Sunday, November 20, 2005

Book, therapy for survivors of disasters

"WHEN I first interviewed Joel, he admitted to being afraid of the rain. He believed that every strong rain would bring on another mudslide. I introduced the draw-a-person-in-the-rain as a therapeutic intervention, which seemed appropriate at the time because of the nature of his fears. I was surprised by his first drawing in the series, because he portrayed a young boy with adequate coping skills and no fear of the rain ... I continued to probe. What resulted was a series of drawings that ran like a storybook. Through drawing and the story he created, he succeeded in breaking through his denials and managed to resolve his fears."

This is an excerpt from a field psychologist's narrative about her therapy session with a boy who survived the 1990 earthquake and mudslides in Nueva Ecija.

Post-disaster relief and rehabilitation should go beyond the material and economic. Survivors need healing, not just of their physical wounds, but of their spirit as well. Adults, and children most specially, are vulnerable to the long-term psychological effects of their horrible experiences if no one helps them address and process their trauma.

Noted clinical psychologist, researcher and author Dr. Ma. Lourdes A. Carandang has been involved in addressing post-traumatic stress of survivors of major disasters in recent years and helping them come to terms with their pain and loss.

The book, "Pakikipagkapwa Damdamin: Accompanying Survivors of Disasters" (Bookmark, 1996), is the result of Carandang's and her Ateneo de Manila University team's efforts, funded by Unicef, to give psychological aid to survivors of the 1990 earthquake and the 1991 Mount Pinatubo and 1993 Mayon Volcano eruptions.

This "helping manual" for those working with survivors could very well have been written for the November landslides that claimed hundreds of lives and destroyed thousands of homes in Luzon. It could also find context in the Dec. 26 tsunami tragedy that killed more than 150,000 people along the coastlines of Asia and parts of Africa.

"Pakikipagkapwa-Damdamin," which is being reprinted, is different from other books on psychosocial rehabilitation. It uses the psychological approach instead of the symptom-oriented method. It examines the inner world of survivors by "letting them speak for themselves."
The phenomenology of the helper or carer is also laid bare. How do they see themselves, how do they sustain their level of energy?

Community barometer

The book reveals that children are the barometers of the psychological and emotional climate of the community. No matter how the adults try to conceal their true feelings, the children always provide an accurate gauge of where the community was at.

Children are the perfect entry points for gaining rapport, whether it is through "kodak magic" or games.A therapist uses a number of ways to make the atmosphere more accepting for a child.
Through "mirroring" or imitating the child's posture or facial expression, the psychologist enters the child's world and makes the child feel at ease, connected and accepted.

"Following the child's lead" is letting the child set the pace for beginning interaction. The therapist keeps his voice down, he is friendly but not overeager, and waits for the child's response instead of demanding it.Introductions, using names, sitting close and touching also make the child feel safe. Listening and showing interest in their answers are some of the many techniques to gain entry to a child's world.

Drawing, writing

Child therapists have always relied on nonverbal ways a child communicates. A child's drawing speaks a thousand words. It is also a tool for drawing out more stories.

Says Carandang: "Asking a child to draw enriched our pool of information. Drawing allowed children to re-live their traumatic experiences, a process necessary for their recovery. For example, when invited to draw her story of the earthquake, a 12-year-old illustrated a scene that she had failed to mention during the verbal interview."

Writing, Carandang adds, is also an effective tool for rapport and self-expression among older children. It can even be "infectious" to other children and adults.

Using story metaphors (about a group of ants, for example, that wanted to eat an ensaymada but whose path was blocked by water), play therapy, re-framing or looking at things in a new light, talking about lessons learned, making use of their senses and their connectedness to nature -- these help children make sense of their experiences.

Stuck adults

Carandang recalls her experience working with survivors of the 1990 earthquake in Nueva Ecija: "Working with adults who were in various emotional states was an essential part of the holistic multilevel process. As we met face-to-face with them, we found out that we needed to help them move on with their grieving process, that most of them were stuck and needed help to get unstuck from their immobilized states."

She narrates: "Emotional states varied from bitterness, pain, depression to suicidal thoughts. For some, intrusive thoughts were a problem."

She lists the survivors' lamentations:
"Sometimes, I think I will go crazy."
"We don't know where to turn to."

"Our land was washed out. Everything is gone. I grow weak when I think of it. That used to be land, the most beautiful land. It's gone."

"When everything is back to what it used to be, maybe that is when my mind will be back to normal."

But the survivors were able to cope with what happened. They never blamed anybody for what happened. They continued to hope, worked hard work and persevered. They also recognized the courage their children have given them.

Talking helped: "Alam namin ang damdamin ng bawat isa. Nagbibidahan kami. Kung minsan, nakikibida na ako, nakikihunta ako sa mga kapitbahay para lalong malibang ko iyong iniisip ko (We know what each one feels. We swap stories. Sometimes, I talk a lot about my own experience. I talk about what I think to my neighbors, the better to distract myself from my worries)."

Metaphors of nature

Since their lives have been spent close to nature, Carandang says, adults have a deep emotional bond with it. Familiar nature scenes were used as metaphors to help adults regain a sense of transcendence or ability to look beyond their present situation.

One therapist used two mountains that marked the boundaries of the relief center -- one barren, the other lush -- to re-frame the outlook of an adult stuck in his feeling of loss."Many adults," Carandang says, "believed that God sent the disasters to punish them for their wrongdoings."
The team had to explain to survivors that the disasters were not their fault in order to bring them out of self-blame.

The support system, prayers, even specialized techniques such as hypnosis and massage helped those suffering from psychosomatic reactions.

Recalls Carandang: "Perhaps the most tender and touching part of the prayer service that our team experienced was the offertory, where the people, again, despite their sorrow, offered themselves quietly to the Lord, calling Him Amang mapagmahal (loving Father).

Finally, the community offered a big rock -- a symbol of their tibay ng pananampalataya (strength of their faith). This last offering served to remind them of the deeper directions of the community's healing: stronger and more compelling than the shared outpouring of grief was the will to renew lives of enduring trust, faith and hope."

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