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|Hope in the Ruins - Page 4|
Anthropologist and physician Paul Farmer, the UN special envoy to Haiti since August 2009, has a concept he calls "appropriate technology," which, I believe, describes our TRM-C model. He contends that "one should only use the simplest technologies required to do a job." Where mental health treatment is concerned, I'd add that one should only use the gentlest, least intrusive technologies required. For example, the use of "titration," which psychologist Peter Levine introduced to somatic therapies, is central to our work. Titration, a term that comes from chemistry, means to work with small increments of traumatic material, watching the client's level of activation, and then shifting to material that's less distressing, neutral, or even positive, before returning again to the traumatic material. This rhythm reflects a natural pattern in the autonomic nervous system, where excitation alternates with calming. Titrating exposure to traumatic memory and dysregulated physical sensations while helping people experience more relaxing, positive body states, slowly brings about profound changes at the physical, emotional, and cognitive levels. This is "appropriate technology" in action, where the client can heal gently, with little risk of the retraumatization that can come with diving too far into the traumatic material before the nervous system can tolerate it.
Our workshops include a mix of brief psychoeducation about the biology of trauma, demonstrations of the skills, and practice among participants. We've refined our teaching methods so that the pace is fast, and people learn a lot, and have some fun as well. A big hit at all of our trainings is teaching the hokey-pokey, which people around the world love. Another popular icebreaker is having the introductions sung. Each participant sings his or her name and the group sings it back. It's a playful way to create a safe atmosphere for the work ahead. When I was in Rwanda, one of the trainees introduced me to an effective way to do group introductions, which we're using in Haiti now: we go around the circle, and one participant says how he or she is feeling at the moment, and the next two people go into the center of the circle and act it out. Everyone has a turn. Sometimes there's laughter and sometimes sympathetic understanding, but we all know each other much better after the process. It also gives us trainers a heads-up on which of our participants may need some extra attention.
In one introductory circle, a woman said she was feeling sad and had no energy. When the next two participants went into the circle and acted that out, she nodded affirmatively that they'd really shown how she felt. Later, in her small practice group, I asked if she was willing to do a demonstration with me about what she'd described. She told the group that her fiance had died in the earthquake; she'd held his hand when the building had come down on him.