NLP Trauma Recovery Manual 2011

NLP Trauma Recovery Manual

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Trauma Recovery: A Manual For NLP Practitioners © Richard Bolstad et alia, Use Permitted as Needed

Contents RESILIENCE, RECOVERY AND CHRONICITY ................. Resilience, Recovery and Chronicity .......................................... Patterns of Resilience and Recovery ........................................... Patterns of Chronicity .................................................................. Key Questions ...............................................................................

3 3 5 6 7

IMMEDIATE RESPONSES ....................................................... 8 Problem Ownership ..................................................................... 8 Roadblocks to Communication / Reflective Listening .............. 9 The Worst Is Over (Verbal First Aid)......................................... 10 Acknowledgements: NLP Responses to Major Disaster ........... 12 MANUAL: ENGLISH VERSION............................................... RESOLVE Model ......................................................................... Purpose of This Information. Getting Practical Help First ...... Helping People in the First Weeks .............................................. Preparing for the Trauma Process ............................................. Factors That Make the Process Work ........................................ The NLP Trauma Process ........................................................... Eye Movement Integration ..........................................................

13 13 14 14 15 18 19 22

MANUAL: JAPANESE VERSION ............................................ 24 MANUAL: SAMOAN VERSION................................................ 35 CIVIL DEFENCE HANDOUTS AND APPENDICES ............ 43 A Guide For Emergency Response Workers ............................. 43 Research Form .............................................................................. 49

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Resilience, Recovery and Chronicity

When a traumatic event occurs, a neural network is set up with memories of the event (VAKOGAd), instructions about attempted responses (K), a time/place coding (Hippocampus) and an emergency rating (Amygdala). If the emergency rating is low enough, a pattern of Resilience occurs, where the person is distressed by the event but able to keep functioning normally. If the rating is high enough then at least for some time a PTSD-style response will occur and the person will have severe difficulty performing normal daily functions. The neurotransmitters which connect the new neural network are those present at the time, which is likely to include a lot of transmitters such as noradrenaline and adrenaline. The aim of the Amygdala connection is so that in any future similar events, the neural network will have override priority and be able to stop the Frontal Cortex (Conscious Goalsetting etc) from endangering life by thinking through a planned response. While this mostly saves lives, occasionally it results in a panic response which is triggered accidentally by sensory stimuli that are themselves not dangerous. In that case most people will gradually edit the neural network over the next couple of months so that it no longer interferes with everyday functioning, a pattern called Recovery. Some people have a pre-existing thinking style which makes recovery difficult (eg a pattern of constantly checking in case something bad is about to happen again) and they will then continue to have problems long term, a pattern called Chronicity. Which of the 3 patterns will occur is determined by the pre-existing thinking style and model of the world, previous experience of similar trauma, the severity of the current traumatic events, and the social support available at the time of the current trauma.

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Trauma and Human Resilience “Epidemiological studies estimate that the majority of the U.S. population has been exposed to at least one traumatic event, defined using the DSM–III criteria of an event outside the range of normal human experience, during the course of their lives. Although grief and trauma symptoms are qualitatively different, the basic outcome trajectories following trauma tend to form patterns similar to those observed following bereavement. Summarizing this research, Ozer et al. (2003) recently noted that “roughly 50%–60% of the U.S. population is exposed to traumatic stress but only 5%–10% develop PTSD” (p. 54). However, because there is greater variability in the types and levels of exposure to stressor events, there also tends to be greater variability in PTSD rates over time. Estimates of chronic PTSD have ranged, for example, from 6.6% and 9.9% for individuals experiencing personally threatening and violent events, respectively, during the 1992 Los Angeles riots (Hanson, Kilpatrick, Freedy, & Saunders, 1995), to 12.5% for Gulf War veterans (Sutker, Davis, Uddo, & Ditta, 1995), to 16.5% for hospitalized survivors of motor vehicle accidents (Ehlers, Mayou, & Bryant, 1998), to 17.8% for victims of physical assault (Resnick, Kilpatrick, Dansky, Saunders, & Best, 1993). Although chronic PTSD certainly warrants great concern, the fact that the vast majority of individuals exposed to violent or life-threatening events do not go on to develop the disorder has not received adequate attention. It is well established that many exposed individuals will evidence short-lived PTSD or subclinical stress reactions that abate over the course of several months or longer (i.e., the recovery pattern). For example, a populationbased survey conducted one month after the September 11th terrorist attacks in New York City estimated that 7.5% of Manhattan residents would meet criteria for PTSD and that another 17.4% would meet the criteria for subsyndromal PTSD (high symptom levels that do not meet full diagnostic criteria; Galea, Ahern, et al., 2002). As in other studies, a subset eventually developed chronic PTSD, and this was more likely if exposure was high. However, most respondents evidenced a rapid decline in symptoms over time: PTSD prevalence related to 9/11 dropped to only 1.7% at four months and 0.6% at six months, whereas subsyndromal PTSD dropped to 4.0% and 4.7%, respectively, at these times (Galea et al., 2003).” – Bonanno, 2004 Bonanno, G.E. “Loss. Trauma and Human Resilience” American Psychologist, January 2004, Vol. 59, No. 1, pages 20–28 (Quote from page 24)

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Patterns of Resilience and Recovery The American Psychological Association says research suggests "10 Ways to Build Resilience", which are: (1) maintaining good relationships with close family members, friends and others; (2) to avoid seeing crises or stressful events as unbearable problems; (3) to accept circumstances that cannot be changed; (4) to develop realistic goals and move towards them; (5) to take decisive actions in adverse situations; (6) to look for opportunities of self-discovery after a struggle with loss; (7) developing self-confidence; (8) to keep a long-term perspective and consider the stressful event in a broader context; (9) to maintain a hopeful outlook, expecting good things and visualizing what is wished; (10) to take care of one's mind and body, exercising regularly, paying attention to one's own needs and feelings and engaging in relaxing activities that one enjoys. (11) Learning from the past and (12) Maintaining flexibility and balance in life … are also cited. In the research below, Japanese ancestry Americans had only 14% of the incidence of PTSD that European ancestry Americans had. That beats any PTSD treatment success rate I've read about! Polynesian (in the research, specifically Hawaiian; in many ways the same culture as New Zealand Maori or Samoan) ancestry also reduced PTSD rates to 35%. Resilience is pretty much the core successful human response to disaster that NLP seeks to remedially create (in fact NLP goal-setting, reframing and dissociation are all listed in the 10 points above). Note that research show that resilience is not a set personality trait so much as a set of actions you can choose to take. Also note that in the same research, a past history of being a survivor of violence almost doubles the risk of PTSD (177%). Good relationships buffer us from harm, bad ones signal a need for extra support. Schnurr, P.P., Lunney, C.A., and Sengupta, A. “Risk Factors for the Development Versus Maintenance of Posttraumatic Stress Disorder”, Journal of Traumatic Stress, Vol. 17, No. 2, April 2004, pp. 85–95

Patterns of Chronicity Adapted From Andy Austin These strategies or patterns of thinking may seem innocuous during easy times, and then create Chronicity during traumatic times. To the person, they seem normal ways of approaching challenges, and it can help to show them how these patterns ensure that positive change is impossible. Having done that it becomes possible to install more resilient patterns, for example installing new key questions. The Big “What If…” Question 

“Yes, but, what if… which means…(an impossible to manage scenario)?” The positive intention of negative “What if?” questions is to attempt to anticipate and find solutions to future challenges, but by running it on impossible scenarios, the person is locked in panic. 5

The Big “Why…?” Question 

“Why did this happen to me?” The positive intention of past-related “Why?” questions is to find new meanings, but the person rejects each possible future-oriented meaning and keeps searching as if trying to find a meaning which can change the traumatic event or recreate the past.

The Big Maybe Response 

When asked to scale their current experience of an emotion, or give any report on their internal experience, the person says they are not sure, or prefaces their answer with “Maybe”. The positive intention of “Maybe” responses is to avoid mistakes such as false hope, but by refusing to commit to any specific data, the person can never measure change and can never experience success.

Testing for Existence of The Problem Rather Than Testing for Change 

Even though 99% improvement might be made, if the person with chronicity is able to locate just 1% of the problem existing, this will generally be seen as representative of 100% of the problem existing. The positive intention of “Can I still do it?” responses is to detect and respond to danger effectively, but by failing to notice improvement the person continuously reinstalls the entire problem.

Negative Nominalisations 

The person talks about their traumatic responses as if they were “things” rather than actions. “I have Trauma”, “I have PTSD”, “I have a Wounded Inner Child”, “I have a Clinical Depression.”. The positive intention of Negative Nominalisations is to explain what is happening by labelling it, but the result is that the processes being discussed seem permanent, damaged and even become personified as malevolent, and so are unable to be simply changed.

Being “At Effect” rather than “Being At Cause” 

By being “at effect” the person experiences emotional problems happening to them, rather than being something that happens by them. A person “at effect” will seek treatment rather than seek change. Questions such as “Will this work for me?” or statements such as “It didn’t work for me.” And “It worked for a day and then the problem came back.” Presuppose that the problem and the NLP process are 100% responsible and the person themselves is 0% responsible for their own results. The positive intention of “At Effect” responses is to explain what is happening without being at fault, but by not allowing for the possibility of their responses affecting their internal experience, the person makes it impossible to change their experience.

Three Stage Abreaction Process 

  

The person has a “nocebo” (I will not please; the opposite of placebo) response to NLP processes where they have an “uncontrollable” negative response to all interventions designed to actually help them change, although they permit interventions which maintain their problem. The positive intention of “Abreaction” responses is to protect the person from feared results of the change process, but it blocks all change. Stage 1. Signal (Implied Threat of Emotion) eg “This is making me feel ill.” Stage 2. Increased Amplitude of Signal (direct Threat of Emotion) eg “Now I really feel sick. Your process is harming me. Stop or I will start screaming!” Stage 3. Abreaction (Punishment of the Practitioner) eg vomiting, convulsing, running out of the room screaming, uncontrollable crying.

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Key Questions Deciding what you’ll ask of life! Adapted from Steve Andreas (Core Questions) 1. Resourceful state; Rapport 2. Ask them what situation, or what context they want to find the core question for. (eg. “at work” “my relationship with my kids” “dealing with a client/student”) 3. “As you think of that situation, imagine stepping back into your body there. Notice what you see through your eyes there, what you hear, and what you feel in your body. Be aware of how you are deciding what actions to take.” 4. “If there were a question that quietly guided all your behaviour in this context, what would it be?” 5. “Now think of that question. Check that when you say that question to yourself, it reminds you of the situation.” (You’re checking it has the same submodalities; ie feels like thinking of that situation itself). 6. “If you knew, what is your unconscious mind’s positive intention in asking this question in this situation?” If the person tells you a negative intention (like “to get me worried”) ask “And if it gets you that fully and completely, what even more important thing will you get through that?” 7. “Is there a question that would be even more effective in getting you the positive benefits you want in that situation?” 8. If there is, say “I’d like you to step back into your body in that situation, and say the new question to yourself -actually say it aloud now, as you imagine being in that situation. Notice that when you’re in that situation now, the new question is quietly at the back of your mind, guiding your behaviour, and check that that feels much more enjoyable! Imagine a future time, when you’ll be in that situation again, and check how asking that new question changes the way it feels.”

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Immediate Responses Who Owns The Problem? Different communication skills work in different situations. Learning communication skills is no help unless you also learn when to use which skills. One interesting question to ask any time you are talking, or spending time with another human being is, 'Who needs to have their problem solved so that everyone will feel happy?' If the answer is 'no-one', that's great! In that situation no-one owns a problem, to use a new piece of jargon. If the answer is 'me', then I own a problem, in this sense. And if the answer is anyone else, then the other person owns the problem. This way of understanding situations was developed by Doctor Thomas Gordon, author of P.E. T Parent Effectiveness Training and many other books. Notice that this way of using the words 'own a problem' is different from the way many people use the phrase. For now, I'd like you to get used to this new way of thinking about it. When I talk about someone 'owning a problem', I don't mean that it's their fault, and that they should fix things up or anything like that. I mean that they are the ones who are not feeling happy about things, or who need something to change so they can feel happy. They are the ones who feel angry, hurt, sad, frightened, resentful, embarrassed, or otherwise unaccepting of the situation. The following diagrams explain this model as it is used in this training. No Problem Area I Own A Problem

Other Person Owns A Problem Both Of Us Own A Problem (Conflict)

Rapport

Helping Skills

Problem Solving & Assertive Skills

Conflict Resolution Skills

The Problem Ownership Model

The skills which achieve these aims

Instructions: Read each situation below. Identify, in these terms, who “owns the problem” 1. The person who shares your workspace plays a radio at a high volume, making it difficult for you to concentrate. 2. A colleague tells you she is worried about failing an important staff evaluation. 3. Your family often have political debates, such as discussing whether Ronald Reagan was a good or bad economist. 4. Your partner expresses disapproval of your taking a training course. 5. A repair shop has failed to meet three consecutive promises to have your car ready. 6. A worker in your department complains that her responsibility level isn't challenging enough. 7. Your partner looks increasingly worried and tense and tells you they “can’t cope with it all.” 8. One of your family members is increasingly late getting the dishes washed, and you end up waiting to be able to use the bench space. 9. Your child fails to turn up on time for a dental appointment that you must pay for anyway. 10. A lot of your work time is spent willingly giving advice to less experienced staff. 8

Roadblocks Roadblocks are responses intended to be helpful, but which are high risk responses when someone else owns a problem. Thomas Gordon lists twelve such responses. Imagine how it would feel for you if you asked the instructor to explain something in the course and got a response like this...

