Case Example 2: The World Trade Center Attack, September 11, 2001

It is chilling to face the reality that terrorism has increased so significantly since the first World Trade Center bombing in 1993. The truck bombing of the Alfred P. Murrah Federal Building in Oklahoma City killed 168 people and injured more than 500 others (Kight, 1998), and the four plane crashes on September 11, 2001, killed almost 3,000 and affected millions of citizens who watched the events unfold on television and who joined in the national grieving process. After September 11, I developed a new tripartite formulation for the assessment of the traumatically bereaved child (Webb, 2002b), specifying factors that are particularly compelling for traumatically bereaved children following terrorist attacks. Included are the following, which are fully discussed in Helping Bereaved Children (Webb, 2002a, 2010): • Extent of violence/trauma/death (including degree of destruction and proximity to the event) • Degree of life threat • Solitary versus shared experience • Loss of a family member (typically a parent) • Loss of a predictable future To what extent can crisis or bereavement groups help children who have experienced traumatic grief under these unique circumstances? Do the guidelines I reviewed earlier in this chapter apply in a crisis of this magnitude? Because I lived in the Greater New York suburbs at the time of September 11, 2001, I know that there was a great lag in the implementation of bereavement services by various agencies. Initially, this was understandable, as families were not ready to grieve because they were still focused on the identification of remains and hoping for a miracle. Certainly, the first guideline, “give information about the crisis,” was operative here insofar as the families needed to know if their loved ones had been found. Information was very slow in coming, which added to the stress, to the continuation of hope, and to feelings of denial about the death and postponement of funerals and memorial services. The second task, “encourage detailed recounting of the crisis,” was not appropriate due to the traumatic nature of the deaths and the probable mutilation of the bodies. Developmental factors would affect children’s ability to comprehend or accurately envision the nature of the deaths. Many children and adults saw bloodied people running from the scene in television playbacks. Some schools, in well-meaning efforts to help, encouraged children to draw or write about what they saw, and several children drew pictures of the falling bodies of people who chose to jump rather than to wait for certain death in the raging fires. We do not know whether children who drew these pictures and wrote stories or poems about the event were traumatized or relieved by doing so. The third task, “universalize and normalize individual reactions,” certainly is relevant here. Parents and children need to be informed that some of their reactions, such as sleep difficulties, are related to their traumatic bereavement. Information about PTSD helps older children and parents understand some of their symptoms. However, many children, even those who attended bereavement groups, could not bear to talk about their losses until after the 6-month anniversary (Hartley, 2004). So the timing of normalization has to occur in synchrony with the children’s readiness to share some of their reactions. The fourth task, “identify strengths and new coping abilities,” also is time sensitive. It is difficult for people to comprehend that they might gain strength through surviving a loss of this magnitude. Most would rather turn back the clock and resume their previous lives. Many would resent anyone suggesting that they will “grow” from the experience, and this abstract idea would be lost on most children. However, the outpouring of gifts and offers to help in the form of teddy bears and other toys probably did have an effect on many children, who may have marveled that people they did not know from all parts of the country and the world tried to help them. CONCLUDING COMMENTS This chapter, emphasizing the wide applicability of group work with children, recommends a helping approach that combines play and art activities as a means of furthering communication with young clients. The group modality appeals to youngsters, who benefit from the sense of belonging and peer support intrinsic to an effective group. In group work with children, activities are considered as therapeutic tools, so the distinction that is sometimes made between “activity groups” and “therapy groups” does not apply. Instead, I have proposed an integrated model that joins both approaches. It is important for the success of a group that the leader or leaders plan its composition and involve the members in adopting certain guiding principles that will assure each person confidentiality and respect. When these procedures are followed, the group can result not only in improved social interactions but also in increased feelings of self-esteem among individual members. The special circumstances and guidelines for conducting crisis debriefing groups have been presented. Unlike other groups, which require prior screening of members, a crisis group consists of all individuals who shared a traumatic event. Timely and detailed attention to the emotional state of each individual helps prevent future possible symptom development, even as it helps group members realize that many of their feelings are shared by others. Bereavement groups with traumatically bereaved children must respect their varying abilities to deal with their painful traumatic memories. Accepting the support of others can help them heal, even as they can gradually reach out to other group members. I hope that this chapter will encourage more social workers to use groups with children and will thereby reduce the neglect of this helpful modality in work with young clients. DISCUSSION QUESTIONS AND ROLE-PLAY EXERCISE 1. Review some of the advantages of group interventions for children. What is the appropriate manner for preparing a child to enter a group? 2. Imagine that in a group for children with divorced parents, the male and female leaders disagree about the issue of visitation with the noncustodial parent. Consider the ideal way for the leaders to resolve their differences and speculate about the possible repercussions in the group if the matter remains unresolved. 3. How would you begin a group composed of 6- to 8-year-old children with parents who died in a traumatic explosion? Role-play what you would say and how you might deal with the silence of children who cannot talk about the death because it is too painful. 4. Identify a crisis event involving a group of children that was reported in the news media. Outline a model preventive intervention approach that would utilize group debriefing with the child survivors.