Jung influenced the ideas of the 20th-century leading art therapists - M. Naumburg, E. Kramer, M. Liebmann and others - about the human psyche. In the second half of the 20th century, American researchers proposed the phenomenological approach (E. Husserl, M. Heidegger) for the organization of an art therapy process. Studies by such scientists as D. Waller, R. Wolf, T. Dalley, and E. Zierer are also of interest. Hanna Kwiatkovska had a great influence on the development of art therapy, she included it into diagnosis and treatment of families (Kopytyn, 2002).

Toy therapy is an art therapy method intended for an individual work. This method is based on a child's identification with a favorited character of a cartoon, a fairy tale or a favorited toy. A toy is used as an intermediate object, a mediator in the relationship between a child and an adult (psychologist, teacher, doctor). F. Zimbardo devoted one of his works to this method (Zinkevich-Evstigneeva, 2001).

Toy therapy is used to help in resolution of intra- and interpersonal (internal and external) conflicts; to improve social adaptation; in corrective work, to relieve children's fears, stuttering, behavioural disorders or emotional injuries; to prevent maladaptive behaviour of children and adolescents (correction of protesting, oppositional, demonstrative behaviour via acting out typical conflict situations from a child's life together with their parents or peers by using toys).

An Israeli clinical psychologist, Dr. Shai Hen-Gal, has conducted research and proposed toy therapy for children who survived war and natural disasters. Currently, various forms of art therapy exist and are being developed.

Analysis of recent research projects and publications. The studies related to mental traumas and their consequences were mainly carried out within medical, general psychological and medical-psychological research projects (Yu. Vashchenko, B. Karvasarskyi, R. Laza rus, K. Maksymenko, G. Mozgova, V. Myasishchev, etc.). Some studies clarified the specifics of stress experienced because of armed hostilities (S. Balashova, O. Boyko, M. Varii, G. Dubrovynskyi, A. Romanyshin, etc.).

Post-traumatic stress disorders were studied mainly from the perspective of the psychology of an individual's emotional sphere of (Yu. Aleksandrovsky, F. Vasylyuk, T. Kyrylenko, T. Tytarenko, O. Sannikova, O. Chebykin, etc.). The following factors influencing the occurrence of post- traumatic mental disorders were examined in different works: the peculiarities of reactions to stressful events (H. Selye, T. Holmes), the specifics of a personal profile (F. Alexander, H.F. Dunbar), some personal traits (O. Zhuzzhanov, V. Symanenkov, O. Telnova), types of social- psychological maladaptation (T. Aivazyan, Yu. Gubachov, N. Zavatska, etc.). The studies carried out by V. Abramov, O. Gavrilov, K. Maksimenko, N. Maksimova, G. Mozgova, K. Ostrovskaya, L. Shestopalova, L. Yuryeva revealed the main studying directions and problems of an individual's post-traumatic stress disorders - medical and psychological, social-psychological, psychological-pedagogical.

The article purpose is to substantiate theoretically the essence of Hibuki-therapy as a method of toy therapy and to reveal its assistance in overcoming children's mental trauma.

The study objectives are:

1. To analyse the concept of mental trauma and its impact on a child' s personality.

2. To analyse theories of mental trauma

3. To substantiate the therapeutic model of Hibuki- therapy and discuss how it supports the rehabilitation of children's mental health.

Research methods. To achieve the study goal, the following theoretical methods were used: analysis, synthesis, generalization, analogy in order to formulate the main scientific problem of the study and to determine its methodological foundations.

mental trauma hibuki therapy

The main research material

The problem of mental traumatization in childhood remains actual for many decades, it is studied because of the demands of psychological theory and practice, since human life includes many traumatic experiences. Difficult life situations accompany an individual even during seemingly the happiest period of his/her life - childhood. The cases of traumatic experiences can be physical abuse, separation from significant others or their loss, emotional coldness on parents, adverse life events.

The representatives of various psychological theories point to the pathogenic influence of mental trauma on the further development of a child's personality and psyche.

“Psychological trauma” means a life event that affects significant aspects of an individual's existence and leads to deep psychological experiences. A preschool-age child is unable to overcome independently a psychological trauma developed a result of a stress reaction, so, without an external help, it leads to severe mental breakdowns in the most cases (Valdes, 2005).

In the modern scientific works, mental trauma is also defined as a state of intense fear experienced by a person under a sudden, potentially life-threatening event that exceeds his/her capabilities and that, therefore, he/she is unable to control or react effectively (Levine, 1998; Zettl & Josephs, 2001).

A mental shock is a threat to life and imprints deeply in human consciousness. Negative manifestations of a traumatic impact may occur not immediately, but after a long time or even decades later. Many researchers examined the influence of a past psychological trauma on an adult's personality (Mendelevich, 2002).

