Immigrant and refugee preschoolers` sandplay representations of

The Arts in Psychotherapy 34 (2007) 99–113
Immigrant and refugee preschoolers’ sandplay
representations of the tsunami
Louise Lacroix, MA, ATR a,b,∗ , Cécile Rousseau, MD a,b ,
Marie-France Gauthier, MA, AT a,b , Abha Singh, MA, AT a,b ,
Nadia Giguère, MA a,b , Yasmine Lemzoudi, BA a,b
a
Department of Creative Arts Therapies, Concordia University, Montréal, Québec, Canada
b Department of Transcultural Psychiatry, Montreal Children’s Hospital, Canada
Abstract
Extensive media exposure to natural disasters such as tsunamis may cause adverse effects including psychological distress and
even posttraumatic symptoms in young children, particularly those who have suffered previous losses and trauma. This paper
analyzes spontaneous representations of the 2004 tsunami through sandplay by a group of immigrant and refugee preschoolers,
beginning 2 weeks after the tragedy. The children used a variety of coping strategies, making both nonverbal and verbal references
to the tsunami. It was represented using a variety of figurines, including religious ones. We considered the children in light of
four categories based on family homeland and psychological affinity to the tsunami experience. Our results suggest that sandplay
provides an appropriate space to express and work through emotions stemming from the interaction of past and present experiences
of adversity.
© 2006 Elsevier Inc. All rights reserved.
Keywords: Tsunami; Media exposure; Sandplay; Immigrant; Preschoolers
Introduction
The sandplay project is a preventive program for preschoolers. It is part of a larger series of art therapy workshops using different forms of creative expression designed for schools in multiethnic neighborhoods (Rousseau,
Lacroix, Bagilishya, & Heusch, 1999; Rousseau, Lacroix, Singh, Gauthier, & Benoit, 2005; Rousseau, Singh, Lacroix,
Bagilishya, & Measham, 2004). Coincidentally, the sandplay project began only 2 weeks after the tsunami in Asia
(26 December 2004), in a neighborhood with a predominantly South Asian population. The children were indirectly
exposed to the tragedy to varying degrees, either through the media (television news) or through their family’s worries
and distress. The sandplay workshops became a space where the children could spontaneously express their feelings
about the disaster and try to make sense of it. This paper analyzes the children’s representations of the tsunami in the
sand tray with a view to discovering how they understood and reacted to this event and describes their strategies for
coping with it.
∗ Corresponding author at: Department of Creative Arts Therapies, Concordia University, 1455 de Maisonneuve Blvd West, S-VA 264, Montréal,
Québec H3G 1M8, Canada. Tel.: +1 514 848 02424x7384; fax: +1 514 848 4969.
E-mail address: [email protected] (L. Lacroix).
0197-4556/$ – see front matter © 2006 Elsevier Inc. All rights reserved.
doi:10.1016/j.aip.2006.09.006
100
L. Lacroix et al. / The Arts in Psychotherapy 34 (2007) 99–113
Natural disaster and preschoolers: the tsunami experience
According to Lazarus, Jimerson, and Brock (2003), floods are the most common natural disaster and are extremely
dangerous because they occur without warning and can be very destructive. Typically, preschoolers who have experienced natural disasters display regressive behaviors, including clinging, thumb sucking, fear of the dark, bedwetting,
and whimpering, along with other symptoms, such as frightened facial expressions, loss or increase of appetite, and
night terrors (Lazarus et al., 2003; National Institute of Mental Health, 2000). These authors also suggest that there may
be other symptoms, such as reliving the trauma through play, avoiding remembering, or anticipating a reoccurrence
of the event. Despite their developmental level, preschoolers are greatly affected by their parents’ reactions to tragic
events. However, only a few children will be at risk of developing posttraumatic stress disorder (PTSD) (National
Institute of Mental Health, 2000). Initial PTSD symptoms last at least a month, and other symptoms may appear
many months after the disaster: nightmares, flashbacks, distress over similar events, routine avoidance, increased sleep
disturbances, irritability, startle reaction, and poor concentration (Lazarus et al., 2003; National Institute of Mental
Health, 2000).
Although the news media play a very important role in providing information about natural disasters, it is increasingly recognized that media exposure may have a negative, even harmful, impact on children. Extensive media
exposure reduces geographical distance and may induce psychological distress and posttraumatic symptoms, particularly in young children, who absorb images without having the cognitive and emotional tools to integrate them
(Lengua, Long, Smith, & Meltzoff, 2005; Pfefferbaum et al., 2000). The National Child Traumatic Stress Network
(2005) points out that children who have had previous experiences of loss and have been exposed to violence can
be greatly affected by indirect exposure through the media, which may enhance their risk of PTSD. Before September 11, 2001, there was barely any information and even less research on the emotional impact of media exposure
to trauma. Recently Cohen (2005) has found a range of mental disorders following the World Trade Center attack
and identified risk factors of profound stress reactions to media exposure, specifically in younger children who
had prior experience of trauma. According to Cohen, 10.5% of schoolchildren experienced symptoms associated
with PTSD; a range of other mental disorders were also observed, such as agoraphobia (15%), separation anxiety (12.3%), conduct disorder (10.9%), anxiety (10.3%), and major depression (8.4%). Although more research is
needed in order to determine the profile of the children at risk of developing PTSD symptoms, it has been recognized that immigrant families are more vulnerable, since there are numerous trauma survivors among them (Gurvitch,
2005). Also, in Canada, a large number of immigrants and refugees are of low socioeconomic status, which further
increases the risk (Gurvitch, 2005; Kennedy, Charlesworth, & Chen, 2004; U.S. Department of Veterans Affairs,
2006). As on September 11, images of the tsunami tragedy invaded the screens of every household. The images
presented may have been difficult for preschool children to understand, and their parents’ reactions to them and
their feedback to the children could have been confusing and troubling (Tisseron, 2002), although the parents’
ability to establish an emotional distance from the television images may have buffered their impact on the children. Many studies report that when parents have previously been exposed to organized violence or disaster there
is evidence of increased symptoms in their children’s reaction to disaster or traumatic events (Ancharoff, Munroe,
& Fisher, 1998; Danieli & Dingman, 2005; Davidson, Swartz, Storck, Krishnan, & Hammett, 1985; Greene, 2001;
Gurvitch, 2005; Kennedy et al., 2004; Krystal et al., 1998; Nader, 1998). Past experiences and trauma may resurface or be exacerbated when a person looks at images of disaster, potentially resulting in increased psychological
distress. According to Tisseron, such tragic images can also trigger emotionally charged family memories, which
are passed on to the children, especially the younger ones, though on an emotional rather than a verbal level. He
further explains that it is not so much the distinction between reality and fiction that matters to children, but rather
the distinction between an event happening “here” and “elsewhere.” The parents’ emotional response is also very
important.
