March 3, 2019


Dr. Ayalon Ofra Nord COPE Center Email:

“Family as the optimal treatment unit”

As family therapists, we are often faced by dire circumstances that threat the fine fabric of the family system. We wonder ever so often at the inner strength that holds the family together in face of trauma and crisis that are intense beyond words. Our experience bears evidence that the family as a social system is a crucial resource for recuperation from crisis. At the same time we are also aware of the dangers that are involved in every crisis. The breakdown of traditional family and community structures by direct victimization, death, displacement or poverty often results in inner changes, such as “role reversals”, meaning the shifting of adults’ role over to youngsters. This results in parents’ loss of control over their children, with radical implications for children’s rehabilitation in the post-trauma era. Additional stress factors emerge when parental distress triggers violence in the homes. Traumatic events such as death, injury and poverty increase the likelihood of violence against women and children. Paradoxically, when men feel that they fail to protect their women and children, they may over-compensate by exercising violent control over them at home. Mothers who may be the sole survivors of war or terror, are often brutalized and abused, and their children take the brunt. Children of traumatized parents are left without adult support even within their own home. Holocaust studies of `second generation syndrome’ show that children carried the impact of their parents’ suffering into their adult years. Parents’ guilt over their own helplessness to protect their children from ordeals also accounts for their inability to contain, listen and accept their child’s pain. All these complex developments call for new & sensitive ways of approaching traumatized families in treatment. We wish to present here the “empowerment therapy approach” used to help traumatized families to resume the role of the family as a resource for coping, nurture and heal. The idea behind ’empowerment’ is to approach the family as a functional unit and to enhance its coping skills, such as: communication, listening and containing the mental pain of its members, help develop new strategies for handling difficulties of the traumatized members, dealing with loss of parental authority, and creating an atmosphere of support and healing (Ayalon, 2006). Families need to be empowered so that the adults can recapture their parental roles and learn new “coping oriented roles”.

From victim to victor

We believe in changing the negative energy generated by crisis into a healing spiral that pulls people up. With some help, family members are apt to find their inner hidden resources. The question here is: how do we make the move from being a victim to becoming a victor? It seems that it is a matter of changing attitudes and acquiring new skills for taking an active role in resolving the crisis, assuming responsibility for self healing, and assuming responsibility for healing other family members. This is a new challenge for the family therapist.

The art of healing –

when trauma is “beyond words” When traumatic crisis is so intense, when the pain and disruption are “beyond words”, we can offer the family “non-verbal” and psychologically-safe methods of expression and sharing. We offer them access to the world of symbols and metaphors. One of the most effective tools in eliciting “healing metaphors” in our practice is a set of illustrated therapeutic cards called COPE Cards , that belong to a specially designed genre of associative-therapeutic cards (the OH- Cards series). These cards enable their users to access deep feelings and narrate their experiences in a safe and protected way. By using COPE Cards, family members can learn to identify their own particular ways of coping with crisis, stress and trauma. The experience of randomly selecting cards and dealing with the associations they evoke can elicit new coping ideas. COPE Cards help family members reach their unspoken pain and discover inner strength. Images presented in the “COPE cards elicit hidden memories or fantasies related to the previous family experiences.

“BASIC Ph” coping modes with Therapeutic Metaphoric Cards

In the process of seeking ways to promote resilience and healthy ways of coping in the family, we use our model of “coping resources” acronymed “B.A.S.I.C. Ph”. This is a holistic multi-channel method. The name represents six modes of coping resources, reflected by the cards:

Belief systems, Affective expression, Social support, Imagination/creativity, Cognitive processing, Physical behaviour. (Ayalon 1992; Lahad 2000). These modes are represented here by the following six COPE “hand-cards”: Belief Systems refer to faith, either in God or in a supernatural power. It also represents trust in other human beings or trust in oneself. Faith and hope are well documented mental coping resources with trauma (Frankl, 1988).

Affect means the opening up of the feeling-aspect. The “heart” in this card symbolizes a range of emotions: love & hate, fear & courage, grief & joy, jealousy & compassion and so on. This coping mode involves the ability to recognize feelings and to name them. It allows the expressing of feelings and sharing them with other family members, by verbalizing (telling, writing, role-playing) or by non-verbal activities, such as free play & art.

