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OH_cardsFINAL.qxd 3/9/07 10:18 am Page 1 Healing trauma with Belief metaphoric cards Survivors of disasters can fall into a vortex of helpless despair – or climb a healing spiral using a variety of resources. One effective tool to aid recovery is the deck of COPE cards Affect by Dr. Ofra Ayalon Social Crisis and disaster are part situation. The rage can be to becoming a victor? Some of life. We are exposed to turned against inwards or do it by taking an active role dangerous environments against others. in resolving the trauma, through war and terrorism, assuming responsibility for ecological, natural or Trauma, then, can create a self-healing, assuming technological disasters and vortex that pulls people responsibility for healing urban violence. Poverty, down and tempts them to others. Others may choose racial persecution and adopt the victim identity, to compassion and forgiveness. physical or sexual abuse also the detriment of all previous One dramatic example is the cause suffering and trauma, personal achievements and forgiveness rituals engaged as do individual crises such future plans. When the in by the Amish community as loss and death of dear ‘traumatic narrative’takes in Pennsylvania after six ones, destruction and loss of over, it becomes the centre of girls were killed by a local home, abandonment and our thoughts, feelings and milk lorry driver3. Some betrayal. relationships. The price for survivors focus on altruistic adopting victimhood is work and lobby for important The trauma vortex giving up control over one’s social causes. One example Imaginative/ Survivors of such disasters life. One example was H, a is Mrs. G, the mother of a metaphoric are often left feeling helpless survivor of an Israeli school murdered girl, who wished or depressed, plagued with disaster, where adolescents to spare the life of her guilt or anger, caught in the were held as hostages and 22 daughter’s murderer and Cognitive trauma vortex. This metaphor, of them killed. Twenty years made it her life mission to reprocessing coined by Peter Levine1, later, H still signed all his fight against the death describes the whirlpool of letters as ‘victim of the penalty in California4. chaos in the aftermath of Ma’alot massacre’. He visited trauma. Also called the ‘black the graves of his schoolmates There are healing methods hole’of trauma, it is a every day, apologising to that will help traumatised downward spiral that traps them for his survival2. individuals manage their the traumatised, who may hyperarousal and contain find it difficult to control From victim to victor their explosiveness and their sensations, images, Adifferent outcome of hypersensitivity. This can be feelings, thoughts and trauma can be a healing done by shedding light on the behaviours. Their essential spiralthat pulls people up. pull of the trauma vortex, and needs for safety are shaken, People are apt to find inner providing knowledge and as is the right to exist hidden resources, and practice of coping resources. without danger, the sense of transform their priorities by It is, however, imperative to competency and the ability to attending to family, social understand the nature of control one’s destiny. Anger and spiritual values. traumatic reactions and how Physical and rage mount, coupled with individuals and groups (body/mind) a deep sense of powerlessness How do we make the choice vacillate between the two at their inability to right the to move from being a victim vortices, from hope, optimism, 22 therapy today September 2007 OH_cardsFINAL.qxd 3/9/07 10:18 am Page 2 energy and altruism to BASIC Ph coping modes creative ways of expressing Getting started fatigue, frustrations, In the process of researching painful memories. Images in The first step toward disillusionment, polarised for ways of promoting the COPE cards elicit recovery and healing is to thinking and back again5. resilience and healthy ways personal hidden memories or reach physical and of coping, we have developed fantasies related to the psychological safety and COPE – the art of healing a new model of ‘coping traumatic experience. Any security. In this safe space, it When trauma is beyond resources’acronymed BASIC COPE card (or combination is possible to vent feelings by words, we look for non-verbal Ph. This is a holistic of several cards) can function verbal and nonverbal means, and psychologically safe multimodal framework that as an opportunity to surpass to share dreams, nightmares methods of expression and contains six modes of coping dire reality and find solace and other traumatic sharing. People are relieved resources: Belief systems, in imagination. reactions. When appropriate, when offered the opportunity Affective expression, Social 5. Cognitive reprocessing mourning and memorial to approach their painful support, Imagination/ means using cognitive skills rituals can promote positive experiences step by step, creativity, Cognitive processing, to make sense of the trauma affirmations of resilience. starting by using symbols Physical