Laczko and Collett (2004) of the Migration Policy Institute report that “there are approximately 433,000 persons
who were born in the main affected areas (India, Sri Lanka, Thailand, and Indonesia) living in Canada, and far more
Canadian-born who retain family links with the region” (Laczko & Collett, 2004). Although we have no exact figures
for the neighborhood where the research took place, 63.8% of the children in our study were of South Asian origin,
which indicates that many of the parents could very likely have been worried about family members back home.
Furthermore, a high percentage of the families in these communities came to Canada as refugees and may thus have
experienced traumatic events, both human-caused and natural disasters, before emigrating (Gurvitch, 2005; Ton, 2004).
L. Lacroix et al. / The Arts in Psychotherapy 34 (2007) 99–113
101
In our study, 29.5% of children’s families reported having been exposed to persecution before leaving their homeland.
This may have increased the traumatic impact of the tsunami, which would explain why so many children represented
the tsunami disaster in their sand trays.
Emotion and the brain
There is a risk that the brains of young children with unresolved trauma or grief experiences may malfunction and
fail to process emotions properly, so that the children face obstacles in integrating and self-regulating emotions (Cook
et al., 2005; Siegel, 2001). Siegel emphasizes that since the integration process is at the core of mental phenomena, it is
essential to well-being and psychological resilience. Trauma is also responsible for changes to Broca’s area (language
area in the left hemisphere), which result in difficulty verbalizing and narrating past experiences (Van Dalen, 2001,
cited in Steele, 2006). Areas of the right hemisphere located within the orbitofrontal cortex regulate bodily functions,
perceptions and appraisal of emotions (Siegel, 2001; Weinberg, 2006). The orbitofrontal cortex and the amygdala are
clearly involved in memory storage and facilitate emotional experiences associated with two types of memory (van der
Kolk, 1994; Weinberg, 2006), described by Steele (2006) as “implicit” and “explicit.” The first is nonverbal and the
second verbal. Explicit memory uses words to describe what we are thinking and feeling in order to process information,
to reason, and to give meaning to our experiences. Michaescu and Baettig (1996) define implicit (nonverbal) memory
as a process that they call “iconic symbolization,” which gives experience a visual form, allowing it to be retrieved so
“it can be encoded, given a language, and then integrated into consciousness” (Steele, p. 2).
Research suggests that nonverbal expression of emotions and actions has a more immediate effect than the use of
words (Cook et al., 2005; Malchiodi, 2003; Siegel, 1999, 2001) and can be activated through “sensory” interventions
(Steele, 2006). Sand offers a unique tactile and sensory experience, which recalls to most of us our very first play as
a child (Lacroix, 2002). Art, in its different forms (drawing, painting, sand picture making, sculpting, etc.), allows
children to represent their experiences directly or using iconic symbols. Art making then becomes an “effective almost
necessary avenue” (Steele, p. 2) to allow exposed children to release their traumatic experiences and transform implicit
experience into an explicit (cognitive) experience. Such a process implies a restructuring of emotional processing
(Adler-Nevo & Manassis, 2005; Sleek, 1998; Steele, 2006). When children use meaning-creation strategies, they
become able to integrate and self-regulate their emotions.
Sandplay workshop with preschool children
Many play theorists have demonstrated how play allows children to face adversity and destabilizing emotional
experiences by giving them an opportunity to master these feelings (Landreth & Sweeny, 2000; O’Connor, 2000).
Kalff (1973), creator of sandplay, drew her inspiration from Margaret Lowenfeld’s world technique (Lowenfeld,
1935/1969, 1979). In sandplay, children can choose from a vast array of miniature human characters, religious figures,
animals, and objects used for transportation, housing, food, and so on (Lacroix, 2002) with which to create scenes in a
sand tray (Lacroix, 1998). The inside of the sand tray is painted blue, so it can easily represent the sky or ocean. Kalff
(1973) insists on trays of a very specific size, corresponding to the child’s field of vision and facilitating safe immersion
in play. Lacroix (2002) has found that children may organize their sand trays in a variety of ways, to represent either
ideal or troubling situations, or to solve specific problems. Sandplay is a good technique for working with preschool
children, since it offers many opportunities to express a wide range of emotions nonverbally through various uses of
sand (digging, pouring, hiding, burying) (McMahon, 1992; Mitchell & Friedman, 1994).
As it is within the family that children first learn about the wider world, both directly and indirectly, as mediated
by their parents, it is not unusual for preschoolers to create scenes relating to family issues. Many studies suggest that
children’s choices of themes and figurines are associated with gender and developmental stage (Kay & Greenway, 1994;
Mitchell & Friedman, 1994; Sjolund & Schaefer, 1994). Girls often represent the home (including mothers, fathers,
children, food, and fairy-tale characters), whereas boys most frequently represent the outside world (with animals and
soldiers) (Kay & Greenway, 1994; McLoyd, Warren, & Thomas, 1984; Poest, William, Witt, & Atwood, 1989).
Since children 4–6 years old are unable to put their feelings or perceptions of death into words, Malchiodi (2003)
suggests that those who have experienced significant loss express themselves through the imaginative world of symbols
and picture making. Yet children at this developmental stage do not have the skill to draw pictures of complex
experiences, or even to make recognizable drawings of people, animals, or other things. Sandplay offers ready-made
102
L. Lacroix et al. / The Arts in Psychotherapy 34 (2007) 99–113
symbolic objects that they can put together to make a three-dimensional picture that helps them better understand their
or their parents’ experiences of loss.
In telling the stories they had represented in the sand trays, some children were capable of verbalizing at length,
although the structure and context of their stories did, of course, correspond to their developmental stage.
When the project team realized that the children’s play was being strongly influenced by the tsunami, we decided
to analyze the children’s verbal and nonverbal production by asking the following questions:
1. How do preschoolers from a multiethnic neighborhood represent the tsunami in sandplay?
2. What emotions are aroused?
3. What individual or collective coping strategies do children use to work through feelings aroused by such a disaster?
Method
The project was carried out in kindergarten classes of a multiethnic school in Park Extension, a disadvantaged
Montreal neighborhood. Its cheap housing and high turnover have made this neighborhood a favorite of new immigrants.
Until 1980, the area was predominantly Greek. Most recently a large South Asian community has settled in (Rousseau
& Machouf, 2005). Five classes of 4- and 5-year-old children (n = 75) participated in eight sandplay sessions. The
project was approved by the Research Ethics Board of the Montreal Children’s Hospital. Parental consent was obtained
for 58 children, so the refusal rate was 23%. Each class attended the sandplay workshop every second week over a
period of 4 months. The 60-min sessions were part of the regular school day.
As the opening ritual for each session, the children sat in a circle to sing an action song selected by the teacher.
