Part of being a compassionate companion to someone who has survived trauma is an awareness of the far reaching effects trauma can have on a human being. Regardless of the type of trauma experienced, the whole of a person is affected. This makes companioning a survivor a unique case. One of the difficult things about trauma compared to other “issues” we may face in spiritual direction, is that we are not only dealing with relational or emotional wounds. Even if the person has never been physically harmed we are dealing with damaged biological systems, so we must incorporate their biology into the direction experience. It is helpful to have an understanding of the physical responses people have to trauma both so that we can offer appropriate and helpful disciplines as needed, but also so that we can carefully navigate those physical aspects of the spiritual life that may be under strain.
The major physical responses to trauma that may affect the direction relationship, but be invisible to the eye, mostly take place in the brain. During a traumatic experience, the frontal lobe of the brain shuts down. The frontal lobe is the part of the brain that helps us with reason and decision making. After the event is over, the frontal lobe often has trouble re-establishing connections, especially around events related to the trauma itself. This invisible injury may express itself in direction as difficulty being present and a lack of language. It may be hard for the directee to explain their own emotions or thoughts to both themselves and their director. The lower regions of the brain, sometimes referred to as our “reptilian brain,” get overstimulated during overwhelming events. This is the instinctive part of the brain that integrates and interprets input from your internal organs, including muscles, joints, and balance system, to give us a sense of being embodied. Trauma interrupts these communications as well as making it difficult to distinguish the past from the present. Trauma also distorts social awareness, creates defensiveness, and interferes with abilities to regulate.
We also see trauma affecting other systems in the body. The hormones that regulate our fight or flight responses often become stuck, flooding the body unexpectedly. A survivor’s body may be full of trapped energy. This over abundance of adrenal hormones wears on other systems. One theory of understanding trauma’s physical affects is called Polyvagal theory. This refers to the two vagal systems that run throughout the body. These are located above and below the diaphragm. We experience these systems as the difference between something making one’s heart pound or breathing increase versus something being “gut-wrenching.” If the upper vagal system has been affected by trauma, directees may suffer from a lack of prosody, poor face to face gaze, flat facial affect, sound hypersensitivities, and inappropriate posture during social engagement. If the lower vagal system has been affected, we may see poor mood and affect, atypical state regulation, a low threshold to become fight or flight, a low threshold to become dissociative, lower gut problems, or fibromyalgia.
Understanding these effects of trauma can help us to be patient and compassionate in meaningful ways with our directees who have survived trauma. Incorporating grounding experiences, recommending practices that help with brain health (for example, coloring), being sensitive to the frustrations that come with lack of language and so perhaps offering Visio Divina over Lectio, all of these are ways that we can compassionately care for the whole of our directees as they begin to heal.
*Suggestions for further reading:
The Body Keeps the Score, by Dr. Bessel Van Der Kolk
In An Unspoken Voice, by Dr. Peter Levine
In The Village of Care series we have the opportunity to hear from helping professions, who are not spiritual directors themselves but who can collaborate with spiritual directors to combine and expand resources for survivors. These voices come from medical, mental health, research, ministry, and public service. The goal in hearing these varying perspectives is to give us as spiritual directors some insight into the experiences that our directees may be having with other helpers in their lives, and language to talk about it with them. The expectation is that we are learning from our colleagues in other fields, and translating their advice where appropriate to the context of spiritual direction. We encourage you to make an effort to get to know care providers in your community now, so that you have relationships to lean on when greater context is needed.
The moment right before a patient’s consult with an Oncologist, where I know they will receive a cancer diagnosis, always makes me very anxious as a nurse coordinator. I usually wait outside the room and introduce myself only a few moments before the doctor comes in because I don’t want there to be any empty conversation space. I know that empty space means they will undoubtedly ask me about their results and I never want to lie (and what feels more mean than saying, “I’ve seen them. Wait a few more minutes for the doctor to come in...”). I know their life will never be the same and this is the first red letter day of a new chapter of their lives.
I sit with the patient and family after the doctor drops a bomb and explains in attempted-plain-medical-English, but I know most of what was said sounds like French and it’s hard for patients to move past the word “cancer.” A lot of patients feel that the ‘waiting and not knowing’ is the hardest part. Oftentimes, imaginations go a little wild and patients picture the worst, most painful treatments and a slow, long death. Whether someone finds out they have an incurable disease that will most likely lead to their death, or an early-stage cancer that will most likely be cured with treatment, the “cancer” word has a way of pulling someone’s life sharply into focus, and their mortality at the forefront of their minds. At the same time they are bombarded with practical issues such as who will pick up their kids from school, how will they pay their expenses if they aren’t working, who to share this news with, and when to tell close family and friends.
Being a support person such as a nurse, counselor, or spiritual director can certainly be a challenge. The training we have received has taught us to actively listen, but what if our client doesn’t know how to start talking about or processing their hurricane of many emotions that they may be feeling all at once? Using my experience as an oncology and hospice nurse for 10 years and speaking with Laurie Ostracher, LCSW, I’ve put together some basic tips for supporting your client with a cancer diagnosis. I’ve got some good news! You don’t need to be Ghandi or come up with inspirational or overly spiritual quotes! With some general prompts, focus on listening and let the client direct the conversation.
The training we have received has taught us to actively listen, but what if our client doesn’t know how to start talking about or processing their hurricane of many emotions that they may be feeling all at once?
