Crisis Counseling: an Overview

psychology in the cultivate days, Vol. 46(3), 2009 Published online in Wiley Inter scientific discipline (www. interscience. wiley. com) C 2009 Wiley Periodicals, Inc. in font 10. 1002/pits. 20370 CRISIS COUNSELING AN OVERVIEW JONATHAN SANDOVAL, AMY NICOLE SCOTT, AND IRENE PADILLA University of the Paci? c Psychologists on the job(p) in enlightens atomic number 18 very much convictions the ? rst contacts for peasantren experiencing a potentially accidental deformitytizing answer or change in military position. This article re imbibes primary concepts in crisis focus and describes the comp unrivalednts of mental ? rst wait on.This form of focusing must(prenominal) be developgenially and culturally assign as hale as singularized. effectual preventative slew interdict post- accidental injurytic emphasis syndrome and facilitate averageal melancholy wait ones associated with any losses go by dint of. These pr numberion activities atomic number 18 in add ition discussed. Some clawren whitethorn contain resources beyond those that the school posterior bear, and appropriate referrals can unite electric razorren and adults to a mixing of wieldments much(prenominal) as psychformer(a)apy and medication, in addition brie? y outlined. C 2009 Wiley Periodicals, Inc.Most barbarianren and adults atomic number 18 resilient and ask ways of coping with focussingful events. In fact, according to the internal Institute of cordial Health (NIMH 2001), recovery from crisis movie is the norm. peasantren usually need minimal assistance from family members, teachers, clergy, or different caring adults. Others, special(prenominal)ly those with few neighborly lives, enter into a crisis disk operating system (Barenbaum, Ruchkin, & Schwab-Stone, 2004 Caffo & Belaise, 2003 Litz, Gray, Bryant, & Adler, 2002 Ozer, Best, Lipsey, & Weiss, 2003). People in crisis are in what Caplan (1964) foothold a nation of psychological disequi librium.This disequilibrium pop offs when a hazardous event challenges normal psychological reading and coping. Individuals a great deal be feed irrationally and withdraw from normal social contacts. They can non be admirered using usual counseling or teaching proficiencys. Nevertheless, children in crisis are usually also in school. School psychologists and early(a)(a) guidance individualnel department must be equal to support teachers, parents, and the children themselves during periods of crisis. The primary goal in back uping an individual who is undergoing a crisis is to intervene in such a way as to renovate the individual to a previous take aim of functioning.For children, this means returning to the status of learner. Although it whitethorn be manageable to utilise the moorage to enhance personal growth, the immediate goal is non to commence completely the individuals major(ip) dimensions of personality, except to restore the individual to creative proble m solving and adaptive coping. Of course, by successfully resoluteness a crisis an individual pass on to the highest degree apt(predicate) acquire refreshful coping skills that testament lead to improved functioning in rude(a) situations, but that is only a desired, possible take, not the sole mark of the process (Caplan, 1964).Beca engagement failure to cope is at the heart of a crisis, the on fightd motion of coping is an overall objective of crisis intervention. P SYCHOLOGICAL F IRST A ID School psychologists and opposite genial health personnel croping in schools are in a position to offer psychological ? rst aid (Parker, Everly, Barnett, & Links, 2006). identical to medical ? rst aid, the idea is to intervene early when a hazardous event occurs for an individual, and offer compassionate support to facilitate adaptive coping. At the analogous time, the need for further intervention may be assessed and planned. match to The National Child accidental injurytic Stre ss web and National Center for Post damagetic Stress Disorder (posttraumatic stress disorder) (2006) thither are eight core psychological ? rst aid actions. Of course, the exact actions taken need to be tailored to the particular circumstances of crisis dupes. Cor serveence to Jonathan Sandoval, Department of educational and School psychological science, Benerd School of Education, 3601 Paci? c Avenue, Stockton, CA 95211. E-mail emailprotected? c. edu 246 Crisis Counseling Overview 247 Making Contact The ? st action is to hit a relationship with verbal and nonverbal means with the child. for the close part speaking, the sooner contact is made the better. By simply being carnally present with the child and supporting nonverbal behavior alone, anxiety can be lessened. Providing Safety It is crucial to protect children from further harm by moving them to a secure location and attending to their basic call for for food, drink, sleep, shelter, or freedom from further danger. To relieve tension, it is also helpful to provide a level for play and relaxation.Children need to be protected from the look of strangers and the