Solution Giving Commanding: "Just shut up and calm down will you!" Warning: "If you carry on interrupting I'm not having you in this course." Moralising: "You should have more consideration for those who did understand." Lecturing: "Research shows that a state of uncertainty is a valuable learning aid; it helps you pay attention to the next part." Advising: "Why don't you go out of the room and look it up in the book."

Judgments Blaming: "There's no-one to blame but you for that is there?" Name-calling: "We really do get some idle-brained people on the course don't we." Analysing: "I'm sure I was quite clear. Are you looking for a bit of attention?"

Denying Praising: "Good on you for making an attempt to get it. That's the main thing." Reassuring: "You poor old thing. Hang in there; it's bound to make sense later." Distracting: "Maybe we should play a game at this point."

Interrogating Questioning: "Do you always have trouble with learning? Is there something outside the course that's distracting you tonight?

Reflective Listening This skill involves reflecting feelings and information from what you heard the other person saying. Colleague: "I'm in a real stew over this class presentation we've got on Monday." You: "You're worrying about how your presentation will go?" Colleague: "Well I told my friend I'd meet him for an early lunch at that time. I thought I'd just skip the project session. I didn’t realise it would be important." You: "It's changing your plans at this time that’s hard?" Reflective listening is an extremely useful helping skill, and to use it well, you need to be feeling free enough of your own problems to focus on the other person. You also need to trust the person to find good solutions rather than wanting to convince them of your own. This is not a skill for when you want to influence the person. Reflective listening also requires the person to be willing to talk: you can't force them to open up. Also, of course, when simple information is required, you need to give it, not just listen empathically. Reflective listening tells the other that you are interested in their concerns, that you can accept them having problems and trust that they will solve them. It deepens your relationship, as you will really start to hear what clients and colleagues say. That is its risk, and its beauty. As a spin-off benefit, colleagues may benefit from your modelling and start to reflectively listen to your concerns about them. Reflective listening is even more effective when you match the sensory system (visual, auditory, kinesthetic, unspecified) of the person you are listening to. For example, if the person said “My week has been so gloomy.”, you might say “It’s hard to see the light at the end of the tunnel.” If the person said “My week has been out of tune.” you might say “You’ve had difficulty finding the theme.” 9

The Worst Is Over (Verbal First Aid) From Judith Acosta and Judith Simon Prager, Jodere Publishing Group, San Diego 2002

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The Worst Is Over (Verbal First Aid) continued… From Judith Acosta and Judith Simon Prager, Jodere Publishing Group, San Diego 2002

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Acknowledgements: NLP Responses to Major Disaster Earthquake 2011 Dr Richard Bolstad [email protected] These instructions are in English, Samoan and Japanese Thank you to: • • • • •

Dr John Grinder, Richard Bandler, Steve Andreas and NLP trainers across the world who created the core method. Asenati Toilolo-Meijn (who translated the manual into Samoan) and The New Zealand Trauma Recovery Team at http://www.traumarecoveryteam.org.nz/nlp-traumarecovery/ who taught the method in Samoa Richard Bolstad, Lynn Timpany, Barbara Belger and other NLP Practitioners in New Zealand who developed the methodology in the Christchurch Earthquake Yuile, Yoko-san; Sakai, Toshihiro-san; Ito, Mayumi-san; and Yanai, Reiko-san who translated these notes to Japanese All the NLP Practitioners in Japan, Samoa, Chile, New Zealand and elsewhere, whose courageous spirit will put this into practice.

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An N.L.P. Model of Therapy (RESOLVE) 1.

Resourceful state for practitioner -self anchoring -clear problem ownership

2.

Establish rapport (pacing) -rapport skills -match sensory system use -Milton model language eg Verbal First Aid -match client’s values/Metaprogram use

3.

SPECIFY outcome. -“How would you know if the problem disappeared?” -challenge presuppositions -set wellformed outcome

4.

Open up client’s model of the world -elicit current strategy -pattern interrupt (interrupt the strategy) -pretest. “Can you do it now?” -content/context reframes

5.

Leading to desired outcome (change techniques) -anchoring techniques eg Resource Anchor -submodalities techniques -strategy installation -parts work eg Key Questions -Time Line techniques -trance and healing -physiological techniques eg Eye Movement Integration

6.

Verify change

-test. “Can you do it now?” “That’s right, it has gone." -use client’s convincer strategy.

7.

Exit process

-check ecology -futurepace

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English Manual

Contents 1. Purpose of This Information. Getting Practical Help First 2. Helping People in the First Weeks 3. Preparing for the Trauma Process 4. Factors That Make the Process Work 5. A Sample Script for the Trauma Cure Process

1. Purpose of This Information. Getting Practical Help First This is information for people with expertise in NLP and is not intended for public use. These notes are designed to support certified NLP Practitioners to help people after an earthquake. An excellent Japanese/English manual on preparing for and handling earthquakes is put out in downloadable form at http://www.seikatubunka.metro.tokyo.jp/index3files/survivalmanual.pdf In an event such as an earthquake, the first priority is to save lives and very basic NLP pacing and reframing is useful in the moments of disaster events happening. At this time, what is useful to say includes encouraging people by telling them that they are doing well, that now that the event has happened the worst is over and they can continue to work out what to do. However, physical actions to provide safety, water, food, community support and eventually electricity and sewage become priorities rather than NLP sessions in the immediate aftermath of disaster. In an earthquake, aftershocks continue to happen for some weeks and alertness about danger is a realistic response. Once people feel safer physically, most people will be remarkably resilient and even helpful to others around them, and their unique way of being resilient (which may seem obsessional, selfish, overly rescuing of others etc) does not need to be “fixed” wih NLP. After some months, 5-10% of people, depending on the cultural situation, will continue to be sleepless, panicking etc and will benefit from the NLP trauma process described in detail below. Some people who have traumatic responses to older events will have them re-stimulated by the current crisis and may benefit from this process earlier, mostly in relation to the earlier events.

2. Helping People in the First Weeks In the first weeks after the event, there is still real physical danger. So, in sessions it's really important to accept that some anxiety is normal, and that people also need to be able to relax and rest. Realistic Goals Set goals about responding to the current situation in a way that is satisfying. • "Ideally, how would you like to be able to respond to this uncertainty?" • "How would you need to respond to feel really pleased about how you had coped with this challenging situation?" • "Whats important to you about how you deal with this?" 14

Collapsing Anchors Especially any kinaesthetic triggers for anxiety. Useful Internal Questions Most people having problems, and also most people getting prepared, are asking themselves unhelpful "What if..." questions (“What will happen if my house falls and crushes me?” etc). Encourage the person to ask more useful "how" or "what" questions (“How can I best respond now to be safe?”). Peripheral Vision Teach clients how to relax using peripheral vision, relaxing their jaw and spreading their vision out to the side, which causes relaxation. Tell them to teach everyone else they know, especially children. This is by far the easiest way to relax without having to think. It's very fast and very effective. Strategies for Dealing with 'Overwhelm' Another common response is overwhelm, or generalised stress. These people need a really good strategy for prioritising and chunking down to a manageable step. The strategy will usually work much better if it also includes a great core question (eg “How can I best respond now to be safe?”) as one of the steps. (It could also include peripheral vision as one of the steps.) For example: Trigger such as aftershock - “How can I best respond now to be safe? - Imagine the first small step and check that it feels ok - do it! They are checking “What’s the first step of the most important thing now?” Strategies for Dealing with Aftershocks There may be lots of people panicking with aftershocks. Having a strategy for a resourceful response helps. For example count to 3, taking breaths, if it's still moving, go to the safest place such as under a table. Know which place to go in every room you are in. However you do it, support people to have some kind of plan about how they prefer to respond to the ongoing aftershocks and future pace it. Practical Contacts http://www.traumarecoveryteam.org.nz/

[email protected]

If you need help with Free Fast treatment for Earthquake Psychological Trauma please call 0800 NLP Recovery 0800-657-732 and they will take your details and get someone to contact you, or to book a free session email : [email protected]

3. Preparing for the Trauma Process 1. Be in a Resourceful State Yourself, and Establish Rapport You may be about to hear some disturbing stories that you want to stay dissociated from. You may be about to see people in profound distress. It may be useful to stack a few more resources on to your own resource anchor, and create a 'thought' access for it (not only pressing fingers together or similar) like a 'word' or a colour or phrase, so you can quickly regain resourceful state each time. Be aware of your response to others: especially if you are working in larger centres where there will be an sense of connectedness. This could mean that emotional events (eg more bad news, somebody 15

turning up with anger...) can shift the whole room full of people (they may have all been in rapport for a few days). Become aware of the 'rapport leader' and get in rapport with them,if ecological and ethical, so you can reframe carefully. Match the person's breathing, posture and voice, and reflective listen. 2. Check Their Resourcefulness Is the person able to stay calm enough to talk to you about something pleasant or neutral? If not (i.e. you calibrate the person is distressed or they tell you they are distressed) check with them whether they want to learn how to relax now, so that the experience is easier (this is useful as they may have some misconceptions about an NLP session being the same as a counselling session - i.e. that you need to talk about painful experiences, this would be an opportunity to teach them it will be different to that). If, after helping/teaching them how to relax, this is still difficult you may need to arrange to conduct the session at a later time. There may be some obvious acute physical responses to anxiety that you need to be prepared for; vomiting, hyperventilation, fainting or screaming. We would suggest you have a "first aid kit" handy for such times, which could include a discretely placed bucket, tissues, and a soft cushion / place to lie down. 3. Check What Problems the Person Has Been Experiencing What symptoms of trauma does the person experience? Briefly ask them to tell you, and reflective listen (restate what they say). Reassure them this can change. From their description you may be able to check off many symptoms from the list on the form. Post Traumatic Stress Disorder (DSMIV 309.81) symptoms include: • repeated, distressing memories / dreams of event • acting or feeling as if the event were still happening • intense distress when exposed to images or sounds resembling the event • efforts to avoid anything that could remind the person of the event • inability to experience a normal range of emotions and interest in life • not planning as if life had a future • difficulty concentrating, or relaxing, or difficulty sleeping • sudden anger / Startle responses • nightmares or sleep disturbances Are there any other problems you need to know about (for example, medical problems)? The scaling question could be asked before beginning the script. It says: "On a scale of 1 (neutral or calm) to 10 (the worst they can think of) how bad does it feel now?" You can use this same question in follow-up to check the success of the process. 4. Set the Goal How would the person be acting, thinking and feeling if these problems were solved? If this person's problems were solved, what else would change? Is that okay for them? If not, ask what they need to do to make it okay for them. You are checking for ecology issues eg that the person is afraid that if they don't have their panic, they might not keep themselves/others safe. Use Reframing e.g.: Client "I know that I should try and stop panicking, but I'm afraid that if I get too relaxed I won't be able to respond fast enough if another one happens." Practitioner "You wonder if your anxiety is sort of protecting you by helping you stay alert so you can respond quicker." 16

Client "Yeah" Practitioner "Well I think of it as being like electricity power points in the wall. I know they're dangerous and I need to be alert when I'm round them, but being frightened when I am trying to plug in something doesn't make me safe; it would make me more likely to do something unhelpful. Actually it's being able to be calmly aware that helps me to be most safe." Client "I can't stop thinking that this could happen again at any time. How can I ever feel safe again?" Practitioner "I agree with you that one of the things we learn from events like this is that the world is not always safe. But what happens out in the world is not what causes us to feel safe or feel unsafe. There are many people who are completely physically safe and have never experienced a physical injury, but who have terrible panic attacks. There are many people who live calmly even though their job, for example cleaning windows on high buildings, involves placing themselves in real physical danger. Feeling safe is something that we do inside. What happens in the world is not predictable and not always in our control. What happens inside us can be changed once we learn how to take charge of our brain. Once we do that we can change the things in the world that can be changed, live comfortably in the uncertainty about those things that we cannot predict or change, and learn to choose wisely which situations are which." 5. Give an Overview of the Process Eg "This whole process usually takes less than half an hour. The aim is for you to feel relatively comfortable throughout. Most people find that their symptoms disappear immediately. Your brain learns new responses very quickly." You may give The Person An Experience Of How The Way They Imagine Things Causes Their Body To Respond eg Have the person turn around with their arm stretched out pointing. Tell them "Just go round carefully to where your arm feels tight, and see where you're pointing.... Now come back to the front.... Now imagine turning round again, but this time imagine that your body flows easily way round further, perhaps twenty or thirty centimetres further than before. You'd be pointing at a totally different place. What would you be saying to yourself if you went around that far?... and now turn around with that same hand and see how far you go NOW!" 6. Explain Dissociation in NLP Terms Eg "We are going to teach your brain to react differently to the memories of the event. People can remember events in two different ways. If you think of a simple, enjoyable event you've experienced recently, like eating breakfast today [choose another event if breakfast reminds the person of the trauma], you can remember what you saw through your own eyes [wait for the person to remember] and enjoy all the feelings of eating that breakfast. It may even make your mouth water. That's one way to remember it. Another way to remember it is to imagine seeing yourself sitting in the room eating. Watch yourself over there eating, as if you were watching from a distance. Even make a still picture of yourself, like a photograph, perhaps a black and white photograph. When you see that picture, it's not so easy to get the feeling of enjoying eating breakfast. You need to step back into your body to taste it again. It's quite okay to remember the feeling in your body eating breakfast. But there are some things it's better to step back from, so you can see what happens, but you feel separate from it. People who are enjoying their life can choose which way to remember each thing. We are going to teach your brain to automatically remember those old unpleasant events in a way that keeps you separate from the feelings you had then. That means the other problems you've had will disappear, and you'll get the enjoyment you want in life. Does that sound useful?"

