The newsletter of the
International Trauma Training Institute (ITTI)
Mike Dubi, Ed.D., LMHC, Editor
Jeanne Thomas, MBA, Associate Editor
Spring 2019, Vol. 2, No. 1

I hope you are getting back into the swing of things after the holidays and that you are doing well.

As you know, we at ITTI are constantly on the lookout for new, innovative and forward looking treatment interventions. For our March 11, 2019 session we will be offering Complementary & Alternative Therapies for Trauma (COAT), something mental health workers will enjoy and find useful in working with clients and for themselves as a way of expanding their treatment options. The course, taught by renowned expert Joffrey Suprina, Ph.D., will examine the ideas and techniques from Traditional Chinese Medicine, Ayurveda Medicine, the Creative Arts and other approaches. This training has both theoretical and practical aspects that will enhance almost everyone’s clinical work.

Also, if you enjoy traveling and would like to visit historic and beautiful Vienna as a presenter and/or attendee, watch for our announcement and call for proposals for the next EB-ACA (European Branch - American Counseling Association) conference in Vienna, Austria on Sept 27-28, 2019.

ITTI is in the process of developing a series of advanced certifications in Trauma, Forensics and Addictions. We will keep you updated about these projects and hope to get them up and running sometime in the Spring.

Beat wishes to you all.

Mike Dubi, ITTI, President
Digital Online Training Mentoring Learning Education Browsing Concept
beginning on
March 11, 2019.

To see course descriptions and to register, click this link:


Joffrey S. Suprina, Ph.D. is the Dean and Associate Professor of the College of Counseling, Psychology and Social Sciences at Argosy University. He is a current board member of the Association for Spiritual, Ethical, and Religious Values in Counseling (ASERVIC) and has held leadership positions in SACES and ALGBTIC.

As a practitioner scholar, Dr. Suprina is a licensed mental health counselor (LMHC) and supervisor who has worked with a wide variety of clients and supervisees in a myriad of settings including university counseling centers, psychiatric hospitals, clinics and private practice. In addition to being an LMHC, he is also a hypnotherapist, massage therapist, musician, dancer, actor and director and integrates those perspectives in his clinical work. Dr. Suprina regularly presents with over 100 professional presentations, workshops and guest lectures, has published in a variety of professional journals and books and is the Editor of The Practitioner Scholar: Journal of Counseling and Professional Psychology.His practice and research areas of expertise include holistic wellness, LGBT issues, multiculturalism
and trauma.


An Art Therapy Mission of Relief for Syrian Refugee Families in Lebanon
Mercedes Ballbe ter Maat, Ph.D., LPC
The political, social, and religious crisis in the Middle East has caused millions of Syrian families to seek refugee status in neighboring countries. Lebanon has taken the brunt of Syrian refugees, as the border between Lebanon and Syria has been historically relaxed and elastic in allowing free trade between these two countries.

Now more than 8 years into this crisis, Lebanon has closed its borders to Syrian neighbors after providing refuge to over 1.5 million children and families (BBC Report, 2015). A country of 4 million residents, the refugee population has caused Lebanon resources to be depleted and offer little to nothing to families in need. The social, labor, and political tensions between residents and refugees have increased, causing refugee families to be afraid of leaving their tent settlements for fear of being the target of violence. Understandably, Syrian families feel as though they face a no-win situation: They can either return to their country to face religious and political persecution and possible death or stay in Lebanon to face conditions leading to depression, anxiety, aggressive behavior, and lack of control.

The Kayany Foundation, a Lebanese non-governmental organization and the Red Pencil International, a non-profit humanitarian organization of creative art therapists teamed up to provide a school-based intervention for Syrian refugee children (and parents) attending a Kayany school. I was asked by the Red Pencil International to lead a group of creative arts therapists to Lebanon to provide Syrian refugee children and parents with a means for emotional expression, opportunities to increase their understanding of past experiences (Rousseau et al, 2005), make sense of a challenging present, and build community by offering personal support in group art and dance/movement therapy settings.

One of the reasons why the creative therapies were an important way of conducting therapy and relief was because of the language barrier. Although we had translators, we knew that some children even with translators would not be comfortable expressing verbally the trauma that they had experienced in Syria, in moving to Lebanon, and in the tent settlement camps. At the start of the mission the children looked sad and timid; they were not sure what we wanted them to do with the art materials provided, as though they had not been exposed to (or not often) to art materials.

Another goal of the mission was for the children and parents to make sense of the lived experiences in their own country and make sense of the challenges that they were facing at present time. These challenges included animosity with the host community, parents struggling to find jobs, financial hardships, not getting along with community members, living in tent settlement camps in below- poverty conditions, and the frustration of wanting to return to their native country but could not.

A final goal was to develop social and community cohesion by offering personal support in group art therapy experiences in a contained and unique setting. This was important because the only or one of the only support systems they had was each other. No matter what their life experiences were in Syria before arriving in Lebanon, these families were now dealing with similar issues and shared many experiences. In Lebanon; they were all refuges, they all had very little money; most of them lived in tent settlement camps; most of them had very little to no resources, such as health care.