behaviour8,9. These narrative as it unfolds in and metaphors. One of the six modalities merge into one reaction to the visual images Any COPE card or most effective tools in in our worldwide trauma- of the cards. This is yet combination of cards can eliciting healing metaphors coping training programs, another mode of gaining serve as a trigger for the is a set of illustrated cards and are represented by six control over posttraumatic narration of the event and called COPE cards, that COPE ‘hand’cards (see issues and painful memories. responses to it. Using the belong to a specially previous page): The purpose of re-telling the COPE Cards provides an designed genre of associative traumatic story is to re-visit opportunity for recounting cards (the OH-cards series). 1. Beliefsystems refer to the scene in safe mode personal recollections of faith in God or a supernatural (thereby releasing its grip of traumatisation in a safe COPE cards, initiated by power, trust in other human terror andhorror), analyse environment, since myself, painted by the beings or trust in oneself. and understand the demand metaphoric stories triggered Russian artist Marina Faith and hope are well- of the situation, and plan by the visual images of the Lukyanova and issued by documented mental coping strategies of rescue and cards are one step removed the German publisher resources with trauma10. coping. from anguished reality. This Moritz Egetmeyer, represent 2. Affectis the feeling 6. Physical (body/mind) ‘creative distance’facilitates an international joint effort aspect of consciousness. The coping modes. The trauma recall and the working to deal with the heart symbolises love and is stored in the body. Levine1 through of trauma consequences of traumatic hate, fear and courage, grief suggests the use of body experience. The use of image events and help heal psychic and joy, jealousy and awareness and somatic and imagination serves as a wounds6. The 88 cards compassion etc. This coping experience for unfreezing the protective screen against enable their users, whether mode involves chiefly the somatic trauma and being overwhelmed by playfully or therapeutically, ability to recognise feelings regaining body-mind control. intense emotions. When the to access deep feelings and and name them, and then to These methods are used to memories become too much narrate their experiences. By express them by verbalising build a flexible balancing of to bear, one can always using COPE cards, (telling, writing, dramatising) tension and relaxation, return to the imagined story, participants can learn to or by nonverbal activities, establish body-boundaries or look for other cards that identify their own particular such as free play, dance, and re-examine the may serve as anchors for a ways of coping with crisis, painting, sculpting or music. relationship between sense of thriving, surviving stress and trauma. The 3. Socialcoping skills focus personal space and trust. and healing. experience of randomly on interaction with others. selecting cards and dealing Such interactions include the The other projective- Identifying coping skills with the associations they giving and receiving of metaphoric cards in the set, This activity aims to discover evoke can elicit new ideas support by family members, which support verbal and our normal ways of coping. and possibilities, instead of friends and also professional nonverbal expressive and also identify those repeating familiar patterns helpers. In the aftermath of methods, help to access coping modes that are of thought and response. trauma, there is a strong repressed experiences. We blocked in times of crisis. COPE cards help us reach need to bear witness – the have found this multimodal What resources would be our inner pain and discover traumatic experiences need approach most effective in required to make them our inner strength. Asort of to be acknowledged, helping people cope with available in times of need? ‘virtual training’takes place expressed, listened to, trauma and negotiate ways in dealing with challenging witnessed by caring others, of resolving conflicts in 1. Spread the six COPE situations, in surfing beyond tolerated, contained, treated situations of violent armed ‘hand cards’face up on the time and space, in and healed. conflicts, suicide prevention table, and identify each of experimenting with possible 4. The Imaginative/ and domestic violence. In them according to the BASIC AN Y R solutions to conflict-laden metaphoricmode is the key actual traumatic situations, Ph model (Belief, Affect, B Y R issues – all within the safe to coping when traumatic people usually employ a Social, Imaginative, A G +/ world of image and experiences are ‘beyond combination of coping styles Cognitive, Physical modes). E N metaphor7. words’. It offers many to survive. 2. Pick six cards at random TO S therapy today September 2007 23 OH_cardsFINAL.qxd 3/9/07 10:18 am Page 3 from the COPE cards deck transformed by the use of all the fact that there was no In conclusion and place them face down on six coping modes. real rope in the water.’ There is no one single top of the ‘hand cards’, so Cognitivesolutions, the appropriate method of that each ‘hand card’is The tsunami: examples search for information and coping for all situations, all covered by one card. The following are examples understanding: ‘Two weeks people or all ages. Each 3. Turn the top cards up, one of the variety of coping after the tsunami, I still person, family, and at a time, and reflect how modes emerging from COPE could not fall asleep. So community has their specific they connect to the ‘hand cards work with survivors of night after night I searched combination of coping card’that represents one the tsunami disaster in for information about modes, which constitutes coping mode. Let the top Thailand11. The stories were tsunami on the web. Then I their basic coping language. card help you describe how triggered by the COPE cards started visiting schools and The effective way for the you use the relevant coping as a response to the sharing my newly acquired therapist to help is to join mode in your life, in a question: What helped you knowledge. That is why they the victims’basic language, positive or a negative way. most during and after the sent me to this training.’ and then guide them in For example: My disaster? Physicalactivity: ‘I had to developing additional coping ‘imagination’coping mode Belief in God or in immerse myself in the hard resources. helps me detach myself from supernatural powers: ‘At the work of cleaning the debris my worries (positive), and time of the Tsunami I was of the storm. This was the Ofra Ayalon, PhD is an my ‘social’coping mode praying in the mosque. The only way I could manage my internationally renowned makes me needy and over- wave arrived abruptly, anxiety and sadness.’ traumatologist, author and dependant on others flooded the street, circulated Another teacher said: trainer in the field of trauma (negative). the mosque and did not ‘Working with children, I and coping with terrorism. 4. Now, think of a time in touch it. Amiracle happened succeeded in calming them She is currently Director of your life when you and I was saved with the down by engaging them in Nord Cope Center in TIVON, experienced severe stress or grace of God.’ vigorous movements until Israel, and senior consultant crisis. Turn the remaining Affectand expression of they tired, sat quietly, at the Community Stress COPE cards face up and their feelings: ‘There was a breathed deeply and Prevention Center in Israel. choose three cards that time when I experienced an relaxed.’ Email: [email protected] describe this experience. immense feeling of pain 5. Try to identify which of inside me. It’s hard to References the coping modes you have explain. I could not find 1. Levine P. Waking the tiger: healing trauma. Los Angeles: North employed to deal with that words to share my feelings Atlantic Books; 1997. crisis. Use the cards to tell with my friends. I did not 2. Desivilya S, Gal R, Ayalon O. Long-term effects of trauma in the story of your coping. dare burden them with my adolescence. Anxiety, Stress and Coping. 1996; 9(3):13-150. 6. Try also to identify those agony. That’s why these 3. ABC World News, October 2006. modes that you have not cards were so important for 4. Personal communication, 1999. used – and turn their me: they allowed me to deal 5. Ross G. Beyond the trauma vortex: the media’s role in healing representative cards face with my own feelings, same fear, terror and violence. Los Angeles: North Atlantic Books; 2003. down. These cards represent as everybody else in our 6. The UK distributor of the COPE cards (and other OH-Cards) is those coping modes that group. I am not ashamed Steve Weir at Transform Your Life; www.transform-your-life.org; were blocked by the any longer. It is a relief.’ tel 0114 221 5599. traumatic event. Social skills: ‘I volunteered 7. Ayalon O. The HANDS project: helpers assisting natural 7. Find cards that will help to help people who were disaster survivors. Community Stress Prevention. 2003; 5:127-135. you reactivate those blocked hurt. Their suffering was 8. Ayalon O. Rescue! Community oriented preventive education. modes. much greater than mine. By Ellicott City: Chevron Publishing Corporation; 1992. 8. Reflect on the whole helping others I helped 9. Lahad M. Darkness over the abyss: supervising crisis process of how you identified myself.’ intervention teams following disaster. Traumatology. 2000; your existing resources for Imagination: ‘Do you want 6(1-4):273-294. coping with crisis and how to know how I was saved 10. Frankl V. The will to meaning. New York: New American you activated additional from death? As I was Library; 1988. resources. Share your drowning, I imagined a 11. Ayalon O. Children’s response to terrorist attacks. In: Knafo D. reflections. Re-tell the story strong rope in the water. I (ed) Living with terror, working with trauma. New York: Jason of your traumatic seized it and pulled myself Aronson; 2006. experience, and how it was up. I was saved, in spite of 24 therapy today September 2007

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