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This publication The effectiveness of a proposed guidance program in decreasing PTSD reactions among

children in the northern part of the Gaza Strip has been funded by the Directorate General of the
Development Cooperation, Ministry of Foreign Affairs and International Cooperation - Emergency
Programme AID 10042 within the project Emergency intervention for the vulnerable groups affected by
PTSD and psychosocial distress in the Gaza Strip (10042_GAZA_CISS_5),
The views expressed in this publication are those of the authors and do not necessarily reflect the views or
policies of the Italian Development Cooperation - Ministry of Foreign Affairs and International Cooperation.
The Italian Development Cooperation - Ministry of Foreign Affairs and International Cooperation are not
responsible for any inaccurate or libellous information, or for the erroneous use of information.

CONTACTS
CISS Cooperazione Internazionale Sud Sud
Local Office Jerusalem: Mafrak Al Dahey, Beit Hanina, Jerusalem
Local Office Gaza: Al Mina al Rashid Street, Abu Ghalion Building 2
Telefax: +972 (0)2 6561012- E-mail: jerusalem@cissong.org
Office in Italy: via Marconi n. 2/a, 90141 Palermo
TEL. 0039 091-6262004/6262694 FAX 091347048
E-mail: info@cissong.org Web site: www.cissong.org
EL WEDAD SOCIETY FOR COMMUNITY REHABILITATION
Main Office Gaza: Gaza League of Arab States opposite to Fares Station
Telephone: 00970 826 41955
Fax: 00970 826 41957
E-mail: mail@elwedad.org
Web site: www.elwedad.org

Italian Development Cooperation Unit Jerusalem


Mujeer Eddin Street 2
Sheikh Jarrah - Jerusalem
http://www.itcoop-jer.org/
Tel: +972(2)532 74 47

September 2014
Cover Photo by: Sergio Cipolla

Action Research
The effectiveness of a proposed guidance program in decreasing
PTSD reactions among children in the northern part of the Gaza
Strip

Realised in the framework of the project:

Emergency intervention for the vulnerable groups affected by PTSD and


psychosocial distress in the Gaza Strip
(10042/GAZA/CISS/5)
17th December 2013 30th September 2014

Funded By
ITALIAN DEVELOPMENT COOPERATION ITALIAN
MINISTRY OF FOREIGN AFFAIRS and INTERNATIONAL
COOPERATION
Implemented by:
CISS Cooperazione Internazionale Sud Sud
In collaboration with:
El Wedad Society for Community Development

PREFACE
The present action Research has been made in the framework of the Project Emergency Intervention in
support of the vulnerable groups affected by PTSD and psychosocial distress in Gaza Strip Implemented
by CISS in cooperation with El Wedad Society and funded by ITALIAN DEVELOPMENT COOPERATION
ITALIAN MINISTRY OF FOREIGN AFFAIRS and INTERNATIONAL COOPERATION
The project aims at improving the psychosocial conditions of 519 children at risk and their families in Beit
Lahya, Gaza and Jabalya through the provision of integrated services of psychosocial, educational and
psychological support in 4 Community based Organizations (CBO) and 3 hospitals, as well as at home and
through the creation of playrooms. The beneficiaries are children (8-17 years old) who experienced the loss
or destruction of their houses, and/or the displacement or the death or injury of family members. Most of
them live in areas closed to the border and to the so called buffer zone.
The methodology of the Project foreseen three interrelated component:
Playrooms and Psychosocial laboratories: The idea of creating playrooms is based on the need of creating
"safe places" for children and to protect their "right to play". The playroom is set-up by the children
themselves with the support of animators and psychologists by using different techniques (play therapy,
drama therapy and art therapy). From the psychosocial point of view the role of the playrooms is to provide
adequate psychological support to children in suitable and safe places.
Mobile Clinic: The mobile clinic is composed by psychologists and animators who carried out home visits for
the children affected by PTSD. The role of the animator/social workers is to create a friendly environment
where the child and his family can feel comfortable and safe. Each intervention of the mobile clinic has been
structured according to the guidelines identified in the Guidance Program.
Clown therapy service in the hospitals: the Clowns in the hospitals address specifically the psycho-social
needs of the hospitalized children and their parents. The work of the clowns is to apply the techniques of
psychological support already experimented in the playrooms by using the clown therapy. In a context
such as the hospital, and considering the specificity of the addressed problems, it is even more difficult to
create a direct contact with the patients because of the limited time (sometimes the children and their
families are in the hospital just for few days) and of the feeling of fear of the minors hospitalized. The
clown helps in shortening significantly this time and to deconstruct the classic relationship psychologists /
animators vs patients. In this way the setting that is created, besides of being positive and cheerful, is also
based on trust and empathy. This factor maximizes the potential outcomes of the psychological and
educational support. There is also a positive benefit for the staff of the hospital and the families of the
patients.
The action research is a tool to verify the effectiveness of our work and methodologies in dealing with
children affected by PTSD in the Gaza Strip.

Contents
Research abstract ....................................................................................................................... 5
Introduction ............................................................................................................................... 6
Study problem ............................................................................................................................ 7
Study objectives: ........................................................................................................................ 7
Study importance: ...................................................................................................................... 7
The main terms of the study ...................................................................................................... 8
Theoretical framework ............................................................................................................... 8
First-The concept of psychological trauma ................................................................................ 8
Diagnoses of post-traumatic stress disorder on children: ......................................................... 9
Causes of psychological trauma: ..............................................................................................10
The most common symptoms of trauma:................................................................................11
Factors related to the intensity of trauma: ..............................................................................12
Second: The emotional rational treatment..............................................................................13
The main steps for cognitive emotional treatment .................................................................15
The foundations of the program ..............................................................................................16
Research Hypothesis ................................................................................................................16
Third: Research Methodology and Persuaders: .......................................................................16
Samples of the Study:...............................................................................................................17
Research Methodology: ...........................................................................................................17
The validity and Reliability of the Scale....................................................................................17
Program objectives: .................................................................................................................20
Sub objectives: .........................................................................................................................20
Validity of the guidance program:............................................................................................21
Research Outcomes .................................................................................................................21
Conclusion and recommendations: .........................................................................................24
Thanks to: .................................................................................................................................25
Index of Abbreviation: .............................................................................................................26
References:...............................................................................................................................27
Annexes description of the sessions and applied test: .........................................................28

Research abstract
The main goal of this research is to examine the effectiveness of implementing the proposed guidance
program in decreasing the PTSD reactions among children at the northern part of the Gaza Strip, the
program was implemented on two groups of male and female children, the first group consists of 34
children, their ages range from 13 to 17 years, the second group of 32 male and female children, their ages
range from 8 to 12 years.
The semi-experimental method was used in this research, and its outcomes revealed that there are
statistically significant differences in the mean score of both groups in the pre and post tests on the PTSD
reactions scale and the differences were in favour of the post test, it also revealed that there is an important
effect of the guidance program in decreasing negative PTSD reactions among the targeted groups of
children.

Introduction
The mental health problems and in particular PTSD are widespread phenomena among children in Gaza.
Together to the siege, the Israeli military operations in the past years have deepened this problem. During
the Israeli military operation Cast Lead in 2008/2009, 313 children have died (approximately 23% between
the ages of 5 and 10 years and 62% between 11 and 17 years) and more than 1,400 were injured. The
majority of these (a total of 261 children) lived in densely populated areas of Gaza City and in the North
Governorate. Studies conducted after 3 years from the operation revealed that 56.6% of children showed
moderate reactions to trauma, and 10.6% severe reactions.
The Israeli military operation Pillar of Defence of November 2012 has caused the death of 47 children (16 of
which are under the age of 5 years), as well as the destruction of some 2,000 homes and 136 schools and
the wounding of 516 children and adolescents. The impact of the Pillar of Defence has been dramatic. The
analysis of the World Health Organization in December 2012 revealed a need for psychological support for a
number of citizens between 25,000 and 50,000. Among them children and adolescents are especially at-risk.
The impact of "Pillar of Defense" on the psychosocial health of children has been also assessed directly by
CISS and El Wedad. The result shows that 45.54% of children were affected by PTSD and 99.28% of the
children reported different symptoms such as fear, anxiety, nightmares.
The more recent military operation, Protective Edge in July 2014, had also heavy consequences. According to
OCHA data, more than 2100 Palestinian have been killed (around 80% civilians), among them more than 500
children. Approximately 18,000 homes were either completely destroyed or severely damaged, leaving
about 108,000 people homeless. UNRWA estimates that between 65,000 and 70,000 people will remain as
long-term displaced. The majority of the population of Gaza has lost its economic income increasing the
sense of depression of the adults that will inevitably affect the children. According to data from UNICEF
3,106 children were injured. 51600 children are homeless and according to initial estimates at least 373,000
children are in need of immediate psychological support to cope with the trauma. The data from UNICEF
and OCHA also reported an increase of 91% of sleep disorders, nervousness, aggression and depression
among children, loss of appetite in 85% of adults and a significant increase in the incidence of spontaneous
abortions.
Among the major consequences of the instability determined by the siege imposed on Gaza, various studies
and analyses reveal how psychosocial discomfort and disease are prevalent all over the Gaza Strip.
The trauma can have different reasons, from destroying houses and agricultural roads and land to the siege
that impede the movement of people and goods. All those circumstances have a severe impact on the
Palestinian people physically, mentally, psychologically and socially and there is no doubt that children are
the most affected category because of their lack of cognitive and life experiences and the limited available
coping mechanisms.
There is no doubt that childhood is the most important stage of a person's life, as the experiences children
go through in this stage have a substantial role in forming their personalities, so if these experiences are
painful or shocking, they might negatively affect building a normal personality in the future (Abdel-Rahman,
2006).