curious, and they need to be spared watching scenes of a traumatic event in the media (Young, Ford, Ruzek, Friedman, & Gusman, 1999). Stabilizing Affect Counselors must demonstrate nonverbally that they are able to be calm and composed. Adults modeling calmness and competence can spread abroad that problems may be solved and emotions can be concealled in time. A counseling relationship will be great to help the child manage fear, anxiety, panic, and grief. Nondirective listening skills are most effective.However, it is also important not to offer unrealistic reassurance or to encourage defense force as a defense or coping mechanism (Sandoval, 2002a). Addressing Needs and Concerns Once the crisis actor has been able to formulate an accurate, comprehensive statement to the highest degree the assimilators perception of the situation by identifying all of the sources of concern, it will be possible to begin the process of exploring potential strategies to improve or resolve the worked uply hazardous situation. Jointly, the crisis worker and pupil review the strategies explored and select one for trial. The outcome should be an action plan.This is much like the problem solving that occurs in conventional counseling, but must be preceded by the steps antecedently mentioned. Moving too quickly to problem solving is a special K mistake of novices. However effective the problem solution is, the very process of turning attention to the coming(prenominal) and away from the past is bene? cial in and of itself. tin Practical Assistance Helpers need to be direct with children and take an b lay on the line role in managing their milieu. Be establish parents may be disabled by the disaster, it is comforting to see some adult taking control and making decisions.Some solutions may involve actions by early(a)s, such as teac hers or school administrators. To the effect necessary, the crisis worker may act as an intermediary communicating with authorities on the childs behalf. When working in schools, a delegate will be to reunite children with their parents or loved ones. Plans need to be in place to communicate with parents and track children should a disaster occur at a school site (Brock, Sandoval, & Lewis, 2001). Facilitate Connections with Social Supports purpose social supports may be particularly dif? cult during times of crisis.In a disaster, for example, whole communities are affected. there is a disruption of both schools and social services. There is often an absence of adults with whom children can process feelings of loss, dread, and vulnerability. psychological science in the Schools inside 10. 1002/pits 248 Sandoval, Scott, and Padilla Nevertheless, it is usually possible to ? nd either a assemblage of peers or family members who can provide worked up support and temporary physical assistance during the crisis. In this way the pupils energies may be devoted to coping with the crisis.Being with and sharing crisis considers with positive social support systems facilitates recovery. Conversely, lour levels of social support often predicts traumatic stress replys (Barenbaum et al. , 2004 Caffo & Belaise, 2003 Litz et al. , 2002 Ozer et al. , 2003). If family is not lendable, on that point are often community resources that may substitute and the crisis worker should be knowledgeable approximately them. Facilitating Coping During the process of crisis intervention, the student will subscribe temporarily pose dependent on the crisis counseling for direct advice, for touch action, and for supplying hope.This situation is temporary and before the crisis intervention interviews are over, the crisis advocator must spend some time planning ways to restore the student to selfreliance and self-con? dence. This restoration may be accomplished by consciously movin g into a position of equality with the student, sharing the responsibility and authority. Although ahead the crisis counselor may set out been very directive, eventually he or she strives to return to a much democratic stance.Techniques such as one-downsmanship where the counselor acknowledges the pupils contribution to problem solving, while minimizing the counselors own contribution (Caplan, 1970) permit the counselee to leave the crisis intervention with a perceive of accomplishment. support individuals to ? nd alternative rewards and sources of satisfaction using problemfoc customd coping (Lazarus & Folkman, 1984) is most helpful. Providing anticipatory guidance involves connecting children to knowledge and resources, and involves providing information about stress reactions and future challenges that the client will sheath.It acts to reduce distress and promote adaptive functioning. each action strategies must be implemented in the context of what the student thinks is p ossible to accomplish. Crisis ? rst aid providers can emphasize what positive there is in the situation, even if it seems sex actly minor. For example, even the victim of a sexual ravish can be congratulated for at least surviving physically. The