Reconciliation with the sea after the tsunami

July 30, 2018

Reconciliation with the sea after the tsunamiWorkshops for helpers following the tsunami disaster in Thailand, June 2005Dr. Ofra Ayalon Institute of Nord, TivonFor the first time in six months, since the tsunami destroyed her residential beach in Phanganga, twenty-eight-year-old Taiwan dared to go to the beach. Twenty-eight members of the young teacher's family perished in the disaster. At a "reconciliation with the sea" ceremony, which took place at a workshop for caregivers survivors of the tsunami on the beach on the Thai island of Phuket, Tiahuan said: "Since the disaster I have been very afraid of the sea, but to my surprise, in this encounter with the sea, I feel calm and calm." The sea in Phuket, which is the source of life for the islanders and their source of livelihood, has become a source of anxiety and anger and a focus of pain and loss for the residents affected by the tsunami disaster. Their inability to disconnect and move away from the threatening sea made it difficult to recover from the horror of the catastrophe. In June 2005, six months after the disaster destroyed many communities along the coast of Southeast Asia and claimed more than 5,400 victims in Thailand alone and countless victims in neighboring countries, a number of trauma treatment workshops were held on the Thai island of Phuket, attended by some 200 teachers, doctors and mental health workers from Thailand, Singapore, Malaysia and Indonesia. The participants, many of whom were directly affected by the tsunami, came to learn ways of therapeutic intervention in individual and collective trauma, and to apply them to the affected communities and their educational systems. The workshops were initiated by the Joint Distribution Committee in the United States, which specializes in helping disaster hotspots around the world, and under the auspices of education patron Princess Mom Dosdi Privatra from Bangkok. The aim of the workshops was first and foremost to strengthen the participants' coping resources in the post-traumatic sediments that remained in them following the tsunami, while helping them build support systems for the local populations that were directly or indirectly affected **** *** Under the guidance of three Israeli facilitators, representing three areas of expertise in trauma intervention and treatment: psychologist/traumatologist Dr. Ofra Ayalon, Nira Mizrahi an arts therapist and Dr. Gilat Reisch an expert in pediatrics and family medicine and mind/body balance. Circles of vulnerability and circles of support in the event of a mass disaster such as the tsunami disaster, the helpers, who are supposed to be part of the "circles of support" and rehabilitation of the affected communities, are also at the same time in the "circles of vulnerability", since the disaster may also harm them, their families, relatives, friends, students and neighbors. At such a time, the boundaries between helpers and helpers are breached, and an over-identification and involvement with the affected population is created, which makes it difficult for the helpers to meet the professional tasks of providing help and treating trauma. The common destiny of victims, survivors, and caregivers in the community places extraordinary demands on professionals who, as "miracle survivors" (potential victims), may also suffer feelings of anxiety and guilt (Ayalon and Shaham, 2000). Due to the great burden placed on them, the helpers tend to ignore these difficulties and are likely to suffer burnout and post-traumatic symptoms themselves When we dubbed the workshop participants, it turned out that many of them suffered losses of their family members, their homes and villages were destroyed in the disaster, many were eyewitnesses and hearing witnesses to the destruction and destruction, and others volunteered to help the children and families of the victims. A number of teachers said that the great wave destroyed their school, but this happened on Sunday, when classes did not take place and so they and their students were miraculously saved. They were still upset by the experience of the possible closeness to death. In their imaginations, they continued to reconstruct what could have happened if the school had been populated at the time of the disaster: "I keep thinking about who I would have tried to save, and what would have happened to the other children I couldn't reach. These images haunt me day and night."Understanding the immediate needs of the assistants, we built a continuing education program that operated simultaneously on two levels: on a personal level – a personal/supportive attitude was created for each member of the group, while recognizing that they are in the circles of vulnerability. The participants were given many opportunities to process their experiences and receive support from both colleagues and facilitators, to prevent secondary traumatization and to strengthen their personal resilience. At the professional level – the learning of the subjects related to the understanding of trauma as well as the methods of treatment and educational intervention were taught in an experiential way, combining body and mind, with an emphasis on developing nonverbal forms of expression through means of movement, relaxation, touch, guided image, art creation, dubbing with metaphorical cards and encouraging personal stories. All these measures have been tested and found to be highly effective in acquiring strategies of helping and assisting survivors and for developing coping skills in stressful situations and traumas. Strategies for treating trauma During the five-day workshop, participants abandoned the white-plated chairs and collapsed on the carpet in the extensive lecture hall. On a huge screen, images and titles of the various presentations were projected. The program included lectures (with the help of a skilled interpreter) on the different aspects of the traumatic reaction: the