It is well known that the consequences of the military occupation in form of invasion, aggression, siege,
closure and wars lead to a lot of problems, especially for children since they are subjected to greater
psychological pressure, crises and traumas.
The recent researches outcomes have proven that the major factor in determining the reactions of the
human being is not only the traumatic action itself but, also, the ability or inability to face the event. Ability
facing the event means ability to control the situation, which helps the person to control the feelings of
confusion, anxiety, fear and the symptoms that accompany it, like rapid breathing and heartbeat,
hypertension, etc.

Study problem
There is no doubt that wars and aggression have devastating and long term impacts on an individual's
psychological, social and mental health.
The two researchers noted traumatic reactions to the war in the Palestinian people, especially children, such
as lack of sense of security, increase of the sense of helplessness, frustration, together with many other
reactions. Therefore the current search is an attempt by the researchers to prepare a curative and guidance
program to mitigate the effects of trauma in children, by taking a sample of traumatized children.
Accordingly the research problem was formulated in the following basic question:
How effective is the proposed counselling program to alleviate the severity of the psychological traumas in
children aged from 8 to 17 years?

Study objectives:
The present study aims at identifying the effectiveness of the proposed counselling program to alleviate the
severity of the psychological traumas in children aged from 8 to 17 years.

Study importance:
The importance of this study can be summarized as follows:
1- The importance of the current applied study is revealed in the fact that it attempts to prepare a
counselling program to alleviate the psychological traumas in children aged 8 to 17 years.
2- Enabling children to overcome the traumatic reactions resulted from the exposure to trauma through the
followings:
-

Making the target group aware of their psychological conditions.

Helping the target group to get rid of the inappropriate thoughts concerning negative expectations
about themselves and about others and the future.

Helping the target group to get rid of the negative emotions which have a role in the origination and
continuation of frustration and lack of self-efficiency.

3- The researchers hope this study will serve those who are generally interested in psychological health who
will benefit from the results in the preparation of a psychological guidance and counseling program for
children who are in need of assistance in this regard, to face the psychological problems they suffer from.
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The main terms of the study:


1-Psychological Trauma:
Psychological trauma is exposing an individual to shocking experience, whether deriving from physical or
psychological threat or from an actual exposure to death or injury.
2- The Guidance Program:
It is defined as a number of counselling and therapeutic techniques designed to help traumatized children to
overcome symptoms and disturbances resulted from a trauma

Theoretical framework
First-The concept of psychological trauma
Freud calls trauma the consequences of living a painful and sudden experience that carries with
problematic psychological symptoms , which usually ends up in a person adaptation failure, definitely
leading to incremental disorders in bio-energy, so that over excitement becomes too much for the
respiratory system to handle. Laplanche and Pontalis (1997, 300) define it as an unexpected experience in
someone's life, where the individual finds himself unable to appropriately react, consequently
maladjustments might be shown.
Ursano points out that the traumatic experiences are serious, confusing and surprising events. They cause
fear, anxiety, and withdrawal from social life and avoidance from contacts with others; they are also highly
intensive, unpredictable and non-recurrent. They can affect the individual himself like a car accident, a crime
of violence like sexual exploitation, or they can affect the entire society as in the case of war or earthquake
(Abdel-Khaleq, 1998, 53). There are 2 types of traumatic events:
a) A shocking, non-recurring event that only happens once, as in the case of an accident or catastrophe etc.
b) A shocking event that goes on for a long period of time like sexual exploitation. Those events have more
severe consequences on the individual involved (Deer Grove, 2002, 1-3).
The two researchers see psychological trauma as an unexpected, surprising and external event that scatters
the individual's integration and endangers his life and to whom the individual responds by overwhelmingly
feeling of extreme fear and deficiency. There is no doubt that the frequent exposure of children to crises
causes them more harm than it does to adults, and in addition to physical harm, the psychological impact
may remain for a lifetime.
According to the concept of Individual Differentiation, reactions toward the traumatic experiences vary
between individuals: what forms a severe trauma for someone may just be a painful experience for another.
A psychological trauma in its events and severity does not affect people the same way, it depends on
multiple factors like severity, duration and level of exposure, the individual's perception of the event, his
evaluation and interpretation, his age and maturity, his personality and its degree of structural and
functional cohesion, past experiences and, finally, the social support (UNICEF Regional Offices, 1995, 22)

Diagnoses of post-traumatic stress disorder on children:


There are several diagnostic criteria for post-traumatic stress disorder (PTSD). The fourth Diagnostic and
Statistical manual (DSM-IV) for psychological disorders of the American Psychological Association identified
the diagnostic criteria for the post-traumatic stress disorder, as follows:
a) The individual experienced a traumatic event:
1- The individual witnessed or experienced an event or more that involve the death or the threat of
death to oneself or to someone else, or to one's own or someone else's integrity or safety.
2- The individual responds to this experience with severe fear or terror or disability, in the case of
children they may experience irritation or turbulence.
b) The individual restores the traumatic experience in one or more of the following:
1- Experiencing painful memories in the form of photos, ideas, or sudden perceptions connected to the
traumatic experience; in the case of children they show some type of recurring playing that is
connected to the traumatic experience.
2- The traumatic event or parts of it appear in dreams (nightmares). Specifically for children, their
dreams are frightening and they lack the ability to identify the context in which those dreams take
part and they cannot find a justification for them.
3- A person behaves or feels as if the traumatic event is happening all over again, with regards of
children their behaviours reflect certain parts of the traumatic event
4- The individual experiences the feelings of confusion and disturbance when he is exposed to codes or
internal or external signs that are connected to the traumatic event in general.
5- The individual shows physiological reactions when exposed to those signs.
c) The individual constantly avoids all the stimulants connected to the traumatic event; this appears in at
least three of the following:
1- Exerting efforts to avoid ideas, feelings, and talks connected to the trauma.
2- Making efforts to avoid places, people, and activities related to the trauma.
3- Forgetting certain parts of the traumatic event.
4- Experiencing feelings of isolation and exile from others.
5- Inability to feel love and compassion.
6- Clear lack of attention for major activities or willingness to participate in them.
7- Feeling that the future is unpromising and limited.
d) Appearance of constant symptoms (at least two of the following) after the exposure to trauma: difficulty
in getting asleep or in sleeping itself, susceptibility, arousal and anger and irritation episodes, difficulty in
concentrating, hyperactivity.
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e) The symptoms mentioned in (b, c, d) usually last over a month; they are divided into three types
according to the period of exposure to the traumatic event:
1- Severe symptoms: symptoms last for less than three months.
2- Chronic symptoms: they last for more than three months.
3- Late symptoms: symptoms start to appear after six months of exposure to the traumatic event
(DSM-IV, 1994, P427).
Causes of psychological trauma:
1) Physical obstacles: for example being alone in prison, or forbidding an individual from satisfying his need
to socialize with people, or depriving him from water, food or destroying his possessions.
2) Social obstacles: like cruel frustration which arises when dealing with others, thereby inhibits our
determination, hinders our desires and touches our dignity.
3) Economic obstacles: difficult economic conditions, difficulty in accessing work or income and poverty are
a major source of depression because they forbid the most disadvantage people from satisfying their basic
needs and the needs of their families.
In addition, there are many situations that may cause people experiencing severe psychological crises.
If we have a look at the major causes for psychological traumas that occur to children in Gaza, we can
mention:

the destruction of houses: it is known that the feelings of security and stability shape the strongest
needs that a human in general and a child in particular have. Maslow located security at the second
place after satisfying physiological needs. The home of a child is supposed to be the safest
environment for him, and when this home is violated or destroyed, children lose security and
safety, leading, in turn, to feelings of fear and anxiety, that therefore affects the child's personality
in general.
explosions, live shooting towards the population and bombardments, especially late at night, which
targets everybody specially the young,
Frequent cases of injuries or death among families members or friends

If this is the state for the community as a whole, children are the most affected by such conditions. But,
again, there is a difference among children in the extent, degree and the way they are affected.
This variation can be attributed to a group of subjective and personal factors, which can be summarized in
the following:
1- the child's perception of the traumatic event plays a major role in specifying the child's personal meaning
of the traumatic event. This means children who watch a certain event are affected by it in different ways,
which depends on the personal characteristics of each child.
2- the psychological stress resulting from hard situations, based on the magnitude and type of variables
come up in the child's life and his ability to control them.
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3- the presence of other factors or stress that accompany the traumatic event, which have direct effects on
the child, including: the fact that a crisis is sudden or predicted, the repetition of the stressful event, the fact
that the event is individual or collective, the loss of something or someone, the physical harm, the degree of
threat due to the event on the childs life, the violent factor whether seen or as personal experience.
The most common symptoms of trauma:
The symptoms of the trauma show up directly or after few months. Trauma can happen to an individual at
any age, including children, some of the symptoms that appear on them are:
1) mental symptoms: lack of concentration, the child is unable to understand what he is reading, mental
distraction, and fast forgetfulness, inability to continue reading, fear of reading, loss or lack of motivation to
read.
2) physical symptoms: pain in the body, pain in the head, stomach and chest, loss of vitality, difficulty in
breathing, weakness in muscles, loss of weight, pain in the muscles, pain in the eyes, trembling limbs (Abu
Hain, 2002, 2 ).
3) disorder in habits: loss of appetite, aggression, introversion, bedwetting, psychological symptoms,
extreme fear, excessive confusion, annoying dreams and nightmares, insomnia, anxiety, excessive grief
(Ministry Of Education, 2001, 2).
Strengthening the parents to help a child with a trauma:
There is no doubt that parents play a crucial role in the recovery of their children from traumatic experience,
or at least to reduce its severity, and then to help them in restoring their well-being. Parents know their
children the most; therefore they are the best ones to provide them with care and protection.
There are many strategies that help parents in providing help to their children who suffer from psychological
traumas, including:
1- providing help and personal support to children whether individually or in groups.
2- providing information to children regarding the normal post-traumatic experience responses.
3- clarifying the best ways to deal with psychological and behavioural disorders that occur after the
traumatic experience.
4- fathers talking to their children about the trauma and its causes in an attractive manner far from
intimidation.
Based on the importance of the role parents play, it is necessary to enable the parents to deal with their
psychological traumas and then help their children to overcome the effects of the psychological traumas
they may face, so it is substantial for parents or adults to get involved with their children in learning how to
cope with psychological traumas, this involvement helps in the following:
1) getting rid of painful feeling.
2) individuals develop a sense of empathy and emotional participation.