Next the children would create their own little worlds in their sand trays. Plays was nondirected, although sometimes
a theme was suggested, which they could use if they wished. Two children were assigned per sand tray. There was
a divider in the middle, which could be removed by either child if they wished to work together. Themes that were
explored were family, siblings, transportation to school, language spoken at home, seasons, favorite animal, favorite
food, and favorite feast or celebration. The children were then invited to tell a story about the pictures they had created.
The closing ritual was another action song.
Each group consisted of four children and an art therapist. The children were given an opportunity to play individually
or with the other children in their group, using verbal and nonverbal expression. They could choose from a variety of
traditional sandplay figurines: people, animals, vehicles, housing, food, religious figures, and so on.
The results of an earlier pilot project had shown, however, that a relative lack of multicultural figurines limited the
children’s ability to create other than host country scenes, so we added a number of culturally diverse spiritual symbols
and everyday figurines: different types of housing, people in national costume, flags of different countries, and houses
of worship and deities of several religions. The main countries of origin of the 58 children were Pakistan (11), Sri
Lanka (9), India (8), Bangladesh (7), Ghana (4), Morocco (2), Tunisia (2), and Haiti (2). Some families had come as
immigrants through regular channels, others as refugees.
Photographs of each sand tray were analyzed using a checklist to describe the content and structure of the scenes.
During the sessions, each child’s affect while creating the scene and telling the story was noted, as was whether he
or she selected the figurines specifically, randomly, or with great emotional investment. The children’s stories were
transcribed and underwent content analysis.
Symbols used in story, myth, spontaneous creation, play, and dreams serve as tangible signs of a different kind
of reality (Kast, 1992; Zittoun, Duveen, Gillespie, Ivinson, & Psaltis, 2003). Each figurine in the sand tray can have
a number of different meanings, but the child provides the first interpretation of the scene. There are three levels of
symbolism: the first one is associated with the child’s personal history, the second with the culture, and the third is
more universal or archetypal (Enns & Kasai, 2003).
General results
Representation of tsunami
Close to a third of the children depicted the tsunami, often over long periods (up to 4 months), and they made
extensive use of religious figurines. A total of 29% of the children represented the tsunami, 9% of them directly (the
L. Lacroix et al. / The Arts in Psychotherapy 34 (2007) 99–113
103
tsunami itself, devastating floods, or babies who ended up in trees or on rooftops) and 20% indirectly (sea monsters
devouring people and animals; cars, houses, and other things hidden in the sand).
Nonverbal representation
The figurines used to represent death were skeletons, tortured people, dead people, dismembered bodies, coffins, and
crosses. Adversity was represented by a variety of figurines, such as monsters (dragons and sea monsters), anthropomorphic animals, sorcerers, soldiers, and a number of dangerous animals, including scorpions, lions, sharks, dinosaurs,
octopuses, spiders, and snakes. Supernatural or divine figures, with and without assigned roles (sometimes to blame,
sometimes rescuers) were symbolized by fairies, the Silver Surfer, flying carpets, deities of different religions, angels,
mausoleums, the Taj Mahal, temples, and churches. Chaos and destruction were represented by turning houses, cars,
and miscellaneous objects upside-down. Many bodies and cars were buried in the sand, and different objects and
characters were hidden in wooden boxes, under carpets, or inside furniture.
Verbal representation
When telling their stories, children often commented on their sand tray scenes, emphasizing certain aspects, minimizing others. They sometimes talked about the destruction and how it happened by saying things like “This is a
tsunami,” “Everything was destroyed or broken,” “Everyone is dead,” or “People died in the water.”
Children situated the disaster in any or all of three different ways: (1) identifying with the situation by saying “This is
happening in Sri Lanka,” (2) distancing themselves from it by saying “This is happening in Vietnam” or some unknown
place, or (3) displaying signs of fear that the tsunami could happen here by saying “This is happening in Canada.” The
feeling of proximity may have been linked to the real proximity of their parents’ worries and of the omnipresent TV
images.
Other children assigned blame or made sense of what happened by saying “God is responsible for all that,” “The
monsters and scorpions are eating everyone,” or “The sorcerers were turning live people into dead ones.” In some cases,
children said that the people were praying to God.
Emotions
Most of the time, the children were very enthusiastic about their stories and pleased with their sand creations. Direct
expressions of distress were rare, but the main negative emotions were sadness, followed by anxiety. Indirect expression
of emotion, allowing distance and protection from reexperiencing distress or anxiety (including transgenerationally
transmitted distress or anxiety), was mainly through angry characters in the sand tray. Children were able to come to
terms with traumatic events and transform them symbolically without emotional charge.
Coping strategies
The children expressed religious and spiritual themes with the use of traditional figures such as the Hindu gods
Shiva and Ganesha, along with many deities and angels who rescued people and animals. The figurine most often
employed as a savior to take people away from the disaster zone was the Silver Surfer, a Marvel Comics superhero
(Silver Surfer, 2005). Magic carpets were also used to transport characters away from the affected area. Mainstream
cultural and significant objects or animals were also used at times: snake, spider, donkey, and the Islamic crescent
moon.
Other rescuers were protective human figures, such as police officers, fire fighters, and soldiers, along with mythic
and heroic figures, such as Harry Potter, Jackie Chan, Batman, Superman, and Mickey Mouse.
Technology – helicopters, ambulances, fire trucks, and bridges – was also used as a means of escape. Nature was
depicted as a safe place through the use of mountains, trees, elephants, and Simba the lion, from the movie The Lion
King.
Tsunami representation as an echo of the child’s personal, family and community experience
We considered the children in light of four categories based on family homeland and psychological affinity to the
tsunami experience: (1) first-generation immigrant children from an affected area, (2) second-generation immigrant
104
L. Lacroix et al. / The Arts in Psychotherapy 34 (2007) 99–113
Fig. 1. There were many dead bodies close to the castle.
children whose families were from an affected area, (3) immigrant children from other regions for whom the tsunami
echoed their own anxieties about dislocation, and (4) immigrant children from other regions in whom the tsunami
triggered memories of traumatic events in their family or homeland.
Immigrant children from affected area
Rohan, a 6-year-old Hindu boy, immigrated to Canada from Sri Lanka when he was 2. At home he behaves well,
prefers to play alone, and sometimes feels restless. He is easily distracted and nervous in new situations and loses
confidence. He has had these symptoms for the past 6–12 months. His family has not yet been reunited. At school he
is described as an achiever, although disruptive, agitated, and restless.
In his first sand tray (Fig. 1), Rohan placed many dead or fallen bodies, skeletons, a Taj Mahal, an elephant, a
samurai, anthropomorphic sea creatures, a snowy conifer, and miscellaneous other figurines. The tray was purposefully
disorganized to represent destruction. He did not use the word “tsunami” in his story, but said that those who were
not dead were praying to God: “There was a skeleton. There were many dead bodies close to the castle. The other
people were praying to God.” Representing the people as praying seems to suggest that people’s relationship to God
will protect them from disaster, or perhaps a way for them to work through their suffering.
