(Faure - "Pavane")
some are strong at the broken places".
(Ernest Hemingway, Farewell to Arms)
Recovery is a lengthy process. Individuals vary, both in their reactions to traumatic events and in the amounts of time they need for different stages of the healing process. By the time you come to this chapter, you might feel that your healing has begun and that you are moving along the path towards recovery, even though there is still a very long road ahead.
The human spirit seems to be able to find new strength in the aftermath of terrible events and eventually triumphs over adversity. Whether you are ready now or many months from now, you can begin to think about a future for yourself and start to visualize where you would like to be, when you have moved beyond your traumatic experience.
Visualization is a very powerful tool in the healing process. There are many stories from the medical community about people who have greatly enhanced their recovery or far exceeded anyone's expectation for their health by visualizing themselves getting better. This is not meant to be a substitute for following good medical advice or an excuse to avoid therapy but an additional tool. In the safety and privacy of your own imagination, you can create an image of how you want things to be in your future. Use the exercise below to help you with this.
Read through the instructions a few times to familiarize yourself with the steps before carrying out the visualization exercise. It can be repeated as often as you wish. You can also tape-record the instructions or have someone read them to you, so that you don't have to keep looking at the page.
1. Settle back in a chair where you can sit comfortably, with your back supported. Allow yourself to begin to relax slightly. Take a few deep breaths. With each breath, exhale fully and bring the next breath in more deeply, into your diaphragm. Feel your belly pushing OUT as you breathe in fully and pulling IN as you exhale completely. Listen to your breathing. Let distracting thoughts or sounds around you just pass by - you don't have to attend to them for a moment. Close your eyes now and let any excess tension begin to drain away from the top of your forehead down past your neck and shoulders, down your arms and hands and OUT through your fingertips. Let any excess tension in the lower part of your body drain away now, down your tummy and thighs, past your calves and ankles, and OUT through your toes. Enjoy the feeling of being calm and relaxed.
2. Now, begin to see yourself, as you would like to be, the way you want to be, in the future. Imagine that you are surrounded by a golden-blue light, which signifies the state of your well being. Look around you. What kind of place are you in? What are you doing? What colours can you see around you? Are there sounds? Are the sounds clear? Soft? How are you feeling? See and sense yourself with a new self-respect and a new understanding of yourself. You are accepting yourself more fully than ever before, discovering courage and strength you didn't know you had. Enjoy this feeling of arrival. Feel at peace with yourself. Stay with this feeling for a while. When you are ready, come back to the room you are in and know that you have the strength to move forward in your life.
This visualization technique may be repeated as often as you wish. It is intended to bring you a sense of calm and comfort during your journey to recovery.
There might be some pressure from others, or from yourself, to forgive those who might have had some part in your traumatic experience. It is equally likely that you are holding on to some feelings you have not been able to forgive yourself for. Forgiveness is a very difficult issue to come to terms with. Premature forgiveness, especially toward those directly responsible for harming you, may be detrimental to your healing. It may feel as if you are being pressured to say that something is okay, that it doesn't matter any more, when that is very far from the truth of how you really feel.
Try, then, to think about forgiveness in another way. Rather than excusing behaviour or an action or erasing it from your memory, think about 'forgiveness' as permission to move forward a little, into the present. You are not forgetting what happened but, instead, accepting that it did happen. In this way you are letting go, a little at a time, of the feelings that have kept you stuck. You are allowing yourself to experience life today as a little bit freer from the past.
You can still proceed with any search for justice that you are involved in, but you needn't feel you have to wait for that process to be finished before you can heal. Your sense of outrage, your trauma experience - that you have been looking at in the same way for so long - can be 'put' into a mental container, just like a box on a shelf. It has not gone away, but it has a place to rest for a while. You decide when you want to take it out and look at it again. This shift in attitude will help you to forgive yourself and work to accept yourself as you are now, and to live more in the present.
Even for people who feel they are well on the way to resolving their traumatic experiences or their losses, an upcoming� anniversary' of the event can have an extremely unsettling effect. You may be taken by surprise, especially if you feel you have 'dealt with' your reactions. You may not expect to find yourself suddenly depressed or agitated again, unable to concentrate or even beginning to have dreams or flashbacks once more. The researcher Bessel van der Kolk explained this succinctly, saying, 'the body knows the score� (1994). In other words, our subconscious seems to mark time and, when it gets close to the anniversary date, presents us with a series of reminders.
If some of your post-trauma reactions have returned with intensity around an anniversary time, this does not signify that you are 'not dealing� with your trauma. It should not be viewed as a backward step in your healing. Instead, try to look at anniversary reactions as one more natural step in your recovery. Once you have a framework for understanding what is happening to you, your reactions become more predictable and you can begin to feel more in control.