The concept of mental trauma was introduced by the German neurologist A. Eulenburg in 1878. The history of the “mental trauma” concept goes back to the early works of Z. Freud and pre-Freudian works of J. M. Charcot and J. Breyer. The most comprehensive study of this problem was carried out within the psychoanalytic approach (Thoma H., Kachele H., 1996).

The concept of “trauma” was borrowed by Z. Freud from medicine and literally translated from Greek means “wound”, “damage”, “result of violence”. Borrowing this concept, psychoanalysis transferred it to the psychological level (Mendelevych, 1995).

Z. Freud created the first psychoanalytic theory of trauma, where this phenomenon was considered as an affect deeply rooted in the unconscious and having a pathogenic effect on the human psyche that was the basis of neurotic disorders. He saw the source of trauma not in external events, but in the psyche itself, in the splitting of the “Ego”, which led to traumatic anxiety based on unconscious fantasies. According to Z. Freud, unpleasant painful experiences were repressed, while the affects associated with them continued to develop and led to attempts to put an end to unbearable torment and, as a result, to neurotic disorders. The mechanism that triggers neurotic disorders was external trauma and the internal psychological shock that accompanied it.

Z. Freud's ideas influenced new approaches to mental trauma. The idea on fixation on a trauma, which was studied by his students S. Ferenczi and G. Simmel, became a key moment in the modern treatment of post-traumatic stress disorder (PTSD) (Thoma H., Kachele H., 1996).

Mental traumas were also studied in analytical psychology, founded by K.G. Jung. From his point of view, disturbances in “Ego” functioning were caused not only by a sexual trauma, but by all tragedies, all misfortunes of human life, each of which, in its own way, was unique (Jung, 1995).

K.G. Jung no less than Z. Freud tried to find a universal complex behind neurotic disorders, but his own research led him to understanding the multiplicity of traumas, the idea on many different individual stories and fantasies about trauma. K.G. Jung believed that mental trauma always disturbed affectivity and this disturbance went on throughout life.

Mental trauma is also examined within the ideas of modern psychoanalysis, in particular, in the theory of object relations, which includes a fairly wide theoretical range of different schools and directions, but with one common point: they believe that relationship with an object plays the main role in a child's mental life.

The foundation for this new psychoanalytic direction was the theory of hospitalism (R. Spitz) and John Bowlby's attachment theory. Studying deprived children, the scientists came to the conclusion that the absence of a mother led to irreversible consequences for their development: a lost object of love was a mechanism triggering psychosomatic diseases, so that children became more vulnerable to the influence of life stresses, their biological regulatory processes were destroyed (Thoma H., Kachele H., 1996).

The modern theoretical concept of the therapeutic model for trauma (M. Murray) is based on the psychoanalytic tradition (Murray, 2004). The main provisions of this theory are presented in the declaration of vital needs, significant for a child's development, namely, the need for safety, security, stability and permanence. Their satisfaction contributes to the formation of a “natural child” who is able to understand and express his/her feelings due to existing abilities and aptitudes. Mental injuries, deprivation and violence cause him/her unbearable mental pain, so by growing up, he/she tries to protect him/herself by suppressing painful feelings via pain relief (using food, alcohol, tobacco, drugs, etc.) and techniques for distraction (such as relationships with other people, work or computer overuse, etc.). These protective mechanisms provide temporary anaesthesia to reduce the mental trauma impact. Over time, this way of pain avoiding turns into addictive behaviour. Suppressed painful feelings and defence mechanisms contribute to a powerful potential for aggression. In this way, a “natural child” is suppressed and a person loses the ability to perceive life, enjoy it and find satisfaction.

The theory of mental trauma was also developed in the context of stress theory (Selye H.) (Selye H., 1992). The scientist considered mental trauma as a special form of stress reaction. According to his concept, traumatic stress occurs when a stressful factor is intense, long-lasting and, overloading a person's capabilities, leads to physiological and psychological traumatization. In this case, we are talking about a traumatic event, which in terms of strength and duration goes beyond the existing experience and regulatory capabilities of a child, and can cause clinical forms of stress, usually associated with post-traumatic stress disorder.

An interesting theory was proposed by the well- known American scientist and P. Levine (Levine, 1997), who believed that mental trauma could be caused by events such as war, abuse, including emotional, physical and sexual violence, deprivation, accidents or natural and man-made disasters. His approach to understanding trauma and post- traumatic stress disorders can be classified as integrative, as the author widely used developments in the humanities and natural sciences, relied on knowledge in the field of biology, neurophysiology, neuropsychology and immunology.