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4. Factors That Make the Trauma Process Work 1. Rapport Breathe in time with the person Sit in a similar position to them Use similar voice tone, speed and volume Restate their comments to confirm you've understood 2. Use Language That Creates Positive Internal Representations of Success Rather than "This may be scary", say "I'm not saying this will be totally comfortable". Once you've started, refer to "the way you used to feel when you thought of this" and "the problem you had", placing the difficulty in the past. 3. Get a Clear Pretest and a Clear, Convincing Post-Test Before, at step 3. of the process, ask the person to notice their anxiety just enough so you and they can confirm that it has been a problem, and they would know if it changed. After, at step 8 of the process, ask the person to try to get back the anxiety and have them confirm that it has changed. If it hasn't, don't try to pretend its working. Actually re-run the process till it works and the person is convinced, or has a plan to test it as soon as possible. Many people do not fully notice the change until you point it out to them. Some people need to try three or even five times to be convinced. 4. Keep the "Roles" or Perspectives in Each Chair Distinct Always speak to the person as if they are actually in the theatre when they sit on the theatre seat. Always speak as if they are actually in the projection booth when they sit in the projection booth seat. If, while in the projection booth seat, the person begins to talk about what it was like inside the traumatic experience, have them stand up and move "out of the projection booth". You want both seats safely separated from the memory. 5. Know Your Choices for Times When the Person Isn't Dissociating a) Have the person stand up and fire their resource anchor. b) Walk around the room with them. c) Have the person get out of the projection booth and imagine they are further away from the movie screen. d) Use the Reframe below 6. Be Clear in Your Mind What a Phobia/Traumatic Response Is in NLP Terms If it could be caused in 30 seconds it can be cured in 30 seconds. Emotionally healthy individuals recall positive experiences associated and negative experiences dissociated. A phobia or an anxiety disorder caused by trauma is just an accidental mis-storage of a memory. 7. Reframe: for When a Part of the Person Doesn't Want to Let the Fear Go "Now I know that there's a part of you that thought it was important for you to hold on to those old feelings. A part of you may have been trying to keep you safe, or to make sure that you really learned the lesson of this event. But holding on to the feeling hasn't actually kept you safe. It has made your life more dangerous by having you live in fear. If that part of you really wants you to have learned from that event, then it will really keep you safe by letting go of the feeling now, and keeping the things you needed to learn." 18

5. The NLP Trauma Process A Sample Script For The Trauma Process 1.

Establish Rapport, Set Up Resource Anchor

"Before we start, what I'd like you to do is to remember a time when you felt in charge of what you were doing, perhaps when you were doing something you know how to do [like baking a cake, or driving a car], and get back the memory of a specific time, so you can step into your body at that time, and see what you saw, hear the sounds, and fell the feeling of being in charge. Now, as you feel that feeling, I want you to press together the thumb and little finger of your left hand and enjoy the sense of being in charge ... Great; now release the fingers and come back to being in the room here, and stretch." Repeat for two other positive feelings instead of "being in charge" e.g. "confidence", relaxation", "humour". Your being able to create that positive feeling in yourself as they think of it will also help. If they can't think of a time when they felt positive, have them remember a time when someone they like had that feeling, and feel what that person must have felt like. 2.

Test Resource Anchor

"OK, now stretch and have a look out the window. Just see something you didn't notice before ... Good; now press that thumb and little finger together and feel the difference." Check that the anchor (thumb-finger touch) causes the person to shift their breathing/body position/facial expression back to a positive state similar to the one they used remembering the times. If not, repeat step one, emphasising their re-experiencing each positive state. 3.

Pretest

"Right, now before we start, I just want to check this thing that has been a problem. I'd like you to just briefly think about the things that have been upsetting you. What does it feel like to remember that? On a scale of 1 to 10 where 1 is calm and neutral and 10 is the worst imaginable, how does it feel now?” Check for a clear shift in breathing, body posture and facial expression. If you need to, to draw them back out, have them stand up and press the thumb and little finger together until they are out of the memory. "OK. Come back to here now. You'll know when that changes now won't you?" 4.

Set Up The Movie Theatre

"Now panic attacks [or "flashbacks/nightmares/Post Traumatic Stress/phobias like you've been having"] is just a result of the brain having a scary experience and storing it in a less than useful way. The brain did that the first time you had that experience, and it took it less than 30 seconds to do. So its just that easy to change once we know how the brain did that." "To change it, what we need to do first is set up a kind of movie theatre here. You've been to a movie sometime, so you know there are seats here [point to movie theatre seat] and a screen up here [point to front -ideally a blank wall]. And sitting in the movie theatre here, I want you to see a picture up on the screen, of yourself, a black and white photo. It could be of the way you look now, or of you doing something you do at home, or just a photo like a recent one you've seen in a photo album ... Have you done that?" 19

“Good. Now, before you had that experience that was scary, there was a time when it hadn’t happened yet, and you were safe. Take all the time you need to remember that time, and make a picture of yourself at that safe time before the event. Put that picture of you looking safe before the event up on the screen now, and turn it to black and white too. Have you done that?” “Great. And after that experience that was scary, there was a time when it was over, and although you still had memories of the event, you were physically safe. Take time to remember that safe time after it happened, and put a picture of yourself at that time on the screen. Have you done that too?” nb if there has not yet been a time that is physically safe, you may need to create an imaginary time in the future. "OK. Now I'd like you to stand up out of that chair and come back here. This is a chair in the projection room from where they show the movie [seat the person now in the second chair, behind the movie theatre chair]. There's a glass screen through which you can see the movie theatre and you can see that other you sitting in the movie theatre, watching a black and white photo on the screen. Can you see that person in the theatre seat?" 5.

Run The Movie Forward "Dissociated"

"So now, as you stay in the projection room, safe behind the glass, you can run the movies, and watch as that other person in the theatre watches them. And because there are holes on the side of the glass, you can hear the movie, because we're going to show a movie soon. And you’ll be safe and comfortable here, maybe with something nice to eat and drink while you watch the person watching the movie." "What I want you to do is to run a movie of yourself in that time when the unpleasant event happened. The movie will start before the event, at the time when you were safe before, and will run through the time after the event, once you were physically safe again. Like any movie, it will show the important parts of the story, form beginning to end, but this movie will be in black and white, like an old film. OK? Now, while you run the movie, I’d like you to watch that person the movie theatre. They may have some response to the movie, but you're in the projection room, so just run it through and watch their watching. OK, go ahead, and tell me when you're done." 6.

Fast Rewind the Movie "Associated"

"Now, in a moment, I'm going to get you to pretend that you float out of the projection room and into the movie at that safe end scene. It may help you to close your eyes to imagine that. Once you're in the movie, in the body of that earlier you, turn the movie to colour. Then we're going to run the movie backwards, from the end to that safe beginning, but fast, like fast rewind on a video. You've seen a video rewind, but this will go so fast the whole thing will only take a second and a half, so it goes zziiiiiiipp! Got that? Okay, now; float into the movie, at the end, turn it colour and zziiiiipp! ... Once you're done, turn the movie back to black and white, and float back to where you actually are, here in the projection room ... Hi." 7.

Repeat until Change Occurs

"OK. Now I want you to be here in the projection booth and watch again as that person in the movie theatre sees the movie through from safe beginning to safe end ... OK? Great; and again, imagine you float into the end and turn the movie to colour, then run it backwards zziiiiipp, and come back to the projection booth once its done ..."

20

"Great. Have a stretch ... Now try and get back that picture at the start of the movie [If they can't, go to step 8]. Now again, watch from the movie projection booth as that person watches the black and white movie, float into the safe end and run it backwards fast in colour, and come back here. Tell me when you're done...". "Good. Now I want you to try to do this process, a bit faster, and do it through as many times as it takes till you can't get back the movie, or you realise that the feeling has suddenly gone. Some people say the movie gets blank spots and fades out; some say it's as if the tape snaps. It's probably started already. Just go ahead and try to run the movie each way till you know you can't. Then tell me ...". 8.

Verify Change (Post-test)

"Great. ,And notice that the feeling went with the picture. Okay; now stretch and look out the window. Notice something there you haven't seen before ...". "Okay, now what I want you to do is have a go at remembering that time, and try and get back the feelings you used to have about it." [Smile]. "How's that now? Different!" Check from the person's body posture, breathing and facial expression that this is a different, more relaxed response than the pretest. "Now I'm not suggesting you'll enjoy that thing now. Just that the uncomfortable feeling is gone. There's often a little uncertainty, as you try to go to remember, because this was a reliable response you had. You had that problem for a while, and it’s strange for it to be different, now. Pretty amazing isn’t it?" [Try again until the person realises it’s different]. 9.

Ecology Check and Future Pace

"Now one thing that has happened occasionally, is that when someone had an anxiety, it gave them something to do. So now it’s important to find out what you can do instead. I'd like you to think of a future time, the kind of time when, in the past, you would have responded in that old way; and notice what you're doing instead, and how you're feeling. How is that? ...". "And think of another situation when, in the past, you'd have had that problem. How is it different now? ... Is that okay for all of you?" “On a scale of 1 (neutral or calm) to 10 (the worst you can think of) how does it feel now?” "Excellent. Welcome to your new life. That was big change wasn't it!"

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NLP Eye Movement Integration Some General Notes Eye Movement Integration (EMI) was developed by Connirae and Steve Andreas in 1989. Similar processes are noted in previous Reichian Therapy, and of course previously NLP trained psychologist Francine Shapiro has a similar method called Eye Movement Desensitization and Reprocessing (EMDR). Compared to EMDR, EMI has less interest in creating a long therapeutic protocol, less interest in conscious memory restructuring, and more flexibility with the movements used. EMI also uses NLP insights about anchoring and eye movement accessing cues. Gestalt Therapist Danie Beaulieu has built a more elaborate model around the method in her book Integral Eye Movement Therapy. Andrew Austin has a quicker protocol which he calls Integral Eye Movement Therapy (IEMT) on which the following notes are based.

Recommended Readings • • •

Austin, Andrew, Integral Eye Movement Therapy Practitioner DVD Set, IEMT, London, 2010 Beaulieu, Danie, Eye Movement Integration Therapy, Crown Publishing, Bancyfelin, Wales, 2004 Shapiro, Francine, Eye Movement Desensitization and Reprocessing, Guilford Press, New York, 1995

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Integral Eye Movement Therapy (IEMT) Adapted from Andrew Austin: a) Resourceful state for the Practitioner. b) Establish rapport c) Elicit the undesired state Ask: “What is the feeling you want to change?”… “And out of ten, how strong is this feeling, with ten being as strong as it can be?” Ask: “And how familiar is this feeling?”… “I thought so; that’s why it’s a problem.” Ask: “And when was the first time that you can remember feeling this feeling… now … it may not be the first time it ever happened, but rather the first time that you can remember now.” Allow the client 20-40 seconds to access an event. Do not offer guidance or advice and allow the client to perform his or her own search. When client has accessed their earliest recollection ask: “And how vivid is this memory now?” d) Do the Eye Movement Process Tell the client: “OK, look at my hand and keep your head still. As I move my fingers hold that memory vividly in your mind for as long as possible… and if this memory fades, try very hard to bring it back… try as hard as you can to retain that experience.” Face the person with your hand a metre from their face. Tell them to stop moving their head, until they actually do stop. Use smooth even movements and a wide range. Move back and forward starting with horizontal movement (A) and then with corner to corner across the centre (C). Do three movements each way. If one movement is very easy, use others. Continue until client protests that they cannot retain or recall visual memory. e) Perform The Three tests Test 1. Ask: “And how does that memory feel now?” Test 2. Ask: “And what happens when you try access that feeling now?” Test 3. Ask: “And when you think about the possibility of that kind of event in the future now, what comes up for you now?” If a negative kinesthetic emerges then repeat the process and locate next memory. f) Variation for multiple issues: As you start to do this, instruct the client: “And you can talk to me as we do this. Allow your mind to move around through time to different events, experiences and memories, the logic of which need not make any sense… and talk to me as this happens, tell me what images come to mind as we do this…” Observe closely for state shifting and changes in representation. These are often represented by muscular twitches around the eye etc. At each shift, prompt the client’s awareness: Ask: “…and what was that one…” 23

Japanese Manual

■内容 １．この情報の目的。何よりもまず実際的な援助を得る ２．初めの数週間の人々への対処法 ３．トラウマプロセスの準備をする ４．各ステップを確実に行うためのポイント ５．トラウマ治療プロセスのサンプルスクリプト

