|Making Waves to Heal Tsunami Survivors:
Preliminary Notes on an Innovative Intervention in Thailand
An EMDRIS team recently spent 12 days on a volunteer mission in Thailand organized on site by Jane Lopacka (Cambodia/UK) and by Gary Quinn coordinating the Israeli team. The main goal was to train and supervise Thai therapists in providing EMDR to the tsunami survivors. Dr. Quinn was the trainer, and additional Israeli facilitators included Alan Cohen, Joel Comet, Fran Yoeli and myself, along with Carolyn Neunuebel from Hong Kong. Jane and Mary Bunn (USA) led a preliminary two-day trauma seminar. Then Dr. Quinn led the three day Level I training of 67 Thai therapists in Bangkok. Immediately following this, the Israeli team headed south to the area devastated by the tsunami, where Jane joined us for trauma work with the victims. (The plan to supervise the new Level I trainees could not be immediately implemented—see Alan’s article this issue; so we were going to do whatever we could to help while preparing the groundwork for the teams to follow.) The Associate Dean of Thailand’s Thammasat University-- Faculty of Medicine, Dr. Sutatip, who had been in the afflicted area almost constantly since the tsunami trying to coordinate search and rehabilitation efforts, provided entry into the temporary camps, connection to the people needing most help, and every kind of assistance in making the mission a success.
Members of the team performed individual and group EMDR sessions with adults in the camps, with surprisingly good results. These efforts will continue to be coordinated by Jane, a highly-experienced trauma counselor based in Cambodia, focusing on provision of EMDR by the Thai Level-I therapists under supervision of experienced EMDR practitioners. The team engaged in several kinds of work in the south, including Fran’s eclectic techniques for alleviating trauma and her care of team members who were reacting themselves to the situation, and Alan’s systemic efforts coming out of his Community Stress Prevention Program. The notes below will concentrate on my main area of interest, the group work done with children and adults, with the help of Dr. Sutatip, and the beach intervention.
After Dr. Quinn’s initial success with a well-known woman from the main Nam Khem camp, we had entrée to work with a group of the camp children. With the able assistance of Dr. Sutatip, I applied an adaptation of the Integrative Group Treatment Protocol developed by Jarero et al. in Mexico, based upon work done in South America with children after hurricanes and floods, with the first group of Thai children. The work included having the children draw a series of pictures, and applying bilateral stimulation after each drawing.
Instead of the “safe place,” the children were first asked to draw a picture of a personal strength, to engender a kind of resource connection (Brurit Laub). We learned that requesting a “safe place” usually evoked places that were recently destroyed by the tsunami, thus prematurely activating the traumatic material. The personal strength was processed by having the children drum on the table alternating left and right hands. More kids and adults were attracted by the table-banging and attendant excitement, and adults were asked to stand behind the children and alternately tap the kids’ shoulders. Next, the children were asked to draw a picture of the tsunami, and to write down in words what they lost. (For all of them this included their home, and for many—relatives and friends.) These pictures were processed by more table banging (on the picture) and via “butterfly hugs” (Lucy Artigas). Positive affirmations regarding the adults’ commitment and love for the children were added, which I realized after the fact was a kind of multiple, group cognitive interweave. For instance, the adults were asked whether they loved their children before the tsunami; then the kids were asked whether they loved their parents; and finally the parents were asked if they still love their children after the tsunami. One wise woman volunteered that they love their children even more after the tsunami than before. (This spontaneous statement seemed to hint at a marvelous phenomenon which we were uncovering among the survivors: the possibility that the destructive waves of the tsunami could be countered by waves of love!) Was this a psycho-physical manifestation of Newton’s law of action and reaction? Or a psycho-spiritual law of “conservation of love”?
The children were asked for two consecutive drawings of how they felt. Most drew faces, and virtually all exhibited a significant reduction in their level of stress. Each drawing was processed by the bilateral stimulation of their choice. The final drawing they were asked to do was of the future. Most showed a rebuilt village, going back to school, etc. In one group, this drawing was followed by singing a song written by Dr. Sutatip, with content referring to coping with loss and moving on. The success of the group encouraged Dr. Sutatip to give my “crazy idea” a try, and she asked the kids if they would be interested in joining an outing to the beach the next day. Surprisingly, most of them excitedly said they would seek their parents’ permission.