response of the body and the nervous system, the psychological and social aspects, the signs of traumatic reactions, methods of initial diagnosis and methods for developing coping skills. The participants received information that would help them locate the most in need of treatment among the survivors, learned to identify typical reactions to the different ages of children and adolescents, and to discern risk factors for ongoing traumatic disorders. They also experienced a wide variety of ways of treating, coping with and relating to the processing of trauma. The acquisition of professional knowledge was done while experiencing experiential learning in the methods and methods of treatment presented to them. The experiential experiences included different ways of expressing the pain that is stored in the body and does not find expression: methods of body awareness, release of pain and the restoration of physical stability, proper use of breathing and relaxation, expression of color and form according to the principles of movement art therapy, music and therapeutic use of voice, therapy using personal symbols (symbol therapy) archetypal symbols (Mandelhötz's drawings) and the use of metaphorical cards (KSM) for dubbing and personal empowerment / reconciliation with the sea After a series of experiential activities, designed to create a connection and trust between the participants and the three Israeli facilitators and to bridge the cultural and language gaps, we proposed to hold a ceremony of "reconciliation with the sea", aimed at dulling the residues of anxiety that arose again in every encounter with the sea. The stages of preparation for the ceremony took place in the "protected space" of the workshop: the participants underwent a process of mutual acquaintance, experienced muscle relaxation and breathing relaxation. And then enthusiastically engaged in colorful paintings of personal "security symbols", which are supposed to create images of protection and inner strength. After the paintings were completed, the participants agreed to leave the protected space and expose themselves to a renewed encounter with the sea. The intention of going ashore was to turn guided exposure to the sea into a corrective and empowering experience. The paintings that became "security symbols" were woven by the participants on a rope and hung along the seashore. The symbols that hung between the trees and flew in the light breeze gave the beach a new look, strange and familiar at the same time. Following the following instruction, the participants dispersed on the beach, collecting seashells and pebbles and painting them with their favorite personal color. In this way, they appropriated the seashells and delegated their own personality traits to them. Later, the participants created a half-gurney, facing the water and the shells painted with their hands. One by one, they approached the sea and placed the painted seashells on the waterfront, in a symbolic gesture of reconciliation. Some did so in silence, some murmured a prayer. This symbolic activity aroused great excitement among the participants and the echoes were evident throughout the entire workshop. The burnout of disaster therapists MassStudies point to risks of burnout and secondary traumatization of those who help in the disaster (Lahad, 2005). It appears that the physical proximity to the scene of the incident and the social proximity to the victims increases the risk of those who help develop post-traumatic stress reactions, which can negatively affect the quality of their work and personal lives. This phenomenon is referred to by various names such as: "erosion" (Pines, 1984), vicarious vicarious traumatization) or "proximity exhaustion" ("compassion fatigue" (1996 Figley,). Following the collective trauma, the person who assists in the disaster, like the survivors themselves, may also experience an amputation in the sense of continuity of his previous life or in part: the breaking of the expected continuity of a place that has been destroyed and changed its face, of time that has frozen at the breaking point of the trauma, of cause and effect due to the inability to attribute the destruction and loss to previous acts, the painful disconnection of social ties and the forced change of professional functioning. As a result of breaking these continuities, the helpers, as well as the victims-survivors, may experience shock, confusion, frustration, fear, terror, and damage to their sense of control over their own destiny (Omer and Alon, 1994). Those attending the workshops reported signs of trauma that continue to plague them six months after the disaster: sleep disturbances, bouts of fear, being flooded with recurring images of the victims and the devastation wrought by the disaster, feelings of guilt for not preventing damage or not helping enough, and self-blame for being saved while many others perished in the disaster… There were those who were tossed between two poles: between the feeling of an "omnipotent" helper and a feeling of helplessness and despair. "I tried to grab and hold the girl's hand, but the strong current separated us"… "We wanted to go to the disaster site immediately to help, but we were also afraid that the tsunami would strike again… " One of the participants, who is restricted in walking due to her age, was troubled by the question: What would have happened to me if I had been at the site of the disaster? How would I run when the others fled to a high place or climbed the trees?" . Many actions during the workshop were aimed at restoring balance to the assistants by repairing the fracture in the coatings that were interrupted by the disaster. We placed great emphasis on connecting their activities and functions in the field of education and care before they were called upon to intervene in the disaster and their activities during and after the disaster. We also continued to equip them with a professional "toolbox" suitable for their