crisis situation often leads to a diminution in self-esteem and the acceptance of blame for the crisis.With an fury on how the child coped well given the situation so far, and how the person has arrived at a strategy for moving forward, there can be a restoration of the damaged view of the self. Drawing from the self-concept literature, it may also be important to emphasize positive views of the self in speci? c orbits, as self-concept has been theorized to be a hierarchical and multidimensional construct (Marsh & S scramlson, 1985 S withstandlson, Hubner, & Stanton, 1976). According to the compensatory model (Marsh, Byrne, & Shavelson, 1988), which holds that selfconcept in different domains may be additive, it may be bene? ial for stu dents to development their self-concept in one area if it has been diminished in some other area as a result of a traumatic event. Helping children recognize competence in other areas besides the ones affected by the trauma will protect feelings of self-worth. This notion of building up other branches of self concept, such as pedantic self-concept, is also supported by Shavelsons hierarchical model (Shavelson et al. , 1976). Create Linkages with Needed Collaborative work Prime candidates for resources in umpteen cultures are clergy, but these resources may also be an in? ential neighborhood leader or politician. In non- horse opera (and western) cultures the family is an important system of support during times of crisis. Keep in mind that de? nitions of family do differ considerably. psychology in the Schools DOI 10. 1002/pits Crisis Counseling Overview 249 In many non-western cultures when individuals enter a crisis state, they turn to individuals (shaman) who are acknowled ged within their communities as possessing special insight and helping skills. Their helping skills often emphasize non-ordinary existence and the psychospiritual realm of personality (Lee and Armstrong, 1995).Referral Although this is not one of the core psychological ? rst aid actions, as the ? rst and perhaps only person on the scene, the school psychologist should be helpful. Attend to physical needs, offer appropriate reassurance and anticipatory guidance, and help those in a crisis state to take positive action to facilitate coping (Sandoval, 2002a). As soon as possible, however, facilitate an appropriate referral to a culturally appropriate helper and/or to community- found services, and follow-up to determine that a fraternity has been made.D EVELOPMENTAL I SSUES I N C RISIS C OUNSELING A child of 5 and an adolescent of 16 have radically different faculties for dealing with information and reacting to events. Differences in cognitive, social, and emotional development mea n that they will respond other than to hazards and will need to be counseled differently should they develop a crisis reaction (Marans & Adelman, 1997). The corresponding event (e. g. , the death of a parent) may be a crisis for a preschooler as well as a high-school senior, but each will react and cope with the event differently.Counseling with younger children often involves the social occasion of nonverbal materials, many to a greater extent(prenominal) directive leads to call forth and re? ect feelings, and a focus on concrete concerns as well as fantasy. The use of drawing, for example, has proved very effective in getting children to express what has happened to them (Hansen, 2006 Morgan & White, 2003). In terms of increasing self-concept with children after a crisis, one must consider the dimensionality of self-concept as it relates to cognitive, spoken communication, and social factors (Byrne, 1996 Harter, 1999). Self-concept dimensions tend to increase with age.That i s, young children are able to make judgments about themselves in terms of concrete and observable behaviors and tend to display all-or-none thinking. Thus, self-concept at this age tends to have few dimensions. Children at this age describe themselves in relation to accepted categories, such as I am 5 or I have blond hair, and are able to make simple comparisons such as I am shout and he is not crying (Harter, 1999). Although young children tend to have very positive descriptions of the self, negative life story experiences, such as a traumatic event, may cause them to view themselves negatively.During middle childhood, self-concept dimensionality increases and children are able to make more global statements about their self-concept. However, they will often overestimate their abilities. Their descriptions change from being concrete to traitlike. Children during this horizontal surface also begin to use social comparison as they referee themselves and they can make social com parison statements, such as I am more shy than most gulls or Im good at (one subject) and not (other subjects). All-or-none thinking may continue at this stage, which may cause children to view themselves negatively (Harter, 1999).Traditional talk therapies such as nondirective counseling capitalize on a clients readiness for rational thought and high level of moral development and are more likely to be effective with adolescents. With adolescents, the school psychologist can also acknowledge and use the ageappropriate crisis of establishing an identity. During adolescence, more differentiation of the self occurs and peers may be use for social comparisons. Abstract concepts are used to describe the self, and there is an awareness of multiple selves, where they may behave or act differently in different contexts.Adolescents begin to make statements with interpersonal implications, such as, psychological science in the Schools DOI 10. 