Psychological services to families are most efficiently provided on an outreach basis. All families should be visited in their homes or in other shelters. Two workers with different fields of expertise may visit families together as part of a “buddy system”. Together they should make sure that the biological, psychological and social needs of all family members are catered for and that the family dynamics are fully absorbed. Family needs must be attended both on the level of the family as a whole and on the basis of all their individual members. If stress responses are due to ongoing stressors, they need to be identified and if possible ameliorated. This may involve arranging for creature comforts such as food, shelter, warmth, toilet facilities and medicine. Reuniting families is still very important. So is reuniting families with familiar social and helping networks and new networks. If it has been assessed that the family is tense and dysfunctional since the disaster, stress responses still active from the impact phase of the disaster need to be ameliorated. Support and crisis counselling should be instituted in a family setting using principles described in section 6.1.
46 Thus, in a safe environment facilitated by the therapeutic relationship,
detailed cognitive emotional and behavioural recognition of what the family went through is achieved. Which survival strategies worked when in what interaction and which did not, why, and with what consequences, is ascertained and validated with family members. The sense and normality of their responses in the disaster context is pointed out, as is the reason for lack of need to maintain such responses currently.
Family members may express to each other how they saw the disaster from their personal perspectives and express feelings to each other from such perspectives. Understanding of each other may resolve guilts and angers and strengthen mutual esteem and bonds. Family dignity and identity are preserved, or even enhanced. Adaptive meanings of the experiences may well emerge. Vulnerable family members need special attention. Nevertheless, if the individual’s symptoms are used as vehicles to signal family distress, this needs attention. Adults The same principles apply to individual adults as for families and may occur contiguously with family healing. Thus reuniting with families and with social networks is beneficial to individuals as well as to whole families. However, intimate one to one counselling relationships allow more personal issues to be addressed in more depth. While stress responses experienced by individuals may be able to be placed in logical context to ripples from disaster, personal counselling often deals with situations where the connections to such contexts may be hidden. Then people may appear to suffer irrational biological, psychological and social manifestations or symptoms. Reasons for the disconnections may be protection against reliving traumatic events (e.g., sense of imminent death, deaths of others, helpless abandonments), accompanying negative judgements (guilt, shame, rage, outrage), or unacceptable meanings of oneself and the world. The connection may be retrieved through offering skilled and deep recognition of the symptoms, their origins and deep empathic understanding as to why memories of the event are disconnected.
Connections of symptoms to the original event are retrieved through reassessment of traumatic feelings, cognitions, judgements and meanings and seeing that they are not warranted today. Retrieval of connections to the traumatic event then allows once again understanding the symptoms in terms of rational biological, psychological and social survival responses in abnormal situations. With reconciliation of past and present, individuals tend to develop new realistically positive meanings and views of self and the world.
Such acute trauma therapy may prevent long term fragmentations of the mind and development of many entrenched symptoms and illnesses. Therapeutic
47 skills need to match the complexity of how the mind deals with trauma. They need to be able to additionally include dealing with past vulnerabilities and meanings, defences personality styles and cultures, all of which compound with the way affected people present. Note that it may not be enough to simply reassure that symptoms are normal. Such reassurance may only be meaningful when all healing principles are in place, resulting in full cognitive and emotional awareness of causes, consequences, connections and reasons. This results in a narrative story of the disaster and its consequences.