Trauma ... resilience ... and “How did you do that?”

Following the Blue Mountains Bush Fires, on the outskirts of Sydney, in September/October 2013, the NSW State Government Ministry of Police and Emergency Services sponsored the establishment of a Bushfire Disaster Recovery Counselling/Support Service. Gateway Family Services, an existing NGO in the Blue Mountains, was contracted to run this service and they had to establish a whole new service within less than three weeks. So, they assembled a team of counsellors/ support workers whom they already knew, or co-opted from existing services, and established the Step By Step service. I have been honoured to be engaged to provide clinical supervision/support to this team.

Step By Step was funded to help people deal with the aftermath of the fires, and nothing more. However, we all know that the trauma of going through a bushfire cannot be separated from other traumas and difficulties. There are couples who separated in the aftermath of the fires, and we can only speculate that the trauma of the fire exacerbated whatever cracks were already existing.

SO ... one of the team met with an elderly woman whose house had been destroyed in the fires. Total devastation. It turned out that her husband had died six months or so before that. So ... a year ago, she lost her husband of 50 years ... six months later, she lost the house that she and her husband had built together in the bush ... and she lost all her photos of her husband. (The State government might want to separate these into two separate issues ... we all know that, for this woman, they are all part of the same trauma!).

Before Christmas, people were consumed with the reality of accommodation, dealing with their house insurance company and the local council about clearing debris, and so on.

My colleague met with this woman soon after Christmas. This wasn't a "counselling" conversation, just a catch-up, so my colleague casually asked how Christmas had been.

Client:    Oh ... I guess it was okay. I mean, I went to my daughter's place, like I always do. I didn't really feel like it ... I would gladly have just pulled up the bedclothes and stayed in bed.
Worker:  Really ... how did you do that?
Client:    Oh ... I don't know. I REALLY wasn't looking forward to it ... but I guess I kind of had to.
Worker:  Really? ... but given everything that happened, how did you do that?
Client:    Oh, I don't know ... I guess I just had to!
Worker:  What do you mean?
Client:    Well, I just had to.
Worker:  How come?
Client:    Well, it's my job to make the Christmas pudding. I mean, I always do it.
Worker:  Really? So, given everything that you've been through in the last couple of months, how were you able to do that?
Client:    If I hadn't done it, they wouldn't have had any Christmas pudding.
Worker:  So, somehow, despite losing your house, you were still able to think about what would be important for your children and your grandchildren. Wow! How did you do that?
Client:    Well, I just had to.
Worker:  Okay ... but given everything, how were you able to do that?
Client:    Oh ... I don't know.

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In the aftermath of the Blue Mountains bushfires, there has been MUCH media and political attention to what services are needed. A professor with expertise in childhood trauma was quoted as saying that about 8% of the children in the Blue Mountains will show some identifiable post-traumatic stress reaction. This led to a cry for widespread mental health screening of all school children in the Blue Mountains.

(Even IF 8% of children will show some difficulties, this ignores the fact that at least 92% will NOT!)

In the face of some genuine stories of personal suffering, there were calls to implement mental health screening of EVERYONE in the Blue Mountains!

There are real examples of stress and suffering, particularly in the two to three months immediately after the disaster. Nonetheless, as Zoellner and Feeny (2014) observe,

Contrary to popular belief, resilience is the norm following trauma exposure (e.g. natural disaster, rape, car accident, combat). Indeed, this is one of the remarkable findings emerging from the study of psychological reactions to traumatic events. These events do have profound impacts on people's lives, but, for the majority of trauma survivors, long- term psychiatric problems and impaired psychosocial functioning are unlikely. In fact, some trauma survivors Š actually experience improved psychological and social functioning. (pp. 4-5)

Zoellner and Feeny (2014) conclude that the majority of research on natural disaster shows that MOST people have a significant psychological reaction or trauma in the immediate aftermath of the disaster, and that MOST people resume "normal" functioning after three months WITHOUT any counselling intervention. They also show that, for that minority who DO experience ongoing difficulty, probably the major mitigating factor is immediate, post-trauma support.

So, a counselling/support service, right there from the beginning, is clearly important in reducing ongoing difficulty.

(It is also interesing to note that international "best practice" in disaster management stresses harnessing the existing resources of the community rather than bringing in high-profile expert services!)

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So ... MOST people show resilience in some way or another. Our job is to go looking for it.

Yet, this is NOT about "looking for positives". In the earlier example, if my colleague had responded, "Wow! Fantastic! You were still able to do the Christmas pudding! Isn't that great?", the client would have been well within her rights to say (or, at least, think), "What are you going on about? Haven't you heard how awful this has been?"

We might think it is about "looking for positives" ... however, if it doesn't feel "positive" to the client, you should probably let the client go home and just continue talking to yourself!

One of the things the Solution-Focused approach has in common with the broader "strengths perspective" and resilience focus (or, even, Positive Psychology) is an emphasis on success in the face of failure or challenge. However, the Strengths approaches seem to be interested in "what are your strengths, demonstrated in this situation?". Positive Psychology seems to go further and wants to "quantify" or measure your strengths (and I fear the "Positive" in Positive Psychology runs the risk of the same difficulty in people's perceptions as mentioned in the last paragraph — that this is just "looking for positives".

The Solution-Focused approach is much more interested in the fact that this woman seems to have been able to be successful (even a little bit) in this situation, with a genuine curiosity about what aspects of herself — which had perhaps been hidden from her previously — had led to her being able to do this.

I might say, "Wow! That's great!" "I'm REALLY pleased you did that!"

This is a GENUINE sentiment ("I am genuinely pleased that you have been able to do this"); however, "Positive Reinforcement" ... "Positive Feedback" ... even "Empowerment", seem like something the therapist DOES to the person ("My job is to empower you").

"How did you do that?" is not about me empowering you. It is about me inviting you to reflect on your on behaviour in a particular way.

My colleague, Ian Johnsen, draws the helpful distinction between positive reinforcement and positive engagement. He comments that "Wow, that's great!" is positively reinforcing; however, it does not ask anything of the person. "How did you do that?" invites the person to reflect on his/her behaviour and success. Positive reinforcement is something I do to the person. Positive engagement engages the person to do something.

Further, he notes that "praise" may be hard to give genuinely if a person is underperforming or especially if the small positive changes in their behaviour are still far outweighed by mistakes or difficulties. "How did you do that?" can be asked even when the "success" does not seem obvious.

THREE LITTLE WORDS — but powerful reflection.

"How did you do that?" — firstly, implies that whatever this is, IT IS worthy of asking about.

"How did you do that?" — second, suggests that YOU did it.

"How did you do that?" — third, invites you to REFLECT on what you did.

Like all good Solution-Focused questions, this is a question designed NOT to obtain information but to invite the client to notice different things about her/himself.

 

REFERENCE

Zoellner, L. A. & Feeny, N. C. (2014). Facilitating Resilience and Recovery Following Trauma. New York: Guilford.