1002/pits 250 Sandoval, Scott, and Padilla Bec ause I am shy I do not have many friends or People trust me because I am an honest person (Harter, 1999). In reviewing the crisis intervention principles and procedures just outlined, it seems tenable to expect that younger children would have a greater dif? culty acknowledging a crisis, and would be more prone to use immature defenses such as denial and projection to avoid coping with a crisis (Allen, Dlugokinski, Cohen, & Walker, 1999).In contrast, an adolescent might use more advanced defenses such as rationalization and intellectualization. In counseling children, more time might be spent on exploring reactions and feelings to the crisis situation and establishing support systems that engage in lengthy problem solving. With older adolescents, then, it may be possible to focus much more on establishing sane expectations and avoiding false reassurance, as well as spending more time on focused problem-solving activities. ATTENDING TO C ULTURAL D IFFERENCESMany events that frequen tly stimulate a crisis reaction in the dominant culture, such as a death, a self-annihilation, or a natural disaster, may or may not have a similar effect on members of other cultures (Sandoval, 2002b). Sometimes a reaction to a traumatic event will be culturally appropriate but will seem to western inwardnesss to be a breakdown of ordinary coping. Extreme outward-bound expression of grief by wailing and crying followed by self-mutilation and threats of suicide spare-time activity the death of a loved one may be normal coping behavior expected of a survivor in a particular culture (Klingman, 1986).A cultural informant will be multipurpose in indicating what normal reactions to various traumatic events are for a particular culture. One of the most important expressions of culture is language. Many important cultural concepts cannot be satisfactorily translated from one language to another, because the meaning is so bound up in cultural values and worldview. If possible, crisis i nterveners should speak the same language as their client and be familiar with their cultural perspective.In an emergency, this human body of match of counselor and client may not be possible, so school psychologists need to be prepared to work with interpreters and cultural informants. tutelage to nonverbal communication is also important during a time of crisis. A number of behaviors including form of eye contact, physical contact, and proximity can be different between members of different cultures (Hall, 1959). Because these behaviors are subtle, counselors may easily pretermit them without help. Training in cross-cultural work may be de bered through workshops or by consultation with an experienced psychologist.A ? rst step in working with children from different cultures will be to learn the effect to which the client has become acculturated to the dominant culture. One cannot assume that a child is fully a member of either the culture of the familys origin or of the Ameri can mainstream. Working with the child and family will be severalize on the priming coat of culturally appropriate intervention. P REVENTING PTSD The common goal of responding to children experiencing situational crises is to prevent the formation of PTSD. This syndrome, ? st identi? ed among military combat veterans, also manifests itself in children. Their reaction is similar to that in adults, although their reactions may be somewhat different and the symptoms will vary with age (American psychiatrical Association, 2000). To be diagnosed with PTSD, a person who has been assailable to trauma must have symptoms in three different areas inexorable reexperiencing of the traumatic stressor, persistent avoidance of reminders of the traumatic event, and persistent symptoms of increased arousal.These symptoms must be present for at least one month, and cause clinically signi? cant distress or impairment in social, occupational, or other important areas of functioning (American psyc hiatrical Association, 2000). Children are more likely than adults to have symptomatology cogitate to aggression, anxiety, depression, and regression (Mazza & Overstreet, 2000). As noted earlier, traumatic stress reactions Psychology in the Schools DOI 10. 