The two weeks or so leading up to an anniversary date are likely to be the most difficult period, in terms of the return of traumatic reactions. Your anxiety level rises, as the date becomes closer and associated feelings are recalled. Once the trauma anniversary has passed, you will probably notice a dramatic reduction in symptoms. Although you may have been very upset and agitated, it probably won't take you long this time to feel your normal self again.
Anniversary reactions can be managed, to reduce their impact. it is a good idea to plan some sort of symbolic ritual that will be personally meaningful to you, to help you mark the occasion. This could be as simple as lighting a candle at a particular time of day, or taking a moment of silence (alone or with others), making a donation (of money or of your volunteer time) to a particular cause, attending a church service, taking a walk in the park, requesting that a meaningful piece of music be played on a radio program, etc. The point is that you choose an action, no matter how small, that allows you to acknowledge what has happened and pay tribute to the person or thing that has been lost. In this way, too, you honour yourself for having come this far in your life, in spite of the trauma.
Native American Indians used a form of a 'blessing ritual' for such occasions, described in the book, Good Grief Rituals by Elaine Childs-Gowell (1992). This ritual consisted of gathering a candle, a bowl of water and some sage, the herb that is traditionally associated with wisdom. At the time or in the place you have chosen to mark the anniversary (this might be outdoors or indoors) you light the candle, dip your fingers in the water and touch your forehead, saying, 'Bless my forehead, that I may understand fully'. Next you dip your fingers in the water and touch your eyes, saying 'Bless my eyes, that 1 may see clearly', then you touch your lips with the water, saying 'Bless my lips, that I may speak the truth', then you dip your fingers in the water and touch your heart, saying 'Bless my heart, that I may carry strength and courage'. Now the sage is crushed between your fingers, and you inhale its pungent smell, then you wash your fingers in the bowl of water. The water is poured away, while you pause and reflect for a moment, and then the candle is blown out.
Not everybody needs professional help to recover from a traumatic experience (Herbert, i996). Recovery means that you have been able to integrate your traumatic experiences into your everyday life and although the memory of it has not gone, you are able to think about your experiences without feeling overwhelmed and out of control. The length of time it takes you to reach this stage will be particular to you. Every person differs in their own experience of a trauma, even if all the people at the time of the event were in exactly the same position. Likewise, each person's path to recovery is unique. However long it takes you, the most important point is that you allow yourself to recover in your own time and don't feel pushed by the expectations or advice of others.
Despite all your efforts, there may be times when you feel you are 'stuck' and you just can't seem to move beyond the trauma on your own. This is an indicator that you would probably benefit from professional help. It is not a sign of weakness, and in fact this recognition that you might need outside help is a sign of your own personal strength. It indicates that you are able to take personal responsibility for your recovery and that you recognize your own limits and boundaries.
Certain forms of therapy have been found to be very effective in helping people recover from trauma. However, it is important that you find yourself a professional who really understands trauma and who is properly qualified and registered with a professional body. Finding the Right Professional Help
In the UK, you can seek appropriate help either through the National Health Service (NHS); a private insurance scheme (if you have got such a plan); the legal system (if you are entitled to compensation for the damages you suffered); or by finding yourself a registered private psychotherapist who is experienced in this area.
Often, the best starting point is to visit your medical practitioner. He/she should be able to advise you on the services that are available in your local area. Most medical practitioners can recommend therapists, such as clinical psychologists, psychiatrists, clinical nurse specialists, community psychiatric nurses (CPNS) or others, who might be able to help you heal from the trauma. Again, it is extremely important that you seek help only from a professional who has been properly trained and has experience in the area of traumatic stress reactions.
Even if you find that your medical practitioner isn't very supportive or doesn't seem to understand, don't give up! Try ringing the Family Health Services Authority (FHSA) or any similar regulating body, who should be able to recommend a different medical practitioner.
Many public services can only offer limited therapy time to you and sometimes they can have very long waiting lists. If you feel that a long waiting time would be very difficult for you to manage, you should discuss this with your therapist and also your medical practitioner. There may be a priority treatment service for certain difficulties or they may be able to suggest other alternatives for you while you are waiting.
Alternatively, if you can afford to pay for yourself or have a private insurance plan, you could see a private therapist. Your medical practitioner may also be able to recommend recognized therapists that work privately in your area. A register of approved and qualified psychotherapists is available from the United Kingdom Council for Psychotherapies (UKCP) and also from the British Association for Behavioural and Cognitive Psychotherapy (BABCP). The British Psychological Society (BPS) also publishes a register of all Chartered Clinical Psychologists or Chartered Counselling Psychologists. The British Association for Counselling (BAC) should be able to recommend suitable trained counsellors or counselling agencies in your local area. The Eye Movement Desensitisation and Reprocessing (EMDR) Association for the UK and Ireland also has a list of their approved and registered members, but be sure to cheek that the recommended person is also suitably qualified and registered with one of the other above bodies.
