J. Eric Gentry

The newsletter of the
International Association of Trauma Professionals

Mike Dubi, Editor
Jennifer Bass,
Associate Editor
AUGUST 2013       
In This Issue
Multidisciplinary Treatment
Teen Survivors in Haiti
Sandtray Therapy with Trauma Survivors

Trauma in Poetry
 by Ira Slotnik, MSW, MA,  CAC III
 Night Visitor

Your ghost visits me at night sometimes,

when I am

lonely and aching

or have put down my reading

to haunt the halls of sleep.

Drifting off, shifting automatically

to my 
side of the bed, I make room

for her,


for her.

I succumb to slumber, and

she slides in silently,

burrowing under the blanket

like a cat

assuming her position,

    molding to my

insinuating herself into my psyche,

until dreaming,

feeling her there,

I hold your ghost, hold her close,

rapt in a shroud of memories

too painful to expose to the

light of day.





 He archived donated documents - personal reports of pogroms and pilgrimages,

famines and fascists,

assigned the Dewey Decimal designations,

inserted them gently and just so, amid

historical and metaphorical,

pedantic and romantic,

biography and geography.

Finding each a home.


Then war checked him out

to fight hand-to-hand,

foxhole-to-foxhole, registering the faces of death

before returning him -

a long overdue book,

binding broken, undecipherable scribbling

in the margins,

pages stained, or missing...


Walking wounded, he was lost in the stacks

carrying volumes of experience

he could not catalog, could  not 










Friday, October 18, 2013

9am - 5pm

Sarasota, FL


 Jane Webber, Ph.D.




Thursday, October 17, 2013

9am - 5pm

Sarasota, FL


Joe Grimaldi, Ph.D.









International Association of Trauma Professionals is now on Facebook! Connect to stay in touch with our training opportunities and current events.





Lee Norton, Ph.D.


 Tips for Clinicians:  Using Multidisciplinary Teams for Trauma Resolution


Trauma work is too complex and challenging to do alone. It is important to build and maintain a strong network of professionals who can contribute to effective treatment plans. Clinicians should look for co-existing medical, psychiatric, educational, family, and social problems that need to be addressed as part of trauma evaluation and treatment. Some helpful questions include:

  • Has the client been cleared for treatment by a medical doctor?
  • Has the client had a physical exam in the past year?
  • What conditions is the client being treated for?
  • What medications is the client taking?
  • Has the client had any medical treatment, surgery, or hospitalizations in the past year?
  • If a female, how old is the client? Is menopause contributing to the clinical picture?
  • Does the client currently suffer from or has she suffered from educational disabilities or problems in school or college?
  • Are there any indications that the client self medicates with drugs, alcohol, excessive work, exercise or sex, or any other means to regulate CNS symptoms?
  • Has the client ever been diagnosed with any other mental health condition, and if so, is there a pattern to multiple diagnoses?
  • Is the client a person of faith and, if so, is he active in his faith?
  • Does the client have adequate housing, nutrition, transportation, and opportunity for recreation?
  • Does the client have legal problems?

While therapists cannot address all clients' collateral problems, it is essential that we learn the nature of their current and past stressors in order to discern what to treat first, how to administer treatment, and the best timeline for treatment efforts. 





Andrea Adams

Nick Abraham

Leon Altamirano

Gina Vonderhaar Aden

Mzola Ahuama-Jonas

Loubna Alkhayat-Hatahet

Amy Alsum

Kathy M. Altieri, PhD

Pauline E. Amaismeier

Heather Anderson

Marie-Lou Andresen

Kathryn E. Angell, PhD

Audrey S. Autrey

Rachelle Auerbach

B. Darlene Avery

Diane Azar-Cohen

Elke Bach-Zeerocah

Suzanne Backman-Yorton

Brooke Baker

Debra Baldwin-Betty

Lisa Bard

Christine H. Barfield

Kelly Barry

Stacy Bartlebaugh

Laura L. Belcic

Kimberly Bell

Sarah Bell-Schell

Tara Benincasa

Paula Bennett, PsyD.

Krystle Berryman

Kevin Bert

Linda Best-Elser

Elizabeth A. Billings

Marleen Billiot

Isiah Bingham

Wendy A. Biondi

Kristin Birchenough

Sarah Bird

Laura Birholtz

Jennifer Bischoff

Bonnie Bobbett

Jasper M. Boomer

Brandi Bowen

Deborah Bowser

Gail Boyd

Teaka Wheatley Boyhen

Jennifer M. Bradt

Rachel Brandt-Greenfeld, Ph.D.