So, we have examined different scientific approaches to understanding mental trauma. There are also various methods of psychotherapeutic influence on children and adults to correct it.

A toy is used for mental trauma correction to help establish an emotional contact, remove emotional tension, develop mental processes, expand the worldview on the surrounding world and prevent maladaptive behaviour. A toy encourages a child to play, while a psychologist uses the therapeutic influence of games to help adults or children overcome psychological and social difficulties that hinder their personal and emotional development.

The psychological corrective effect of games for children is achieved due to an established positive emotional contact between children and adults. The game corrects negative emotions, fears, self-doubt, expands children's communicative skills and increases the range of actions with objects available to children. Toy therapy means interactions of an adult with a child on the latter's own terms, giving him/her an opportunity to freely express him/herself with the simultaneous acceptance of his/her feelings. Today, the scope of toy therapy has expanded significantly.

Playing is also the main method for work with children from 2 to 12 years old, due to their age-limited cognitive development and poor ability to verbalize their thoughts and feelings. Games is an integral part of children's lives; they help learn social rules and establish relationships with the surrounding people. This method is effective if a client manages to play freely and with joy.

Z. Freud, describing children's games (the story of Hans, a boy, etc.), pointed out that the child turns what he experienced passively into active play. In the 20s of the last century, M. Klein first began to use toys in the psychoanalysis of children. She considered children's games to be an analogue of free associations that open access to unconscious material (Thoma H., Kachele H., 1996).

Playing is the only activity where children are free from coercion and pressure from a hostile environment. And therefore, children obtain more opportunities to express unconscious drives, feelings and experiences, which cannot be accepted and understood in the real relations of children with the world. M. Klein believed that almost any playful action of a child had a certain symbolic meaning, expressing the child's conflicts and repressed urges. This symbolic meaning must be interpreted by a therapist and brought to the child's consciousness.

Games were firstly used by A. Freud in her work with children survived the bombing of London during the Second World War. If a child had an opportunity to express his/her experiences in a game, he/she was freed from fear and this experience did not develop into a psychological trauma (Freud, 1997).

In the book “Children and the War”, A. Freud vividly described the differences in the ways how adults and children expressed their reactions to the bombing of London. After a raid, adults talked again and again about the horror they experienced. Children who experienced the same almost never talked about it. Their reactions to what they experienced were expressed in the game. Children built houses out of cubes and “dropped bombs” on them. The toy buildings were in “fire”, sirens sounded. An “ambulance” took the killed and wounded to hospitals. Such games lasted several weeks. A. Freud discovered that games were an important factor in establishing emotional contacts with children as they helped children expressed themselves freely.

Following Z. Freud, T. Hug-Hellmuth was a strong advocate for the use of play in child psychoanalysis, and she offered toys to children with whom she conducted play therapy so that children could express themselves. Chronologically, her work precedes the work of A. Freud and M. Klein, and she did not formulate a certain approach and used play materials only with children aged 6 and older. Nevertheless, she drew attention to how difficult it was to apply the methods used in therapy with adults to work with children.

In 2006, an Israeli program (using a toy) was created to help children after the Second Lebanon War. Later, in 2011, it was used to work with Japanese children (to reduce the impact of trauma from the tsunami that hit Japan).

This program is called “Hibuki”, which means “hugs” in Hebrew. The central “person” of the program is a soft plush dog with a sad face and long paws - a toy that “came to life”, very cute, who hugs children and asks them to tell about their fears and problems. In Japan, along with the Israeli program, Japanese doll therapy was also used.

The program was designed specifically for post- traumatic psychological recovery by the American-Jewish Joint Distribution Committee (“Joint”) in cooperation with the Israeli Ministry of Education, the Psychological Counselling Service and the Faculty of Psychology of Tel Aviv University.

“Joint” experts emphasize that the experience accumulated in Israel about acting in emergency situations and after them in order to overcome stress and injuries is quite rich and can really help in other countries as well.

The work of these Israeli specialists in countries such as Haiti and South Asia has shown that treating of trauma, especially for children affected by war or natural disaster, is a vital step in their recovery.

The idea to create the first soft therapeutic toy - Huggy-Puppy (Hibuki, translated into Hebrew) belongs to the Israeli doctor Shai Hen-Gal. The aim of intervention (a short-term intervention involving one or two meetings with a child) is to encourage children to care for Hibuki they were given. Research by Shai Heng-Gal and his colleagues confirmed the effects of this intervention, which requires minimal resources.

According to Dr. Heng-Gal, the therapeutic effect of his method is that children feel support from Hibuki. An adult gives a child this toy dog and says that the child should take care of it. If the dog gets scared at night, the child should help it fall asleep. It is necessary to calm it down and take it to a kindergarten or school. Children take on an active role that promotes self-soothing. Instead of focusing on their own anxieties, they shift their focus to caring for their new friend.

