The Sept. 11, 2001, terrorist attacks in the United States had a deep impact on the Japanese children who were living there. Unlike adults, however, they have fewer ways of expressing their grief.

Masako Mori, a clinical psychologist who is a counselor at the Japan Education Center in Connecticut, is treating two children who lost their fathers in the New York attacks by using play therapy.

“Adults can talk to their close friends to relieve stress, discuss problems and find ways to resolve them. But children cannot because their cognitive and linguistic abilities are not fully developed,” she said in a recent interview.

“Play therapy allows them to express their feelings, thoughts and emotional struggles to relieve stress.”

One of the two children was a kindergartner referred to Mori about a month after the terrorist attacks, which killed nearly 3,000 people in New York, Pennsylvania and Washington D.C.

Mori was then finishing her Ph.D. in clinical psychology at Columbia University and had already treated a number of patients during her internship and clinical studies.

When the attacks happened, one little boy had only been in the U.S. for a few months and was having problems adjusting. He was restless and emotional at kindergarten and did not listen to his teacher.

On the morning of Sept. 11, the boy watched the collapse of the World Trade Center on television with his mother, but did not know that his father had been killed in the attack.

Then he stopped talking about his father completely and the adults around him avoided speaking about his father.

About a month later, still unaware his father had died, the boy attended a memorial service at ground zero. “Papa, where are you?” the boy cried as he refused to leave the site.

And his behavioral problems only got worse.

“Many people think they had better not mention traumatic events to the people affected by them, but that is not always the case. When you experience strong grief or fear, they will not go away from your mind. It is important to talk to someone you trust, and in the case of children, express their feelings through play,” Mori said.

During the first play therapy sessions, the boy would repeatedly build towers with wood blocks and crash a toy plane into them. At times, he played hospital with toy doctors and nurses, setting up an intravenous drip.

“That probably showed the boy’s desire for his father to be alive,” Mori said, adding that it was also a way for the boy to try to overcome the traumatic experience of losing his father.

The psychologist worked with the boy’s mother and teachers to give him an environment in which he would “feel fully secure in expressing any kind of emotion,” she said.

She also had the family establish a strict daily routine — telling him well in advance of any changes — to help to lower the boy’s anxiety.

About two months after the therapy started, the boy’s drawings began to change. Violent black scrawls and scary images changed into pictures of people, animals, the sun and smiling faces, Mori said.

The boy also began asking questions about his father and crying at times, a departure from his emotionless reaction when he was told of his father’s death. He started participating in group activities in his kindergarten class and made several friends.

When communicating with people who have experienced strong stress or grief, it is important to respect “their willingness to talk,” Mori said.

“You are asking questions not because you want to know, but because you are worried about them. See their reaction, listen patiently no matter how they express themselves, understand and empathize with them,” she said. “It’s the same with children.”

Meanwhile, Mori, who has counseled a number Japanese expatriates in the aftermath of Sept. 11, said the Japanese public generally has a low awareness of the importance of mental health care.

“Many of the Japanese parents were not familiar with mental health care issues and, particularly, they have never heard of posttraumatic stress disorder,” she said.

She said that in Japan there is a stigma attached to mental health care and many Japanese tend to feel ashamed of seeking counseling.

Mori said mental health problems have been increasing in Japan in recent years, including bullying, child abuse, and self-mutilation, but many do not know where to seek help.

“In the United States, when teachers spot a learning problem, for example, the child will be examined by the school psychologist and will receive speech therapy and so forth through the school,” she said.

“And if a child is suspected of depression, he will see a school counselor and then be referred to a clinic. Such a referral system is firmly established in the United States, but Japan has a long way to go.”

Although there are a growing number of mental problems in Japan, many people do not know where to seek help, according to the psychologist.

“I want to establish in Japan a system where children have swift access to mental health services covered by health insurance whenever parents or teachers spot a problem,” she said.

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