Although this can seem a bit overwhelming at first, it is very important that you ask for as much information as possible. Don't just accept things at face value. It is perfectly acceptable to ask professionals about their experience and qualifications. If they are properly registered and qualified they will be more than happy to show you their relevant practising certificates. If you don't feel comfortable with a therapist, trust your own feelings! You won't progress with your process of recovery if you feel that you can 't have an honest, open and trustworthy relationship with your therapist. Finding the Right Type of Therapy
There are so many types of therapy available; it can be very confusing to decide on what might benefit you most. Research has shown that Cognitive Behavioural Psychotherapy (CBT) or Cognitive Therapy (CT) - which uses similar approaches and methods to the ones that we have been using in this book seem to be very effective therapies for treating post-trauma reactions. In addition your therapist might be trained in a method called Eye Movement Desensitisation and Reprocessing (EMDR), which is also increasingly used alongside other therapeutic approaches, such as CBT or CT. More detailed research of the use of this method is currently beginning to emerge; EMDR was specially developed to be used with people who have been traumatized (Shapiro, 1995) and patients seem to be reporting increasingly that it has been effective and helpful to them.
There are also some alternative therapies available that you might want to consider in conjunction with your psychotherapy, for example, aromatherapy massage, homeopathy and craniosaeral therapy may be very helpful in supporting your therapeutic healing process. Again, be very careful to use qualified, registered and reputable practitioners.
Whatever type of therapy or therapist you decide on, you might find it very helpful to use some of the exercises or suggestions in this book with your therapist during your recovery process.
Lastly, whether you have travelled your path of recovery on your own or with friends or a partner or with the help of a Professional, the final stage is to mark the journey that you have made in a personally meaningful way.
Expressing your story through some artistic means can be a powerful healing tool. Even though you may have never done anything 'artistic' in your life, and are convinced that you have no creative talent, this exercise can still be valuable. Many trauma survivors have found that writing or creating something to represent their ordeal symbolically was a vital step in their recovery.
Compiling a scrapbook of clippings and photos, finger-painting, wood-carving, drawing a series of sketches, painting in crayon or watercolour or oil, writing a short story, composing a poem, making an audio- or videotape, are all creative ways of telling your story. But they are by no means the only ways to use - even painting a sign is an artistic task, if the intention is to help you in your healing.
Here are a few suggestions to get you started:
1. The 'Breathing Line'
When you start to explore methods of creative expression, it is best not to be too concerned about the finished product. Just pay attention to what your senses tell you to do. The book Managing Traumatic Stress Through Art by Cohen, Barnes and Rankin (1995) suggests that, as a start, you pick up a pencil and draw a line to represent your breathing. Your line(s) might be short or long (quick breaths or deep breaths), curved or straight, flowing or broken. As the rate of your breathing becomes slow and relaxed, you may wish to draw it with your eyes closed. By producing a simple line drawing, you are showing, on paper, how you have mastered your traumatic stress reactions through control of your breathing.
2. 'Imprint of Fear'
Another exercise suggested by Cohen, Barnes and Rankin is called the Imprint of Fear. Select or mix several strong paint colours to represent your fear. Combine the colours you have chosen to form an abstract painting of the feelings of fear you experienced, both during and after your trauma. In a variation of this exercise, you could use the bold colours of finger-paints to make handprints, which you place on top of each other, in different positions.
3. Collages
The collage method has been used successfully by Falklands War veterans who received post-traumatic stress therapy at the Royal Naval Psychiatric Hospital in Haslar. A collage can be made by pasting together clippings, photos, magazine cuttings/pictures or other substances, like cloth, sand, dried flowers, etc. on a hard surface such as cardboard or poster board so that the result depicts your traumatic experience. A collection of the collages produced by military personnel treated at the Haslar Hospital was exhibited some years ago by the Manchester Art Gallery. The images and emotional struggles depicted in these collages were vivid and powerful. Whatever your artistic inclinations, you can cut and paste and use colour and texture to create a collage that depicts your journey out of trauma.
Try not to put off this task: it will help you express in a complete and genuine way the impact of the trauma on your life. Let it be a final healing task that allows you to make sense of things so that you can put them to one side. Or, if you choose, it could become a more public expression that you might share with family or friends or significant others. It is a unique way to tell others what it is like to live through chaos and put yourself together again. It symbolizes the completion of your journey.
The sun will sometimes melt a field of sorrow that seemed hard frozen: may it happen for you".
(Sheenagh Pugh)
(Faure - "Pavane")