The idea of taking the kids to the beach as a therapeutic intervention came to me naturally. I had worked with groups of children and bereaved families in Hospice and bereavement programs in the US, and co-led a multiple-family bereavement group for Israel’s Ministry of Defense. All of these incorporated art therapy in the group work. I also take individuals and groups out to nature to facilitate psychological and spiritual growth. The children’s losses and anxieties were directly related to the ocean. It was clear that most if not all of the children and their parents harbored fears of the sea. We had witnessed one of several false tsunami alarms which caused numerous villagers to flee the area, some crying hysterically. Clinical experience tells us that exposure to the source of fear is the most direct and efficient way to overcome the fear. In addition, we know that the principle of continuity is important after trauma: anything that could get the kids back to their pre-trauma state as quickly as possible would be beneficial. We also know the power of group interventions, providing holding, modeling, and social support to people suffering from similar problems. I assumed that taking the kids to the beach, and giving them a good time there (making sand castles, etc.) would provide a corrective emotional experience and opportunity for overcoming or making progress against fears of the ocean. This would also provide opportunity for dealing with the losses sustained in the tsunami, which could be worked on further, and which the group of children might be able to deal with more openly afterward.
I had already found the opportunity to check the water temperature (in case the kids would be willing to go in), and it was nice and warm, even warmer than in Israel.
The next day we arrived with our pickup truck, and were glad to find six children ready to go as well as a couple of adults. On the way to the beach I asked the kids if they were afraid, and all but one boy admitted they were indeed. They were told this was only natural, and that we would try to deal with the fear together. We got to the beach area, and approached the sand. As a preliminary group enhancing activity we built a sand mountain together, all pushing sand toward the center. Now a bit more acclimated to the beach, a bit more together as a group, and a bit hotter than before, we formed a line facing the water, holding hands. I instructed the kids to approach the water, together, with room for each to go at their own pace, and modeled hesitation and taking a step back, but then continuing. The straight line quickly showed the signs of individual variation, as the kids with more fear hesitated, while the less fearful pulled forward. Within half a minute, the leading children led a charge to the water, and fears were drowned in the spray of splashing kids making some waves of their own.
In subsequent trips to the ocean with larger groups of children, we experienced the importance of the Emotional Protection Team (Jarero & Artigas), including all the therapists and interpreters, who were available to provide holding and encouragement to both children and adults, especially those requiring special attention. Some children had trouble approaching the water, and received bilateral EMDR stimulation until all eventually did. Some adults also used the activity to work on their ocean phobia, while others joined the kids in constructing sand castles and swimming playfully among the waves. There was room for expression of aggression (smashing sand castles, rough and tumble between some of the boys), which could be worked through and discussed later. For almost all, this was the first time back to the beach since the tsunami over a month before, thus counteracting the natural tendency to avoid the source of fear, which would solidify the anxiety. It was also one of the first highly pleasurable social experiences for the participants since the tragedy, reminding them in a simple but concrete way that they were still capable of constructive activity, and of playful enjoyment. One mother bereaved of her two children had a very strong emotional response which required hours of working through by Fran and Jane-- but even this difficult experience hopefully left her in a better place to continue mourning her losses while going on with her life, while teaching us the importance of initial assessment and preparation.
While implementing this pilot innovation, we met a group of volunteers from the business and publishing world (Todd Leong and his team from Admotiv and Tom Yum Magazine), involved in tsunami relief efforts. After witnessing one of our beach excursions, they are intent on expanding the initiative into an ongoing program that will potentially reach thousands of Thai children, and perhaps even more in Sri Lanka and Indonesia.
It seems that our team created a very worthwhile intervention using the most basic of psychotherapeutic principles, and the most natural of settings. I think we can all be proud that EMDR Israel, EMDR’s Humanitarian Assistance Program, and Israel’s National Council for Voluntarism (ISRAAID), played such a major role in helping the victims of the tsunami. Consultation for the group work with children was provided by Nacho Jarero and Lucy Artigas (Mexico) and Jim Knipe (USA). The “making waves” project will hopefully continue to embody international and interreligious cooperation, the power of natural healing, of family and of the human spirit, all committed to washing away fears and riding the waves of life.