As Dr. Hyun-Gal has noted, children who received this toy suffer less from anxiety and depression. The more they care about Hibuki, the better they feel. The therapy dog has amazing healing power for children who have experienced severe mental trauma.

The Israeli psychologist was motivated to choose the described intervention by the analysis of the literature, which suggested that responsibility for caring for others and encouraging active overcoming of difficulties during stressful periods expanded people's capabilities and made them less vulnerable and susceptible to stressful situations. From the point of view of child development, this game has also an important developmental function.

The literature about toy therapy suggests that children are more likely to project their feelings and anxieties onto toy figures (especially animals) in order to identify with these feelings and regulate these emotions while caring for the toy figures.

Another perspective of the study refers to the literature on attention, anxiety and stress reactions. It has been suggested that anxiety disorders (in both adults and children) result from attentional biases and are associated with fear-inducing stimuli.

In addition, anxious people tend to focus on themselves; their feelings and their mental processes are related to fear; and attention training and self-awareness reduction can lead to significant reductions in anxiety levels in such individuals.

The proposed method encourages a child to focus on the toy dog' s feelings and needs, as well as on the child's role as caregiver, thereby offering a distraction from their own fears and anxieties. Taking care of a soft toy, the child can dispel his/her fears and worries. It is very important that the child begins to feel like a competent caregiver, and not a restless person who needs help.

Parents of the children are also involved into this process, and they receive instructions on how to care for Hibuki.

The latest research has evaluated the potential effectiveness of the method proposed by Dr. Hen-Gal for young children who have experienced psychological trauma.

The program proposed by Dr. Heng-Gal has been developed into our therapeutic model “Hibuki”, which involves a longer intervention (three to six months). The model developed by us is based on the principle that children who actively confront experienced stressful situations can alleviate their fears and better adapt to life after any trauma (parental divorce, accident, combat, etc.).

The components of therapeutic help for children to cope with their mental trauma are:

- active position of the child;

- shifting/transfer the focus of attention;

- transfer of the emotional state from the child to Hibuki;

- confidence and self-development.

More than 100,000 children in Israel have been treated with the aforementioned therapeutic model, and recent studies conducted at Tel Aviv University have shown that this model does show very effective results in reducing post-traumatic reactions and stress among the children participated in the program.

Therefore, the goal of the “Hibuki” therapy model is to support and rehabilitate the mental health of children who have suffered from war or other adverse life events.

A child is introduced to Hibuki by an adult who has completed the appropriate training course. By playing with the dog, the child transfers its difficult experiences and emotions to Hibuki and in this way starts the recovery process after the injury. The dog does not leave any child indifferent because of its sad face, long paws that allow Hibuki to “hug” the child all day and other special features. This approach has been repeatedly tested in practice.

A team of Israeli experts has already introduced Hibuki therapy to thousands of volunteers in Ukraine and refugee shelters in Europe and Israel.

Training is carried out in long and short seminars and includes:

- training of therapists;

- introduction Hibuki to children (the child finds a Friend and takes care of him);

- therapy

The advantage of the therapeutic model is that a therapist can receives quick feedback.

Today, Hibuki is an important tool that helps Ukrainian children cope with the trauma of war. Doctors, psychologists and volunteers in Ukraine and abroad are asking for Hibuki so that children they care for it. Cuddle toys are needed by everyone - both children and adults. Such a conclusion can be made by the results of the scientific research examining the importance of hugs in the life of every person.

Psychologists say that, in order to feel good, we need at least eight hugs a day. And people who hug more than twelve times a day are the most harmonious and happy.

Moreover, positive changes occur in the body at the chemical level: when hugging, the so-called happiness hormone - endorphin - is released into the blood, as well as the well-known trust hormone - oxytocin, - which reduces anxiety and increases the feeling of security. At the same time, the level of stress hormones decreases, along with which tension and carelessness disappear. It turns out that the more hugs and touches are used, the higher happiness is. This is especially important for the harmonious development of children.

Conclusions

As a result of the theoretical study, we determined that the concept of “mental trauma” implied damage caused to a person's mental health under the intense influence of adverse environmental factors or acute emotional, stressful effects of other people on the person' s psyche.

Based on the literature review concerning the problem of mental trauma in childhood, we noted the complexity of this phenomenon and the lack of a unified approach to its understanding.

We have determined that an early trauma not necessary become an emotional experience of a small child, but later it might manifest itself and determine his/her personality in adult life.

The perspective of further study of our therapeutic model can be an empirical study on the impact of Hibuki - therapy on children's mental health recovery.

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