Yuki Joy Brien

Johnna Brockover

Andrea Brown

Robert Brown III

Joanna Brown-Torres

Mary Brugger

Roland A. Buccialia

Lynne R. Burley

Michelle A. Butler

Joanne Cabrera

Jessica Campbell

Jane Canseco

Rick Carlson

Christa Carrington

David Carroll

Debra Carter

Janet A. Castellini

Rachael Cavegn

Samantha Chambers

Yih Jia Chang

Melissa Chaput

Beverly T. Chevalier

Kimberly K. Christensen

Crystal Christophersen

Janice L. Chua

Jennifer Clark

Daniel K. Clothier

Marissa Cohen

Bronwyn Cole

Regina Collins

David A. Copeland

Alicia Cormier

Toni Cormier

Dionna Cotton Cornelius

Katherine Correia

Lacey Rose Cos

Michelle Crede

Helen Victoria Cruz

Jennifer Crytser

Claudia K. Curiston

Jennifer Daffon

Jamie Daniels

Deborah Ann Davis

Ryan T. Day

Donna M. DeAscentis

Jaclyn DeGorter

Denise DeHerrera

Laura DeSantis

Christine DesJardins

Felicia Desmarais-Toupin

Laurie M. Donaldson

Bradley Dorrill

Tamar Draughn

Alex Drummond

Laura Duncan

Cheryl O'Neal-Dunn

Robert Ebersole

Karim Elba Jung

Matthew R. Evich

Brenda Fabian

Alisa Failor

Karen Falk

Lissette Fernandez

David B. Fetterman

Deni A. Fholer

Cheryl Fisher

Mary Fisk

Erin Fitzgerald

Jessica Fleeger

Shaleyah Floyd

Nida Foley

Christine Foreback

Valerie Forsch

Edward R. Fossum

Erainia Freeman

Lisa French

Barbara Gaddy

Gregory C. Gambone, Ph.D.

Lara Garabian

Daniel A. Gardner

Jennifer L. Gathercole

Susan D. Gerber

Dodie Gill

Michael J. Gillespie

Cynthia Glasgow

Edith Glaza

Karen Goehring

Jaime Goffin

Suasn L. Gomola

Kimberly D. Goodrich

Daryle Marie Gracey

Kathleen Gordon Granado

Christine S. Grant, Ph.D.

Kathleen Grau

Alan Gruber

Joanie Gruber

Lorraine Guglielmini

Elizabeth L. Guide

Keisha Lynn Gulley

D. Charlene Hackett

Debra Joyce Halls

Lindsay Hamachek

Laurie Hamilton

Heather Hargis

Alyssa Hart

Michele Hart

Bernice E. Harvey

Huey Hawkins

Joel Haynes

Rachel Hayslette

Sharene Heisler

Margaret Hernandez

Rachel Heyne

Robbie Hickman

Maureen V. Himchak

Eric Hoff

Helen M. Hogan

Lori L. Holder

Marcelyn Holmes

Bridget Holyfield-Moss

Olivia K. Hook

Erica Hoover

Steven Hopper

Olivia M. Howard

Sharon M. Inglis

Julia Israelski

Sharon Jackson

Laura James

Eileen Jandrisevits

Neil A. Jepson

Eric M. Johnson

Luke C. Johnson

Josephine Jones

Roger L. Jones

Sandra Jones

Suzana Jones

James B. Jordan

Paul E. Jordan

James W. Kendall

Mary P. Kennedy

Beatrice Kerr

Jessica M. Kilgore

Lindsey Kirdahy

James Kirk

Susan M. Kloch

Janette Knox

Thomas E. Komopka

Carol J. Kopsco

Laurie Ann Kraus

Elizabeth Krzewski

Michele LaBaw

Tami Labul

Jennifer Lacey

Sarah Lavanier

Janet S. Laws

Gerard Lawson

Deborah Lee

Beatrice Lewis

Cheryl Libera

Maryann Lingg

Lisa Lipton

Veneis Little

Carole Love

Darlene Loveday

Patricia K. Luckey

Brooke Luebke

Lisa Tenney Lyon

Beverly A. Lyons

David P. Maki

Carmen E. Maldonado

Jennifer M. Malone

Anne Van Heyste Malouf

Susan D. Mandel

Melissa Manzi

Michelle Marcowka

Julie Marino

Steven P. Marks

Sarah Marsh

Jennie W. Mastrofini

Stephanie Maszak

Jaime Maurella, Ph.D.