In his second sand tray (Fig. 2), Rohan again placed skeletons and dead bodies, adding a fire truck, ambulances, and
soldiers. In the middle was Shiva, and nearby the Silver Surfer, carrying a baby. The tray was well organized. Rohan
told this story:
The sorcerer attacked a man and will transform him into a skeleton. Mickey Mouse tells Shiva that the silver man
is about to save the baby. He is running and sees dead soldiers. Later on the police arrive and find the sorcerer
Fig. 2. The sorcerer attacked a man.
L. Lacroix et al. / The Arts in Psychotherapy 34 (2007) 99–113
105
dead. The angel [transparent, top left] is saying that the world will die and the only survivor will be the little boy
[green] talking to the angel [top left].
In this tale about disaster and survival, praying (and perhaps communicating with the angel) will save the little boy.
Although there were several rescuers (the fire truck, ambulances, Shiva, and the Silver Surfer) in the scene, Rohan
remained very anxious when telling his story.
In his third sand tray, Rohan showed a strong attachment to the Ganesha figure, explaining: “There was a country
full of bad people and everyone is dead. It is a story about death, and I don’t know anyone.” This tray was about many
deaths and there was no rescue. In saying that the country was “full of bad people” who died, he used the same moral
framework of evil and good as in his previous tray, when he said that those who were praying were safe, to make sense
of the events and symbolically protect himself and his family from the possibility of further trauma.
His fourth sand tray included two Ganesha figures facing each other. This time death was mentioned in the story
of an accident. In the fifth sand tray, adversity was again the prominent theme, with very little representation of a
rescuer. For the first time, however, Rohan clearly said, “This is happening in Sri Lanka.” In the sixth sand tray, Rohan
shifted the adversity and ongoing death theme by saying, “This is happening in Canada.” This could be interpreted as
a strategy to protect his people in Sri Lanka by removing the threat, or as an expression of fear of a possible repetition
of the disaster in Canada.
Rohan was absent for the seventh session. His last sand tray (Fig. 3) was the most organized, with soldiers in rows.
Once again there were skeletons, the Silver Surfer, a sorcerer and two babies. His last story explained: “The men could
not kill the sorcerer, but the soldiers know each other and are friends. They can defend against the sorcerers. The
Chinese man [samurai] is protecting the baby from the pig. The skeletons are making faces.” Although still alluding
to numerous threats, this story does not directly involve death, but rather solidarity among peers (soldiers) and the
successful protection of children by an adult figure.
Through the sandplay scenarios, Rohan was able to freely express some of his fears and anxieties, which he
may have picked up from his parent’s worries about their family members or relatives in their homeland. Many
children who experience direct or indirect loss do not even begin to grieve, because it may be implicitly forbidden to
speak about the loss in their family, and they may thus fear being overcome with terrifying thoughts (Ayyash-Abdo,
2001; Cohen, Mannarino, Greenberg, Padlo, & Shipley, 2002). Rohan took advantage of the nonverbal and verbal
process to reenact some aspects of the natural disaster and work through his associated emotions. He was able to
find some meaning in the tragedy by indirectly suggesting that it might be a punishment for bad people and that
prayer could be protective, and to imagine a number of survival strategies involving different rescuers. His remark in
the last session that the skeletons were making faces may suggest that the idea of death was less anxiety-inducing.
Fig. 3. The men could not kill the sorcerer.
106
L. Lacroix et al. / The Arts in Psychotherapy 34 (2007) 99–113
Fig. 4. God makes the truck sink into the sand.
His coping strategies were mainly spiritual, depending on divine figures such as Shiva (known as the “giver” god),
Ganesha (the god of knowledge, the creator and remover of obstacles), and an angel, but some were human, relying
on soldiers and fire trucks to come to the rescue. These survival strategies appeared to be partially successful as the
baby, probably Rohan’s self-projection, survived in every sand tray with the assistance of the various divine and human
rescuers.
Second generation children from affected areas
Vikas is a 5-year-old Hindu boy, born in Canada to Sri Lankan parents. At home he behaves well and is very active,
but he is easily distracted, nervous, or clingy in new situations, and he loses his self-confidence. His family has not
yet been reunited. At school he is described as compliant, affectionate, enjoyable, nice to other children, yet agitated,
restless, and anxious.
In his first sand tray (Fig. 4), Ganesha was in the center, surrounded by many other figurines, including a Vietnamese
flag. Shiva was also included, but was taken out of the tray at the end. When narrating his story, Vikas said: “The fire
truck, which is very heavy, arrives, but God makes it sink into the sand. The king found rocks and skeletons in the sand.
At the end all the cars in the sand hit the dragon.” In this story, Ganesha was responsible for causing the accident. The
skeletons in the sand indirectly suggested the tsunami. There was no rescue represented.
For his second sand tray, Vikas recounted: “Later on, the helicopter came to rescue all the friends and a man who
lost his mother. At the end, the grandfather [the man who lost his mother] is dead, and all the friends, as well.” Although
there were now rescuers, there were still no survivors.
Vikas filled his third sand tray with cars, ambulances, fire trucks, police cars, a variety of animal figures, and a
dragon. This was his story:
All the vehicles were in the garage, but there was a problem because the dragon wanted to set them all on fire.
The animals wanted to kill the dragon and the frog had an idea. The frog tells the dragon not to do it and to close
his eyes. Meanwhile all the animals are throwing balls at the dragon, and the police joined them with a tractor
full of sand and threw it on the dragon, who didn’t like it. It worked because the dragon dies. The lion tells the
spider to throw sand on the dragon then to set it on fire, then the dragon dies. This is happening in Canada.
Although the return of the dragon means a repetition of adversity, all the characters unite to destroy the dragon.
Like Rohan, Vikas preferred to set his story in Canada. This can be interpreted as either protecting Sri Lanka or a fear
of traumatic repetition.
Vikas continued to create similar scenes in his next three sand trays. The fourth, fifth, and sixth sand trays involved
adversity, represented by fights with animals, and the deaths of many people. The location of the disaster clearly shifted,
starting with the third sand tray, when it took place in Canada. It moved closer in the fourth tray, which was set in
Montreal, and then in the fifth one, it had moved again, this time to “a faraway country.”
The seventh sand tray was again filled with many rescue vehicles. For the first time, despite adversity, there were
many survivors and several bad people were caught.
L. Lacroix et al. / The Arts in Psychotherapy 34 (2007) 99–113
107
Fig. 5. Airplanes want to attack the sorcerers.
The eighth sand tray (Fig. 5), was very well organized; all the vehicles were placed in rows. It also included a hidden
treasure (not visible in the picture), and a magic carpet. Vikas told this story:
The airplanes are next to the cars because they want to attack the sorcerers. There was a magic carpet and a
treasure. The sorcerers wanted to steal the treasure, but the bad people will attack them with the airplanes. The
magic carpet can fly everyone but the sorcerers. The magic carpet left and soldiers attacked the sorcerers that
finally died because friends were helping with the attack.
