His tiny hands clutch a crayon and the tip of his tongue sticks out as he concentrates on drawing his "safe place."
When he's finished, a series of colorful slashes bolt across the paper. It is, he explains seriously, a picture of "my good dad and my mom."The young artist is 4 years old. He is one of the 3- and 4-year-olds who have gathered in Primary Children's Medical Center for a group "play therapy" session intended for victims of sexual and physical abuse.
Ronda Nelson, a clinical nurse specialist who co-facilitates the group with licensed clinical social worker Michelle Thompson, asks another little boy which puppet he feels like "checking in with" today.
He selects a shark. And when she asks him how he feels, the shark speaks for him in a deep, growly voice. "I'm mad," he says. Then laughter lights the boy's young face. "And I'm happy because of Santa."
In her 28 years doing this work, Nelson says little has changed with the children and their problems. A lot has changed with how therapists and technology tackle those problems.
"Psychiatry has been called the study of the soul. The kids we see are really traumatized in some way. Our emphasis is on getting them to express how they feel."
Therapists are more specialized, Nelson says. "It promotes healing faster; they know what they're doing. We can send the children to people who really know what works."
She also cites advances in technology as good news for the young victims of sex abuse. The advances allow for fine-tuned diagnosis. "Fifteen years ago they never, ever diagnosed childhood depression because children don't act like an adult who is depressed."
Abuse itself hasn't changed, but "kids have the feeling now they can talk about it. It doesn't have to be a secret. I tell them to keep telling until someone believes them."
Besides group work, the children are in individual therapy with their own therapists. Parents, who now form their own support group in the lobby as their children meet, will soon have their own group, led by social worker Denzel Grimshaw. He is part of today's session with the children.
The parents need support. In this group, they are not perpetrators but must deal with what has happened to their children at the hands of baby sitters, neighbors, friends, other children or relatives - people they all trusted.
The inner strength and resilience of the children amazes Nelson. Developing it, along with the realization that children have choices, is a key goal with this group. They talk about how to walk away from situations, how to be "safe in an unsafe world." They learn about empathy - something that abuse can steal from them.
Because children so young are often nonverbal, they learn to express feelings like anger by making animal noises. A pigtailed girl roars like a lion at one point and they stop to discuss what she's feeling.
They learn about their bodies and good and bad touches. They learn to dial 911 in a real emergency. They are given the right to make choices, beginning with simple things like what color Play Doh they want.
And the messages sink in.
What, Thompson asks, "would you say if someone asks you to take your clothes off."
"No!" the boys and girls shout. "I don't like that!"