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3) re-evaluating the traumatic event in a factual manner far from fear and stress that accompany the event
when it occurs.
4) thinking of ways to help put things back to normal.
5) attempting to look at things and at the future with hope and optimism.
6) when talking about psychological trauma, whether with parents or with children, you should follow the
following:
a. choose a place that is characterized by calmness and tidiness.
b. taking into account that it is extremely important to determine the right time to talk, and to set
sufficient time for the conversation.
c. it is important to listen carefully to the speakers, whether the speakers are the parents or the
children and encourage them to talk without any coercion or compulsion.
d. the provision of open questions is better than closed ones, it is important not to ask too many
questions.
7) its known that Gaza strip represents a stressful environment for all the residents especially children.
Parents at home, teachers at schools, psychologists and social workers, each one has to do his parts in
helping children who are exposed to traumas, in order to overcome them. Children ought to be helped,
particularly those living in areas with high incidence of armed clashes and constant shelling from tankers and
aircraft, living in areas of continuous danger, on how they can face traumas.
Children living in dangerous zones are affected in a way that appears in their limited activities. Sometimes
those children spend most of their time inside their houses considered the safest place.
Thus, it is important:
1- providing the maximum protection for children, especially if being exposed to danger is unavoidable.
Children must be trained in taking some simple self-protection activities or tips like (what do I do if .).
Through trainings, children will gain new habits they could apply to protect themselves if they find
themselves in dangerous situations.
2- encouraging children to participate in daily life activities, like participating in cleaning, preparing meals
and eating with the group (family, friends), or engaging in artistic activities, singing and drawing, playing.
3- encouraging the participation of children with adults in many simple activities that represent part of the
normal life they were living before getting exposed to the traumatic experience. This will help the child to
have a sense of familiarity and tranquility, and the feeling that he is living in a safe place.
Factors related to the intensity of the trauma:
1) The degree of expectation of the trauma and the preparation for it:
Ask whether the event was: expected or surprising and unexpected,
Ask whether the parents were: prepared or unprepared,
Ask whether the children were: prepared or unprepared.
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If the event was expected and people were prepared, they can cope in a better way after the event is over.
It is also important to understand the duration of the traumatic event (minutes, hours, days, months): the
longer the duration of the event is, the greater is the depth of the effects it has on people, the higher is the
risk of developing Post Traumatic Stress Disorder.
2) The degree of exposure of children and parents to the life threatening events:
It is important to know which of the following events were experienced:
-

hearing threats of violence toward others,


hearing the cries of help from others,
seeing injured people,
seeing others fall dead,
direct exposure to injury.

More the children and the parents were affected directly, more painful was their experience.
3) Psychological support:
Priority when dealing with cases.
Psychological support in dealing with the catastrophe is according to two factors:
First: according to the area, you have to deal first with the people that are closer to the catastrophe site,
that is:
-

the exact place where the catastrophe occurred (a residential building that was destroyed),
the area where the catastrophe occurred (the street where the building is located),
the surrounding area to the location (neighbourhood where the building was located)
the external areas (the surrounding neighbourhoods).

Second: According to the psychological state, it is important to deal with the ones who have been exposed
to psychological traumas in a way that makes them feel safe and calm.
Third: Group discussion:
If group discussions were held between you and a family which all or most of its members were injured,
short termed psychological support must focus on their ability to cope and adapt to life all over again.
Discussion between survivors might create a feeling of belonging to the human society in each one of them,
and that there are others who share the same pain and injury. The presence of people in one place (a tent or
shelter or a class in school) makes them feel they have become like one family, they care for each other, and
for children who are with them at the same place, even if they are not their children (Syrian Ministry Of
Education, 2011, 4-15).
Second: The emotional rational treatment
Rational emotive therapy (RET) is a psychotherapeutic approach which proposes that unrealistic and
irrational beliefs cause many emotional problems. Ellis proposed that people become unhappy and develop
self-defeating habits because of unrealistic or faulty beliefs.

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Albert Ellis, the founder of the Rational emotive therapy - RET", believes that the reason behind emotions
and behaviours is the individual's thoughts and perceptions about the events; people create psychological
problems for themselves through talking with themselves and their self-assessments and converging their
preferences into urgent needs. for example, there is a difference between the rational phrase that says: I
prefer to have a high income, and the irrational phrase that says: I need to have a high income. Ellis quotes
from Hamlet: There's nothing either good or bad but thinking makes it so. Beliefs might be rational, and
leading to emotions with moderate severity, which are considered healthy, or they might be irrational and
leading to severe emotions which, in turn, will also lead to disorder that will hinder the capacity of achieving
goals and feeling happy (Todd & Bohart, 1999),
From Ellis's point of view individuals have two common goals, which are:
A) Sustaining life and experiencing relative happiness and being free of pain. Rationality is shaped in
thinking of ways that contribute to achieving those two goals, but irrationality includes thinking of ways that
prevent or block achieving those goals, individuals also feel upset sometimes when they are trying to
achieve their goals and obstacles or events come in their way and block achieving those goals, or even
prevent them from happening, so individuals start to develop beliefs and ideas that might be positive or
negative, and negative irrational beliefs and ideas develop feelings and behaviours which do not help in
achieving those goals. This indicates that events themselves do not create feelings, it is the beliefs behind
those events that contribute in forming those feelings and presenting them in a specific manner (Ellis, 2004).
The idea of treating the content of thinking and how to think has formed a general starting point to rebuild
the cognitive construction for the client is based on the assumption that the individual's idea about events
and not events themselves are responsible for the change in his moods. This is the basis of the perspective
Ellis adopted in treating the uneven behaviour and the sad thoughts through the following:
1- Doing a cognitive modification in behaviour. This is done by knowing the way of thinking and its
mechanisms and then guiding it toward aimed treatment after developing the new desired concept.
In other words, the modified cognitive construction of an individual is based on modifying and correcting the
erroneous perceptions and negative habits, based on logic and proper mental organizing.
2- Modifying the misperceptions: supporters of the cognitive therapy believe that the problems
experienced by people are caused by the way they think on how to realize themselves and others
around them. Wrong thinking arises due to realizing irrational situations plus the presence of rigid rules
and typical methods, which put behavior on automatic inflexible paths. They all form wrong starts for
thinking and perception
3- Replacing negative thoughts with positive ones: this represents a purpose and a goal to cognitive therapy.
Through it, a process of modification and change occurs to perceptions and personal interpretations and not
just to behaviour, because emotional turmoil is not a sentimental case isolated from personality
components, it is part of an integrated interactive system which starts with the internal behavioural activity
(intellectual) till it reaches the external behavioural activity. (Nassar, 1998, 89)
Ellis's theory in cognitive treatment relies on many basic concepts, including:
1) An individual is born with the willingness to be rational and logical in his thinking and he can be the
opposite.
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2) The conceptual, sensory and thought processes play their role in shaping a rational logical behaviour and
an irrational illogical behaviour, he feels, notices, realizes, thinks, and then acts, which means he performs
behaviour in a situation.
3) Rational and irrational thinking can be taught to an individual since childhood through family, peers and
the nature of the culture of the society he lives in.
4) Emotional turmoil arises from the irrational and illogical patterns of thinking; this leads to some kind of
neuroses.
5) External events are not directly responsible for our emotional disorders. The way we think, the way we
perceive and where we go are responsible for this turmoil.
6) Individuals tend to correct their bad or good doings and they see themselves as good or bad based on
their accomplishments, which affects their feelings toward themselves and their actions and others too.
7) Self-esteem (the way an individual perceives himself) and the reasons behind his behaviour form the
major sources behind the emotional turmoil in the future, and these irrational illogical ideas and negative
emotions which are self-defeating must be fought by reforming the mechanisms of thinking, perceptions,
concepts and directions which an individual adopts till he has a logical, rational, organized realistic thinking.
(Al-Saffar, 182, 2002) (Sofyan, 42, 2002)
The main steps for cognitive emotional treatment
Literature points that the steps of a guiding process according to Ellis's theory of emotional cognitive
treatment are based on the following stages:
1- The ideas sensing stage: irrational ideas are put under attention, usually they are filled with violent
emotional feelings which affect the individual and his interaction and compatibility with his inner world
which is represented by ideas, concerns, perceptions, and preferences, and his external world, represented
by the surrounding environment from friends, peers and relatives.
2- The analyzing stage: an internal prolonged conversation about these ideas, and that what he feels from
fear, misery and disorder is a result to these ideas dominating his thoughts and behaviours.
3- The refutation stage: in which, focus is on what Ellis calls the counsellors struggle to reorganize the
clients perception, where the client is trained on how he can redo a perceptual organizing and get rid of
the problem, and disengaging his perceptions and illogical ideas and untie all the spatial and temporal chain
events undertaken by emotional abnormal emergency circumstances.
4- The reorganizing stage: the client helps the counsellor gain the ability to reorganize the irrational ideas
according to a new mechanism which relies on logic and high consciousness and the right perception to the
surrounding events.
5- The enforcement of perceptual effectiveness where the clients trained to use the right logical thinking
mechanisms in facing the following events without going back to the previous thinking methods. (Al-Naeimy,
2011, 187)

15

The foundations of the program:


Any program is based on a theoretical basis. In designing the current guidance program the two researchers
followed the logo therapy according to Frankel, as the researchers see it the most convenient for topics like
our current study, ie psychological traumas. Such theory is based on the following theoretical principles:
1) Freedom of will: freedom of will represents the first basis for logo therapy. An individual owns this
freedom and it is what identifies him from other creatures. This freedom is not ultimate, it is limited by a lot
of factors. Frankel points out in this regard that an individual is not free or separate from certain factors,
whether they are biological, social or psychological, but he will remain free to take certain positions toward
these factors and circumstances. (Frankel, 1967, 3)
2) The will of meaning: the will of meaning represents the second basis for logo therapy. When an individual
has the freedom to make his life choices, then he will be able to have the strength and the will to look for
the meaning these choices represent. Frankel points that the will of meaning is always represented in the
individual's attempt to look for meaning, which is a basic strength in his life, and that the frustration of the
will of meaning leads to the existential void which could lead to neurosis. (Frankel, 1988, 29)
3) The meaning of life: it is considered the third basis for logo therapy, it means that life under all
circumstances and factors has a meaning, an individual could explore this meaning through doing a certain
job, or living a certain value, or by suffering when he faces an unavoidable situation, or one he cannot run
from, or a fate he cannot change; this direction he just took toward this fate, or this suffering is what
represents meaning. (Hutzell, 1990, 113)
Research Hypothesis:
The research hypotheses are stated as follows:
1- There is a statistically significant difference at ( 0.05) between the mean scores of the experimental
group, who ranged in age from (13-17) years, before and after the application of the program for the benefit
of the post application of the PTS scale.
2-There is a statistically significant difference at ( 0.05) between the mean scores of the experimental
group, who ranged in age from (8-12) years, before and after the application of the program for the benefit
of the post application of the PTS scale.
3- There are no statistically significant differences at ( 0.05) between mean scores of the experimental
groups, who are between the ages of 8-13 years and aged from 13-17 years, after the implementation of the
program on a scale of PTSD.
Third: Research Methodology and Persuaders:
Target Group of the Study:
The target group of the study includes (213) traumatized male and female children from the north part of
the Gaza Strip; all of them were involved in a project Emergency intervention for the vulnerable groups
affected by PTSD and psychosocial distress in the Gaza Strip

16

Samples of the Study:


Three samples of children included in this study.
The first one is a pilot sample randomly selected from the target community of study in order to examine
the validity and reliability of PTSD scale used in this research; this sample composed of (42) male and female
children, their ages ranging from(8- 17) years.
The second sample is composed of (32) male and female children. Their age is ranging from 8 to 12 years,
systemically and randomly selected from the target community.
The third sample is composed of (34) male and female children. Their age is ranging from (13- 17) years
systemically and randomly selected from the target community.
The following table describe the two samples concerning sex and age:
Table no. (1)
13-17
8-12
Total

Male
22
14
36

Female
12
18
30

Total
34.00
32.00
66.00

Percent
51.52
48.48
100%

Research Methodology:
The semi experimental method was used in this study as it is the most suitable one for such kind of studies,
using the one-group experimental design that is based on pre and post testing.
Two main tools were used in this study are the Child Post-Traumatic Stress Reaction Index and the Guidance
Program:
1-CHILD POST-TRAUMATIC STRESS REACTION INDEX: The instrument tool is composed of 20 items, the
Scores on this tool range from (0-80), the high score means high traumatic reactions and the low score
means low traumatic reactions.
The validity and Reliability of the Scale:
The validity:
That valid test means to what extent the scale measures what is supposed to measure.
The validity of the scale was tested by two means as follows:
(A)The referee validity:
The scale was introduced to a jury of specialists in a mental health and psychometric testing, no
modifications were recommended by the jury.
(B) The internal consistency validity:
Internal consistency validity indicates the correlation degree of each item with the total average of the test.
It also indicates the correlation of the average of each scope with the total average. This validity was
calculated by using Pearson Formula.
According to table (2) the coefficient correlation of each item within its scope is significant at levels (0.01)
and (0.05).

17

Table (2)
Correlation Coefficient of the scale
Item

Pearson
Sig. Level
Correlation

1. Is (event/what happened) something that would upset, or


bother, most children your age a lot?

0.347

sig. at 0.05

2. Do you get scared, afraid or upset when you think about


(event)?

0.676

sig. at 0.01

3. Do you go over in your mind what happened- that is; do you


see pictures in your mind or hear sounds in your mind about (the
event)?

0.526

sig. at 0.01

4. Do thoughts about (event) come back to you even when you


do not want them to?

0.732

sig. at 0.01

5. Do you have good or bad dreams about (the event) or other


bad dreams?

0.669

sig. at 0.01

6. Do things sometimes make you think it might happen again?

0.704

sig. at 0.01

7. Do you feel as good about things you liked to do before (the


event like playing with friends, sports, and school activities?

-0.464

sig. at 0.01

8. Do you feel more alone inside, or more alone with your


feelings-like other people really do not understand how you feel
about what you went through?

0.712

sig. at 0.01

9. Do you feel scared, upset, or sad that you do not really want
to know how you feel?

0.734

sig. at 0.01

10. Have you felt so scared, upset, or sad that you could not
even talk or cry?

0.754

sig. at 0.01

11. Do you startle more easily or feel more jumpy or nervous


than before (event)?

0.481

sig. at 0.01

12. Do you sleep well?

-0.645

sig. at 0.01

13. Do you feel bad/guilty because you didnt do something you


wish you had done? Or if you did do something you wish you
had not done? For example, to stop something from happening,
help someone else, or because it was not as bad for you as it was
for someone else?

0.628

sig. at 0.01

18

Item

Pearson
Sig. Level
Correlation

14. Do thoughts or feelings about what happened get in the way


of remembering things, like what you learned at school or at
home?

0.771

sig. at 0.01

15. Is it as easy to pay attention (concentrate) as before (event)?

-0.474

sig. at 0.01

16. Do you want to stay away from things that make you
remember what happened to you? (what you went through)

0.605

sig. at 0.01

17. When something reminds you, or makes you think about


(event) do you get tense or upset?

0.827

sig. at 0.01

18. Since (event) are you doing things again that you had once
stopped doing? Such as wanting to have someone near you,
sleeping with someone, sucking your thumb or fingers, biting
your nails or wetting the bed more often?

0.610

sig. at 0.01

19. Do you have more stomach-aches, headaches, or other sick


feelings since (event) than you did before?

0.464

sig. at 0.01

20. Is it harder for you to keep from doing things you wouldnt
have done before? For example, getting into fights, disobeying,
more riding your bike more recklessly, taking other kinds of
chances, climbing on things, swearing at someone, not being
careful when you cross the street or during play?

0.716

sig. at 0.01

R table value at df (40) and sig. level (0.05) = 0.393


R table value at df (40) and sig. level (0.01) = 0.304
The results of table (2) show that the values of these items were suitable and highly consistent and valid for
conducting this study.
Reliability of the Questionnaire:
The test is reliable when it gives the same results if it is reapplied in the same conditions.
The reliability of the test was measured by Alpha Cronbach and the Spilt- half techniques.
Table (3)
Reliability coefficient
1- By using Alpha Cronbach Technique

19

Alpha Cronbach Technique


Scope

Total

Correlation

Total

20

0.833

From table (3) we can be sure the questionnaire has a good reliability.
2-by using Split half:
Correlation between two parts (even X odd) and modify by Guttmann:
Table (4)
Spilt half Technique
Total

Before

After

20

0.710

0.830

Total

From table (4) we can be sure the questionnaire has a good reliability.
According to tables (3) and (4), the test is proved to be reliable. Alpha Cronbach coefficient is (0.833) and the
Spilt- half coefficient is (0.830) that indicates that the questionnaire is reliable to be applied in the study.
2- THE GUIDANCE PROGRAM:
The program is formed of (12) sessions, (8) sessions for children and (4) sessions for children and their
families and it relies on the following techniques: lecture, relaxing, practical exercises, and role playing, selftalk, dialogues. The researchers relied on the Socratic dialogue, where Socrates's goal was moral repairing
for humanity, but not by speeches and sermons, but by people exerting efforts to reform themselves, and
the dialogue takes the shape of a deductive dialogue, and it starts by asking for things that seem known, but
it opens minds for facts that haven't crossed the Interlocutors' minds. Full description of the guidance
program is attached.
Program objectives:
The main objective: to build a guidance program to reduce the severity of the negative PTSD reactions
among the targeted children in Gaza governorates.
Sub objectives:
-

To enlighten the individuals of the participating group about their psychological condition, so every
one of them would recognize his weakness areas, because sensing the problem is the first step of
solving it.

Helping individuals of the participating group to use more positive acquaintances.


20

Helping individuals of the participating group to get rid of the inappropriate thoughts concerning
negative expectations about themselves and about others and the future.

Helping individuals of the participating group to get rid of the negative emotions which have a role
in the origination and continuation of frustration and lack of self-efficiency.