Although adversity was still present, more strategic avenues, such as the magic carpet and soldiers, played the role
of rescuers. The treasure could have a number of symbolic meanings. In the literature on sandplay and symbolism, it is
often seen as a route to spirituality, a positive symbol (Bradway & McCoard, 1997; Cooper, 1978). Since a treasure is
usually found after a long journey fraught with trials and hardship, Vikas may have been approaching a more peaceful
state.
The shifting location of the disaster and the different fight scenes enacted over eight sessions may illustrate Vikas’s
struggle to find a means of coming to terms with the situation. He used a variety of coping strategies through the
process: (1) protective figures such as soldiers and police officers were sometimes rescuers; (2) mythic figures such
as Jackie Chan, Harry Potter, and the Silver Surfer were also rescuers; (3) magic objects such as the flying carpet
took people away from the adversity. Unlike Rohan, who used several different divine helping figures, Vikas may
intentionally have given up on divine intervention, since he only used religious figurines in the first session, when he
attributed responsibility to Ganesha and ended by taking Shiva out of the sand tray. Although each story had the same
overtones of fighting, there was a slow progression throughout the sessions, as the number of survivors increased.
Immigrant children for whom the tsunami echoed their own anxieties
Ali is a 5-year-old boy, born in Canada to Tunisian Muslim parents. At home he is described as being oversensitive,
often distracted, worried, and anxious. Sometimes he is unhappy, cries once in a while, and is fearful. At school he
suffers from stomachaches, and is agitated, isolated, and anxious. He is distracted and easily frustrated and cannot
concentrate; he fights with other children and loses control in new situations. He is described as rarely happy.
For his first tray (Fig. 6), Ali slowly selected specific figurines, including Shiva, Ganesha, and many other deities
from different religions, and placed them in a very organized pattern. His story was that “God wanted everything, all
the skeletons and other people, to fall down.” He may have been referring to the tsunami, which was interpreted by
some communities as an act of God.
All his subsequent sand trays portrayed scenes of death involving people or animals with few, if any, protective,
elements.
108
L. Lacroix et al. / The Arts in Psychotherapy 34 (2007) 99–113
Fig. 6. God wanted all to fall down.
The eighth sand tray was used solely by Ali, who was unwilling to share the space with anyone else. Once again
animals played a large role, but this time, there were also rescue cars in the tray. Ali first said: “The army tank is
killing all the animals because it wants to get ahead.” He then went to tell a second story: “There is an accident and the
motorcycle is on fire. The skeleton is killing the whole army and the animals, but the octopus is killing the skeleton.
Only the lion survives, because he was hiding under the mountain. He comes out and then all the animals come back
to life.” This was the first story in which Ali said that all the animals came back to life, which is the standard concept
of death for his developmental stage.
Ali expressed a state of anxiety in all his trays, depicting the deaths of people and animals. It was not until the end
of the entire process that Ali gradually, at his own pace, had began to include elements of resilience. Although the link
between Ali’s anxiety and the tsunami may not obvious, it is possible that the tsunami, suggested indirectly in the first
tray, may have increased Ali’s pervasive feeling of insecurity.
Immigrant children for whom the tsunami triggered memories of trauma
Angeline is a 5-year-old girl from a Catholic family. She was born in Canada to Haitian parents. At home she is
described as a good child who suffers from stomachaches, gets angry easily, is anxious and unhappy, cries often, and
fights once in a while. She is jealous of a newborn sibling at home. At school she acts differently. She is willing to help
other children, stable, thoughtful, and a model student, although she occasionally lies and cheats.
This vignette shows how the tsunami triggered a direct memory of a previous trauma: the flooding in Gonaives,
Haiti, in the fall of 2004.
In her first sand tray, Angeline used six houses, including some with snow on them, a Haitian flag, a Taj Mahal and
a cross. She put a coffin on the right-hand side of the tray. She explained:
This story is happening in two countries. The boy was playing basketball and didn’t know where Santa Claus
was. He went back home, touched an electric wire, got hurt, saw the butterfly falling down, picked it up and took
it home. His mother tells him she doesn’t want the butterfly at home. He hides it under his bed. He takes the flag
and puts it in another country. His mother is very, very angry.
In her story, Angeline said nothing of the tsunami or flood, but in her tray, the presence of both the Haitian flag and
the Taj Mahal supported her statement that it was happening in two countries.
The second tray centered on mother-child issues and conflict. The third sand tray (Fig. 7) featured many feathers,
four parasols, and three buried skeletons. Angeline told this story:
L. Lacroix et al. / The Arts in Psychotherapy 34 (2007) 99–113
109
Fig. 7. This is a country of feathers.
This is a country of feathers. He (pointing to the samurai) wants to eat the girl, he is too low and the girl was
protecting herself from the sun. He climbs the mountain and then flies to the bottom and finally eats the girl. He
then walked until he met the feathers; he sneezed and lost his road. He walked and walked a very long period
and he saw skeletons, he then dug into the earth to find his friends. He found one of his friends dead and buried
him. The next day he went home. There was a lot of rain. He’s carrying umbrellas to protect the dead body.
This scene quite directly depicts what happened both in South Asia and Haiti: searching for the bodies of relatives
and friends.
The fifth sand tray was organized with streets, and houses of different cultures. There was a Taj Mahal, standing
cutouts of the Taj Mahal, and various other religious images, including Christ and the Virgin Mary, a carpet covering an
Easter egg, a cross, a bridge with a butterfly on top, the flags of Ireland and Iran, and a little girl. Angeline told this story:
The little girl will find the egg hidden under the carpet and will eat it. She didn’t listen to her mother and she
went far away from home. She went to the wonderful castle (Taj Mahal), but no child was allowed to enter it.
After a while, she left and found a wounded butterfly that couldn’t fly anymore. The girl took the butterfly home,
but when she got there, she found her parents quite worried and not happy at all. The white cross shows where
the egg is hidden. Later on, the mother goes with the girl to get another egg that they will eat for lunch. There is
the Lord who tells the children where to find the egg.
The recurrent theme of the wounded butterfly may refer to her wounded soul, but the little girl’s ability to find an
egg (food), that is, to be fed and helped by her mother in spite of everything, may demonstrate her resiliency.
Angeline’s sixth sand tray was very well organized and showed the interior of a house. There were mothers and
babies in their cradles. For this sand tray her story was this:
Today my mother wanted to go somewhere. She wanted to eat and she cooked eggs and had chocolate. Later
on, my mother sent me to bed. There was rain and the sound of a big boom coming from the earth. Then my
mother’s friend and my friend came home and we all went to a restaurant. This was happening in Vietnam.