１．この情報の目的。何よりもまず実際的な援助を得る。 これはＮＬＰに熟練している人たちへの情報であり、一般の方が使用するために意図されたも のではありません。 これからご紹介する記事は、資格を有するＮＬＰプラクティショナーが震災後の人々を助けるこ とを支援するために書かれたものです。 地震への準備ならびに対応については、すぐれた日本語－英語マニュアルがありますので、 次のサイトからダウンロードして下さい。 http://www.seikatubunka.metro.tokyo.jp/index3files/survivalmanual.pdf 地震のような事象において、まず初めにやる重要なことは命を救うことであり、災害の起きてい る渦中では、まさに NLP の基本であるペーシングやリフレーミングが役立ちます。このとき、役に 立つのは、「よくがんばっていますね。もう災害は過ぎて、最悪な事態は去ったから、これからどう するかを考えていけますね」というようなことを伝えることにより、励ますことです。しかし、災害直 後は、安全、水、食物、コミュニティサポート（自治体の支援）、そして次に電気と下水設備を確保 するというような具体的な行動が、ＮＬＰのセッションよりも優先事項となります。震災において、 余震は数週間続くこともあり、現実的な対応は危険に対する警戒です。 いったん身体的に安全になったと感じれば、多くの人は、明らかに立ち直りが早くなり、自分の 周りの他人に対して役立とうさえします。そして、その人独自の立ち直り方は（もしかすると強迫 的であったり、自分勝手に見えたり、他の人を過度に救おうとしすぎるなどのように見えるかもし れませんが）、ＮＬＰで対処する必要はないでしょう。文化的な状況にもよりますが、何ヶ月か経っ た後でも 5～10％の人々が眠れなかったり、パニックなどを起こし続けることがあります。その場 合、これからご紹介するＮＬＰのトラウマ治療の手法から恩恵を得られます。古い出来事（記憶） に対してすでにトラウマ的な反応がある人のなかには、今回の危機によって再びトラウマ反応が 24

刺激される人もいるでしょう。その場合、たいていはその古い記憶（出来事）に関してこのプロセス が役立つかもしれません。

２．初めの数週間の人々への対処法 震災後の最初の数週間は、まだ現実の物理的な危険が存在しています。そのため、この期間 に行うセッションに際して了解しておくべき大事なことは、いくらかの不安感は正常だということ、 そして人々はリラックスして休養できる必要もあるのだということです。 ■実現可能な目標 満足いくように現在の状況に対応をするというゴールを決める。 ・「理想的には、どのようにこの不確かな状況に対応できることを望みますか？」 ・「この恐ろしい（ひどい）状況を自分がどう切り抜けたかということについて、 心からよかったのだと思うには、どのように対応をする必要があるでしょうか？」 ・「あなたがこれにどう取り組むかということに関して、何があなたにとって大切ですか？」 ■アンカーをつぶす（コラプシング・アンカー） 特に、心配や不安を引き起こす身体感覚（Ｋ）的なトリガーに対して。 ■有益な自分への問いかけ 問題に直面している、または問題に備えようという人たちの多くは、自分自身に対して「もし～し たらどうなるのだろうか？」という助けにならない質問をします。（「もし家が倒壊して私が下敷きに なったらどうしようか？」 etc.）そうした人にはより役立つ「どのように」や「何」の質問をするよう促 してあげましょう。（「今、安全を確保するために最もよい対応は何だろう？」） ■周辺視野 クライアントに周辺視野を使ったリラックスできる方法を教えましょう。例えばあごをゆるめて、 視野を外側に広げていくとリラックセーションをもたらします。クライアントの知っている人みんな に、特に子どもにこれを教えるように伝えましょう。これは考える必要のないリラックスするための いちばん簡単な方法です。とても速くて効果的です。 ■ 「圧倒される（打ちのめされる）」ことに対する戦略（ストラテジー） 別のよくある反応は、圧倒されることや全身にかかるストレスです。これらの人々は、優先順位 を付けることと、扱いやすい手順に細かく分割する（チャンクダウン）ための、良い戦略（ストラテジ ー）を必要としています。その戦略（ストラテジー）は、プロセスの一ステップとして重要な核心的な 質問（例えば、「今、安全でいるために、私はどのように最善の対応ができるだろうか？」）も含ん でいれば、たいていはよりうまく働きかけるでしょう。 （ステップの一つとして、周辺視野を含んでもよいでしょう。） 25

例えば、余震のようなトリガーについては、－「今、安全でいるために、私はどのような最善の 対応ができるだろうか？」－　最初の小さいステップを想像して、大丈夫だと感じるかをチェックし ましょう。－　そして、実行！　これにより「今、最も重要なことの最初の一歩はなんだろう？」とチ ェックしているのです。 ■余震に対する戦略（ストラテジー） 余震でパニックになる人々がたくさん出るかもしれません。リソースのある状態で対応するため の戦略（ストラテジー）があると役に立ちます。例えば、3 つ数えて呼吸を取り、それでももしまだ 余震が続いていたら、テーブルの下などの安全が必ず確保できる場所へ行くなど。あなたがいる どの場所においてもどの場所に移動できるかを知っておきましょう。どの方法で援助するにしても、 引き続き生じる余震にどう対応したいかについて何らかの計画を持つように人々を支援し、それ を未来ペース（イメージリハーサル）しておくことです。 ■何かあったときの窓口（連絡先） 他の言語によるＮＨＫラジオの情報を得たいときにはこちら http://h.hatena.com/herbe/243597512623822452 ツイッターの情報 http://blog.twitter.jp/2011/03/blog-post_12.html あなたが無事であることをオンラインで知らせるには http://savejapan.simone-inc.com/ 誰かの消息を調べるには http://japan.person-finder.appspot.com/?lang=ja グーグルの地震情報ページも役立ちます。 http://www.google.co.jp/intl/en/crisisresponse/japanquake2011.html

３．トラウマ・プロセスの準備をする。 １)自分自身がリソースのある状態（リソース状態）になり、ラポールを築いてください。 　これから、あなたは気分を害するような話を聞くかもしれませんが、そのストーリーからは「分離 （体験）」の状態を維持したいでしょう。また、かなりひどいストレス下にある人たちに出会うかもし れません。そのため、あなたの既存のリソース・アンカーにさらにリソースを積み重ねておくと役に 立ちます。その際、ハンドジェスチャーのような身体感覚のアンカーだけではなく、「言葉」「色」「フ レーズ」などの「思考によるアクセス」も創っておいてください。それは、毎回、素早くリソースのあ る状態を再生するためです。 　他の人に対する自分の反応も自覚してください。特に、一体感が創り出されているような大きな 施設などでプロセスに取り組むときに注意してください。たとえば、悪い報告、怒りを爆発させるな どの感情的な出来事はその場にいる人たち全体に影響することもありうるという意味です。その 場にいる人たちはすでに数日間みなラポールを取っているかもしれないからです。そのため、エ 26

コロジーにかない、倫理的である場合、「ラポール・リーダー（ラポール確立をリードする人）」を意 識して、その人たちとラポールを築いてください。そうすることで、注意しながらリフレーミングがで きます。相手の呼吸に、姿勢や声にマッチングし、相手の思いを反映するように心から傾聴してく ださい（＝ＴＣを学んでいる方は「映し返しの聞き取り」）。 ２)取り組んでいる相手のリソースの状態をチェックしてください。 　相手は、あなたに快適なことか、ニュートラルなことについて話せるぐらい冷静さを保つことがで きますか？　そうではない（キャリブレーションにより相手がストレス下にあることが分かるか、もし くは相手がストレスを感じていると訴える）場合、今、リラックスの仕方を知りたいかどうか、本人 に確認してください。そうすることで、プロセス経験がやりやすくなるからです。中には、NLP セッ ションが通常のカウンセリングと一緒でつらい体験を話さなければならないと誤解していることも あるので、この点をクリアしたほうが取り組みやすくなります。また違いを伝えるチャンスにもなり ます。リラックスする方法を教えた後でも、まだ困難であるなら、後日セッションのアレンジをする 必要があるかもしれません。また、不安感により急性の身体的反応を生じることもあるかもしれま せんので、それを心しておいてください。たとえば、嘔吐、過換気、気絶、叫ぶといったものです。 それにそなえて、バケツ、ティッシュ、横になるためのクッションか毛布などの「救急キット」を用意 しておくといいかもしれません。 ３）取り組んでいる相手の方が、どんな問題を経験してきたのかをチェックしてください。 　 その方はどんなトラウマ症状を経験しているのでしょうか？　簡潔に話してくださいとお願いし、 反映的に耳を傾け、相手の言うことを言いなおしてください。そして、これは変えられますと安心さ せてあげましょう。その方の説明からリストにあるような多くの症状がチェックできるかもしれませ ん。PTSD(DSM-IV 309.81)には、以下のような症状が含まれます。 ・出来事の、ストレスになるような記憶／夢が繰り返し続く。 ・その出来事が今も起きているかのようにふるまう、または感じる。 ・その出来事に類似したイメージまたは音にさらされると極度なストレスがある。 ・その出来事を思い起こさせるようなことを回避しようとする。 ・生活における通常の感情や関心がもてない。 ・人生に未来があるように計画しない。 ・集中すること、リラックスすること、もしくは眠ることが困難。 ・突発的な怒り／仰天反応。 ・悪夢または睡眠障害 　他に知っておくべき問題はありますか（たとえば、医療的な問題）？ 　状態の度合いを測るための「スケール」質問をはじめにするのもいいでしょう。「１が冷静または ニュートラル、10 が自分の思う最悪だとして、1－10 の物差しで測るとしたら、今どのくらいを感じ ていますか？」と。フォローアップのセッションで同じ質問をすることによりプロセスがうまく行って いるかを測れます。 ４）ゴールを設定してください。 　生じていた問題が解決されたら、その人はどのようにふるまい、考え、そして感じているでしょう か？　この人の問題が解決した場合、他に何が変わるでしょうか？　本人にとって変わることは 27

大丈夫ですか？　大丈夫でないのなら、大丈夫にするために、何が必要かを聞いてください。ここ で、本人のエコロジーの問題を確認しています。たとえば、パニック症状がないと、自分自身／他 者の安全を維持できなくなるのではと不安に思っているなど。 リフレーミングの使用例： クライアント（C）：「パニックを止めようとするべきなのはわかっているのですが、リラックスしすし てしまうと、何か起きたときに素早い対応ができなくなるのではないかと不安で す」 プラクティショナー（P）：「不安感が、警戒心を保って機敏に行動できるように守ってくれている のではないかと思うのですね」 C:「ええ」 P:「そうですね、それは壁についている電気のコンセントのようだと私は思います。危険なのはわ かっていますし、周辺をいじるときは警戒する必要があるのは分かっていますが、コンセントに 何かを入れようとするときに怖れていては安全とはいえません。それでは、逆に助けにならな いことをしてしまうかもません。実際、冷静に注意していられることで、私はいちばん安全でいら れるのです」 C:「また同じことがいつか起こるのではないかという思いから離れられません。再び安心できるな んてことがあるのでしょうか？」 P:「あなたのおっしゃることは分かりますよ。このような出来事があると、世界はいつも安全だとい うわけではないということを、教えられます。でも、世界で起きる事象が、私たちの安心感、ある いは不安感を引き起こすわけではありません。中には、完全に身体的に安全で、身体的に損 傷を負ったことがないのに、ひどいパニックアタック（パニック発作）に会う人もたくさんいます。 また、高層ビルの窓ふきとか、身を危険にさらすような仕事をしている人でも、冷静に穏やかに 生きている人たちもたくさんいます。安心感を得るというのは、私たちの内面で行われることで す。世界で起きていることは予測できませんし、必ずしもコントロールできません。どのように自 分の脳を使うかさえ覚えれば、自分の内面で起きることを変えることができます。自分の内面を 変えられれば、世界における変化することが可能な物事を変えることができ、予測または変更 できない物事が不確定のままでも、安心して生きることができ、そしてどの状況がどちらの場合 なのかを賢明に見極めることを覚えられるのです。 ５）プロセスの概要を伝えてください。 例「このプロセス全体は、ふつう 30 分以内に終わります。プロセスのねらいは、あなたが比較 的心地よくなれるようにすることです。ほとんどの人はすぐに症状が消えると感じます。脳という のは、新しい反応の仕方を即座に覚えるのです」 　想像することが、どのように身体的反応を変えるのか。それを経験させてあげてもいいでしょう。 その方法として、「（手を肩の高さにまっすぐあげて）注意深く、体を回せるところまで体をひねり、 腕がきついかなと感じるところで止め、指先にあるものを見てください……。では前を向いて、今 度は想像してください。イメージの中でふたたび身体をまわしますが、今度は、楽にスーッと流れ るように体が回転して、さっきよりも 20 センチか 30 センチ先までひねれると想像してください。今、 さっきとは全然違うところを指さしています。そんなにぐるりと回転したとき、あなたはどんな言葉 28