1002/pits Crisis Counseling Overview 251 are to a signi? ant extent dependent on the childs level of development (Joshi & Lewin, 2004). particularly among younger children, traumatic stress reactions are less connected to the stressor and more likely to take the form of generalized fear and anxiety. It is certainly not true that all children, if untreated, will develop PTSD. In fact, recovery is the norm (NIMH, 2001). Recent studies regarding the prevalence of PTSD in children and adolescents estimates that about 15% 43% of children have experienced at least one traumatic event in their lifetime.Although estimates vary by extent and type of trauma, a button-down estimate is that 12% 15% of children may develop PTSD half a doze n or more months future(a) a disaster (La Greca, Silverman, Vernberg, & Prinstein, 1996 McDermott & Palmer, 1999). In a review of the literature, Saigh, Yasik, Sack, & Koplewicz (1999) report that rates of psychological trauma among children and adolescents (as indicated by the armorial bearing of PTSD) vary considerably both within and between types of crisis events (with rates of PTSD ranging from 0% to 95%).Some may even develop longterm characterological patterns of behavior following a disaster, such as fearfulness (Honig, Grace, Lindy, tenderman, & Titchener, 1999). These character traits, exhibited later in life, may originate as negative coping responses to the trauma. Severity of symptoms is related to the magnitude of exposure to the event itself, and the degree of psychological distress experienced by children in response to trauma is measured by some(prenominal) factors. The closer a child is to the location of the event (physical proximity), or the agelong the expo sure, the greater likelihood of severe distress.Having a relationship with the victim of trauma also increases the risk (emotional proximity). A tertiary factor is the childs initial reaction those who display more severe reactions, such as becoming hysterical or panicking, are at greater risk for needing mental health assistance later on. The childs immanent understanding of the traumatic event can sometimes be more important than the event itself. That is, the more the child perceives an event as impenetrable or frightening, the greater the chance of increased psychological distress.Additionally, children who experience the following family factors are at an increased risk those who do not live with a nuclear family member, have been exposed to family wildness, have a family register of mental illness, or have caregivers who are severely distressed themselves (Fletcher, 2003). Children who face a disaster without the support of a nurturing friend or relative appear to suffer m ore than those who do have that support available to them. Symptoms in children may be more severe if there is agnatic discord or distress and if there are subsequent stressors, such as lack of housing following a disaster (La Greca et al. 1996). The traumatic death of a family member also increases the risk of stress reactions (Applied query and Consulting, Columbia University Mailman School of Public Health, & saucily York Psychiatric Institute, 2002 Bradach & Jordan, 1995). Finally, children who have preexisting mental health problems or previous exposure to gruelling or frightening events are more likely to experience more severe reactions to trauma than are others. Symptoms may also be heightened among social minorities (La Greca et al. , 1996). La Greca and her colleagues (1996) discuss ? e factors related to the development of severe symptomatology 1) exposure to disaster-related experiences, including perceived life threats 2) preexisting child characteristics such as penury and illness 3) the recovery environment including social support 4) the childs coping skills and 5) intervening stressful life event during recovery. These factors may move with biological factors that make the child particularly vulnerable, such as genetically based premorbid psychopathology and temperament (Cook-Cottone, 2004).Clearly intervention must supply an appropriate recovery environment that is suited to a childs characteristics and facilitates coping. termination of what intervention is appropriate for a given student should be based on assessment of risk for psychological traumatization. Nevertheless, school is an important environment where prevention and healing can take place. Cook-Cottone (2004), drawing from the literature on children with cancer, has outlined a protocol for reintegrating children into school following a traumatic experience that has led to their absence from school.Psychology in the Schools DOI 10. 