As therapists, we've been trained to think that we should focus primarily on emotions. We often elicit negative emotions, believing that they must be purged before there'll be room for hope and other positive emotions. We're particularly anxious to assuage trauma survivors, whose desperate, unbearable pain seems to demand immediate relief. We frequently assume that all clients must feel hopeful and believe that life is meaningful before they'll make much progress in therapy or in life.
But the fact is that in the wake of catastrophe, it's often impossible to summon up the least glimmer of hope or faith or sense of life's meaning. How, for example, can you suggest to someone whose child has been shot in a schoolyard, who has lost a home to a hurricane, or who's been raped as a child by family members that there's hope for the future, that they'll feel "better" someday? To clients who have suffered such profound trauma, it's ludicrous to suggest that they can be coaxed into feeling hopeful about the future.
In these cases, the trauma therapist may be in something of a bind. Trying to "drain off" negative emotions by focusing on the pain---asking clients to rehash what happened or to speak repeatedly about their terrible feelings---is likely to make them feel worse. Just asking such clients an open-ended question about their emotional state---"How do you feel today?"---may exacerbate already terrible feelings or call forth a sense of numbness and apathy.
But favoring positive emotions and subtly trying to subdue negative ones can backfire. Asking these clients to imagine a time when they won't feel suicidal or reframing their trauma as an opportunity to "grow" can trivialize their suffering and inadvertently insult them. These efforts may also strike them as manipulative, as though the therapist is trying to maneuver them into a hopeful response they're not ready for.
How do we get beyond this impasse? We can begin by looking again at the ways people have found consolation and support in the thousands of years before psychotherapy was developed. Throughout history, human beings have found rough relief and a modicum of comfort in the immediate obligations and habits of ordinary, daily life. The greatest incentive to go on coping lies in their relationships with other people, not only those who comfort and support them, but those who depend upon them.
Sometimes, the simplest act can have profound power. I learned recently of a Red Cross survey given to disaster survivors, asking them to name the most helpful "intervention" they'd experienced right after the disaster. Many said they most appreciated being given a cup of coffee by an aid worker. It wasn't fancy trauma therapy, but I suspect the familiarity and ordinary helpfulness of the act implied to survivors that, in spite of catastrophe, normal life was still going on. In receiving a cup of coffee lay some small kernel of hope for the future.Focusing on Day-to-Day
Germaine came to see me after her adolescent son had been killed in a gang-related shooting. She'd just lost her job, was drinking heavily, and was almost paralyzed with grief. She entered therapy not to make herself feel better, but so that she could go on living for the sake of her other two children.
Germaine said she'd been going to a support group, and while it helped to get dressed, get out of the house, and be with others, the overall experience wasn't particularly useful. "I feel like I'm being swallowed up by how much it hurts, like I could, literally, drown in the pain."
Of course, I didn't know the answer. But clients often have within themselves the budding solutions to their own dilemmas, though they may not recognize it at the time.
"It helps when I make a list," she said finally. "Some days, when I get up in the morning, I make a list of what I need to do and, somehow, those days seem to go a little bit easier--maybe because I have a plan, sort of like a map for getting through the next few hours. When I don't have my list, it's a lot worse. I can just sit and cry all day."
This pursuit of minutiae can have a powerful impact on the client. In creating a list, Germaine acknowledged her own agency and strength. If I were to praise her, no matter how sincerely, for managing to get up every morning, it might have sounded condescending. Focusing her attention on what she was doing for herself helped her to recognize her own strength and her ability to keep going despite her pain.Starting with Baby Steps
Strangely enough, the "distraction" of living fully in the present seems to be the only real cure for the terrible things life can do to us, the only real source of hope in hopeless situations. As therapists and healers, we can't make people feel hopeful, nor can we reverse the tragedies that make them feel hopeless. But we can help them slowly begin building, out of life's own materials, a place in which hope can nest.This blog is excerpted from “The Pragmatics of Hope." Read the full article here. >>Want to read more articles like this? Subscribe to Psychotherapy Networker Today!