Kathryn R. Maz

Alanna McCaffery-Bushnell

Michael McClary

Patricia McGettigan

Lindsay McGovern

Elizabeth McKee

Abigail McNeal

Kristy McPherson

Dale K. McQueeney

Rachel Corinne Meeks-Johnson

Vanessa Meredith

Donald A. Milazzo

Kate Zandra Miles

Stephanie Miller

Gabrey K. Milner

James Milner

Ami Moore

Amy Moore

Cheriece Moore

Victoria Mulbah

Luana Mueller

Marsonne. D. Myers

Michele J. Nadel

Laura Lee Nastri

Reginald O'Connor

Erin O'Donnell

Robin O'Donnell

David Oothoudt

Jeannine Pablo

G. Pace

Betty Pacheco

Anthony Paige

Marcela Paiz

Ruth B. Palmer

Tami Lynn Paxton

Melanie Pearl

Claire Peasley

Camille Pejero

Scott Pelletier

Rachel Perillo

George E. Peters III

Linda H. Phelps

Jeanne Phillips

Delorr Pickering

Carol L. Piscitelli

Christy Plumly

Ann Porter

Tangenise S. Porter

Tracey Post

Marus Potter

Patrick Powell

Elo Pranno

Bonnie Prizio

Maud Purcell

Jeffery Ramirez, Ph.D.

Donna Claire Read

Pauline A. Richard

Tenisha S. Rigby

Laurie Riehm

Brandi Rilkoff

Carlos Robles

Tammy Rodriguez

Renee D. Rogers

George Rosemond Jr.

Nancy Roth

Andrea Rudolph

William Rufenacht

Katherine A. Rufle

Leslie Russell-Martin

Kimberly Sacra

Yvonne E. Saldana

Frederick R. Sautter, JR.

Elizabeth Schallack

Joleen M. Schrad

Jody Schultz

Herbert A. Schwager

Ron Schwenkler

Dawn Angelen Scovel

Marianne M. Seeber

Susan E. Shaffer

Joni Shaw

Kerry Shea

Carol Graham Shekhar

Aneisa Lynn Sherrill-Mattox

Brenda Sing-Ota

Glen D. Skoler

Ira Slotkin

Marcel Slowly

Katherine Ann Smutka

Nicole Soltas

Melinda L. Somogyi

Jennifer Speiden

Christine Spuhler

Victoria Stafford

Nicholas M Stanco

Sarah Steger

Lindsay Stone

Sharon D. Stremel

Kristina T. Strong

Tomilu Stuart

Debra Sumberg

Patricia Susuki

Jaqueline Szabo

Gail Taylor Szykula

Kristin Tabiadon

Barbara Tamayo

Stephanie Tappan

Kathy Taussig

Kathryn Toberun Taylor

Philip B. Terry-Smith, Ph.D.

Rebecca Thomas

Sharon Thomas-Parker

Laura Thompson

Rebecca Timlin-Scalera, Ph.D.

Eve Tomanelli

Carolyn A. Trasko

Katherine Hayes Trentham

Jennifer Trimarchi

Suzanna B. Trimble

Veronica S. Turner

David Umbras

Toni Uzzalino

Sandra Valente, PhD

Daniel VerBout

Deborah Vogt

Cyndi Vuu

Theresa Walker

Katherine Leila Wardi-Zonna

Dustin Weeks

Rachel Whelan

Laura Whitman

Karen S. Wiemers

Tammy L. Wilgenbusch

Mike Wilkins

Cynthia Willhelm

Carl Williams

Seanna S. Williams

Kathleen Leigh Willis

Jessica Wilson

Bruce Wismer

Linda Sue Wittman

Christina Wohleber

Julie Wojtaszek

Jason Workman

Robert L. Wymss

Joan M. Ybarra, Psy.D.

Ferial Youkhanna

Janice M. Yount

Thea Yurman

Nicolene Zapach

Lauren M. Zarozny

Quick Links
Trauma Practice: Tools for Stablization and Recovery
Anna Baranowsky, Ph.D.
J. Eric Gentry, Ph.D.
Franklin D. Schultz, Ph.D.
ISBN: 9780889373808
Second Edition
(2010) Hogrefe & Huber, NY
101 Trauma-Informed Interventions (2013)
Linda Curran, BCPC, LPC, CACD, CCDP-D
 Mike Dubi, Ed.D, LMHC, President
J. Eric Gentry, Ph.D, LMHC,
Vice President
 Lee Norton, Ph.D., MSW, LCSW,
Vice President
Join Our Mailing List
International Association of Trauma Professionals (IATP)
5104 N. Lockwood Ridge Rd. 
Suite 207-E
Sarasota, FL 34234
(941) 724-1026




As more and more clinicians become aware of the need to be trained in trauma treatment, and as more and more trauma specialties develop, IATP strives to maintain its position as a leading worldwide trauma education and training organization.