Validity of the guidance program:


The guidance program was introduced to a jury of specialists in a mental health and clinical psychology to
judge the program whether or not it is appropriate technically and scientifically for the purpose of
decreasing the negative reactions of PTSD among the targeted children, two sessions were modified
according to the jury recommendations in addition to the duration of each session.
Research Outcomes
This part presents the findings of the study. The researchers used different statistical techniques using the
Statistical Package for Social Sciences program (SPSS) to show the final collected data results. In addition,
the effect size through (2) was used to measure the effect size of the implemented guidance program.
Tables were also used to illuminate and present these data with analysis and interpretation.
The first hypothesis is stated as follows:
There is a statistically significant difference at ( 0.05) between the mean scores of the experimental
group, who ranged in age from 13-17 years, before and after the application of the program for the benefit
of the post application of the PTSD scale.
To answer this first hypothesis, the researchers used T.test paired sample to show the difference between
the childrens responses in the pre and post scores, and Table (5) below displays the results
.Table (5)
T.test paired sample results of differences between pre and post scores on the PTSD scale for experimental
group (ages range from 13-17) in the total degree of the scale

Mean

Std. Deviation

34

36.029

11.671

34

20.441

8.027

Sig.
value

Sig. level

6.006

0.000

sig. at 0.01

t table value at (33) d f. at (0.05) sig. level equal 2.04


t table value at (33) d f. at (0.01) sig. level equal 2.75

21

Table (5) above shows that there are statistically significant differences between pre and post scale
responses in the whole total degree in favour of the post scale, as the pre mean score of the children of the
experimental group was (36.029) , the post mean score was (20.441).
To calculate the size effect, the researcher used Eta square "2 by using the following equation (Affana,
2000, 42):

Table (6)
The critical values for effect size levels
Effect volume
Test
Small

Medium

Large

0.01

0.06

0.14

0.2

0.5

0.8

To calculate the size effect, the researchers used Eta square "2by using the following equation (Affana,
2000, 42):
t2
=

t2 + df
Also the researchers calculated "d" value by using the following equation:
2t
=

df

Table (7)
"t" value, eta square " 2 " , and "d" for each domain and the total degree
t value

Effect
volume

6.006

0.522

2.091

Large

The results of ( 2) and (D) values shown in table (7) indicate the large effect size of the applied program.
22

The second hypothesis is stated as follows:


There is a statistically significant difference at ( 0.05) between the mean scores of pre and post tests of
the experimental group, who ranged in age from (8-13) years, before and after the application of the
program, which were in favour of the post test of PTSD scale.
To answer this first hypothesis, the researchers used T.test paired sample to show the difference between
children's responses in the pre and post scale and Table (8) below displays the results.
Table (8)
T.test paired sample results of differences between pre and post scale for the experimental group in the
total degree of the scale
N

Mean

Std.
Deviation

32

37.625

9.377

32

23.844

Sig.
value

Sig.
Level

6.714

0.000

sig. at
0.01

8.061

t table value at (31) d f. at (0.05) sig. level equal 2.04


t table value at (31) d f. at (0.01) sig. level equal 2.75

Table (8) above shows that there are statistically significant differences between pre and post scale
responses in the whole total degree in favour of the post response scale, as the mean of pre- test score was
(37.62) , and the mean of the post- test score Was (23.844).
Table (9) shows the effect size of applied program on the children

Table (9)
"t" value, eta square " 2 " , and "d" for each domain and the total degree
t value

Effect
volume

6.714

0.585

2.374

Large

The results of ( 2) and (D) values shown in table (9) indicate the large effect of the applied program.
The third hypothesis is stated as follows

23

There are no statistically significant differences at ( 0.05) between mean scores of the experimental
groups who are between the ages of (8-13) years and (13-17) years after the implementation of the program
on a scale of PTSD.
To answer the third hypothesis T.test independent sample was used to measure the significance of
differences and Table (10) shows the results
Table (10)
t.test independent sample of differences between mean scores of the experimental groups who are
between the ages of (8-13) years and (13-17) years after the implementation of the program on a scale of
PTSD
N

Mean

Std.
Deviation

13-17

34

20.441

8.027

8-12

32

23.844

8.061

Sig.
value

Sig.
level

1.718

0.091

not sig

t table value at (64) d f. at (0.05) sig. level equal 2.00


t table value at (64) d f. at (0.01) sig. level equal 2.66
We can see from the previous table that there are no statistically significant differences between the first
group ranging in age from (8-12) and second group ranging in age from (13-17) years, and this result
indicates the feasibility and effectiveness of the program on both groups.

Conclusion and recommendations:


According to the research outcomes the following points can be concluded:
1) There is a significant effectiveness for the guidance program in reducing the PTSD reactions among
the targeted groups of children.
2) The implementation of the guidance program proved big size effectiveness in reducing and releasing
the negative PTSD reactions among the targeted groups.
3) According to the mentioned conclusion, implementing the same guidance program on children who
have about the same demographic characters and are suffering from PTSD is highly recommended.

24

THANKS TO
We would like to thank all the people who contributed to this research.
First of all, we thank El Wedad Society, local partner in the Project, for their great commitment and
cooperation in reaching the project goals, for their friendship, professionalism and their daily hard work in
favour of the children of Gaza.
A special thanks to Dr. Osama Saed Hamdouna and Dr. Mohammed Ibrahim Aslea who conducted the
research in a very professional way and who supported technically the psychologists in their daily work with
the mobile clinic.
A special mention to the entire projects staff, animators, psychologists, field facilitators and tutors whose
great work and team spirit have been essential in improving childrens wellbeing and in ensuring the success
of the project. They conducted the assessment in difficult circumstances and we really appreciated their
efforts, enthusiasm and professionalism in carried out the activities.
We thank also Mohammad Al Sabawi and Amal Khayal who worked hard in collecting and analyzing the
data, in translating from Arabic into English, in editing and making the graphic of the present research. Their
hard work and their commitment are one of the reasons for the quality of this publication.
Thanks to CISS staff in Palestine, Salvo Maraventano Country Representative, Valentina Venditti Project
Manager and Yousef Hamdouna Local Coordinator, who together followed, coordinated and supported
technically all the phases of the project and of the present research.
Thanks to CISS headquarter for the support during the entire duration of the project.
A special mention is given to the Italian Cooperation who funded this project and who made possible the
publication of this research and to the UTL for the synergic work.
Moreover, we would like to thank all the CBOs - Toot el Ardi, Beit Lahya Development, Future Commission,
Ibn Khaldun, Al Salateen and the Hospitals - Al Rantisi, Al Nasser, Kamal Adwan and Al Durra for their
cooperation and commitment to the projects results.
Finally, our biggest thank goes to all the children who participated in our activities and helped us in
improving our work, who kept teaching us hope, steadfastness and enthusiasm and who push us in going
on.

25

INDEX OF ABBREVIATIONS
BUFFER ZONE: is a military no-go area that extends within the Occupied Palestinian Territory (OPT) along the
entire Gaza Strips border with Israel as well as at sea (Al-Haq organization).
CBO: Community Based Organization
OCHA: Office for the Coordination of the Humanitarian Affairs
PTSD: Post Traumatic Stress Disorders
RET: Rational emotive therapy
SPSS: Statistical Package for Social Sciences
UNICEF: United Nation Childrens Fund
UNRWA: United Nation relief and works agency for Palestine refugees in Near East

26

References
First: Arabic references:
-

Abd Al-Khaleq, Ahmed and others (2000): Disturbances following traumatic events, ideological
study, edition 1, Office of Social Development, Kuwait.
Abd Al-Rahman, Ali Ismael: (2006) Domestic violence, edition 1, Cairo, The Anglo Egyptian Bookshop.
Abu Hain, Fadil (2001): Hain: (2001) Participation in the activities of Al-Aqsa Intifada and its
relationship to psychological emotional problems, Children's rush toward martyrdom and its
relationship with some variables, Al-Aqsa University, Gaza, Palestine.
Al-Naeimi, Mohannad Mohammed (2011): The impact of the guidance program in the mitigation of
the effects of traumatic memory among students, Eighth Arab Scientific Conference for the Gifted
and Talented, Iraq, Diyala University, p 163-190.
Al-Saffar, Rafah mohammed Ali (2002): Irrational ideas among teachers and their relationship to
sex, specialization and length of service, unpublished Master Thesis, Faculty of Education - Ibn
Rushd, the University of Baghdad.
Deer Grove, Itly (2002): Reactions that follow the psychologically traumatic experiences and loss,
translation and localization of Zuhair Zakaria, Psychology Crisis Center, Bergen Norway.
Laplanche, Jean (1997): Glossary psychoanalysis, edition 1, translated by Mustafa Hijazi, Beirut,
University Corporation for Studies, Publishing and Distribution.
Nassar, Christine (1998): Contemporary Trends in Psychotherapy, Lebanon, Publications For
Distribution and Publishing Company.
Sophyan Nabil (2002): Manual in personality and psychological counselling, Taiz University, College
of Education.
The Ministry of Education (2011): Bulletin for guidance counsellors, psychologists and social
workers, guidance bulletin about trauma, the Directorate of Research, Department of psychological
and social counselling, Syria.
UNICEF Regional Office in the Middle East and North Africa (1995): Helping a child who is suffering
from psychological trauma a manual for social workers, health workers and pre-school teachers,
translation of Zuhair Zakaria, Amman, Jordan.

Second: Foreign References:


-

Ellis, A. (2004): Rational emotive behavior therapy: It works for me, it can work for you. London,
Prometheus Books.
Frankel, V. E (1988): The Will of Meaning; Foundations and application of logo therapy, New York
American Library, Penguin Inc.
Hutzell, R,R (1990); An Introduction to Logo therapy, In: Keller. P. a, and Ritt. L. g. (EDS) Innovation in
Clinical Practice: a source book, VOL. 9, New York, Professional resource Exchange Inc.
Todd, I. and Bohart, J. (1999): Foundation of clinical and counseling psychology, New York, Longman,
321.

27

Annexes:
- Annex no. (1)
A table that shows the names of the programmed sessions
Name of the session
Preliminary session
Working on the relaxation skill
Anger and calmness
Self-understanding
Control
Self-confidence
My characteristics
Breaking the negative perception
Strengthening the positive perception
Challenge and resistance
Self-talking (group session)
My wishes (group session)

Session no.
1
2
3
4
5
6
7
8
9
10
11
12

First session: Preliminary session


Opening meditation, examining emotions, setting the session rules, goals and expectations, getting to know
each other and breaking the ice through the activity the name and the feeling.

Goals:
-

Getting to know the meaning of psychological trauma.


Familiarizing the client on the objectives of the sessions.

In this session, which is considered an introductory session (for 15 minutes), the psychologist did the
following:
-

He welcomed the participant and he introduced himself, clarified the goal of the program sessions,
which is to alleviate trauma.
The psychologist and the participant agreed on a number of points they have to comply to, which
are:

* Respecting the appointments of the sessions.