Start by asking what would be the most helpful for them
You may think they would be concerned about death and dying, but they may surprise you and actually be preoccupied with a completely different issue! This sometimes can involve their hair falling out, or the fear of needing an ostomy bag.
Ask, “what kinds of thoughts are going through your head?” or say “It’s hard for me to imagine what you’re feeling like,” (even if you are a cancer survivor).
Be very empathetic and express how sorry you are that they are going through this.
Ask, “what kind of support do you have? Family? Friends?” Are their family and friends actually supportive?
If someone has pre-existing anxiety, support groups may not be the best environments. Classes may be a better fit, as they are more directional. You can ask what kinds of resources their clinic offers, or encourage them to get connected to the social worker at their clinic to find out about their resources.
Breaking the News to Children
Many parents become very concerned with what and when to tell their children. They should share what they know in age-appropriate terms with their children as they find information out themselves. Kids are very sharp and almost always sense that something is “off” before anything is said. Just like adults, their imaginations can go wild if they aren’t told the facts, so oftentimes the plain facts are less scary then what they had made-up in their minds. If your client is hesitant, they can wait until they have a treatment plan in place to tell their kids everything at once. Kids are very self-referential and mostly want to know how their lives will be affected. It can be helpful to make a visual calendar and include items like who will be picking them up from school, when visitors are coming (including relatives staying over). Be aware that telling your children information can come with a loss of control over your privacy. It’s only fair that they can discuss with their friends for support, as it is healthy for everyone touched by the diagnosis to have someone to talk to.
If others are approaching your client and wanting to discuss the diagnosis and your client doesn’t wish to, he/she can say something like “Thank you so much for your concern. Right now I’m really focusing on my kids. How are you? Tell me about what you’ve been up to!”
A cancer diagnosis is a huge blow to someone’s perceived control in their lives. It can really aggravate pre-existing anxiety conditions. You are in a unique position of privilege to come alongside someone in crisis. When I was a new nurse, these words brought me a lot of solace, “People will forget what you said, people will forget what you did, but people will never forget how you made them feel” (Maya Angelou).
TraciLyn Clark RN, BSN, PHN, OCN
Oncology Nurse Coordinator
Few things make us aware of the wildness and strength of weather like a tornado. They often are formed in the aftermath of a storm that by itself is overwhelmingly powerful. They appear quickly and seem to vanish suddenly, leaving destruction in their wake. Advance warning serves to allow some people to protect themselves, but there is little that can be done to protect property or the land in general from the force of a “twister.” Survivors, especially those who are sheltering in their homes when the storm hits, have incredible stories that share many elements. Most people, regardless of what happens to the structure they are in, describe the incredible force with which the wind rips and blows, and in particular, the sounds. It’s described as being “like a freight train,” “explosions,” “deafening,” and “a fighter.” Neighborhoods that have been affected are often described as “war zones.” The violence experienced by survivors is palpable to those of us who listen to their stories or see images of what has been left behind.
The body and soul after violence
Violence touches the body and soul in a unique way. It is difficult to not absorb into our spirits what we have seen with our eyes, heard with our ears, and felt with our skin. In companioning someone who has survived a tornado, we need to be sensitive to not only the grief and questions that come with loss, but the very real and lingering effects of violence. We will do well to remember the very real force and pressure that survivors have lived through. Survivors of violence, even violent acts of nature, need to experience empowerment and encouragement as part of the healing process.
In companioning someone who has survived a tornado, we need to be sensitive to not only the grief and questions that come with loss, but the very real and lingering affects of violence.
Empowerment and encouragement through posture
Some of the simplest ways to bring empowerment and encouragement to the spiritual journey are through trying different postures for prayer or meditation, and practicing gratitude. Practicing gratitude puts us in the position of looking at what is good, what is helpful, and what is holy. Often these are things that cannot be truly harmed, or things that may have been overlooked in what looks and feels like devastation. Using different postures in prayer is a helpful way of bringing the body, and the nervous system in particular, into alignment with our emotions. This allows our body to speak for us when words fail, and conversely, may help us find words for what can become trapped in our bodies.
Some postures to try may include:
-Standing, head up, eyes open.
-Standing with arms at sides, palms open to the front.
-Standing with arms half raised, palms open.
-Standing or sitting with palms open or fists closed.
-Lying on one’s back, palms open and facing up.
In general, we can encourage our directees to continue moving and adjusting their posture until they discern that their body’s position matches the emotion they feel. From this aligned and grounded place they can hopefully enter in to the Presence their unique situation hungers after.
A Prayer for After a Tornado
Oh God, so much has changed!
In mere minutes, the courses of our lives feel different.
Oh God, it was so loud!
The raging strength of the storm was terrifying.
We were so suddenly vulnerable.
We felt our smallness, and it did not feel good.
We feel violated. So much was lost.
Our safe spaces were intruded upon with force.
Our grief is so big, so strong!
Help us to remember.
Help us to remember that You are gentle.
Help us to again hear the Still, Small, Voice with which You speak.
Restore us to a place of tender strength.
Remind us of the power that is in gentleness.
Heal our hearts as we rebuild.
Help us find connection with each other and with You.
Help us to cherish what we have.
Be gentle with us.
Nurture us tenderly.
Soothe us with Your Presence.
SPIRITUAL DIRECTION BLOG
Expanding understanding and best practices for holistic health in the context of spiritual direction.