IATP continues to grow with more than 800 certified members. These certified trauma professionals provide therapy to clients experiencing the negative effects of traumatic stress throughout the world.


IATP's Certified Expert Trauma Professional (CETP) training began in July and is now entering week 6 of the 24-week program. The current CETP cohort continually demonstrates trauma and therapeutic sophistication at the highest level. It is a learning experience extraordinaire for participants and faculty alike.  Stay tuned for another CETP training in January 2014.


In addition, we are offering two one-day courses in Sarasota in October: Sandtray Therapy for Traumatized Clients with the renowned teacher and therapist, Dr. Jane Webber and Professional Assessment Skills for the Non-Psychologist conducted by Dr. Joe Grimaldi, an acknowledged authority on psychological testing.


Over the coming year, IATP is planning to conduct workshops on: The Angry Brain;  Neuroscience for the Non-Neuroscientist; Crisis Intervention Methods; Treatment of Dissociative Disorders; and Compassion Fatigue.



I sincerely hope you can join us in beautiful, sunny Sarasota for these events.


Mike Dubi, President


If you would like to submit an article for this newsletter for our consideration, please contact

mdubi@comcast.netPlease include your complete contact information. Of course, we reserve editorial license. 


The Need for Multidisciplinary Treatment of Traumatic Stress 

Lee Norton, Ph.D., M.S.W., L.C.S.W. 

Center for Trauma Therapy


Effective assessment and treatment of traumatic stress disorders involve identifying the scope of resources required. Seldom can a single clinician meet the complex needs of clients suffering from PTSD, complex PTSD and dissociative symptoms. Trauma is highly

correlated with accidents, illnesses, and problems resulting from poor self care. Survivors often are overlooked or misidentified in the school, legal, mental health, and medical systems. The longer a 

client has "white knuckled" his way through extreme anxiety or relied upon tenuous coping skills, the more likely that a multidisciplinary approach is needed.  


Each assessment should include a careful evaluation of the acuity, severity, and duration of symptoms.   

Some of the indicators of the need for a multidisciplinary approach include:

  • Age at onset of stressors. The earlier the onset of traumatic stress, the more likely that symptoms will become severe and persistent over time, and will require longer, more intensive care. It is critical to ask clients about socio-economic status, birth history, accidents, illnesses, hospitalizations, separations from parents, exposure to alcoholism and drug addiction, mental illness in parents and siblings, concentrated community poverty, and any other stressors that have a serious impact upon child development (see the ACE study for a more detailed discussion of adverse conditions).
  • Medical conditions. The central nervous system is particularly malleable during gestation, childhood, and early adulthood. Trauma evaluations must take into account  factors capable of comprising CNS development. This includes illnesses the mother suffered while pregnant, pre- or peri-natal illnesses or injury, loss of consciousness, high fevers, dehydration, infection, and congenital conditions.
  • Accidents, illnesses, and hospitalizations. Many clients have experienced pre-verbal trauma as a result of serious or chronic illnesses and other conditions that required intrusive or frightening medical treatment. Asthma, seizures, migraines, and diabetes are among many illnesses that can leave an enduring impression on the amygdala and sympathetic nervous system. The same holds true for accidents, and any hospitalizations that overwhelm one's coping mechanisms.
  • Learning disabilities, bullying, problems in school. Children and teens spend approximately a third of their lives in school. This can work to their good or ill. A child who grows up in a chaotic, impoverished home can find refuge in school, especially if she is bright, verbal, and responsive. Schools can provide important buffering factors to trauma.  But the exact opposite also is true. School can be an insurmountable obstacle for an undernourished, unstimulated, sad, frightened, or agitated child. It is critical to learn from clients their experiences in school -- whether school offered a sense of support, self-esteem, and important social skills, or was another source of unmanageable stress. Lack of educational resources, a hostile climate, and being bullied all become threads in a tapestry of fear, anxiety, and shame.
  • Co-morbid conditions. Any mental, physical, or emotional condition can exacerbate traumatic stress and should be identified and managed. Look for mood disorders, chronic or untreated physical conditions, and drug and alcohol abuse and dependence, as these are common in trauma survivors.
  • Number and type of stressors. Most individuals with traumatic stress disorders have sustained more than one stressor and more than one kind of stressor. The more stressors, and the more kinds of stressors, the more severe trauma symptoms are likely to be. Clients often report a specific incident that affected them (they often will perseverate on this), while failing to recognize a host of other experiences that contributed to their traumatic stress reactions. Comprehensive interviews and open discussions are critical to developing an accurate clinical portrait.