を発するでしょうか？……さぁ、同じ手を使って、実際にどれほど遠くまで体を回転させられるか、 今やってみましょう！」 ６）NLP 用語の「分離体験」について説明してください。 例「これから、出来事についての記憶に対して、違う反応をするように、あなたの脳に教えてい きます。人は二つの方法で出来事を思い出すことができます。何か、最近経験したシンプルで楽 しい出来事を考えた場合、例えば今日の朝ごはん《朝ごはんがトラウマの出来事の引き金になる ようであれば他のことを選択》、そのときあなたが自分の目を通して見たことを思い出して《本人 が想起するのを待つ》、そしてその朝食を食べているときの感覚全てを楽しんでください。もしかし たら、唾液が出てくるかもしれませんね。これが一つの思い出す形です。もう一つの思い出し方で すが、それは、あなた自身が部屋に座って食べている自分を見ているイメージを持ちます。離れ たところにいて、そこから自分自身が食べているところを観察するわけです。そこにいるご自身の 白黒の写真を撮ってみてください。その写真を見ているときは、朝食を楽しんで食べているという 感覚は簡単には感じられないでしょう。味覚を思い出すには、もう一度自分の体の中に入る必要 があります。朝食を食べている感覚を体の中に感じながら出来事を思い出すことは、全然大丈夫 なのです。けれども、中には一歩退いて、離れたところから起きた出来事を見る方がいいこともあ ります。人生を楽しんでいるときは、どちらの思い出し方を選んでもいいでしょう。これからあなた の脳にお教えすることは、ああいった不快な過去の出来事を、自動的に、その当時抱いた感覚 から切り離して思い出せるようにする方法です。ということは、あなたが抱いていたあの問題も解 消し、人生をあなたが望むように楽しめるようにしましょうということです。お役にたつでしょうか？

４．各ステップを確実に行うためのポイント １）ラポール 相手の方と呼吸を合わせてください。 同じような姿勢で座ります。 同じような声の調子、話す速度、話し声の大きさにしてください。 相手のコメントを（多少言い方を変えて）返してあげることで、あなたが相手を理解したことを確 認してください。 ２）肯定的で建設的な内的表象（地図）を構築する言語を使ってください。 「これは怖いかもしれません」ではなく、「これは完全に心地いいものになるでしょうと言っている のではありません」と言ってください。いったんプロセスを始めたら、「このことを考えたときにあな たが感じていたように」「あなたが抱えていた問題」というように、困難を過去に設定して言及して ください。 ３）はっきりとした事前テストと、確実で説得力のある事後テストをしてください。 事前に、プロセスのステップ３では、不安感を意識してもらってください。あなたと本人がこれは 問題であったと確認できる程度だけ感じてもらいます。不安感が変化したときに、違いが分かるよ うにするためです。 後に、プロセスのステップ８では、不安感を取り戻してみるように依頼し、以前とは変わっている ことを確かめてもらいます。もし変わっていないならば、うまく行っているふりはしないでください。 29

うまく行き、本人が納得するまでプロセスを最初からやり直してください。もしくはできる限り素早く テストするプランを立ててください。あなたが変わったことを指摘するまで、変化にちゃんと気づけ ない人は少なくありません。中には、納得するまで、３回、あるいは５回繰り返しやってみる必要 のある人もいます。 ４）「役割」もしくは「観点」は、椅子ごとにきちんと区別してください。 相手に語りかけるとき、映画館の座席に座っているときは、必ずあたかも映画館の椅子に実際 に座っているかのように話しかけてください。映写室の椅子に座っているときは、必ずあたかも相 手が映写室に座っているかのように話しかけてください。映写室の椅子に座っているときに本人 がトラウマ経験の渦中はどんな感じだったかを話し始めたら、立ち上がってもらい、「映写室」から 出てもらってください。どちらの椅子も、トラウマの記憶から引き離された安全なものにしておきた いのです。 ５）相手が「分離体験」していないときの、あなたの選択肢を知っておいてください。 ａ）立ち上がってもらい、リソース・アンカーを発火してもらってください。 ｂ）いっしょに部屋の中を歩き回りましょう。 ｃ）本人に映写室から出てもらい、自分が映画のスクリーンから遠く離れているのをイメージして もらってください。 ｄ）６）、７）のリフレーミングを使ってください。 ６）NLP 的に、恐怖症／トラウマ反応は何かを明確に理解しておいてください。 30 秒で引き起こせるのであれば、30 秒で治せるでしょう。情緒的に健全な人は、肯定的な経験 を「実体験」で、否定的な経験を「分離体験」で思い出します。トラウマにより引き起こされた恐怖 症または不安症は、単に記憶の保管の仕方をミスしただけなのです。 ７）リフレーム：相手のあるパートが怖れを手放したがらないとき 「あなたのある部分が、あの抱えていたもとのフィーリングを持ち続けることは大事だと考えてい たのは分かります。あなたのある部分があなたを安全に守ろうとしていたのか、もしくはこの出来 事から大事なことをちゃんと学べるようにしてくれたのかもしれません。でも、そのフィーリングを 抱えることで、あなたの安全は守られませんでした。怖れを抱いたまま生きることで、人生をより 危険にさらしてしまいました。もしあなたのその部分が、あの出来事から学んでほしいと望んでい るなら、今そのフィーリングを手放し、学ぶ必要があったことを心に留めることによって、あなたを 本当に安全にしてくれるでしょう」

5. トラウマ／恐怖症の治療 リチャード・バンドラーをもとに、 リチャード・ボルスタッドとマーゴ・ハンブレットによる 1. リソースに満ちた状態に入り、ラポールを築き、リソースアンカーを作る 30

既にリソースアンカーを作ってあるなら、それをチェックしたら直接ステップ３に進む。 　「始める前にまず、過去に完全に自分のコントロールによりスムースに行動できたこと， 例えば、あなたがよく手順を知っていること（ケーキを焼くとか、車の運転とか）をしている時な どを思い出してください。その特定の思い出の中に戻り、その時のあなたの体の中に入りこん でください。そして、その時に見たこと、聞いたこと、そしてスムースに行動できているその感じ を全てもう一度体験してください。それを感じながら、左手の親指と小指をしっかりくっつけてく ださい。そして、完全に自分のコントロールでスムースに行動しているその感じを楽しんでくだ さい。よくできました。では、指をはなして、現在のこの部屋にいる自分に戻りましょう。伸びを しましょう。」 2. リソースアンカーをテストする 　　　「はい、では、身体をのばして窓の外を見てください。先ほどは気づかなかったものを見 てみて。いいですね。では親指と小指をくっつけて、気持ちの違いを感じてください。」

アンカー（親指と小指をくっつけること）によって、その人の呼吸・姿勢、表情などが、過去の 良い体験を思い出していたときのものと似かよった、ポジティブなものに変わることをチェック します。もしそうならない時は、ステップ１をくり返し、その際ポジティブな経験をしっかりと再体 験するよう強調します。 3. 事前のテスト 　「はい、では、始める前にまず、問題となっていたことについて少しチェックしたいと思い ます。過去にそれが問題であったある時のことをひとつ、今ごく短く思い出してください。それ を思い出すとどんな感じがしますか？」 　「はい、では今、ここの自分に戻ってください。これが今、変化したなら、そうとわかりま すよね、そうではないですか？」

呼吸、姿勢、表情に明らかな違いが起こることをチェックします。もし相手を元の状態に戻す ために必要なら、立ち上がらせて、過去の思い出から脱出するまで親指と小指をくっつけるし ぐさをします。また、「セラピーの論理レベル」の、パターン・インタラプト（パターン中断）を使う こともできます。（「もし私があなたになり変わるとしたら、どうやったらいいのですか？」） 4. 映画館と、「事前」「事後」の写真を作る 　「さて、あなたが持っていたようなパニック発作（またはフラッシュバック・悪夢・トラウマ 後ストレス（ＰＴＳ）・恐怖症・不安症状）は、脳が、怖い思いをした後にそれをあまり役に立た ない形で収納してしまった結果だというだけです。あなたがその体験を初めてしたとき、脳は３ ０秒以内にそれをやり終えたのです。脳がどうやってそれをしたかがわかってしまうと、それを 変えるのは同じようにたやすいことなのです。」 　　　　　　　　　　　　　　　　　　　　　　　　　　　

このプロセスをタイム・ライン・セラピー™と組み合わせるなら、相手をタイムラインの上に浮か び上がらせ、最初の恐怖症またはトラウマ体験の上のポジション３（ずうっと上空の、その出 31

来事よりも手前）まで来させます。相手はそこから、映画のスクリーンがずっと下にあるという 形で見ることができます。 　　　「これを変えるために最初にすることは、映画館のようなものをここにこしらえることです。 映画に行ったことはあるでしょう。だから観客席がここにありますよね（観客席を指差す）。そ れからスクリーンがここに（前方を指差す。できれば何もない壁がよい）。そしてこの観客席に 座って、スクリーンにあなたの写真が映っているのを見てください。白黒の写真です。今のあ なたの様子のままでもいいし、家で何かいつものことをしているところでもかまいません。ある いは、アルバムに貼ってある最近の写真でもかまいません。・・・できましたか？」 　　　「いいですね。では、あの怖かった体験をしたその前に、そのことがまだ起こっていなか った、ということはあなたがまだ安全だった時があります。その時のことを、ゆっくりでかまいま せんから思い出してください。そして、出来事の前の安全な時のあなたの写真を作ってくださ い。その、出来事の前の安全なあなたの写真を今、スクリーンに映して下さい、そしてそれも 白黒にしてください。それもできましたか？」 　　　「すばらしいですね。次に、あの怖かった体験の後に、それが終わってしまって、その体 験の記憶はあるものの、物理的にはもう安全だという時がありましたね。ゆっくりでかまいま せんから、それが起こった後の、安全になった時を思い出してください。そしてその時のあな たの写真をスクリーンに映してください。できましたか？」 　　　「はい、では、そのいすから立ち上がって、こちらに来てください。こちらのいすは、フィル ムをまわす映写室のいすです（相手を、観客席のいすの後ろにある２番目のいすに座らせる。 これは分離体験としてアンカーする。）観客席とはガラスで仕切られていて、あなたは、客席に 座りスクリーン上の白黒写真を見ているあなた自身を、ここから見ることができます。客席に 座っているあなたが見えますか？」 5. 「分離体験」として映画をまわす 　　　「はい、では、あなたはガラスの後ろの映写室で安全な場所にいて、フィルムをまわすこ とができます。そして客席にいるあの人が映画を見るのをここからながめます。ガラス窓の両 端には穴が開いていて、映画の音を聞くことができます。もうすぐ映画を始めます。そしてあな たは安全で快適な映写室にいます。客席の人が映画を見るのをながめる間、何か食べたり 飲むものがあったりしてもいいですよ。」 　　　「あなたにこれからしていただきたいことは、あなたの、あの不快な出来事が起こった時 のことを映画にしてまわすことです。映画は、出来事の前にあなたが安全だったところから始 まり、出来事が終わってあなたが物理的に安全になったところまで、通しで上映します。どの 映画でもあるように、それは物語の要所要所を、始まりから終わりまで映します。でもこの映 画は、昔の映画のように白黒になっています。 　　　よろしいですか？　では、あなたがフィルムをまわしている間、あなたは劇場に座ってい るあの人を見るのですよ。その人は映画に対して何か反応するかもしれませんが、あなたは 映写室にいるのですから、フィルムをまわして、その人が映画を見るのをながめるだけです。 はい、ではやりましょう。そして終わったら教えてください。」 6. 「実体験」で、映画を高速巻き戻しする 　　　「はい、では次に、映写室から浮かび上がり、客席で映画を見ていたあなたと合体して、 安全な最後の映像で止まっている映画の中にすべりこんでもらいます。目を閉じた方が想像 しやすいかもしれませんね。映画の中のあの時のあなたの身体に入りこんだら、映画をカラ 32

ーに変えてください。それから映画を巻き戻しで映します。安全な最後のシーンから安全な最 初のシーンまでね。これを早回しでやります。ちょうどビデオをプレイのまま巻き戻ししたとき のように。見たことがあるでしょう。でもここでは、ものすごく早くまわしますから、全部が１秒半 で終わってしまいます。こんなふうに・・・しゅうううっ！　わかりますか？　はい、では、映画の 中の最後のシーンにすべりこんで。カラーにして。はい、しゅうううっ！　それをやったら、映画 を白黒に戻して、元の自分に戻ります、映写室にいた自分に……はい、お帰りなさい。」 7. 変化が起こるまでくり返す 　　　「はい、では、映写室にいるままで、また客席のあの人が映画を、安全な始まりから安全 な終わりまでを見るのを眺めます。いいですか？　はい、それからまた、最後のシーンにすべ りこむところを想像して、カラーにし、巻き戻します。しゅうううっ！　終わったら映写室に戻りま す…」 　　　「素晴らしいですね。身体をのばしましょう。では、映画の最初にあったシーンを見ようと してください（もし見られない場合は、ステップ８に進む）。はい、ではまた、映写室から、客席 の人が白黒の映画を見るのをながめ、安全な最後のシーンにすべりこんでカラーで巻き戻す。 そしてここに帰ってきます。終わったら教えて下さい。」　 　　　「いいですね。では、この過程を、もっと早くやって見てください。そして、映画が見えなく なるか、（ネガティブな）感情が突然なくなってしまったことに気づくまで、何回でもくり返してく ださい。映画に空白の部分が出てきてフェイドアウトするとか、テープが途中で切れてしまった ようだと報告する人たちもいます。多分あなたの場合もそのようなことが起こり始めているでし ょう。もうフィルムがまわせないとわかるまで、両方向に映画をまわして見てごらんなさい。そ れから教えて下さい…。」 8. 変化を確認する（事後のテスト） 　　　「すばらしい。映画と一緒にあの感情もなくなったことに気づきましたか。はい、では、身 体をのばして窓の外を見てください。今まで気づかなかったものを見て…。」 　　　「では、今からしていただきたいことは、あの時のことを思い出し、その時にあなたが抱い た感情を取り戻そうとして見てください。」（笑顔）「今はどうですか？　変わったでしょう！」