Angeline clearly made the story her own, casting herself and her close friends as the characters. Although there
was some evidence of Angeline’s personal conflicts, which may also be understood as an internal tsunami, there was
a continuing reference to natural disaster.
This continued in the seventh sand tray, where Angeline made the direct link to Sri Lanka:
The lady has a magic wand. She does magic and then the wand falls in the water. There’s a big explosion in the
sea. The mermaid finds the magic wand on her tail. The woman goes to get the baby. The other woman and her
daughter sit down to watch television while the mum makes supper. A bee stings the girl. This story takes place
in Sri Lanka.
110
L. Lacroix et al. / The Arts in Psychotherapy 34 (2007) 99–113
The last tray included elements from all the previous trays: the coffin, the carpet, standing cutouts of houses from
a variety of cultures, the Taj Mahal. In the center of the tray sat a blue butterfly. Angeline told her story:
She [the girl] wants to get in the kitchen, but doesn’t know where it is. She opens a door, finds it, and eats. She
sees the butterfly and brings it to her bedroom. She sits and plays, looks at the lion, and goes to bed.
In this sand tray and story, there is no anger, death or threat, and there is no wounded butterfly; the little girl finds
the “food” and goes to bed without a warning from her mother.
Angeline seems to have been able to start working through both the external reality of the natural disaster and her
own conflicts. There were shifts back and forth between here and far away in the location of the stories, which were
set variously in Sri Lanka, Haiti, Vietnam, Canada, and close to Canada; between different emotions and ambiguities
associated with the loving, caring mother and the angry, dangerous mother; between the lack of food and abundance of
it. Angeline used metaphor, the wounded butterfly and the bee that stings the girl, for instance, to talk about her feelings.
The natural disasters – the big boom inside the earth and the explosion in the sea – echoed her internal emotional state.
She made use of different coping strategies, specifically the umbrellas for better protection, and religious strategies.
The gradually increasing availability of food from sand tray to sand tray, and the girl’s increasing ability to be fed and
to fend for herself could be seen as greater acceptance of her newborn sibling and a partial resolution of her anger
towards her mother.
Discussion
Our results suggest that sandplay affords children an opportunity to express and work through a range of emotions
stemming from the interaction of a variety of past and present experiences. This confirms the observation that creative
expression activities in the classroom can provide a space for symbolic expression and playful exploration, which can
enhance resiliency factors (Ayyash-Abdo, 2001; Malchiodi, 2003; Rousseau, Bagilishya, Heusch, & Lacroix, 1999;
Rousseau, Benoit, et al., 2004; Rousseau, Lacroix, et al., 1999; Rousseau, Lacroix, Singh, Gauthier, & Benoit, 2005;
Rousseau, Lacroix, Singh, et al., 2005; Waaktaar, Christie, Borge, & Torgersen, 2004).
Using figurines and sand, a large number of preschoolers represented the tsunami, directly or indirectly, through
numerous stories of death and disappearance. Contrary to many claims that preschoolers (3–5 years old) do not
understand the irreversibility of death (Ayyash-Abdo, 2001; Cohen et al., 2002; Hilarski, 2004; Melvin & Lukeman,
2000), in most of the stories invented by the children in our study, death was, in fact, irreversible. Some authors suggest
that children who have experienced many losses in the past can develop a greater awareness of death and have a more
mature representation and understanding of death. Since they know from experience that magic cannot undo death, the
concept of permanency may be established sooner than for their peers (Ayyash-Abdo, 2001; Cohen et al., 2002). In an
earlier sandplay pilot project with preschoolers in a similar environment, we found that their representations of death
differed from those of their host-country peers and hypothesized that the transgenerational transmission of trauma and
loss may account for this greater maturity. In the present case, exposure to the tsunami on the television and through
the family’s reactions to it may have further accentuated these phenomena, thus resulting in the repetition and often
quite hopeless representation of death.
Many of the children used the sandplay in various ways to makes sense of death and disaster. Danger was omnipresent
and could be in the form of human beings (soldiers), although for most children, it was probably safer to represent it
metaphorically with monsters, supernatural and wild animals, and sorcerers. Typical age-appropriate moral development was evidenced: good and evil figures clash. The frequent references to God in the stories and the omnipresence
of religious imagery in the sand tray underscore the importance of religion and spirituality in these children’s families. Their citing of “God’s will” as an explanation of the tsunami echoes a sentiment commonly expressed by adults
in the South Asian communities, thus illustrating the strength and sophistication of parental transmission to these
preschoolers. Most of the teachers were surprised by this finding. Volkan (2001) observed a fluidity between the
psychic borders of mother and child, allowing transmission of anxiety, unconscious fantasies, perceptions, fears, and
other feelings about the external world. These conscious and unconscious transmissions may occur through different
channels (Kellerhals, Ferreira, & Perrenoud, 2002). These transmissions contribute to a solid identity (Brunschwig,
1992) and in most cases benefit children, although they may sometimes be a source of pathology or trauma (Bacqué,
2003; Moro, 2002; Volkan, 2001). In this case, the workshops provided an opportunity to bridge the gap between the
way the tsunami was understood at home and the way it was handled at school, where the teachers preferred not to
L. Lacroix et al. / The Arts in Psychotherapy 34 (2007) 99–113
111
address the event directly. The tsunami clearly aroused a range of emotions, depending on the children’s relationship
to the geographical regions affected, but also past or present adversity in their lives. Sometimes – as in the case of
Angeline – the tsunami triggered anxieties linked to a similar traumatic event. In other cases, the effects of the disaster
overlapped with a pervasive anxiety stemming from the uncertainties of the postmigration context.
The children used a number of coping strategies. Although, in a few cases, adversity was overcome with personal
strength and courage, or interpersonal connections and solidarity, most often rescuers were involved. They were of
two main types: humans whose social roles invested them with symbolic importance (fire fighters, for example) or
magical and spiritual beings from the homeland or host country. The use of protective elements from both cultures is
particularly interesting. It may stem from children’s need to build a bridge between their two worlds and to belong to
both. In earlier work, we observed that elementary schoolchildren who used only symbols borrowed from mainstream
culture sometimes had trouble in school dealing with in other areas of their lives (Rousseau, Lacroix, Bagilishya, &
Heusch, 2003). It is interesting to note that the hybridization of symbolic worlds begins as early as kindergarten and
that it appears to play a central role in reconstruction strategies for these very young children.
In the Western world, it is generally thought that children living in families with sound communication systems
and having the opportunity and ability to freely express their feelings about loss will be in a better position to make
sense of their experiences (Melvin & Lukeman, 2000). In other cultures, community and parental transmission of
experiences (filiation), if they can be worked through in various ways, can be very positive at different developmental
stages (Rousseau, Drapeau, & Corin, 1998). For immigrant children, host society institutions, particularly schools,
play a key role in external transmission (affiliation). Schools, with the right approach, could also provide a space where
it would be possible to work through those feelings, allowing support for the family’s internal transmission, rather than
complicating it (Moro, 2002).