Effective trauma treatment often requires a team of clinicians, as well as resources within the community. Clients should be evaluated for medical conditions (e.g., high blood pressure, diabetes, hormonal imbalance, apnea, neurological and metabolic problems), co-existing psychiatric problems (e.g., mood, dementia, OCD), lack of social support, and immediate and extended family stress. Clients who describe overwhelming anxiety, panic, hallucinations, uncontrollable impulses, or suicidal or homicidal ideation should be referred to a psychiatrist who can evaluate and treat the client as part of the safety and stabilization phase of trauma resolution. A psychiatrist also should be consulted for clients with chronic insomnia, inability to concentrate, or for those who engage in self-harm.


Trauma treatment  generally is inhibited when the client lacks sufficient support within the immediate or extended family. When preparing for trauma treatment, the therapist should seek assistance from the client's spouse, parent, friend, or even a whole family. Marriage and family therapists who specialize in trauma treatment can be indispensable members of  clinical teams by educating and eliciting support from the larger system.


An essential part of healing is opening to others, and discovering that the world is fundamentally safe. Traumatized individuals and families often lack skills to find and use resources within the community. As part of safety and stabilization, the trauma team can help clients identify the need for educational, financial, housing, medical, or spiritual support. The team becomes a learning tool, and helps clients understand that they no longer must remain isolated or compulsively self-reliant.


Team work is as important for therapists as it is for clients. Working with traumatized populations can result in secondary trauma, burn-out and compassion fatigue. Trauma treatment teams provide the opportunity to collaborate, make sense of suffering, and share both the burden and the satisfaction of serving such a worthy cause. Therapists in private practice should reach out to other practitioners and organizations in order to protect themselves from vicarious traumatization.       

Haitian Teen Survivors of  the 2010 Earthquake


by Obed Manigat, Ed.D. 


Reflecting on my interview with the five adolescent victims of the January 12, 2010 Haitian Earthquake, their words and experiences continues to have a lasting impact on how I understand and work with victims of trauma.  The five adolescents interviewed were between the ages of 11-16 and were full of potential in Haiti until the earth shook.  They came to realize that their entire reason for being was shattered and disrupted.  Moreover, through the interviews it was apparent that trauma and its impact may take years to manifest itself.  Within the mental health profession, it is an accepted notion that we by nature are traumatized beings.  We experience trauma on different levels at different time of our lives.  Moreover, we have come to understand that life is full of the unexpected but what matters most is how you (we) handle the unexpected.


For the purpose of this article, I have changed the names of the participants in order to protect their identity.  Marc was 13 years old when the earthquake struck.  He resided in a middle class residential neighborhood in the City of Carfour with his mother and siblings.  When the earthquake struck Haiti, Marc was awakened by the screams of his mother as the house shook violently and he was told to leave the home and stand in the courtyard of the house, away from any visible structures.  Marc stood there, almost in a trance, watching the devastation happening before him.  His family heard the loud crash of glass, furniture, and pictures falling off the walls.  They were terrified and astonished at the fact that the two-story building collapsed upon itself, and the room where Marc was sleeping was totally destroyed.  "I was amazed at what happened, I could not believe how everything that I was used to just got destroyed; my home, my neighborhood, and my school.  I started to cry and wondered if it's going to happen again.  That morning I was fussing with my mother about a new pair of shoes I wanted.  Now it all seems meaningless."


Next participant, Nancy, was a 14-year-old young lady who resided in the Delmas 75 area (a suburb in Port-au-Prince) with her mother, and a sibling.  When the earthquake struck, she was at school waiting to be picked up by her mother.  According to her, debris from the missionary structure began to rumble and shake, she heard screaming and when she came through, she noticed concrete slabs, fallen trees, and heard the screams of other children calling out for help. 


As the tremor continued, a sense of helplessness and hopelessness came over her and she began to scream and cry uncontrollably.  She began to feel the earth moving, the sound of rumbling rocks, the crashing of concrete slabs to the ground, and the smell of dirt filled the air.  In the midst of this devastation, she felt a hand rubbing her head and a familiar voice reassuring her that everything was going to be alright.