相手の姿勢、呼吸、表情から、事前のテストのときよりもリラックスした反応に変化したことを チェックします。 　　　「この感じをいま楽しんでくださいなどとは言いません。ただあの気持ちの良くない感情 はなくなったということです。過去の反応ははっきりしたものでしたから、いま思い出そうとする と不思議な感じがしますね。あの問題がしばらく続きましたから、それがいま変わってしまった というのは奇妙な感じです。すごいことですよね？」（相手が変化に気づくまでくり返す。） 9. エコロジーのチェックと未来ペース 　　　「たまにあることですが、人によっては不安感があった時にすることが何かあったのです。 ですから、代わりにどんなことができるのかを決めることは大切です。未来において、以前な らあの古い反応をしてしまったかもしれない時のことを考えて見てください。そしてそうではな い代わりにあなたがどう反応しているか、そしてどんな気持ちでいるか感じてください。どうで 33

すか？　では過去において、問題があった別のときについて考えてください。どのように今変 化していますか？…あなたの全人格にとってそれはよいことですか？」 　「すばらしい。新しい人生にようこそ。ずいぶん大きな変化でしたよね！」

もしも恐怖反応が、重要な利益を（セカンダリー・ゲイン：二次的利得）もたらしていたのな ら、問題を引き起こしていた経験からリソースに満ちた自分へ変更させるためにスウィッシ ュを使う。

34

Samoan Manual Tapenaina ole faasologa o le polokalama. 1. Faavae I le tu’ufaafeagai Faatutusa le manava, nofo, ma le leo Siaki: pe e logo ma sefe lea tagata i lau fesoasoani atu? A leai, ona faaalu lea o le taimi e faamasani ai i lea, pe tuu atu i se isi tagata. 2. Siaki le faa’oaina o le tagata E to’a le talanoa atu a lea tagata ia te oe e uiga i se mea manaia, po’o se mataupu e le patino ia te oe po’o ia? A leai, faaalu lea o le taimi e faamalosi ai ma faamafanafana, faato’a ai, pe filifili se isi taimi. 3. Siaki po’o a aafiaga sa ootia ai lea tagata O a auga o le pagatia o loo maua e lea tagata? Afaina talu ona tupu se mea matautia, ma faamamafaina e le tino (DSM-1V) e iai ona auga: -moe miti agai i se mea na tupu -gaioi, ma faalagona mea sa tutupu -le saoloto pe a faalogo i ni leo po’o ni ata e tai tutusa ma le mea sa tupu -taumafai e alo ese mai soo se mea e toe manatua ai se mea sa tupu -faigata na toe maua faalagona masani, le fiafia i mea e tupu i aso fai soo -le mau tonu mo le lumanai -faigata ona sologa lelei le mafaufau ina ia maua se toafilemu (ae maise pe a moe) -vave oso le ita, ma le tei i mea A fuaina i le 0 (to’a) ma le 10 (tu leaga) o mea e lagona i le taimi nei? (e mafai ona faaaogaina lenei fesili pe a toe iloilo le manuia poo se suiga i lenei polokalama) E iai nisi faafitauli e tatau ona e iloa (pei o ni fa’ama’i)? 4. Seti le faamoemoega Pe faapefea gaioiga, mafaufauga, ma faalogona a lea tagata pea fofo le faafitauli? Afai e fofoina faafitauli a lea tagata, o a nisi mea o lea suia? E manao iai o ia i ia mea? A leai, tuufesili pe o le a le mea e tatau ona faia e lelei mo i latou ia? 5. Faamanino pe faamalamalama le faiga o le polokalama atoa Faataitaiga “O lenei faasologa e lalo o le afa itula. O le naunautaiga mo oe ina ia malolo, ma sololelei i taimi uma. O le tele o tagata latou te le toe mauaina auga ia sa iai pe a maea le polokalama. O le tele o auga e tutupu pe a iai se aafiaga e tasi. E tasi foi la le faasologa o le polokalama e soloia ai le faafitauli lea. E vave le aogaina o le tali mai a lou mafaufau. 6. Ave se faataitaiga i le tagata o le mea e manatu iai e mafua mai ai le tali po’o le faatinoina e le tino. Faata’ita’iga, fai i le tagata e tu ma tusi le lima tusi i fafo, fai ia e “ liliu i ou autafa ma tusi pea lou lima i mea e tau atu iai pe a liliu lou tino seia e faalogo atu ua gata. Autilo i le mea lena e tusi iai lou lima…toe faasaga mai lea i luma…o le taimi lenei, mafaufau o loo e toe faataamilo, ae o le taimi lenei, manatu e faigofie lou liliu i lou itu taumatau, e faigofie lou tino ona liliu i tua, pei e luasefulu, pe tolusetulu senitimita le mamao atu i le mea na e gata mai ai muamua. E ese le mea o le a e tusi iai. O le a ni ou manatu o le a iai pe a e liliu tele faapena?...i le taimi lenei, liliu ma lou lima tusi lena sa faaaoga muamua ma siaki pe fia le mamao o lau taamiloga NEI!”

35

Faamalamalama le le fesootai i le fa’a NGP Faataitaiga, o le a aoaoina lou mafaufau e sui ana taga e fa’atatau i mea na tutupu. E lua ni ala e manatua ai e tagata mea e tutupu. A e manatu i se mea lelei ma le faigofie sa tupu ia te oe i se taimi lata mai nei, pei o le taumafaina o lau meaai o le taeao (sui seisi mea e te manatua pea toe maua mai manatu o aafiaga ogaoga), manatua mea ma e iloa atu i lau vaai (fa’atali sei manatua e le tagata), manatua uma faalogona lelei sa e maua i lea mea taumafa. E susua ou laugutu pe a e mafaufau iai. O le tasi lena o ata e te toe manatua ai. O le isi ala e manatua ai mea e tutupu, o le mafaufau o loo e iloa atu oe, e te nofo i se potu ma ai lau mea taumafa. Autilo atu ia te oe o loo tausami mai, pei e te maimoa ia lou ata mai i se mea mamao. Tago e fau sou ata, pei o se ata sa pue, se ata lanu paepae/uliuli. A e vaai i lea ata, e faigata ona maua faalagona fiafia i lau mea meataumafa. Toe foi i tua i lou tino e toe taumafa lau mea ai. E lelei le manatua o le taumafataga o le taeao. E iai le leleiga pe a e tepa i tua - e iloa atu le mea o loo tutupu, ae le fesootai iai. O tagata e manuia o latou olaga, latou te filifili ituaiga mafaufauga e manatua ai aafiaga. O le a tatou aoaoina le mafaufau e faafaigofie ona manatua aafiaga sa tutupu ma faaeseese faalagona. Lona uiga o faafitauli sa iai o le a tea atu, ona maua lea o le fiafia e manaomia mo le olaga. E aoga lena lagona?

O faiga e galue lelei ai le faasologa 1. Tu’ufa’afeagai Manava i le taimi tutusa ma le isi tagata. Nofo fa’atasi ma ia. Ia tutusa le leo, taimi, ma le leotele/leolaititi ma le isi tagata. Toe faauiga ia upu a le isi tagata e mautinoa ai ua e malamalama. 2. Faaoga gagana e fausia ai faalagona fiafia, (manuia) Ina nei faipea atu “E faafefe tagata”, ae tautala “ou te le faiatu atu e tu lelei nei”. A amata le polokalama, ia faapea au upu “o fa’alagona sa ia te oe pe a e mafaufau i nei mea” ma “fa’afitauli sa iai”, o le tuuina lea o faigata i le taimi ua tuana’i. 3. Ia manino le suega ao lei amata, ma ia mautinoa le suega pe a ma’ea Ao lei oo i le sitepu lona tolu (3) o lenei faasologa polokalama, fesiligia le tagata na te toe manatua le aafiaga mo sina tamai taimi ina ia iloa e ia le fa’afitauli, ma le suiga e maua. A maea le sitepu lona valu (8) o le polokalama, fesiligia lea o le tagata e taumafai ona toe maua mai fa’alagona sa iai, ia mautinoa ua sui. Afai e leai se eseesega, aua nei faataga fai iai ua sui. Ae toe fa’asolo le polokalama seia maua le suiga i le tagata, pe siaki e lea tagata i se taimi lata mai na te faamaonia ai le suiga. O le toatele o tagata e le amanaia se suiga se’i vagana ua e tau atu iai. O isi tagata e fai fa’atolu, pe fa’alima le faasologa o le polokalama e talitonu ai. 4. Ia ese le nofoa o le fale tifaga, ma le potu vili ata. Ia talanoa i le tagata pei o la e saofai i totonu o le potu tifaga - pe a nofo i le nofoa o lea potu. Talanoa i le tagata pei o la e saofai i le potu vili ata pe a nofo i le nofoa o le potu lena. Afai e talanoa mai le tagata i aafiaga ao iai i totonu o le potu vili ata, fai iai e tu i luga ma sau i “fafo o le potu vili ata.” E manaomia ia tu’u faaeseese le nofoa lea ma manatu faapea. 5.

Ia mautinoa ala eseese mo taimi e le tuuvalavala ai manatu aafia a) fai iai e tu i luga ma oomi le taula faaola b) savalivali faataamilo ma ia i le potu c) fai i le tagata e sau i fafo o le potu vili ata ma mafaufau ua alu mamao ma le fale tifaga d) faaaoga le Toe Faata mo le isi itu o le tagata e le’o mana’o e faamamulu le fefe (itulau 25) 36

6. Ia mautinoa i lou mafaufau o lea le fefe vale/aafiaga matuia i malamalama fa’a NGP Afai e tolusefulu sekone le taimi e faatupu ai, e mafai foi ona toe fofo i le tolusefulu sekone. O tagata e maloloina lelei o latou olaga, latou te manatua mea lelei ma tuufaatasi pe faalatalata mai, ae o aafiaga e tuueseese pe tuumamao atu. O le fefe vale po’o le popole e tupuga mai i le aafiaga ua faila sese e le manatu. 7. Toe faavaa le ata: Mo le isi itu o le tagata e le’o malie e tuu le fefe “Ou te iloa e iai lou itu e manatu ae e taua le taofi o fa’alagona tuai. O lou itu lea o lo’o taumafai e te saogalemu, ma mautinoa le lesona i mea sa tutupu . Ae o le taofia o nei fa’alagona e leo maua ai sou mapusaga. Ua atili faigata ai lou soifua i lou ola fefe vale. A fai e manao lou itu lea e te aoaoina mai ai i mea ua tutupu, e pito sili ona e saogalemu pe a faamamulu loa ia faalogona nei lava, ae teuina na’o aoaoga e te manaomia.”

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Fasifaitau tofo o polokalama mo aafiaga 1.

Ia fesootai, ma seti le taula faa’oa

A Sample Script for Trauma Process 1. Establish Rapport, Set Resource Anchor

“Ao lei amata, ou te mana’o e te toe manatua se taimi sa e pule ai i au mea sa fai, pei o le taimi sa e faatinoina ai se mea e te agavaa iai, (pei o le kuka o se keke, ave o le ta’avale, taalo o se ta’aloga, pese, siva) ia toe manatua lena taimi, ia e toe foi i lou tino i lena taimi, toe vaai i mea sa e iloa atu, faalogo i leo na iai i lea taimi, ma le lagona o oe e pule. Ao iai pa lena lagona, ou te manao e tago lou lima tauagavale e oomi fa’atasi lou lima matua ma le tamai lima ao e fiafia i lena faalagona e te pule ai… Lelei, ia toe fa’avaivai ou tamailima ma toe fo’i mai i le potu, falo lou tino.”

"Before we start, what I'd like you to do is to remember a time when you felt in charge of what you were doing, perhaps when you were doing something you know how to do [like baking a cake, or driving a car], and get back the memory of a specific time, so you can step into your body at that time, and see what you saw, hear the sounds, and fell the feeling of being in charge. Now, as you feel that feeling, I want you to press together the thumb and little finger of your left hand and enjoy the sense of being in charge ... Great; now release the fingers and come back to being in the room here, and stretch."

Toe fai mo isi faalogona lelei se lua, pei o le faalogona o le “to’a”, “saogalemu” “mea malie”. E manaia foi pe a toe manatua ou lagona lelei ao manatua e le isi tagata. A le mafaufauina e leisi ni taimi lelei, ona fai lea e manatua se taimi sa iai lea lagona i se tagata e fiafia iai, ma lagona faalagona i lea tagata.

Repeat for two other positive feelings instead of "being in charge" e.g. "confidence", relaxation", "humour". Your being able to create that positive feeling in yourself as they think of it will also help. If they can't think of a time when they felt positive, have them remember a time when someone they like had that feeling, and feel what that person must have felt like.

2.

Siaki le Taula faa’oa

“Ua lelei, ia falo ma autilotilo i fafo o le fa’amalama. Vaai i se mea e te le’i amanaia muamua… Lelei. Ia tago e oomi faatasi lou lima matua ma le tamai lima ma lagona le eseesega.” Siaki le taula (tago le lima matua/laititi) ia sui le manava/tino/foliga i uiga faalia manuia. A leai, ona toe fai lea, ma ia fa’amamafaina le taua o le toe iai i taimi e manatua ai mea lelei. 3.