The location was in an elementary school in the Bekaa Valley, central Lebanon. The school was located about an hour west of the mountain range that separates Lebanon from Syria. The school was created by the Kayany Foundation to specifically educate Syrian children (Syrian children were not allowed to attend Lebanese schools). All the teachers were Syrian as well. We served over 100 children ages 5-13, 6 mothers in the parent group, and more than 20 families during family nights. Dads did not participate; they were at work or chose not to attend. 
Mercedes ter Maat and the Kayany school principal
Art Therapy Children’s Groups
Some of the lessons learned and insights gathered revolved around the incredible resiliency that these children portrayed, while expressing difficulty concentrating and focusing on a directive that required the use of art supplies and self-exploration. Some children were not used to working with art supplies. It was hard for some to turn their focus onto their own selves, to pay attention to themselves, to self-express - all qualities that perhaps were not valued or promoted in their upbringing.
The changing of the meaning of self-esteem was of importance in these groups. The self (in a collectivist society such as the Syrian culture) was a foreign concept to most children. What is best for the tent settlement, what is best for the people living in the tent, what is best for the family and the community takes priority. The whole was more important than the individual, and perhaps that is why some were at a loss when the focus of the art therapy directives was on themselves. We know that in collectivistic societies the emphasis is on external locus of control and external locus of responsibility; the focus is on others. At first children were vulnerable to the circumstances they were facing, they were vulnerable to talk about themselves, and they were reluctant to express hardship for fear of possible reprimand, criticism, and judgement by adults and other children. They were going through a transformation that encompassed what they understood of the past and their identity as Syrian children, combined with the newfound refugee status while trying to grow by the values of a world turned upside down. They were in a society where the present was chaotic and the future uncertain. The present circumstances prevented them from thriving, developing, thinking, creating, focusing on hope, and focusing on the future. The art therapy groups aimed to provide a place of containment, a place where children could feel comfortable talking about themselves and their circumstances, where they could trust one another. Confidentiality among children, teachers, and translators was emphasized; we counted on the rapport already built among the teachers, translators, and children to help decrease the behavioral outbursts that were inherit in these large groups.
Kayany school in the Bekaa Valley of Lebanon
Some of the directives that we introduced in the children’s art therapy group were:
1.    Name illustrations - as they created a picture of themselves they shared the meaning of their name.
2.    Scribble drawings—used for warm-up
3.    Trees of life—a tree in mural paper as a check-in activity – each day children would add something to the tree whether it was a leaf, a flower, a branch, a root... This initiated dialogue about how they were doing and feeling.
4.    Hand tracings—to address personal strengths and identity represented in each of the fingers traced.
5.    Mandalas—representative of the world according to them and of a response to the “miracle question:” If you had the opportunity to create your own world, what would it look like?
6.    Illustrating a folk story - important messages that children remember growing up in their native country told thru a folk story. What was most important to them?
7.    Dream catchers— many children spoke of having nightmares related to the trauma experienced prior to leaving Syrian. We shared the meaning of dream catchers rooted in the Native American culture and created them so that they children could take them home to get rid of nightmares.
8.    Boxes—represent and provide a place of containment, a sacred or secret space for oneself. We created paper boxes for children to decorate inside and out. After the decorations, children create tiny things that are personal and meaningful to them. These tiny treasures ranged from possessions to experiences. We emphasized that these treasures did not have to be shared with others.
9.    Miniature books – created with paper, yarn, and hole punchers so that each child illustrates his/her own story. Each child is the main characters. 
The Mother’s Art Therapy Group
The goal was to offer mothers an art therapy experience that provided a safe and comfortable space where they could connect, find support, and share experiences while creating art. We had anticipated that the mothers needed their own group because of the trauma they had suffered. Moreover, we suspected that they would be more free to share personal and inner thoughts if their children or husbands were not present in the room - preventing additional traumatization to their children by listening to their stories. The topics addressed were primarily related to (1) life in Syria; (2) Life in Lebanon as a refugee, and (3) feelings, such as depressed mood and loss of self-identity due to traumatic experiences in Syria and living in refugee camps. Read full article with more outstanding images:

BBC Report (January 2015). Syrian refuges. Retrieved on June 7, 2015 from

Rousseau, C., Aline Drapeau, L., Lacroix, D., & Heusch, N. (2005). Evaluation of a classroom program of creative expression workshops for refugee and immigrant children. Journal of Child Psychology and Psychiatry, 46:2, pp 180–185.

About the Author
Mercedes ter Maat, Ph.D., LPC, ATR-BC is a professor in the Department of Counseling at Nova Southeastern University’s College of Psychology in Ft. Lauderdale, FL. Prior to joining NSU she was the director of the school counseling graduate program at the George Washington University, Alexandria, VA campus and an assistant professor at Virginia Tech.

Dr. ter Maat has over 30 years of combined working experience as a counselor educator, mental health counselor, school counselor, and art therapist. She participates in local, state, national, and international leadership undertakings in the fields of mental health counseling, school counseling, and art therapy and frequently presents on topics related to multicultural counseling, ethics, motivational interviewing, and the use of art in counseling and therapy.

Dr. ter Maat actively participates in humanitarian work, most recently in Argentina, Swaziland, Lebanon, and Peru, and her research interests are in enhancing the quality of life of immigrant, minority families in crisis by identifying risk and promoting protective factors through school- and community-based interventions.

Dr. ter Maat is past-president of the American Art Therapy Association, the current president of the Croatian Art Therapy Association, and the current president of the European Branch of the American Counseling Association. She is a licensed professional counselor and a board-certified/registered art therapist. 

All courses are NBCC approved
(ACEP# 6674)

March 11 - April 21, 2019


March 11 - May 5, 2019

For additional certification requirements go to,