Antoine was a 15-year-old Haitian male who resided with his parents and grandparents in their newly renovated home.  While at home, Antoine reported being easily distracted and irritated.  His experience of the earthquake was terrifying.  He recalls experiencing hurricanes in the past but nothing was quite like this.  He asked his mother if she had heard anything from his father. He noticed that his house had been damaged; there were cracks all along the walls of the house.  Antoine began to realize the seriousness of the earthquake, his sense of security was suddenly gone.  He raised his hand to his head and began to cry, his mother and grandparents tried to calm him down.  Antoine reportedly screamed "I'm going to die", and with every tremor, came a different concern.  Antoine called out to his father, but his mother replied instead, telling him that his father was not home from work.


Jeanne was a 16-year-old Haitian female who was often identified as an overachiever.  As she felt the earth move, things began to fall, people started to scream, she became very afraid: she was afraid of being hurt, afraid that the house could very possibly fall on her, and afraid that she might even die.  Jeanne stated that this was the first time she really thought of death.  The earthquake did not destroy her house, but it did substantial damage to her mother's warehouse.  She was able to describe the time when the earthquake struck as being very quiet and peaceful.  She recalled the fact that "not a bird was flying around; the dog was especially alert, yet calm in ways that she has never seen before." The next day after the earthquake, she walked to her friend's house.  As she walked through the rubble, she noticed someone lying on the floor fully exposed, she noticed others with a sense of urgency pulling rocks and dirt away from a structure.


Rose-Lucie was 16 years old and near completion of her high school requirements when the earthquake struck suddenly.  She lived with her grandparents, aunts and uncles in a two-story house.  Rose-Lucie was home studying for an exam that was supposed to take place soon when suddenly the earth began to move and things started to fall from the walls and other areas of the house.  She began to scream and wondered what was going on.  At first she thought it was an explosion, but was told it was not, and that she needed to come out of her room on the second floor and go outside with the rest of the family.  Rose-Lucie finds herself stumbling out of her room confused and shaken, as she could not recall experiencing anything like that before in her entire life.  She watched the family home caving in and the two-story home collapsed onto itself.  She began to panic, and was afraid that other structures nearby would fall and kill everyone.


Throughout the interviews, it was apparent that all five participants exhibited symptoms of avoidance; they avoided places that trigger thoughts or any sensory reminders of the trauma.  Their ability to recall the incident was limited to some degree.  Antoine was the most obvious among the participants who often refused to discuss or explore a specific topic, instead they often made light of the situation through humor or abruptly walking out of the interview. The five participants, which consisted of two boys and three girls, were exposed to their nation's worst tragedy; this traumatic experience has had an adverse reaction on them.  This experience exposed the participants' feelings of vulnerability, fear, worries, a sense of grief, avoidance, a loss of self, guilt--which is also referred to as survivor's guilt--(how did I get lucky enough to survive).  It was also reported that some of the participants experienced a certain level of hostility within their homes and communities in Haiti and the United States, hostility being a common trait of children's survival experience.  Yet, as the participants share their experiences, they appear to be more at peace with themselves.  They all had the notion that they survived for a purpose and they are obligated to repay this opportunity in the future by returning to Haiti and helping change lives.


Earthquake kids  

Moreover, there is unmistakable evidence of resiliency among the participants, negative or positive, placing them in survival mode.  They were able to assimilate to the United States of America, making new friends, holding on to their faith, self-medicating (the use of drugs), but nontheless deciding to move on, putting everything behind.  There was talk about making plans to return to help re-build Haiti, and being aware that they are survivors. There was also some promiscuity, especially among the females in this study as a means of a coping mechanism, one that was addressed, along with the self-medication aforementioned.  The participants have experienced the loss of their primary homes and were homeless for an indefinite period of time until they departed Haiti and came to the United States to live and recover from the devastation and the trauma of the earthquake. 


As tragic as the earthquake was, the five adolescents being separated from their homes and flown to the United States was far worse.  The participants expressed concerns for their relatives, friends and overwhelming "feelings of guilt."  Jeanne, Nancy and Rose-Lucie refer to this feeling as that of being abandoned.  Marc and Antoine also refer to this as something they have to live with and refer to it as "this shame."  They all agree that at first it sounded like a good idea to get away and start fresh in "America," only to later realize that they were on the verge of leaving everything behind: their lives, familiar places, friends (injured or not).  One refers to the destruction (chaos), and the organic smell of Haiti, for the fabricated scent of the United States.  Thus far, in spite of the trials that they have experienced since the earthquake, they are slowly recovering.  They have all agreed to take things one day at a time.


Obed Manigat, Ed.D.