1002/pits 252 Sandoval, Scott, and Padill a FACILITATING THE G RIEVING P ROCESS Grieving, and mourning the losses common to most potentially traumatic events, will be among the counseling objectives. Losses may include those of signi? cant others as well as loss of status. However, emotional numbing and avoidance of trauma reminders that accompany trauma can greatly interfere with the process of grieving. Trauma work often takes precedence over grief work nevertheless, finally appropriate mourning must be facilitated (Hawkins, 2002). Worden (2002) has identi? d cardinal labors of mourning. The ? rst task is to accept the reality of the loss and neither deny it has occurred nor minimize the violation on the childs life. It is common for children to fantasize about a reunion or that there has been a mistake about the loss, or that divorced parents will reunite. Before a child can advance to the second task, there must be a reduction in spiritual, magical, or distorted thinking (Hawkins, 2002). Wordens second task is to e xperience the pain of grief. There are many pressures, both cultural and familial, to not express or feel sadness at a loss.Children are told not to be a crybaby and to act like an adult. However, if the emotional pain is not experienced, there may be a manifestation in psychosomatic symptoms or maladaptive thinking or behaving (Hawkins, 2002). The third task of coping with a loss is to adjust to a unexampled environment that does not include the lost status or relationship. The child must learn to create a new set of behaviors and relationships to interchange those lost. The goal is to build a meaningful and authentic new life-style and identity.A failure to accomplish this task leaves a child feeling immobilized and helpless, clinging to an idealized past. The ? nal task of mourning is to withdraw emotional energy from the lost status and reinvest it in other relationships and endeavors. By holding on to the past, lost attachments or else than forming new ones, a child may b ecome stuck. Instead, the trauma victim must eventually embrace a new status. Worden (2002) believes that, when the tasks of mourning are accomplished, the individual will be able to think of the loss without efficacious pain, although perhaps with a good sense of nostalgia and perhaps some sadness.In addition, the child or adolescent will be able to reinvest emotions in new relationships without viciousness or remorse (Hawkins, 2002). T REATMENT School-based Counseling Galante and Foa (1986) worked in groups with children in one school throughout the school year following a major Italian earthquake. The children were encouraged to explore fears, mistaken understandings, and feelings connected to death and injury from the disaster using discussion, drawing, and role playing. Most participants, except those who experienced a death in the family, showed a reduction in symptoms.Another feature of disasters and terrorist acts is a lowered sense of control over ones urgency and heigh tened fear of the unknown. Thus, a focus on returning a sense of empowerment to children will be important. If children can be directed to go into in restorative activities and take some actions to mitigate the results of the disaster, no field of study how small, they can begin to rebuild an important sense of ef? cacy. Finally, there may be issues of survivor guilt, if there is widespread loss of life or property. Survivor guilt is a strong feeling of culpability often nduced among individuals who survive a situation that results in the death of valued others. Those individuals spared, but witnessing the devastation of others, may have extreme feelings of guilt that will need to be dealt with. Children, particularly, ascribe fantastical causes to the set up they see. Consequently, some may Psychology in the Schools DOI 10. 1002/pits Crisis Counseling Overview 253 need to explore their magical thinking in counseling or play therapy about why they fly injury or loss. School comm unitybased support groups can provide one vehicle for feeling connected to others and working through these feelings.Ceballo (2000) describes a short-term adjuvant intervention group based in the school for children exposed to urban violence. Her groups are designed to 1) validate and harden childrens emotional reactions to violence, 2) help children restore a sense of control over certain aspects of their environment, 3) develop safety skills for dealing with the environment in the future, 4) understand the process of grief and mourning, and 5) minimize the in? uence of PTSD symptoms on educational tasks and other daily life events. Such structured support groups can promote resiliency and promote constructive coping with problems.Depending on training and supervision, the school psychologist might also engage in therapies authorize for the treatment of PTSD. These therapies are reviewed in the section on community-based therapy. Time and other constraints often make outside ref erral necessary. Bibliotherapy Bibliotherapy may also be useful following a disaster. A particularly useful resource for children is a book entitled Ill Know What to Do A put one overs Guide to Natural Disasters by Mark, Layton, and Chesworth (1997). The authors focus on four concepts they view as fundamental to recovery information, communication, reassurance, and the reestablishment of routine.They explore childrens feelings that often emerge in the aftermath of a disaster, and offer useful techniques to help young people cope with them. Another technique in which the