Social coping skills focus on interaction with others. Such interactions include giving and receiving support, by family members, friends and also by professional helpers. Imaginative/metaphoric mode is the key to coping. It offers many creative ways of expressing painful memories. Cognitive processing is a mode that uses thinking, knowledge and problem-solving skills to make sense of the traumatic narrative, as it unfolds in response to the visual images of the cards. This is yet another mode of gaining control over past issues and painful memories by re-telling and re-structuring family painful stories and plan strategies for healing.

Physical (body/mind) coping modes refer to the fact that traumatic memories are stored in the body. Levine (1997) and Ross (2003) suggest the use of body awareness and Somatic Experience (SE) for unfreezing the somatic trauma and regaining body-mind control. These methods are used to build a flexible balancing of tension and relaxation, establish body-boundaries and re-examine the relationship between personal space and trust.

We have found our BASIC Ph multi-modal approach most effective in helping families cope with their difficulties and negotiate ways of resolving conflicts in situations such as loss & grief, domestic violence etc. In actual situations family members usually employ a combination of coping styles to survive.

Getting started with metaphoric cards The first step toward recovery and healing is to reach physical and psychological safety and security. In this safe space it is possible for every family member, young and old, to vent feelings by verbal and nonverbal means, to share dreams, nightmares and other traumatic reactions. The projective-metaphoric cards introduced here help to access repressed or hidden experiences and share them.

Telling the trauma story and finding coping resources Any COPE card (or combination of several cards) can function as a trigger for the narration of the event and responses to it. Using the COPE Cards provides an opportunity for recounting personal recollections in a safe environment. Metaphoric stories triggered by the visual images of the cards are one step removed from reality. This “creative distance” facilitates recall and working though of painful experiences. The use of image and imagination serves as a protective screen against being overwhelmed by intense emotions. When the memories become too much to bear, one can always return to the imagined story, or look for other cards that may serve as anchors for a sense of thriving, surviving and healing.

Guidelines for identifying your coping skills with the “BASIC Ph” model

Rational: This activity aims to discover what are our own coping modes that we use to deal with daily hassles and stress and also in crisis situations. In this process participants will also identify those coping modes that are blocked in times of crisis. What resources would be required to open them up and make them, too, available in times of need?


1. Spread the six COPE “hand cards” face up on the table, and identify each of them according to the BASIC Ph model (Belief, Affect, Social, Imaginative, Cognitive, Physical modes).

2. Pick 6 cards at random from the COPE Cards deck and place them face down on top of the “hand cards”, so that each “hand card” is covered by another card.

3. Turn the top card up, one at a time and reflect how they connect to the “hand card” that represents one coping mode. Let the top card help you describe how you use the relevant coping mode in your life, in a positive or a negative way. For example: My “imagination” helps me detach myself from my worries (positive), and my “social” coping mode makes me needy and over-dependant on others (negative).

4. Now think of a time in your life when you experienced severe stress or crisis. Turn the remaining COPE Cards face up and choose 3 cards that describe this experience.

5. Try to identify which of the coping modes represented by the cards you have actually employed to deal with that crisis. Use the cards to tell the story of your coping.

6. Try also to identify those modes that you have not used – and turn their representative cards face down. These cards represent those coping modes that were blocked by the traumatic event.

7. Find cards that will help you re-activate those blocked modes.

8. Reflect on the whole process of how you identified your existing resources for coping with crisis and how you activated additional resources. Share your reflections. Re-tell the story of your traumatic experience, and how it was transformed by the use of all six coping modes.

In conclusion There is no one single appropriate method of coping for all situations, all people or all ages. Each person, family, and community have their specific combination of coping modes, that constitute their basic coping language. The effective way for the family therapist to help the family is to join the “language” of each member, and then guide them in improving their communication.


Ayalon, O. Rescue! Community Oriented Preventive Education. Ellicott city: Chevron Publishing Corporation; 1992.

Ayalon, O. The HANDS project: Helpers Assisting Natural Disaster Survivors. Community Stress Prevention 5 pp.127-135; 2003.

Ayalon, O. Children’s response to terrorist attacks. In: D. Knafo (ed.) Living with terror, working with trauma. New York: Jason Aronson. pp. 171-200; 2006.

Frankl, V. The Will To Meaning. New York: New American Library; 1988.

Lahad, M. Darkness over the abyss: Supervising crisis intervention teams following disaster, Traumatology, 6 (1-4), 273-294; 2000.

Levine, P. Waking the Tiger: Healing Trauma. Los Angeles: North Atlantic Books; 1997.

Ross, G. Beyond the Trauma Vortex: The Media’s Role in Healing Fear, Terror & Violence. Los Angeles: North Atlantic Books. 2003.

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