Editor's Note:

Obed Manigat is a Haitian American who lives in Miami. He works as a therapist in the Haitian community, and especially with victims of the earthquake of 2010.


Sandtray Therapy With Traumatized Clients: An Overlooked Modality

by Jane Webber, Ph.D.


Sandtray child  

The efficacy of expressive therapies using art, play, sand, music, and drama has been increasingly validated with rapid advances in the understanding of the neurological impact of trauma.  Sandtray therapy has been applied to the treatment of veterans of war, victims of sexual and physical abuse and neglect, witnesses to violence, and individuals and families experiencing injury and death in disasters and tragedies (Gil, 2010a; Moon, 2006; Webber, Mascari, & Runte, 2010; Venart & Webber, 2012). There is a growing body of literature on its efficacy in the treatment of both adults and children with trauma across cultures and countries.


Sandtray trauma therapy is defined here as the therapeutic process of creating a three-dimensional scene in sand using miniature figures in a tray as a container of the trauma with the active presence and intervention of a trained therapist (Webber & Mascari, 2008). Sandtray trauma therapy is especially helpful when survivors are stuck in traditional talk therapies. According to van der Kolk, van der Hart, and Marmar (1996), "A traumatic memory cannot be adequately processed if its affective and sensory-motor elements remain isolated from the rest of the memory" (p. 322). Sandtray therapy has been shown to be an effective modality for trauma survivors who are literally scared speechless and suffer from debilitating symptoms of posttraumatic stress. Unable to talk about the traumatic event, survivors need a safe nonverbal therapeutic environment that prevents retraumatization and jump-starts the therapeutic process of integrating fragments of trauma memory (Gil, 2010b; Webber, Mascari, & Runte, 2010; Van der Kolk, 2009).


Sandtray uses four multisensory therapeutic elements: the tray as the trauma container, sand as the medium, water to deepen the medium, and miniature figures to create a scene or story in the sand tray. The approach does not require artistic ability or skill and many individuals recall playing in sand as a soothing experience.


Therapeutic work with sand has roots in Buddhist, Chinese, and Native American cultural and religious rituals that use mandelas and sand paintings.  In his book, Floor Games, H. G. Wells  (1911) described how his children resolved issues as they played with miniature toys and natural materials.  Lowenfeld (1935), the founder of sandtray therapy built her World Play technique upon his discovery when she observed children in her clinic interacting therapeutically with small figures without adult interpretation, thus creating the role of the sandtray therapist as observer of the child's process.  Kalff (1980) integrated Jung's belief in the individual's natural power to heal oneself, Jungian archetypes, and Buddhist experiences in her therapeutic approach called Sandplay. DeDomenico (2002) developed a phenomenological approach to sandtray therapy working with healthy adults and groups that emphasized the responsibility of the builder to make meaning of the experience with the therapist as an active partner and collaborator in the process. Understanding the impact of neurobiological processes in trauma recovery, Gill (2010a) integrated sandtray, art, play, and cognitive behavioral therapy into her work with sexually abused children, chronicling extensive cases using sandtray therapy.


To begin the process, the therapist gives simple directions, inviting the client to view the collection of miniatures, select figures that are appealing, and make a scene in the tray. The collection is composed of various figures: human, animal, mythical, and spiritual, and objects ranging from plants, trees, mountains, and flowers to vehicles, buildings, furniture, rocks, food, medical tools, and cultural artifacts. A figure can become anything the client wants it to be and represents the client's world in a unique way. The individual can choose dry or moist sand to make a mountain, cave, ocean or river in the scene.  Turner (2005) explains this apparent therapeutic anomaly:  "The actual completion of a sand tray is thus deceptively simple. It is the profound psychological and spiritual process that underlies this simple creation of a picture in the sand that will concern us..." (p. 2).


sand tray 3
Photo found on www.yelp.com 

Clients are often surprised at how they were drawn to specific figures, and they report feeling moved to create a scene they had not previously shared. The kinesthetic process of moving the sand and the figures creates a dynamic experience evoking therapeutic disclosure of traumatic events.  


The efficacy of sandtray therapy is demonstrated through its immense physical and emotional power as the experience accesses traumatic memory and facilitates the expression of the trauma story in the tray. When trauma memory is reintegrated with the sensory fragments of the story (visual images, sounds, and smells of the traumatic event), symptoms are ameliorated and treatment can continue. This process empowers individuals to regain mastery through their creative actions and transform their role from victim to victor.