skills. The story of the traumatic experience An essential component of trauma therapy is the opportunity to "speak" (speech and ventilation) of the personal story of a listener who is a sympathetic witness (Eylon and Horowitz, 1996). Each of the participants was given the opportunity to tell their story in small groups, with the listeners being guided by empathic listening without criticism and without giving advice. We trained the participants in the use of artistic/creative and metaphorical means, which were of great help in releasing the personal traumatic story, which due to its intensity is often left without the possibility of direct verbal expression.The reconstruction of the trauma story contributed to the gradual reduction of the emotional burden. In addition, giving testimony made it possible to bring the personal story out of the darkness of trauma into the light, to bring continuity and order into what was experienced during the disaster as chaos and confusion, to fill voids in memory and to gain confirmation of the credibility of the events and experiences of the narrator. The listening and support gave full legitimacy to the personal reactions, which are sometimes experienced as the most frightening and strange. One by one, the stories of the tsunami were heard, as experienced by participants in different areas of the disaster. One of the participants, previously refused to share her plight with others: "I was afraid they would think I was crazy", the security envelope in the workshop helped her release her story about the desperate search for her mother, whose body was discovered three days after the flood that destroyed her village. Another told about the escape from the coastal plains to the mountains from the great wave, about the loneliness, detachment and anxiety she experienced when she wandered in the hills far from the coast, and also about the help with food and shelter that was served to her by the foreign mountain residents. A tone of despair was heard from many stories: "I have lost faith in the world as a safe place." Some have taken collective blame: "Nature punishes people for the destruction they cause." And there were those who spoke of the painful disillusionment after the first stage of social cohesion: "The disaster brought us closer and created many manifestations of mutual help, but after the donation money arrived from abroad, suspicion and competitiveness arose between the people and the social fabric gradually crumbled." Bridging a cultural gap The great challenge we faced as Israeli facilitators was the need to take into account the traditional ways of responding of the participants, which brought with them cultural and religious baggage from various sources such as Buddhism, Islam and Christianity. Most of them admitted that, in accordance with the cultural heritage of Southeast Asia, they had no avenues of expression for their plight. According to them, they felt that it was necessary for them, men as women, to conquer their feelings, to pretend, to avoid expressing sorrow and crying, and most of all – not to talk about the disaster and try to return to "normal life." The question arose of how to bridge the local belief system and social codes with the importance of liberation and personal expression, which are the focus of trauma treatment according to our method. To create a safe bridge that respects tradition and with that allows for development, discovery and expression, we used a tried and tested method called pacing and leading according to the model of Milton Erickson (Rosen, 1996). The accompaniment, also called "joining" or "joining", is a fairly quick method of communication, which allows the facilitator to meet the terms within their frame of reference, to join them in their distress, immediate experiences and worldview from within their culture and experience. The accompaniment is done through the use of the participants' language, tone of voice and body language and aims to create relationships of closeness, understanding and trust. Following the accompaniment came the lead, aimed at freeing the participants from a mental state in which they are stuck following their traumatic experience (Wosner, 1993). The technique of accompaniment and leadership, which was conducted in the encounter between cultures and in a foreign language, requires great attention of the facilitator to nonverbal expressions of the terms. This method of communication is taught by the rescue and assistance teams in mass disasters, and is later used by them in establishing support and assistance relationships with broad and diverse populations of victims and survivors. The Authority for Crying in the Terror of Survivors of Disaster may cling to helpers, and indeed, exposure to the trauma of others has raised previous traumas in the participants and flooded unprocessed losses from their past. The discussion of loss and mourning is carried out with sensitivity to cultural differences and the exchange of information with the participants about discoveries and rituals of mourning processing that are characteristic of their culture. In sub-groups that dealt with art and creativity, work on the body and metaphorical cards (KSM), stories of loss from previous periods, childhood losses, the death of a parent, separation from a partner, a painful divorce and difficulties in daily life arose. During body/mind sessions that touched on the processing of loss and separation, the dam of restraints was breached and the participants reacted emotionally to the "permission to cry". The work on mourning in pairs, in groups and with the facilitators gave room for the expressions of pain, the containment of pain and its relief. The participants rewarded us with tearful hugs. We were surprised and amazed by the discovery of the human base we all share, beyond any cultural and traditional conditioning. Coping resources After the outlet, the time has come to reveal the resources of mental strength, personal