Conclusion
When the school requests creative expression workshops to be held regularly over a period of time (4 months
in this case), with the strong involvement and support of both the administration and teachers, it underscores the
need to provide a safe place for immigrant children to express themselves. Sandplay workshops, which are suited to
kindergarten children’s developmental stage, offer opportunities for both verbal and nonverbal expression and thus for
working through emotions aroused by natural disaster and loss, and offer a means to develop strategies to overcome
adversity and psychological distress. One important question that remains is how schools can realistically incorporate
these workshops without a large team of health-care workers.
References
Adler-Nevo, G., & Manassis, K. (2005). Psychosocial treatment of pediatric posttraumatic stress disorder: The neglected field of single-incident
trauma. Depression and Anxiety, 22, 177–189.
Ancharoff, M. R., Munroe, J. F., & Fisher, L. M. (1998). The legacy of combat trauma. In Y. Danieli (Ed.), International handbook of multigenerational
legacies of trauma (pp. 257–276). New York: Plenum Press.
Ayyash-Abdo, H. (2001). Childhood bereavement: What school psychologists need to know. School Psychology International, 22(4), 417–433.
Bacqué, M. (2003). L’enfant en deuil est-il nécessairement déprimé? Critères d’évaluation du chagrin. In B. Cyrulnik, & C. Seron (Eds.), La
résilience ou comment renaı̂tre de sa souffrance? (pp. 235–248). Paris: Éditions Fabert.
Bradway, K., & McCoard, B. (1997). Sandplay: Silent workshop of the psyche. London: Routledge.
Brunschwig, H. (1992). Passions de famille. Paris: Payot.
Cohen, J., Mannarino, A., Greenberg, T., Padlo, S., & Shipley, C. (2002). Childhood traumatic grief: Concepts and controversies. Trauma, Violence
and Abuse, 3(4), 307–327.
Cohen, M. (2005). Strategic communications and mental health: The WTC attacks, 1933 and 2001. In Y. Danieli, & R. L. Dingman (Eds.), On the
ground after September 11: Mental health responses and practical knowledge gained (pp. 130–136). New York: Haworth Maltreatment and
Trauma Press.
Cook, A., Spinazzola, J., Ford, J., Lanktree, C., Blaustein, M., Cloitre, M., et al. (2005). Complex trauma in children and adolescents. Psychiatric
Annals, 35(5), 390–398.
Cooper, J. (1978). An illustrated encyclopedia of traditional symbols. London: Thames and Hudson.
Danieli, Y., & Dingman, R. L. (2005). The schedule of loss and sorrow. In Y. Danieli, & R. L. Dingman (Eds.), On the ground after September 11:
Mental health responses and practical knowledge gained (pp. 1–15). New York: Haworth Maltreatment and Trauma Press.
Davidson, J., Swartz, M., Storck, M., Krishnan, R. R., & Hammett, E. (1985). A diagnostic and family study of posttraumatic stress disorder.
American Journal of Psychiatry, 142(1), 90–93.
112
L. Lacroix et al. / The Arts in Psychotherapy 34 (2007) 99–113
DiPietro, J. (1981). Rough and tumble play: A function of gender. Developmental Psychology, 17, 50–58.
Enns, C. Z., & Kasai, M. (2003). Hakoniwa: Japanese sandplay therapy. Counseling Psychologist, 31(1), 93–112.
Greene, M. G. (2001). After a crisis: Helping families cope with trauma. Retrieved June 16, 2006, from http://hippyusa.org/Parents/
trauma guide.html.
Gurvitch, A. (2005). What did we learn? A call to action to improve immigrants’ access to mental health services. In Y. Danieli, & R. L. Dingman
(Eds.), On the ground after September 11: Mental health responses and practical knowledge gained (pp. 541–550). New York: Haworth
Maltreatment and Trauma Press.
Hilarski, C. (2004). Unresolved grief. In L. Rapp-Paglicci, C. Dulmus, & J. Wodarski (Eds.), Handbook of preventive interventions for children and
adolescents (pp. 49–65). Hoboken, NJ: John Wiley & Sons.
Kalff, D. (1973). Le jeu de sable. Paris: Epi.
Kast, V. (1992). The dynamic of symbols: Fundamentals of Jungian psychotherapy. New York: Fromm International.
Kay, A., & Greenway, A. P. (1994). The assessment of object relations and object representations in children’s world play. British Journal of
Projective Psychology, 39(1), 35–49.
Kellerhals, J., Ferreira, C., & Perrenoud, D. (2002). Kinship cultures and identity transmission. Current Sociology, 50(2), 213–228.
Kennedy, C., Charlesworth, A., & Chen, J. L. (2004). Disaster at a distance: Impact of 9.11.01 televised news coverage on mothers’ and children’s
health. Journal of Pediatric Nursing, 19(5), 329–339.
Krystal, J. H., Nagy, L., Rasmusson, A., Morgan, A., Cottrol, C., Southwick, S. M., et al. (1998). Initial clinical evidence of genetic contributions
to posttraumatic stress disorder. In Y. Danieli (Ed.), International handbook of multigenerational legacies of trauma (pp. 657–667). New York:
Plenum Press.
Lacroix, L. (1998). Revendication de l’identité chez une fillette sud-américaine adoptée: Une démarche par l’art-thérapie. Prisme, 8(3), 150–159.
Lacroix, L. (2002). Créativité sensorielle par l’utilisation du jeu de sable en art-thérapie. Prisme, 37, 32–45.
Laczko, F., & Collett, E. (2004). Assessing the tsunami’s effects on migration. Retrieved April 1, 2005, from http://www.migrationinformation.org/
Feature/display.cfm?id=299.
Landreth, G., & Sweeny, D. S. (2000). Child-centered play therapy. In K. O’Connor, & L. Braverman (Eds.), Play therapy: Theory and practice. A
comprehensive presentation (pp. 17–45). New York: John Wiley & Sons.
Lazarus, P., Jimerson, S., & Brock, S. (2003). Responding to natural disasters: Helping children and families. Information for school crisis teams.
Retrieved July 18, 2005, from http://www.nasponline.org/NEAT/naturaldisaster teams ho.pdf.
Lengua, L. J., Long, A., Smith, K. I., & Meltzoff, A. N. (2005). Pre-attack symptomatology and temperament as predicators of children’s responses
to the September 11 terrorist attacks. Journal of Child Psychology and Psychiatry, 46(6), 631–645.
Liss, M. (1983). Social and cognitive skills: Sex roles and children’s play. New York: Academic Press.
Lowenfeld, M. (1969). Play in childhood. London: Victor Gollancz (Original work published 1935).
Lowenfeld, M. (1979). The world technique. London: George Allen & Unwin.