* Committing to the ethics of dialogue and discussion..
* Implementing what the psychologist asks you to do during sessions.
* Setting the dates and times for the following meetings.
The psychologist gave the participant a question to think about (for 5 minutes) at home, which is "In your
opinion, what are the reasons that lead to the occurrence of psychological traumas?"
Finally, the psychologist requested the participant to implement a closing meditation (for 5 minutes), where
he asked him to close his eyes and breathe quietly and relax his muscles and feel comfortable and at ease.
28

Second session: Working on the relaxation skill


Goals:
- To help the child in expressing his feelings freely.
- To enable the child to draw what he believes of himself.
- To energize and entertain.
Tools:
White paper (A4), pens, colours.
1) Warm-up: the psychologist repeats the chant of "if you are happy and you know it" without any music
and asks the child to sing along with him, and says: "if you are happy and you know it clap your hands (and
the child claps his hands). if you are happy and you know it clap your hands (and the child claps his hands)..
if you are happy and you know it and you really want to show it if you are happy and you know it clap your
hands (and the child claps his hands), the flower opened.. the flower closed .. the flower opened.. the flower
closed (3 times) jump 3 jumps.. clap 3 times". (a traditional statement)
2) Relaxation: The psychologist explains what is meant by relaxation and how relaxation gives the child such
big feelings of psychological safety and how focusing and concentrating on something good will make the
child feel relief, lucidity and have a clear vision about life, then starts training as follows:
1- Deep breathing relaxation:
The psychologist asks the child to sit comfortably as he pleases, and tells him to breathe deeply, and to
exhale slowly, which will make the child feel completely relieved.
2- Muscular relaxation:
Sit and lie down comfortably, close your eyes, let your body relax, imagine tension melting away gradually.
3- Optical relaxation:
Sit down comfortably and calmly, breathe slowly and deeply, let thoughts flow in your mind without
concentrating on any of them particularly, just focus on the fact that you are feeling completely calm and
tranquil, listen to your own heartbeats while they are beating quietly, when you feel you are completely
relaxed imagine you are in a beautiful place filled with flowers and singing birds, picture everything around
you completely beautiful, picture the people you love are in this beautiful place with you, spend with them
some happy moments, and now after you've spent these joyful moments with them you can say goodbye to
them and comeback to the place you were in before.
Main activity: (With music) (Turn up the volume game)
You tell the child you want to play with him an easy, nice game called turn up the volume:
We want to draw two circles on the floor and leave some space between them, we will write in the first circle
(the one on the right) happiness circle, and we'll write on the second circle (the one on the left) grief circle,
while you stand between the two circles we'll play the music and when I say right you'll go to the right circle
which is the happiness circle, and when you enter it you'll say I am happy, I am glad, jump, laugh, do
whatever expresses your happiness, and when I say left, you'll go to the left circle which is the grief circle,
and when you enter it you'll feel sad and sorrowful, you'll make movements that show your sadness, shall we
begin with music? Let's go, the process is repeated many times.

29

The psychologist should finish up the game with the child's entrance to the happy circle, in every time the
child enters the happy circle, the psychologist should tell him: "I want happiness.. come-on, more
happiness".
After the game, the psychologist asks the child how he felt in the grief circle, and in the happiness circle. Ask
the child to conclude the differences between the two states, encourage him to get rid of the sad attitudes
and replace them with happy ones as much as possible.

Third session: Anger and calmness


Goals:
- Warm-up then opening meditation (relaxation)
"I want to remind you of our last session, we spoke of grief and happiness, do you remember? Can you
remind me what we did?", After talking, the psychologist says to the child: "there are papers, pens and colors
in front of you, I want you to draw a picture of yourself when you are happy, and then draw yourself when
you are sad, you can begin now",.. and after the child is done, you hold the sad image in your hand and you
ask him to answer your questions.." Can you tell me why he is sad? Can you describe his face features when
he is sad? When someone is sad, what happens to him?"Then the psychologist starts to say:"being sad is not
good, when you are sad you are unable to think or rest, you look angry, stressed and nervous etc.".
"Now let's look at your happy image, can you tell me why he is happy? Can you describe how he looks when
he is happy? The psychologist comments on that and says happiness is a treasure that protects the person
from anger and tension, being happy makes the individual think better, now let's compare between the two
pictures", the psychologist wraps up by telling the child the following: "we really need to stay away from
sadness as much as possible and live our lives in happiness because when you are happy you see the whole
world beautiful".
An activity for entertainment: (True or lie)
"I am going to say something about me and you tell me if they are true or they are a lie, do you understand
me? Okay get ready.. (I fought John Cena), (I've never eaten bread), (I was a brave student)".

Fourth session: Self-understanding


Goals:
- Warm-up then opening meditation (relaxation).
"Today we are going to work on something nice and fun, I want you to stand up and look at the floor with
your eyes wide open, I want you to imagine a place, a person, a memory or all three together, when you feel
you are truly safe, remember a place you've lived in, or a place you like to go to or remember a certain
place or a time or a year or a childhood period, in which you feel you were living in safety and happiness
think of that place, maybe it is real or maybe it is just your imagination, just think, whether you are thinking
of a person or a place.. if you want you can imagine the picture of this person or this place.. just imagine the
picture.. imagine the colors in this picture, look at the shapes in that place.. remember where you were
standing, or sitting in that tranquil place.. remember the voices of that place.. remember the light..
remember the scent.. remember everything about that place.. I want you, when you are ready, to take the
pens and the colors in front of you and draw that place.. try to draw quietly.. you dont have to be an artist or
a painter.. I just want you to remember the place with all its events and details.. remember, when you draw a
place that is important and fun for you, drawing could have two faces, a happy face and a sad face, the
emphasis is on the feeling", you should make the child remember what makes him happy and make him
describe it, because by that we make him feel warmth and comfort..
30

After the child finishes the picture, the psychologist starts to discuss it with him.. "tell me where is this
place? Who were you with? Do you want to go back there? Etc."

Fifth session: Control


Goals:
-

Warm-up and then relaxation (opening meditation)

The psychologist starts talking to the child about trauma and says: "We know there are things in life we can't
control and those things have no control over us, but still there are things we can control and things which
can control us, when you wake up you know there are things you are going to have to deal with, and you or
anybody else could be exposed to trauma or to a tough situation at any time, and when you deal with this
trauma you feel like you've lost everything in your life, and the power of control feels like it is far away from
you, life itself seems very far away from you, as if it is happening and going on without having any hand in
shaping it, here you feel like you are about to surrender", in a child's case, he becomes frustrated and he
loses his ability to play and imagine, he loses the ability to have fun, what we are trying to do today is to give
children an experience in resistance, to provide them with an experience so they can be in control over
things.. we let every child tell his story.. tell his own story.. then we use words to describe his feelings.. if we
didn't do so, his fears, losses and lack of hope will continue and grow.. these fears will settle in his body,
thats why we have to give them a chance to express himself in words so these bad, negative feelings are
out of his system, we have to provide him with the chance to get these feelings out and express them in a
safe way.. he has to practice expressing his feelings without any difficulty.
Main activity of this session: The psychologist says to the child:
"Now I want you to tell me a story in which you have experienced a psychological trauma, I want to hear the
story from you" we try to encourage the child to talk, we tell him: "you know each one of us stores trauma
in his body not in his mind.. of course the mind remembers the pain, but we don't want to remember the pain
or even think about it, because this way, the effects of those thoughts on the body stay, the body can't
dispose them, psychological trauma affects digestion, joints, stomach, sleep, drinking habits, our
relationships with others.., now after you've told us about a psychological trauma you've been through, we
want to do an athletic activity, because sports is a good way to dispose psychological trauma, you should
practice some sports like praying, singing, dancing, walking with friends and drinking lots of water, because
water cleanses your body from trauma", here the psychologist will have to perform an activity that makes
the child feel safe, feeling safe will relieve the child.. if the child is not comfortable he won't do anything
based on his own will and this tires the body.
The activity: (with music)
"I want you to sleep on your belly.. learn to stand up.. stand up.. now that you are standing, I want you to
clap your hands .. and say (1,2,3,4).. extend your hands.. rest on the floor.. relax.. look up.. look at the sky..
look at the stars.. look around you.. extend your hands.. hit the floor.. lift your hands to the sky.. higher.. get
down on the floor.. hit the floor hard.. standup.. sit down.. extend your legs.. and your arms.. move your
fingers.. hit the floor with your legs (4 times).. left your hands up.. swing to the right and then to the left...
right.. left.. move your hands in a circular motion.. move them faster.. faster.. now slowly.. let's go faster
now.. faster.. even faster.. now slowdown.. open your arms.. swing right and left.. move your hands now
vastly in a circular motion and say (1,2,3,4) really slow, and say (1,2,3,4) then stand up".

31

Sixth session: Self-confidence


Goals:
-

To clarify the importance of self-confidence in facing the changing events and circumstances in life.
To increase the child's self-confidence.
Warm-up then relaxation.

Tools:
Pencils, colours, white papers (A4).
Activity: Pictures
The psychologist shows a number of pictures to the child, these pictures refer to self-confidence, the child is
asked to choose a picture for himself, after he chooses it, the psychologist asks him: "Why did you choose
this particular picture? What did you like about this picture? Would you like to be like the person in this
picture? Why? What is stopping you from being like this person in the picture?", The psychologist then
comments: "of course this is a picture of someone who has a great position, he enjoys a lot of self-confidence
because he is brave, educated, he is not afraid of any circumstances, he can control the situations he
experiences, etc.".
Supportive activity: The ant and the rabbit:
The psychologist tells the child the ant and the rabbit story.. the psychologist says: "I want to tell you a funny
story, which is the story of the ant and the rabbit, once upon a time, there was an ant and its friend the
rabbit, the ant was very active, it goes every day to look for its livelihood, the ant would eat a little bit from it
and keep a little bit from it for home.. the rabbit, the ant's friend, would just eat it all, it is too lazy to keep
some food for home.. when winter came by, it was too cold for the rabbit to go out, though it was very
hungry, but it couldn't.. when it became starved.. it (the rabbit) thought and thought and then said: "oh, why
wouldn't I go to my friend the ant, I'll surely find some food over there", so it went to its friend the ant and
knocked on the door... the ant said: "who is it?", the rabbit replied "it's me, your friend, the rabbit", the ant
asked: "what do you want?", the rabbit said: "please I want some food", the ant said: "I'll give you food for
one condition, while you eat I'll see your dance, rabbit".
After telling the story, the psychologist asks the child the following questions:
"Who were the main characters of the story? What did you understand from the story? Who was right and
who was wrong? Why? If you were the ant, how would you act with the rabbit? Why?".