child is an active participant in the creation of a book about personal experiences is called the resolution scrapbook (Lowenstein, 1995). Here the child is guided through a set of experiences and activities designed to help the child reprocess traumatic experiences and place completed work in a scrapbook. Evidence for the authorisation of this technique is largely anecdotal to date. Other Adults in CrisisAn import ant feature of a traumatic event is the fact that the adults in the school as well as the children are affected. The teachers, administrators, and guidance staff would be as traumatized as children by an earthquake, terrorism, or an airplane crashing into the school. They will need assistance in coping with the aftermath of the crisis as much as the children will (Daniels, Bradley, & Hays, 2007). It is likely that outside crisis response assistance will be needed to help an entire community deal with disaster and mayhem associated with violence. Community-based PsychotherapyCognitive behavior therapy. There are many treatments being studied for their effectiveness in the area of PTSD. Currently, much of the research suggests that cognitive behavior therapy (CBT) may be the most promising treatment for PTSD (Jones & Stewart, 2007). CBT is a structured, symptom-focused therapy that includes a wide variety of skill-building techniques. All are based on the premise that thoughts and beh aviors can cause negative emotions and patterns of interactions with others. Making maladaptive thoughts and behaviors more functional is the goal of CBT (Jaycox, 2004).CBT uses techniques that comprise elements of cognitive information processing associated with anxiety with behavioral techniquessuch as relaxation, imaginal or in vivo exposure, and role playingthat are known to be useful in the reduction of anxiety (Cook-Cottone, 2004). Psychology in the Schools DOI 10. 1002/pits 254 Sandoval, Scott, and Padilla Another protocol for dealing with treating PTSD is eye movement desensitization and reprocessing (EMDR). It includes many of the same elements as CBT, with the exception of in vivo exposure, and includes rhythmic eye and other tracking exercises (Greenwald, 1998).It has been successfully used with school-age populations (Chemtob, Nakashima, & Carlson, 2002). extend and art therapy. Play and art therapy are also being studied to determine their effectiveness on PTSD sympt oms, especially in young children because of issues in language development (Cole & Piercy, 2007). Because play is a childs natural order of developing mastery over the environment and because many symptoms of PTSD are seen in childrens play, this is a natural course of treatment (Kaduson, 2006). The use of art therapy has also shown to be effective in group work (Hansen, 2006). Medication.As a measure of last resort, medication may be used to treat severe PTSD. Often the symptoms of anxiety or depression that have resulted from exposure to a traumatic experience are treated. Selective serotonin reuptake inhibitors (SSRIs) in particular are often prescribed to treat the symptoms of anxiety and depression, including sertraline, paroxetine, and ? uoxetine (Foa, Davidson, & Frances, 1999). In the adult population, antipsychotic, antiepileptic, and other psychotropic medications have been explored and may be effective depending on the symptoms of the individual (Davis, Frazier, Willifo rd, & and upstartell, 2006).If medications are prescribed to a student, it is important that there be a liaison between the school and the treating physician or psychiatrist to monitor effectiveness and deleterious side effects. C ONCLUSIONS School psychologists are often the contacts in schools when there is a traumatizing event. School psychologists should be ready to administer psychological ? rst aid that is individualized and developmentally and culturally appropriate. By intervening and facilitating coping processes and the grieving process, it may be possible to prevent or minimize the development of PTSD.School-based protocols have been developed to respond to children in crisis. When students are referred to other psychological, psychiatric, or medical services, it is important to designate a liaison between the school and other professionals to maximize optimal treatment and care. R EFERENCES Allen, S. F. , Dlugokinski, E L. , Cohen, L. A. , & Walker, J. L. (1999). Assess ing the impact of a traumatic community event on children and assisting with their healing. Psychiatric Annals, 29, 93 98. American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed. Text Rev. ). Washington, DC Author. Applied Research and Consulting, Columbia University Mailman School of Public Health, & natural York Psychiatric Institute. (2002, May 6). Effects of the World Trade Center sharpshoot on NYC public school students Initial report to the New York city Board of Education. New York New York City Board of Education. Barenbaum, J. , Ruchkin, V. , & Schwab-Stone, M. (2004). 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