resilience and coping ability of the participants. The main axis of our program was the "positive psychology" approach, which focuses on the identification and development of coping resources. Unlike the clinical approach based on the diagnosis of pathology, this approach emphasizes personal resilience, which means – the innate and acquired ability of the person to withstand difficult conditions, to cope successfully and even to prosper and grow out of adversity. We copied to the tsunami workshops the multidimensional model for the development of coping resources called "Gashar Mahad", which was developed in Israel (Eylon and Lahad, 1991; 2000; Lahad and Eilon, 1994) and serves as a basis for training disaster helpers in Israel and in many places around the world (Rosenfeld, Caye, Ayalon & Lahad, 2005). The model, which is built on the assumption of personal resilience expressed in coping with stressful situations, gathers six main "coping channels", which together make up the spectrum of coping with stressful situations: C – the channel of physical activity, that – the channel of intellect, logic and thinking, R – the channel of emotions, M.A. – channel of beliefs and values, H – the social-family channel, D – the channel of imagination and creativity. Each person chooses their own channels of response to stress from the available pool of coping strategies according to their perception of the type and severity of the threat. Some tend to respond through the body and prefer to do something active, some act in an informed manner and seek information and understanding, others seek a channel for expressing their feelings, some rely on faith in a higher power, some turn to society, to help or help, and some cope with imagination and creativity. There is no one way suitable for every situation, for every person and for every age. It is possible to identify different combinations of available coping channels that are characteristic of the individual, the family and the community. Each such characteristic combination constitutes a "basic language of coping." The effective way to help cope in situations of stress and distress is to join the therapist (the intervener) to the basic language, in order to allow the expression and reinforcement of the existing patterns. It is possible to develop the use of additional channels beyond the basic language, thereby enriching the coping resources. The wider the variety of available channels, the more effective the coping will be.  We apply this model in times of emergency following personal or community trauma with families, groups and communities, in issues such as living in uncertainty, losses, grief processing, channeling anger, aggression and vengeance, etc. In order to identify the dominant coping channels, we posed them the question: "What helps you in times of stress and crisis?" The participants chose different cards and described their typical coping channels through them.Here are a number of answers that illustrate the typical use of the various coping channels: Body: "I invested myself in hard work of clearing the rubble and removing the fragments. So cold so I could absorb all my anxiety and sorrow… I managed to calm the children in my class by making a vigorous movement, at the end of which they get tired, sit quietly and breathe deeply." Intellect: "I was 32 years old and a mother of three when my husband was killed. I wasn't prepared for life at all, I didn't know how to run a family. The children influenced me to go back to school. By studying I became stronger, acquired a profession and now I am a teacher. I was saved by studies and thinking." Emotion: "What helps me are the positive emotions. I would like to express my feelings simply, like a child, to laugh, to cry… " Belief system: "During the tsunami, I prayed in the mosque. The wave came abruptly, flooded the entire road, bypassed the mosque and did not hit it. Thanks to the prayer, a miracle happened to me and I was saved." Company: "I volunteered to help people who have been hurt. Their suffering is greater than ours. I felt stronger when I helped them." Imagination: "With the help of imagination, I was saved from drowning. In my imagination I saw a strong rope in the water and clung to it and pulled myself up – I was saved, even though there was no rope in the water…. " The workshops ended with the preparation and presentation of group projects aimed at applying the methods learned in the workshop within the community, in education and in the family. Dr. Emporan Sorenparsit, head of the Thai University, summed up the workshop: "If each of the participants imparts the Torah to ten or twenty more people, wide circles of adults and children will be created who will use these tools to enrich their skills of resourcefulness and coping." Mekorailon, A. Velhad, M. (1990).Life on the border – vaccination and coping with stressful situations of war and peace. Haifa: Nord.Ayalon Publishing, A. and Horowitz, M. (1996). Crisis, coping and hope with situations of threat and loss . Educational operating kit for the transmitter: as a stone cast into a pool of water. Tel Aviv : Israeli Educational Television. 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The Creation of the Soul in the Shadow of Terror: The Israeli Attempt.Lahad, M.and Eilon, A. (1994) On Life and Death. Haifa: Nord Publishing.Omer, H. Valon, N. (1994) . The principle of continuity: a unified approach to disaster and trauma. Psychology D, 1-2, pp. 20-28.Pines, A. (1984). Grinding. Tel Aviv: Tcherikover.Rosen, S.(1996). The voice of Milton Erickson.Haifa: Nord Publishing. Figley, Ch.(Ed.) (1996).Compassion Fatigue. New York:Brunner/Mazel.Lazarus, A. A. (1981). The practice of multimodal therapy. New York: McGraw-Hill. Rosenfeld, L., Caye, J., Ayalon, O.& Lahad, M. (2005). When their world cameapart: Helping Families and Children Manage the Effects of Disaster. Washington DC:NASW Press.

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