32

Seventh session: My characteristics


Goals:
- Warm-up then relaxation.
Tools:
Pencils, colors, white papers (A4).
"I want you to draw on the paper your right hand and draw your five fingers clearly, after you finish drawing,
I want you in each finger to write a good characteristic about yourself, this means you'll write down five
characteristics, each one in each finger, then draw your left hand on the second page, and write in each
finger five characteristics you don't like about yourself, this means you'll write down five characteristics, each
one in each finger, but these are characteristics that you dont like about yourself".
After the child finishes the activity, the psychologist starts to ask him about every detail of these
characteristics: "why do you like this characteristic? What's the most liked characteristic of your own
characteristic? Etc."
The psychologist starts to talk to the child in an understandable language and tells him: "after every hard
event you go through and every person goes through, sometimes you and anyone might be controlled by
states where you find yourself agitated, angry, sad, or nervous, you just feel you can't stop yourself from
thinking about what has happened or imagining it, but you can simply face all of that, you can get rid of
these states by drawing your attention to the outside world, to people, to trees, to everything surrounding
you, instead of focusing on these ideas, let's do this following activity together"
Supportive activity:
"I want you to sit comfortably.. relax your hands and legs, dont sit with your hands and legs stiffed.. breathe
deeply and slowly.. inhale.. exhale.. think of what's around you, then mention five voices you can hear
around you, you can say I hear my brother talking, I hear my breaths, I hear a door closingetc., and again
breathe deeply and slowly.. inhale.. exhale.. think of what's around you, then mention five things you can feel
with your hands, you can say I am touching the chair with my hand, I am touching my clothes etc.".
"Breathe deeply and slowly.. inhale.. exhale.. I know you have been through some really difficult situations,
maybe it would be good for you to talk about them, so you'd feel better.. you know the voices you just heard
were out of your control.. even the things you've touched and have touched your body were out of your
control too.. so is the case of what is called trauma.. trauma itself is out of your control.. it is important to
talk about it.. to get what's inside of you out is a good thing.. to throw the things you are suffering from out
of you.. so let's talk about some of the things that make us feel pain and upset, let's talk about where you
were during the war on Gaza, were you injured or hurt? Did you see anyone in front of you get hurt? How
scared were you? With which point from the ones I just have mentioned would you like to start talking?".
The psychologist starts to encourage the child to talk about the point he just chose for himself and discusses
it with him.
At the end of the session, the psychologist should finish the session with a fun activity and doesn't end it by
talking about pain and sadness.
Activity:
The psychologist writes on a small paper (5 small papers) the names of five animals and birds, on each paper
a name.. then he folds the paper and tells the child: "on each paper there is a name of an animal or a bird, I
want you to imitate the voice of the animal or the bird that comes out with you".. and the child begins to
open the paper and starts imitating the voices, the psychologist must encourage him.. after every time the
psychologist must tell him how great he is and how good he is in imitation.. etc., you can play and laugh, the
33

state of laughing and fun must continue.. on the paper you would write the names of (rooster, sheep, cow,
cat, bird).

eighth session: Breaking the negative perception


Goals:
- The child recognizes what's meant by the negative perception
- The child recognizes how to break the negative perception
- Opening meditation and relaxation
The psychologist asks the child to close his eyes and tells him:"if you were sitting on a chair comfortably,
breathing calmly, relaxing your muscles, all your muscles, focus on your foot and thigh muscles, focus on
your stomach and thoracic cavity, focus on your shoulders and neck muscles, relax all your muscles, breathe
calmly, feel safe, comfort and tranquility, you are in a safe place", then the psychologist performs the
following activity:
He gives the child a paper, a pencil and colors, he asks him: "Can you draw me a triangle?", if the child
answers "No", then the psychologist draws the triangle, if the child answers "Yes", the psychologist tells him
to start drawing the triangle on the paper.. after he draws it, the psychologist tells him:"I have a fun game I
want to play with you.. I want you to name the sides of the triangle, lets name the first side (I can't), and the
second side (I dont deserve) and the third side (I don't have to change), and I made you stand up between
those three sides and I asked you to stand on the first side, which is (I can't), what would you feel? Of course
you'll be affected, you'll lose your self-confidence, and you will really feel that you can't.. what do you think?
Am I right or wrong? so since you've said you can't, you'll feel you are unable and you'll replace the second
side, where you become a helpless person who can't do anything.. am I right or wrong? Therefore, the final
result is that you'll replace the third side, you'll judge yourself, you dont have to change, okay, now let's
discuss this calmly while you are sitting with me, breathing calmly, relaxing your muscles, feeling safe and
secured, imagine yourself sitting comfortably and there is a person right in front of you that you don't like,
you dont want to deal with him, he has negative attitudes with you in your life, just concentrate with
yourself for a few minutes, and I'll help you with words, the person you are imagining right now is someone
you don't like, you dont want to deal with him and has negative attitudes in your life, when you remember
him, you feel upset etc., I think now you are feeling upset, you are not comfortable, your feelings are
negative, therefore notice the ideas that flow on your mind, your feelings, the longer you keep them, the
more you lose, for example, if there was a certain teacher in your school who you don't like, you can't stand
to see him, what could happen?", You listen to the child, you will reply to his words with "yes, you are right,
if you hate the teacher, you'll hate the subject he is teaching you, it is even possible that you'll hate the whole
school because of him, and this is exactly what will happen to you when you experience a psychological
trauma, and you keep on remembering this trauma.. when you remember trauma you'll get affected by it so
much that you won't think about what you should study, you won't concentrate, you'll lose your health, your
weight, sleep, food, your relationships with family and friends, so from here you better make some effort in
overcoming trauma and what it could cause from negative feelings.. and this is what we are going to do in
our next session".

Ninth session: Strengthening the positive perception


Goals:
-

The child recognizes what's meant by the positive perception


The child recognizes how to strengthen the positive perception
Opening meditation and relaxation
34

The psychologist asks the child to close his eyes and tells him:"if you were sitting on a chair comfortably,
breathing calmly, relaxing your muscles, all your muscles: focus on your foot and thigh muscles, focus on
your stomach and thoracic cavity, focus on your shoulders and neck muscles, relax all your muscles, breathe
calmly, feel safe, comfort and tranquillity, you are in a safe place", then the psychologist performs the
following activity:
He gives the child a paper, a pencil and colors, he asks him: "Can you draw me a triangle?", if the child
answers "No", then the psychologist draws the triangle, if the child answers "Yes", the psychologist tells him
to start drawing the triangle on the paper.. after he draws it, the psychologist tells him:"I have a fun game I
want to play with you.. I want you to name the sides of the triangle, lets name the first side (I can), and the
second side (I deserve) and the third side (I have to change), and I made you stand up between those three
sides and I asked you to stand on the first side, which is I can, what would you feel? Of course you'll be
affected, you'll feel more self-confidence, and you will really feel that you can.. what do you think? Am I right
or wrong? so since you've said you can, you'll feel you are able and you'll replace the second side, where you
become a strong, confident person who can do anything.. am I right or wrong? Therefore, the final result is
that you'll replace the third side, you have to change, okay, now let's discuss this calmly while you are sitting
with me, breathing calmly, relaxing your muscles, feeling safe and secured, imagine yourself sitting
comfortably and there is a person right in front of you that you like, you like dealing with him, he has positive
attitudes with you in your life, just concentrate with yourself for a few minutes, and I'll help you with words,
the person you are imagining right now is someone you like, you want to deal with him and he has positive
attitudes in your life, when you remember him, you feel relieved, a bright smile shines on your face etc., I
think now you are feeling kind of fun, comfort, your feelings are positive, therefore if we assumed you have a
lack of self-confidence problem due to a psychological trauma or an event that has occurred to you or to
someone in front of you, in order to think positively, you need to ask yourself these questions: why do I have
this problem? Who is the cause of this problem? How much did this problem cause me to lose in health,
thought, time, social relationships, in my studies etc., for example, if there was a certain teacher in your
school who you really like, you'll love his subjects, you'll get the highest marks, you'll be very happy and you'll
love school, this is exactly what will happen to you when you experience a psychological trauma, always
think of people you love and who loves you back.. always think that you are not suffering alone, there are
people who are standing with you and who love you, thats when you kick out negative feelings and replace
them with positive ones".