The role of the trauma therapist as witness and collaborator follows DeDomenico's (2002) model, being fully present, attending to the client's therapeutic needs and emotional safety, and "actually becoming part of the world building process" (p. 47). The therapist observes which objects were selected, where they were placed in the tray, who is in the tray, what is happening, and who is speaking.  When the scene is completed, the client is invited to take the therapist on a tour of the world in the tray. The client is free to add more figures, change the roles and dynamics in the scene, and reconstruct the story to transform the meaning and the conclusion.  In one sandtray, as a woman shared her story about recovering from a brutal attack, she picked up the miniature representing her attacker, turned him upside down and buried him in the sand. A widow working through the loss of her husband unconsciously turned a bridge in her tray toward a different direction away from his grave as she expressed her struggle with moving forward. In another scene, the victim of a rape piled fences, rocks, and ferocious animals to barricade her from the attacker (Webber, unpublished manuscript, 2011).


A client may create a world in sandtrays across several sessions (Gil, 2010b; Webber, Mascari, & Runte, 2010; Turner, 2005).   The therapist photographs each sandtray scene (with the client's permission), and photographs of previous scenes may be reviewed in subsequent sessions as the client moves through the phases of trauma recovery.  Since the sandtray creation is a deeply personal experience and a part of the client's world, the scene is not dismantled and the figures are not returned to their place on the shelves until after the client leaves.

Sandtray therapy is an effective modality that facilitates multiple approaches to trauma treatment (DeDomenico, 2002; Gil, 2010b; Kalff, 1980; Taylor, 2009; Turner, 2005; Webber, Mascari, & Runte, 2010). Through sandtray trauma therapy, clients have the constructive power to change the actions of figures and their outcomes, and the narrative voice to integrate and complete the trauma story.  


Jane Webber, Ph.D. will be conducting a one-day workshop, Sandtray Therapy for Traumatized Clients in Sarasota, FL on October 18th, 2013. 




DeDomenico, G. (2002). Sandtray-worldplay: A psychotherapeutic and transformational sandtray technique for individuals, couples, families, and groups. Sandtray Network Journal, 6(2). Retrieved from http://visionquest.us/vqisr/publications.htm#textbook

Gil, E. (Ed.) (2010a). Working with children to heal interpersonal trauma: The  power of play. New York, NY: Guilford Press.


Gil, E. (2010b). "This mommy has no milk!" A neglected child's adaption to loss and hunger.  In E. Gil (Ed.), Working with children to heal interpersonal trauma: The power of play, pp. 288-310.  New York, NY: Guilford Press.


Kalff, D. M. (1980). Sandplay: A psychotherapeutic approach in the psyche. Boston:  Sigo Press.


Lowenfeld, M. (1935/1967). Play in childhood. New York: Wiley.


Moon, P. (2006). Sand play therapy with U. S. soldiers diagnosed with PTSD and their families. In G. Walz, J. Bleuer, & R. Yep (Eds.) VISTAS: Compelling perspectives on counseling 2006 (pp. 63-66), Alexandria, VA: American Counseling Association.


Taylor, E. R. (2009).Sandtray and solution-focused therapy. International Journal of Play Therapy, 18(1), 56-68.


Turner, B. A, (2005). The handbook of sandplay therapy. Cloverdale, CA: Temenos Press.


Van der Kolk, B. (2009). Afterward. In. C. Courtois & J. Ford (Eds.), Treating complex traumatic stress disorders: An evidence-based guide (pp. 456-466). New York, NY: Guilford. Press.


Van der Kolk, B., van der Hart, O., & Mamar, C. R. (1996).  Dissociation and information processing in posttraumatic stress disorder. In B. A. van der Kolk, A. C. McFarlane, & L. Weisaeth (Eds.), Traumatic stress: The effects of overwhelming experience on mind, body, and society (pp. 537-558). New York, NY: Guilford Press.


Venart E., & Webber, J. (2012). Healing trauma though humanistic connections. In M. B. Scholl, A. S. McGowan, & J. T. Hansen (Eds.), Humanistic perspectives on contemporary counseling issues (pp. 141-163). New York, NY: Routledge.


Webber, J. (2011). Sandtray stories. Unpublished manuscript.


Webber, J., Mascari, J. B., & Runte, J. (2010). Unlocking traumatic memory through sand therapy. Terrorism, trauma, and tragedies: A counselor's guide to preparing and responding. In J. Webber, & J. B. Mascari (Eds.), (3rd ed., pp. 13-17). Alexandria, VA: American Counseling Association Foundation.


Wells, H. G. (1911/1975). Floor games. New York: Arno Press.