Suega ao lei Amata

“I lenei taimi ao le’i amata, o loo manaomia e siaki le aafiaga ua avea ma fa’alavelave. Ia e toe manatua vave se taimi sa iai lea fa’alavelave nei. O a ni lagona o e toe manatua?” Siaki le suia o le manava, tino, ma foliga. A e mana’omia e toe aumaia le tagata i fafo mai i aafiaga, ona fa’atu lea i luga ma oomi fa’atasi le lima matua/laititi seia mou lea manatu. “Ua lelei, toe fo’i mai i le taimi nei. E te mautinoa lelei se suiga, a ea?”

2.

Test Resource Anchor

"OK, now stretch and have a look out the window. Just see something you didn't notice before ... Good; now press that thumb and little finger together and feel the difference." Check that the anchor (thumb-finger touch) causes the person to shift their breathing/body position/facial expression back to a positive state similar to the one they used remembering the times. If not, repeat step one, emphasising their re-experiencing each positive state. 3.

Pretest

"Right, now before we start, I just want to check this thing that has been a problem. I'd like you to just briefly remember one of the times it's been a problem now. What does it feel like to remember that?" Check for a clear shift in breathing, body posture and facial expression. If you need to, to draw them back out, have them stand up and press the thumb and little finger together until they are out of the memory. "OK. Come back to here now. You'll know when that changes now won't you?" 38

4.

Seti le Ata Tifaga

4.

Set Up The Movie Theatre

“O le fefevale, (po’o manatu fa’aemo/malu’ia/mea fa’amamafa i le mafaufau talu mai se aafiaga matuia/matafefe gofie pei ona tupu ia te oe) o manatu ia i le faiai ua fefe vale ma fa’amauina i se mea e le aoga tele. Sa faatupu e lou faiai i le taimi muamua sa e aafia ai, e lalo ma le tolusefulu (30) sekone na fai ai. E faigofie fo’i ona toe suia pe a iloa le ala na fau ai e le faiai.”

"Now panic attacks [or "flashbacks/nightmares/Post Traumatic Stress/phobias like you've been having"] is just a result of the brain having a scary experience and storing it in a less than useful way. The brain did that the first time you had that experience, and it took it less than 30 seconds to do. So its just that easy to change once we know how the brain did that."

“ A suia , e muamua ona seti se ata tifaga iinei. Ua e alu e matamata i se ata, e te iloa e iai nofoa (tusi i nofoa o le tifaga) ma le mea e faaali ai le ata (tusi i se itu o le fale e leai se ata o iai). E saofa’i i le faletifaga iinei, ou te manao ia e iloa atu sou ata i luma, o lou ata i le lanu uliuli/pa’epa’e. E mafai ona pei o se ata o oe i taimi nei, po’o oe ao fai sau feau i lou fale, po’o sou ata sa e vaai iai i se tusi ata…ua uma ona faia lea mea?”

"To change it, what we need to do first is set up a kind of movie theatre here. You've been to a movie sometime, so you know there are seats here [point to movie theatre seat] and a screen up here [point to front -ideally a blank wall]. And sitting in the movie theatre here, I want you to see a picture up on the screen, of yourself, a black and white photo. It could be of the way you look now, or of you doing something you do at home, or just a photo like a recent one you've seen in a photo album ... Have you done that?"

“Lelei, o le taimi nei, a’o le’i tupu le manatu lena sa e fefe ai, sa iai le taimi e le’i tupu ai, sa e saogalemu ai. Ia faaaoga le taimi umi e te manaomia e manatua ai, ma fau sou ata o lea taimi saogalemu a’o le’i oo i le mea sa tupu. Tu’u lou ata saogalemu i le taimi muamua i luma e vaai ai le ata, ma liliu i le lanu uliuli/paepae. Ua maea ona e faia?”

“Good. Now, before you had that experience that was scary, there was a time when it hadn’t happened yet, and you were safe. Take all the time you need to remember that time, and make a picture of yourself at that safe time before the event. Put that picture of you looking safe before the event up on the screen now, and turn it to black and white too. Have you done that?”

“Lelei, e iai le taimi ua maea le aafiaga sa e fefeai, sa iai le taimi ua muta ai, e ui lava, e ui lava o lo’o e manatua mea sa tutupu, o lo’o e saogalemu Ia faaaoga le taimi umi e te manaomia e manatua ai ina ua maea, tuu lea o lou ata i lea taimi e luma e te vaai atu iai. Ua uma ona e faia?”

“Great. And after that experience that was scary, there was a time when it was over, and although you still had memories of the event, you were physically safe. Take time to remember that safe time after it happened, and put a picture of yourself at that time on the screen. Have you done that too?”

“Lelei. Ou te mana’o e te tulai i luma o lou nofoa ma savali mai i tua. O le nofoa lenei i le potu e vili ai le ata (faanofo le tagata i le nofoa lona lua, i tua o le nofoa o le potu tifaga). E iai le faamalama lea e te autilo atu ai i le potu tifaga ma iloa ai le isi oe o loo saofai i le potu tifaga, o loo matamata lou ata lanu uliuli/pa’epa’e i luma. O e iloa atu le tagata i le potu tifaga?”

"OK. Now I'd like you to stand up out of that chair and come back here. This is a chair in the projection room from where they show the movie [seat the person now in the second chair, behind the movie theatre chair]. There's a glass screen through which you can see the movie theatre and you can see that other you sitting in the movie theatre, watching a black and white photo on the screen. Can you see that person in the theatre seat?"

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5.

Vili le ata agai i luma “fa’ata’ape”

5. Run The Movie Forward "Dissociated"

“ O lenei, a o e iai i le potu vili ata ma le saogalemu i tua o lenei tioata, e vili le ata, ma e matamata i le tagata i le potu tifaga o lo’o matamata i luma. E iai pupu i itu o le tioata, e faalogo atu ai, aua toeititi ona vili lea o le ata tifaga. Ae e sefe ma e malu iinei, atonu e iai ma ni au mea taumafa manaia, ma se vai e inu a’o e matamata i le tagata lea e matamata i le ata.”

"So now, as you stay in the projection room, safe behind the glass, you can run the movies, and watch as that other person in the theatre watches them. And because there are holes on the side of the glass, you can hear the movie, because we're going to show a movie soon. And you’ll be safe and comfortable here, maybe with something nice to eat and drink while you watch the person watching the movie."

“ Ou te manao ia vili sou ata o le taimi lea sa e aafia ai. Ia amata le ata ao e saogalemu e lei tupu le mea sa e afaina ai. Vili le ata e oo i le taimi ua sopoia le mea sa tupu, ua e toe mapu ai. Pei o isi ata, e fa’aalia mea taua o le tala, o le amataga se ia o’o i le faaiuga, o lenei ata e vaaia i le lanu uliuli/paepae pei o lanu o ata tuai.”

"What I want you to do is to run a movie of yourself in that time when the unpleasant event happened. The movie will start before the event, at the time when you were safe before, and will run through the time after the event, once you were physically safe again. Like any movie, it will show the important parts of the story, form beginning to end, but this movie will be in black and white, like an old film.

Ua lelei? O le taimi nei, ia vili le ata, ma e matamata i le tagata lea e nofo i totonu o le potu tifaga. E iai ona uiga faaalia i le ata o loo maimoa atu iai, ae o oe e te iai i totonu o le potu vili ata, amata le viliga o le ata ma matamata i le o loo vaai iai. Ua iai, vili loa, ta’u mai pe uma.” 6.

Vili i tua le ata “tu’ufa’atasi”

“Toeitiiti lava, ou te mana’o ete manatu ua e lelea mai i fafo o le potu vili ata, lelea i totonu o le ata mulimuli e te saogalemu i le ata faaiu lea i luma. A fesoasoani, ona moeiini lea o ou mata ma e fa’atinoina i lou mafaufau. A e iai loa i totonu o lou ata, i le tino o lena ata, ona faaliliu lea o le lanu o le ata e fa’alanu. Toe vili i tua le ata, mai i le faaiuga seia oo i le amataga, ae vave lava pei o le viliga i tua o le vitio. Ua e vaai i le vitio ae vili i tua, ae vave atu le viliga o le ata, na’o ni nai sekone e faapea siiiiiip! Ua iai? Ua lelei. Ia lelea ane loa i totonu o le ata, i le fa’aiuga, fa’aliu lanu le ata, vili i le amataga siiiiip. A uma loa, ona toe liu lanu uliuli/pa’epa’e lou ata, ma lelea mai i le potu vili ata. Talofa”

OK? Now, while you run the movie, I’d like you to watch that person the movie theatre. They may have some response to the movie, but you're in the projection room, so just run it through and watch their watching. OK, go ahead, and tell me when you're done." 6.

Fast Rewind The Movie "Associated"

"Now, in a moment, I'm going to get you to pretend that you float out of the projection room and into the movie at that safe end scene. It may help you to close your eyes to imagine that. Once you're in the movie, in the body of that earlier you, turn the movie to colour. Then we're going to run the movie backwards, from the end to that safe beginning, but fast, like fast rewind on a video. You've seen a video rewind, but this will go so fast the whole thing will only take a second and a half, so it goes zziiiiiiipp! Got that? Okay, now; float into the movie, at the end, turn it colour and zziiiiipp! ... Once you're done, turn the movie back to black and white, and float back to where you actually are, here in the projection room ... Hi."

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7.

Toe fai seia iai se suiga

“ Ua lelei. Ou te mana’o ia e toe iai i le potu vili ata e matamata i le tagata ile potu tifaga ao ia vaaia le ata mai i le saogalemu ile amataga se ia oo i le sefeaga i le fa’aiuga…ua iai? Lelei, manatu ua e lelea atu i totonu o le ata ma liliu fa’alanu le ata, toe vili i tua i le amataga siiiiip, sui uliuli/paepae le ata, ma toe lelea mai i le potu vili ata pe’a uma…” “Malo. Ia falolo…Ia e toe manatu lou ata i le amataga o le ata (afai e le mafai alu i le vaega 8). Ia toe fai, matamata mai i le potu vili ata le tagata ao vaai i le ata lanu uliuli/pa’epa’e, lelea atu i totonu o lou ata saogalemu i le fa’aiuga, toe vili vave i tua i le amataga le ata, fa’alanu, ma e toe lelea mai iinei. Ta’u mai pe a uma…” “Lelei, Ou te mana’o e te faatamoe le faasologa, toe fai ma toe fai faatele seia le toe maua le ata, pe mou atu se lagona sa iai. Fai mai isi tagata ua le toe iloa atu se ata, o isi fai mai ua motu le ata. Ai ua amata. Toe faaalu le ata i luma ma tua seia e iloa ua le toe mafaia. Ona ta’u mai lea…” 8. Fa’amaonia le suiga (suega pe a ma’ea)

7.

Repeat until Change Occurs

"OK. Now I want you to be here in the projection booth and watch again as that person in the movie theatre sees the movie through from safe beginning to safe end ... OK? Great; and again, imagine you float into the end and turn the movie to colour, then run it backwards zziiiiipp, and come back to the projection booth once its done ..." "Great. Have a stretch ... Now try and get back that picture at the start of the movie [If they can't, go to step 8]. Now again, watch from the movie projection booth as that person watches the black and white movie, float into the safe end and run it backwards fast in colour, and come back here. Tell me when you're done...". "Good. Now I want you to try to do this process, a bit faster, and do it through as many times as it takes till you can't get back the movie, or you realise that the feeling has suddenly gone. Some people say the movie gets blank spots and fades out; some say it's as if the tape snaps. It's probably started already. Just go ahead and try to run the movie each way till you know you can't. Then tell me ...". 8.

Verify Change (Post-test)

“Lelei, ua e iloaina ua mou atu faalagona sa iai faatasi ma le ata. Ua lelei; ia falolo ma autilotilo i le fa’amalama, vaai ane i se mea e te le’i amanaia muamua…”

"Great. ,And notice that the feeling went with the picture. Okay; now stretch and look out the window. Notice something there you haven't seen before ...".

Ua lelei, ou te mana’o e te taumafai e toe manatua lena taimi, ia e toe maua mai faalagona sa ia te oe e uiga i le mea na tupu.” (mata ataata), “ea mai nei? Ua ese!”

"Okay, now what I want you to do is have a go at remembering that time, and try and get back the feelings you used to have about it." [Smile]. "How's that now? Different!"

Siaki le tu a lea tagata, manata, foliga ua suia ma tuu faitalia e ese mai i le suega ao lei amataina le faasologa o le polokalama lenei. “Nei la, ou te le faapea atu e te talia lenei tulaga ua iai. Nao le fa’alagona le saoloto ua mou atu. E iai le le mailoa, pe a e toe manatua, aua o lagona mautinoa lena sa iai. Sa ia oe lena fa’afitauli mo se taimi umi, ma e uiga ese le suiga ua iai nei. O se mea e maofa ai, a ea?” (toe siaki se ia mautinoa e le tagata le suiga)

Check from the person's body posture, breathing and facial expression that this is a different, more relaxed response than the pretest. "Now I'm not suggesting you'll enjoy that thing now. Just that the uncomfortable feeling is gone. There's often a little uncertainty, as you try to go to remember, because this was a reliable response you had. You had that problem for a while, and it’s strange for it to be different, now. Pretty amazing isn’t it?" [Try again until the person realises it’s different]. 41

9.