Tenth session: Challenge and resistance


Mohammed is a sixth grade student, he lives in Al-Salam neighbourhood east of Jabalya city, while he is at
school, he and his friends heard planes bombing, so they hurried to his house, and when they arrived,
Mohammed sat with his family, he saw his brother Ahmed and his sister Sua'ad crying from fear.
Usually at night there isn o electricity, all he hears are planes and tanks bombing around, and every now and
then, he hears his neighbours and the surrounding residents screaming, so Mohammed feels really scared,
but still, he was holding it together so he would calm his brother and sister, he would keep on hugging
them.. in the morning he found lots of destruction and demolished houses, he would ask about his friends in
these houses through his mother and father, he heard his mother saying to his father that they had to leave
their house and escape, but his father replied by saying: "what's meant to happen will happen if god
intended it to happen, it's all about fate", the mother agreed with him, but the next day their house was
shelled, thats when the father made up his mind to leave the house, and thats what they did, they went to
a relative's house thinking it would be safer.. but it wasnt, they were surprised how close the bombing was,
35

but they still stayed there hearing the screaming, the bombing, the ambulances.. day and night, till the
aggression on Gaza was over, the family returned to their home and found the destruction, the father
thanked god they weren't in it and that they are all okay, Mohammed then started to laugh at his brother
Ahmed and his sister Sua'ad, saying they were scared, but I wasn't so his father told him:"yes Mohammed,
you are really brave", so Mohammed said: "I heard my father saying everything happens by god's well, and I
believe in God".
After displaying the story, the psychologist asked these questions: "1) What do you think of Mohammed's
attitude? 2) What do you think of Ahmed and Sua'ad? 3) If we asked you to be one of three, Mohammed,
Ahmed or Sua'ad, who would you choose? And why? 4) Why do you think Mohammed didn't feel scared like
his brothers? 5) Can you draw me a picture of the three brothers revealing their states like you've heard the
story? 6) If we asked to advise each one of the three brothers an advice or more, what would you tell them?".
After the discussion, the psychologist comments and says: "indeed, everything is in God's hand, when
someone is scared of something, he gets tired, his concentration decreases, his thinking is not proper, his
health crashes, he could die.., but when you are strong, brave, cohesive, you know how to behave properly,
thats why when you have a problem or you are exposed to trauma, whatever it is, you have to pray to God..
you have to believe in God's well.. death and life are in god's hand.. thats when you can overcome trauma
and its negative emotions.. you have to pray when times are dark.. nothing does good to an individual except
his closeness to god and his prayers".
The psychologist continues: "I know you are tired of talking about war and destruction, but you have to
know that fear is essential when it is moderate, because fear helps us in protecting our selves.. let's end the
session in a fun activity".
The activity:
The psychologist prepares a set of balloons, say 5, and prepares 5 small papers and writes on each paper a
phrase of the following: (I am strong) (I believe in God) (I am not afraid to die) (My well is hard as steel) (I am
against all traumas whatever they are).
The psychologist folds the papers and puts each paper in a balloon, then blows the balloons and tells the
child to run behind the balloons and pop them, every balloon he pops, he opens the inside folded paper and
reads the written phrase loudly 3 times.. and so on till he pops all the balloons and the psychologist finishes
up the session with a relaxing meditation.

Eleventh session: Self-talking (group session)


Title of the session: Wishes and dreams
Goals:
- To let the participants know which negative thoughts cause them pain
- To let the participants know which positive thoughts cause them happiness and pleasure
"Today, we are going to talk about the mind and explain to you that there is a conscious part and an
unconscious part of the mind in other words, there is something called the subconscious this subconscious
is considered a warehouse, where we store our thoughts, especially if they are painful thoughts or feelings
we always try to escape from by forgetting them, but between every now and then, they appear.. in dreams ,
in the slip of a tongue, it causes us great pain and distress, therefore, we are going to perform the following
activity.

36

Activity:
"You will take a paper and a pin and will write down (5) negative letters which have bad effects on you, I'll
help you, for example, I am a shy person, I have a bad memory, I can't concentrate, I am an anxious person, I
became a person with bad temper etc.".
After the activity, the psychologist says: "it's nice that you've performed the activity, now please tear the
paper.. tear it vastly.. faster.. faster.. throw the paper quickly.. quickly.. get rid of all the negative thoughts
and feelings immediately".
Activity:
"Each one of you will take a paper and a pin and will write down (5) positive letters which have good effects
on him, I'll help you for, example, I am a brave person, I have a strong memory, I am not afraid of traumas, I
am a calm person, I am a patient person.. etc.".
After the activity, the psychologist says: "it's nice that you've performed the activity, now please write those
positive letters in a private notebook of your own and keep them with you.. start again by reading the first
letter, take a deep breath.. breathe calmly.. relax your muscles.. feel comfortable.. feel you are in a safe
place.. a place where you are happy and secured. Repeat reading the first letter (10) times with feelings..
then close your eyes and imagine yourself in a new look.. then open your eye".
"Please from this day on, if you notice a negative letter, throw it immediately.. make sure you have the
power to do so.. you can be whatever you want.. thank you and this is the end of our session".

Twelfth session: My wishes (group session)


Goals:
-

Acquisition of the participants the ability to plan for the future


Helping the participants in specifying their wishes
Encouraging the participants to make an effort to achieve their wishes
Warm-up and relaxation

Activity: with soothing music (the pond of wishes and dreams)


The psychologist draws a big circle and asks the participants to stand around the circle, then tells them the
following:"imagine that there is a pool of water in front of you filled with dreams and wishes, every
individual is allowed to take from the pond whatever wishes he dreams and wants to achieve, the
psychologist reaches out his hand as if he is taking water from the pond and mops his body with the water,
he closes his eyes, wanders a little bit and then opens his eyes and says I just made my first wish, now I want
every one of you to do the same".
Then he tells them to say what they wished for and asks them why this wish is not coming true? For
example:"I wished for what's stopping me from achieving it? Of course nothing if I made an effort and
placed my trust in the hands of god".
Finally, the psychologist says:"at the end of these sessions, I want to thank you for the effort you have made,
you were very cooperative and brave ,I love you so much and it was a pleasure meeting you guys, you are the
37

men of the future, protectors of our homeland, but before I leave you I want to implement a fun activity with
you, and whoever wins the competition will win the prize of okay let's begin":
The psychologist divides the group into two parts: the father with group., The mother with the other
group..
1- A hen lays white eggs, what is the color of the eggs a rooster lays? A rooster doesn't lay eggs
2- "Safar elbaidabyadon aw abyaden? Al-SaffarAsfrmshabyad"(traditional statement).
3- In which country does rainbow exist? It is not in a country, it is in the sky.
4- A snake walks on the floor, then how many legs does it have? It doesn't have any legs.
5- Where do the fields of macaroni exist in Palestine or Egypt? They don't, they dont plant it.
6- a house with black residents, red floor, green walls, what is the name of this house? A watermelon.
7- Something with big teeth and doesn't eat? A comb.
8- Where does the sea that has no water exist? On the map.
9- How many eggs does a cat lay? It doesn't lay eggs.
10- "Ashra w ashramsheshreen, wen? Essaa'aashra w ashra"(traditional statement).
11- How many ears do your mother, your father's wife and your uncle's sister have? 2 ears.
Of course the psychologist will spread an atmosphere of joy, happiness and laughter, and after every answer
he says to the participants: "well done, clap your hands for this team,."
A closing activity:
"Now let's all stand up and form a circle, everybody hold the hand of the person standing right next to you,
get closer to each other, you are a beautiful family, you love each other.. you live in a beautiful, comforting,
safe house.. move around in the circle with your hands held together,, (soothing music) repeat with me: "if
you are happy and you know it clap your hands (and they clap their hands).. if you are happy and you know
it clap your hands (and they clap their hands).. if you are happy and you know it and you really want to show
it if you are happy and you know it clap your hands (and they clap their hands), the flower opened.. the
flower closed .. the flower opened.. the flower closed (3 times) jump 3 jumps. clap 3 times (traditional
statement)", thank you and till we meet again".

Notes:
-

The sessions included some activities which may not seem appropriate for all ages, so the
psychologist has the ability to replace them with whatever activities he believes are more
appropriate for his targeted group.
The psychologists who implemented the sessions were given a special training in accordance to the
needs of the sessions.

38

- Annex no. (2)


CHILD POST-TRAUMATIC STRESS REACTION INDEX
NAME _________________________________________________ AGE _______

Answer each question by placing a check mark under which describes the subjects feelings. For the
(event), be specific to the childs experience; e.g. replace (event) with what happened to him/her.
PLEASE BE SURE TO ANSWER ALL QUESTIONS
Event

1. Is (event/what happened) something that


would upset, or bother, most children your
age a lot?
2. Do you get scared, afraid or upset when
you think about (event)?
3. Do you go over in your mind what
happened- that is; do you see pictures in
your mind or hear sounds in your mind about
(the event)?
4. Do thoughts about (event) come back to
you even when you do not want them to?
5. Do you have a good or bad dreams about
(the event) or other bad dreams)?
6. Do things sometimes make you think it
might happen again?
7. Do you feel as good about things you liked
to do before (the event like playing with
friends, sports, and school activities?
8. Do you feel more alone inside, or more
alone with your feelings-like other people
really do not understand how you feel about
what you went through?
9. Do you feel scared, upset, or sad that you
do not really want to know how you feel?
10. Have you felt so scared, upset, or sad that
you could not even talk or cry?
11. Do you startle more easily or feel more
jumpy or nervous than before (event)?
12. Do you sleep well?

NONE

LITTLE

SOME
(of the
time)

MUCH

MOST

13. Do you feel bad/guilty because you didnt


do something you wish you had done? Or if
you did do something you wish you had not
done? For example, to stop something from

39

happening, help someone else, or because it


was not as bad for you as it was for someone
else?
14. Do thoughts or feelings about what
happened get in the way of remembering
things, like what you learned at school or at
home?
15. Is it as easy to pay attention
(concentrate) as before (event)?
16. Do you want to stay away from things
that make you remember what happened to
you? (what you went through)
17. When something reminds you, or makes
you think about (event) do you get tense or
upset?
18. Since (event) are you doing things again
that you had once stopped doing? Such as
wanting to have someone near you, sleeping
with someone, sucking your thumb or
fingers, biting your nails or wetting the bed
more often?
19. Do you have more stomach-aches,
headaches, or other sick feelings since
(event) than you did before?
20. Is it harder for you to keep from doing
things you wouldnt have done before? For
example, getting into fights, disobeying,
more riding your bike more recklessly, taking
other kinds of chances, climbing on things,
swearing at someone, not being careful when
you cross the street or during play?

40