Psychological Services

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Most families may forge new self-respectful identities which include their disaster experiences and reconstructed lives. However, for others earlier difficulties may become entrenched or new ones become evident.
Interventions may include expediting various needs and referrals to various community agencies and networks.
Education and advice may be given about the frequently occurring marital and sexual tensions. They may be seen on the basis of extra personal needs which partners cannot fulfill. Similar education may be given about the meanings of symptoms in children, in terms of their extra needs.
Influences on families of maladaptive coping strategies such as overwork,
increased alcohol and coffee intake and substance abuse may be brought to notice and addressed. Similarly education paralleling that in earlier phases about the sense and origin of delayed stress responses may provide much relief.
More entrenched and deeper problems may require trauma therapy as described in the postimpact phase. In this phase relatively more attention may need to be paid to prior vulnerabilities (e.g., marital problems) beliefs and entrenched defences, conspiracies of silence, avoidance of emotions and more overt symptoms and illnesses. Special attention may be paid to identified “sick” members, but the whole family needs also to be seen in its entire system.
Much skill and sensitivity are required in choosing and dosing the various prongs of treatment. For instance, the family’s strengths and vulnerabilities must be assessed and balanced with the costs in different family members of leaving defences intact, with the potential pain of exposure of traumas,
emotions and unacceptable judgements and meanings.

Once the disaster has been encouraged to be brought to full awareness,

painful silences within the family are replaced with voices of understanding of various members’ experiences and of the family itself. A self-respecting mutually affectionate story is integrated in the family’s history.
Interventions with individual adults may have taken place within family contexts. Individuals’ adaptive roles in families and community networks are facilitated, but referrals are also effected to various helping agencies according to need.
While clarification of the sense of long term or new symptoms and/or symptomatic treatment such as medication may offer sufficient relief for

some, one to one trauma counselling or therapy may be required to heal more entrenched and longer term effects of stress and trauma.
As in previous phases, biological, psychological and social symptoms and illnesses, as well as distresses associated with negative judgements,
meanings, shattered beliefs and ideals of self and the universe, are traced back and made sense of in their original contexts of stressed survival attempts and lost fulfillments. As in the postimpact phase, this may require working through defences and past vulnerabilities (perhaps more so in this phase than previous ones). Trauma ripples are then reworked in terms of past and current realities and adaptive meanings and views of self and the world.
New meanings evolve which include wisdom of the frailties, yet also capacities for resilience and fulfillments of human nature.

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