Siaki siosiomaga ma laa i luma

“O se tasi mea e tupu i si taimi, afai sa iai se mea sa faapoppoleina ai se tagata, sa iai ana galuega sa fai. E tatau la ona sailiili po’o iai ni galuega ese e faaalu iai lona taimi. Ou te mana’o e te mafaufau i se taimi i le lumana’i, le tuaiga taimi, e pei o taimi ua tuana’e tulai mai ai se faafitauli, ma tupu ai manatu pei o mafaufauga tuai e faafetauia ai; o e iloa atu au mea na ua fai, ma fa’alagona ia te oe. Ea mai lea?” “Toe mafaufau i se isi taimi e te iloa lelei a tulai mai pei o taimi ua tea, e avea ma fa’afitauli mo oe. O le a le eseesega ua iai nai?...E talafeagai mo outou uma?”

9.

Ecology Check and Future Pace

"Now one thing that has happened occasionally, is that when someone had an anxiety, it gave them something to do. So now it’s important to find out what you can do instead. I'd like you to think of a future time, the kind of time when, in the past, you would have responded in that old way; and notice what you're doing instead, and how you're feeling. How is that? ...". "And think of another situation when, in the past, you'd have had that problem. How is it different now? ... Is that okay for all of you?" "Excellent. Welcome to your new life. That was big change wasn't it!"

“Malo lava. Maliu mai i lou olaga fou. O se suiga matuai tele, a ea!”

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Civil Defence Handouts A guide for emergency response workers and their managers Engaging in response efforts in the wake of a traumatic event is inevitably stressful for those involved in the emergency response. While the work is personally rewarding and challenging, it also has the potential for affecting responders in harmful ways. The long hours, breadth of needs and demands, ambiguous roles, and exposure to human suffering can adversely affect even the most experienced professional. Too often, the stress experienced by responders is addressed as an afterthought. With a little effort, however, steps can be taken to minimise the effects of stress. Stress prevention and management should be addressed in two critical contexts: the organisation and the individual. Adopting a preventive perspective allows both workers and organisations to anticipate stressors and shape responses, rather than simply reacting to a crisis when it occurs. Organisational approaches for stress prevention and management 1. Provide effective management structure and leadership. Elements include: • Clear chain of command and reporting relationships. • Available and accessible supervisors. • Disaster orientation for all workers. • Shifts of no longer than 12 hours, followed by 12 hours off. • Briefings at the beginning of shifts as workers enter the operation. Shifts should overlap so that outgoing workers brief incoming workers. • Necessary supplies (e.g., paper, forms, pens, educational materials). • Communication tools (e.g., mobile phones, radios). 2. Define a clear purpose and goals. 3. Define clear intervention goals and strategies appropriate to the assignment setting. 4. Define roles by function. 5. Orient and train staff with written role descriptions for each assignment setting. When a setting is under the jurisdiction of another agency, inform workers of each agency’s role, contact people, and expectations. 6. Nurture team support. 7. Consider creating a buddy system to support and monitor stress reactions. Promote a positive atmosphere of support and tolerance with frequent praise. • • •

8. Develop a plan for stress management. For example: Assess workers’ functioning regularly. Rotate workers among low-, mid-, and high-stress tasks. Encourage breaks and time away from assignment.

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Common Reactions to Disasters Most people involved in a traumatic incident experience some kind of emotional reaction. Although each person’s experience is different, there are a number of common responses that are experienced by the majority of those involved. It is reassuring to know that, even though these feelings can be very unpleasant, they are NORMAL reactions in a normal person to an ABNORMAL event. You are not losing your mind or going crazy if you have these feelings. It is often difficult for those who were not involved to understand what the survivor is going through; you may wish to show this pamphlet to friends and relatives, and perhaps discuss your reactions with them. Outlined below are some of the normal reactions to trauma: Emotional Shock  disbelief at what happened  feeling numb, as if things are unreal Fear  of a recurrence  for the safety of oneself or one’s family  apparently unrelated fears Anger  at who caused it or “allowed it to happen”  at the injustice and senselessness of it all  generalised anger and irritability Sadness  about the losses, both human and material  about the loss of feelings of safety and security  feeling depressed for no reason Shame  for having appeared helpless or emotional  for not behaving as you would have liked Physical Sleep  difficulty getting off because of intrusive thoughts  restless and disturbed sleep  feeling tired and fatigued Physical Problems  easily startled by noises  general agitation and muscle tension  palpitations, trembling or sweating  breathing difficulties  nausea, diarrhoea or constipation  many other physical signs and symptoms

Thinking Memories  frequent thoughts or images of the incident  thoughts or images of other frightening events  flashbacks or a feeling of “reliving” the experience  attempts to shut out the painful memories  pictures of what happened jumping into your head  dreams and nightmares about what happened  unpleasant dreams of other frightening things  difficulty making simple decisions  inability to concentrate and memory problems Behaviour Social  withdrawal from others and a need to be alone  easily irritated by other people  feelings of detachment from others  loss of interest in normal activities and hobbies Work  not wanting to go to work, poor motivation  poor concentration and attention Habits  increased use of alcohol, cigarettes or other drugs  loss of appetite or increased eating  loss of interest in enjoyable activities  loss of sexual interest.

Remember that all responses are NORMAL to an ABNORMAL situation.

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Coping Personally a) General Information for Communities Distress is an understandable and normal response to major disasters. Common causes of distress may be related to having been directly at risk from an emergency event, being concerned about family and friends who may be affected, witnessing injuries and distress to others, or being caught up in the panic and confusion that often follows. In addition, feelings and memories related to previous experiences of disasters or other grief and loss may also resurface. Most people experience acute stress during emergency events and most manage with courage and strength. However, sometimes it is only later when the distressing images are recalled that some of the stressful effects start to show. While most people will manage with the support of family and friends, there are times when extra help and support may be needed. Those who have lost loved ones, have been seriously injured, or are highly distressed by an emergency, will often need particular support and care. Our communities have a history of coping with uncertain and troubled times with courage and strength. There are three important things you need to know: 1 • normal reactions to this type of emergency • positive ways of coping • when to get extra help. Normal reactions to a disaster like this include: 1 • shock and numbness, often fear at first • horror and grief when the extent of loss is realised • frustration, anger, helplessness and even sometimes despair when it all seems too much • sometimes fears or old worries may resurface. • These feelings usually settle over the early weeks. Positive ways of coping may be: 1 • supporting one another, especially in the family and in your community • providing emotional support – comforting each other • carrying out practical tasks – tackling the jobs that need to be done a bit at a time and counting each success • sharing your experience and feelings with others - a bit at a time when it is right for you • looking after your own and your family’s general health – rest, exercise, food and company all help (being careful not to drink too much alcohol). When to Ask for help Sometimes post disaster stress can be ongoing and affect your physical and mental health and wellbeing. It’s time to ask for help if: 1 • your sleep is badly affected • you feel very distressed, irritable, on edge or agitated much of the time • you feel hopeless, despairing, miserable or that you can’t go on • you have trouble concentrating, are distracted and cannot do your usual tasks • you feel your health is not so good • you have recurrent nightmares or intrusive thoughts about the emergency • you have new symptoms or old problems may seem to have returned, e.g. breathing, heart and stomach problems. 45

•

For children, withdrawal, aggressive behaviours, difficulties at school, problems separating from parents or going to sleep may indicate the need for help. Adapted from information issued by Queensland Health: Fact Sheets for Psychosocial Disaster Management

Coping Personally b) Information for Volunteers Health, other staff and volunteers are frequently called upon to deal with emergencies, and for some this is the major component of their day-to-day work. When a disaster occurs, there is inevitably an escalation of response. This brings new challenges, intense involvement and often both satisfaction and stress – during the response and sometimes in the aftermath. It is important for staff and volunteers to recognise these needs, responses and coping strategies. They are normal reactions for the most part but may, at times, mean that there is a need for extra support or expert assistance. Health and other emergency staff often have very high expectations of themselves. They, and others, often believe that they should be able to deal with any emergency. So those who find they are having difficulties are often reluctant to seek help. Seeking help early is one of many positive coping strategies. We also know that there are some situations that are more stressful than others. Deliberate attacks, for instance, have particular implications because they can confront us with the malevolent intent to harm others, ongoing threat, uncertainty and concerns for the future. In general they create a background of anger and fear, while at the same time, there is usually a determination not to give in to such threats. Common reactions Staff and volunteers are usually aroused and focused to their tasks in the immediate response period, while at the same time confronting what may be quite horrific injuries, pain and suffering in those they are assisting. At the same time, there is recognition of the loss, grief and trauma that many of their patients confront, and some degree of identification with this. If identification is strong, for instance the patients remind one of one’s children, partner or other loved ones, this may be particularly stressful. The injuries of children and innocent victims are difficult to deal with at all times. Thoughts and images of their distress and one’s own feelings may come back over the weeks that follow. We know that people usually respond well in the emergency, but sometimes have difficult reactions in the aftermath. People have many different ways of dealing with their experiences Sharing feelings with others, including those who have been through it with you, your family and your friends may be important coping strategies involving mutual support. Each person also uses their own particular coping styles, some action-oriented, some more focused on emotional response. Personal strengths, which have been effective in coping with past difficulties, may be useful again. Types of assistance available The types of assistance that are available include provision of information to you personally or through websites. These sources can provide information on some common reactions and what you can do to deal with problems that arise. Assistance may also involve an opportunity to talk things over and have your concerns understood – general supportive counseling. Specialist clinical counseling and treatment can be provided by people with specific expertise in this field. Issues that may arise 46

Some of these are listed below. If they are prolonged, persistent, disruptive and distressing it is useful to seek further advice or assistance. •

•

• • •

Difficulties in returning to normal roles and life. These may seem to be of lesser significance when compared to the intensity and meaningfulness of work during the emergency. You may feel disengaged, irritable or a sense of feeling let down afterwards. Persistence of these feelings of disengagement after the early weeks may indicate a problem. Distressing images, memories and nightmares, disrupted sleep, feelings of irritability, being on edge, difficulty concentrating, fearfulness and anxiety or depression may occur. These reactions usually settle, but if persistent after the early weeks, they may indicate the need for advice or assistance. Feelings of numbness, a loss of feelings generally or feelings for others, may occur as part of a psychological defence to help you with the experience initially. If this persists, it may interfere with your relationships and it could be useful to seek further advice. Old traumas may come to the surface again. These may be reawakened by the stress of the new experience and may need to be dealt with. Other reactions in the aftermath may relate to the intense bonds that are formed with those you have helped, a need to know what has happened to them after they have left your care. These special attachments usually settle over time and are a common response. However, if they become an intense and ongoing focus this may interfere with other relationships and may indicate that you could benefit from the chance to talk through your feelings with a counsellor or others. Coping strategies We know that each person has their own style of coping and these should be respected, especially if they have helped you in the past. Some important points that can assist staff are outlined below:

• • •

•

Sharing your experience with others when you feel ready, including family, friends, and colleagues, and those who have gone through the experience with you. Supporting one another is usually helpful. Talking through any concerns with your supervisor is also likely to be help. Operational reviews and debriefs in later weeks which give you a chance to get your experience in perspective and to recognise both its value and what you have learned. Time out for R&R (rest and recreation). It is vitally important to make time to relax, exercise, eat well and engage in positive life-affirming activities. Time with friends and family and a positive commitment to something you enjoy that is separate from your work, for example physical activities, sport, music, theatre and reading, can be helpful. Writing about your experience. This helps in terms of putting it down, and in a way, outside yourself. Studies now show that this can have positive health benefits. Family Trauma may have a range of impacts on families, some related to separation from you and concern for you. It is important to stay close and share thoughts and feelings with family members at your own pace. Children may be affected indirectly by watching shocking media images, or listening to other children’s stories which may have distressed them. Parents and carers can help by answering children’s questions honestly; acknowledging concerns and fears and helping children understand how they are protected. When to ask for extra help Sometimes post-incident stress effects can be ongoing and affect your physical and mental health and wellbeing. It’s time to ask for help if: 47

• • • • • • • • • •

your sleep is badly affected you feel very distressed, irritable, on edge or agitated much of the time or are having angry outbursts you feel hopeless, despairing, miserable or that you can’t go on you have trouble concentrating, are distracted and cannot do your usual tasks you have recurrent nightmares or intrusive thoughts about the emergency you feel your health is not so good you have new symptoms or old problems have come back you are having trouble with your work you are having difficulties with your relationships you find that you are drinking excessively or doing other things that may have adverse effects.

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OFFICE USE ONLY

Unique No: Name

Date

Address (or former address) Date of Birth Phone – Home

Mobile

I consent to the information gathered on this form being seen by other authorised personnel involved with the NLP First Response team, and the NLP Trauma Recovery Trust. This information will be used for follow-up calls, checking on my progress, and for statistical purposes including research to support future funding). Signed: (by guardian if under the age of 16 years)

BEFORE PROCESS Brief Description of symptoms (client’s words) Note in particular: Sleeping difficulties, general anxiety, panic attacks, sudden anger/emotional highs and lows.

Which of these symptoms did they have (DSM IV)?  repeated, distressing memories / dreams of event        

acting or feeling as if the event were still happening intense distress when exposed to images or sounds resembling the event efforts to avoid anything that could remind the person of the event inability to experience a normal range of emotions and interest in life not planning as if life had a future difficulty concentrating, or relaxing, or difficulty sleeping sudden anger / Startle responses nightmares or sleep disturbances

On a scale of 10 to 1 how does it feel now? Neutral/Calm

Worst they can think of

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AFTER PROCESS

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ONE WEEK LATER

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Please return forms (once a week) to: [email protected] 49