Malchiodi, C. (2003). Using creative activities as intervention for grieving children. Retrieved October 1, 2005, from http://www.tlcinst.
org/creative.html.
McLoyd, V., Warren, D., & Thomas, E. (1984). Anticipatory and fantastic role enactment in preschool triads. Developmental Psychology, 20,
807–814.
McMahon, L. (1992). The handbook of play therapy. New York: Routledge.
Melvin, D., & Lukeman, D. (2000). Bereavement: A framework for those working with children. Clinical Child Psychology and Psychiatry, 5(4),
521–539.
Michaescu, G., & Baettig, D. (1996). An integrated model of post-traumatic stress disorder. European Journal of Psychiatry, 10(4),
243–245.
Mitchell, R. R., & Friedman, H. S. (1994). Sandplay: Past, present and future. London: Routledge.
Moro, M. R. (2002). Enfants d’ici venus d’ailleurs: Naı̂tre et grandir en France. Paris: La Découverte.
Nader, K. (1998). Violence. In Y. Danieli (Ed.), International handbook of multigenerational legacies of trauma (pp. 571–583). New York: Plenum
Press.
National Child Traumatic Stress Network (2005). Terrorism and disaster branch formed within the National Child Traumatic Stress Network.
Retrieved January 13, 2005, from http://www.nctsnet.org/nctsn assets/pdfs/feature stories/tdb.pdf.
National Institute of Mental Health (2000). Helping children and adolescents cope with violence and disasters: Fact sheet. Retrieved July 18, 2005,
from http://www.nimh.nih.gov/publicat/NIMHviolence.pdf.
O’Connor, K. (2000). The play therapy primer. New York: John Wiley & Sons.
Pfefferbaum, B., Robin, J. D., Gurwitch, H., McDonald, N. B., Leftwich, M. J. T., Sconzo, G. M., et al. (2000). Posttraumatic stress among young
children after the death of a friend or acquaintance in a terrorist bombing. Psychiatric Services, 51, 386–388.
Poest, C., William, J., Witt, D., & Atwood, M. (1989). Physical activity patterns of preschool children. Early Childhood Research Quarterly, 4,
367–376.
Rousseau, C., Bagilishya, D., Heusch, N., & Lacroix, L. (1999). Jouer en classe autour d’une histoire. Ateliers d’expression créatrice pour les enfants
immigrants exposés à la violence sociale. Prisme, 28, 88–103.
Rousseau, C., Benoit, M., Gauthier, M.-F., Lacroix, L., Alain, N., Viger Rojas, M., et al. (2004). Drama therapy workshops for adolescent immigrants
and refugees. In Paper presented at the 20th annual meeting of the international society for traumatic stress studies.
Rousseau, C., Drapeau, A., & Corin, E. (1998). Risk and protective factors in Central American and Southeast Asian refugee children. Journal of
Refugee Studies, 11(1), 20–37.
Rousseau, C., Lacroix, L., Bagilishya, D., & Heusch, N. (1999). Atelier d’expression créatrice en milieu scolaire pour les enfants immigrants et
réfugiés. In Report to schools. Montreal: Montreal Children’s Hospital.
L. Lacroix et al. / The Arts in Psychotherapy 34 (2007) 99–113
113
Rousseau, C., Lacroix, L., Bagilishya, D., & Heusch, N. (2003). Working with myths: Creative expression workshops for immigrant and refugee
children in a school setting. Journal of the American Art Therapy Association, 20(1), 3–10.
Rousseau, C., Lacroix, L., Singh, A., Gauthier, M.-F., & Benoit, M. (2005). Creative expression workshops in school: Prevention programs for
immigrant and refugee children. Canadian Child and Adolescent Psychiatry Review, 14(3), 82–85.
Rousseau, C., Lacroix, L., Singh, A., et al. (2005). Sandplay workshops for refugee and immigrant children in kindergarten. In Paper presented at
the bi-annual conference of the Ontario art therapy association, healing art: coping with trauma and loss.
Rousseau, C., & Machouf, A. (2005). A preventive pilot project addressing multiethnic tensions in the wake of the Iraq war. American Journal of
Orthopsychiatry, 75(4).
Rousseau, C., Singh, A., Lacroix, L., Bagilishya, D., & Measham, T. (2004). Creative expression workshops for immigrant and refugee children:
Clinical perspectives. Journal of the American Academy of Child and Adolescent Psychiatry, 43(2), 235–238.
Siegel, D. J. (1999). The developing mind: How relationships and the brain interact to shape who we are. New York: Guilford Press.
Siegel, D. J. (2001). Toward an interpersonal neurobiology of the developing mind: Attachment relationships, “mindsight,” and neural integration.
Infant Mental Health Journal, 22(1/2), 67–94.
Silver Surfer (2005). Retrieved December 7, 2005, from http://en.wikipedia.org/wiki/Silver Surfer.
Sjolund, M., & Schaefer, C. (1994). The Erica method of sand play diagnosis and assessment. In K. J. O’Connor, & C. Schaefer (Eds.), Handbook
of play therapy: Vol. 2, (pp. 231–251). New York: John Wiley & Sons.
Sleek, S. (1998). After the storm, children play out fears. American Psychological Association, 29(6).
Steele, W. (2006). When cognitive interventions fail with children of trauma: Memory, learning, and trauma intervention. Retrieved May 24, 2006,
from http://www.tlcinstitute.org/cognitiveinterventions.html.
Tisseron, S. (2002). Les bienfaits des images. Paris: Odile Jacob.
Ton, H. (2004). Cultural and ethnic considerations in disaster psychiatry. Retrieved June 15, 2006, from http://www.psych.org/disasterpsych/pdfs/
apadisasterhandbk.pdf.
U.S. Department of Veterans Affairs (2006). Risk factors for adverse outcomes in natural and human-caused disasters: A review of the empirical
literature. Retrieved June 15, 2006, from http://www.ncptsd.va.gov/facts/disasters/fs riskfactors.h.
van der Kolk, B. (1994). The body keeps the score: Memory and the evolving psychobiology of post traumatic stress. Retrieved April 28, 2003, from
http://www.trauma-pages.com/vander4.htm.
Volkan, V. (2001). Transgenerational transmission and chosen traumas: An aspect of large-group identity. Group Analysis, 34(1), 79–97.
Waaktaar, T., Christie, H. J., Borge, A. I. H., & Torgersen, S. (2004). How can young people’s resilience be enhanced? Experiences from a clinical
intervention project. Clinical Child Psychology and Psychiatry, 9(2), 167–183.
Weinberg, B. (2006). Sandplay and neurological research. In Paper presented at the national sandplay conference, connecting through sandplay.
Zittoun, T., Duveen, G., Gillespie, A., Ivinson, G., & Psaltis, C. (2003). The uses of symbolic resources in transitions. Culture & Psychology, 9(4),
425–448.