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					Delalama-Delalama

Speaker: Do you think we should get started? Okay. Good morning,
everybody. You see all right? Everybody all comfortable? Did everybody
get your handouts? Okay. My name is Lily Batiama de la Lama, and this is
my partner, Louis de la Lama. We will be talking today about the place of
spirituality in trauma recovery and post traumatic growth.

We'd like to tell you a little about ourselves so you know where our accents
are from. I was born in Spain. Raised between Spain and Austria. I'm
actually an Austrian citizen. I'm half Spanish, half Austrian. I grew up in
Europe. Came here a while ago. I learned English when I came here as
an adult and Louis is originally from Mexico.

We've been together for eighteen years, doing work on helping people on
spiritual with spiritual transitions, and we've studied several of the world
traditions and mythologies and so for and so we're bringing what we have
learned over those years to counseling. Our aim here is we've developed a
model which will help you conceptualize in your mind, how the spirituality
and the world view ... where is it in our conceptual system and how
important is it for people who have undergone trauma if we want to help
them grow.

So our objective today. We're going to go through a lot of things. There's a
lot of concepts we would like you to learn. Our objectives are we want to
present our Holistic Relevance Model, which is the model we came up with.
This model helps us categorize human experience individual experience
into five broad areas. Can you hear me? Am I talking loud enough? Okay.

Because this isn't really doing ... it's just for the video. So it helps us
organize human experience into five broad areas. This will help us to
understand which areas have been impacted by trauma and also to keep
that in mind when we're doing treatment planning. Now we're aware that
this is pretty abstract, and it may not always be practical for rehabilitation
counseling.

However, it can help you for your self to have this model and to keep it in
the back of your mind. If somebody comes to you that you can see that
something has happened to the way their spiritual beliefs or their sense
about the world, when you see that there is a problem then you will be able
to fall back to this model and say I know. I know how this relates to the rest
of their issues.

And how I may be able to help so they can work on these issues.

Spirituality is very important we believe in trauma recovery. And there's a
body of literature about post traumatic growth which I recommend highly if
you search it in on line databases from those schools and so forth. There's
books you can buy on Amazon. And that's very positive, all of that
research.

We're going to describe briefly those dynamics. We're going to apply that
to the case of Danielle and we're also going to try to apply the model to a
case of your choice. So we have a lot to do today.

Holistic Relevance Model is based on the pyramid of relevance, which we
came up. This is not Matlow's pyramid. It's something that describes the
five areas that are relevant to the human being.

What is important about this model is we're used to dealing with the
physical, emotional, and the mind. Here we're extending the mind aspect
to two more levels. Into the abstract mind which has to do with meaning,
how we make meaning with the world. It's really different than our
thoughts. Then there's even more abstract one which is kind of like a roof
over our heads which is a relationship to a higher power which is the
spiritual and religious orienting system.

It's also something we hold in our mind but it's not exactly the same as our
thoughts. So this will help us better understand what goes on the
conceptual world of a person who has experienced trauma. And this will
also help us determine how to help the person, which areas need to be
addressed.

Here we are with more detail. We start with the physical. Everything that is
relevant to the physical level. We can say the body, the home, the car, the
job and observable behavior. From there, it goes from the most concrete to
the most subtle. We can say emotions are more subtle because they're not
actually so tangible but we feel them very strongly.

So on the second level we believe there is an area of relevance that has to
deal with emotions. Which also includes our relationships, which has to do
with what we hold dear, how we relate, how we feel, love, and we put
sexuality there because we hope people are having feelings when they
have sex, right?

So sexuality. The third level has to do with our concrete mind. We believe
it is important to have a distinction between the concrete mind where our
knowledge is and our daily thoughts and then above that we believe there's
an umbrella area--I'm just throwing concepts out there--where our world
view is. How we think about the world. The assumptions we hold about
the world.

This area is not always present in our mind, but it's still very important
because it guides our actions and it guides the way we make meaning
about things. It is also our identity. This is a place that we have a sense of
ourselves, of what we are really about.

And above all this is an area that some experts have called the orienting
system. And I think that's very good. So the purpose of this presentation
we're going to use the term spirituality and religion interchangeably
because what we're really trying to describe is an area in our mind where
we have developed a relationship to a higher power.

And this can be in the form of different religions. You know most all religion
have their type of relationship to a higher power. And so it's
nondenominational. It's an individual thing that we develop. Some people
just follow the religion of the culture that they're born in. Some people
choose their own spirituality.

That's called spirituality when it's less organized, when it's more individual.
And religion when it's more organized and it's more like a community that is
actually doing it. But we believe this is very strong area of relevance in the
human being. And there may be people of course atheists or agnostics.
But they still culturally are somehow forced to deal with this area.

If they say I don't know. I don't know if God exists so I don't want to deal
with that, I'm a scientist for example. That area is still culturally present for
them and they have to make a decision on how they want to take a stand
towards it. Right. Everybody understand so far?
So these levels of relevance are not really layers, they're not static. It's just
a concept to understand these areas that are important to us and they are
from a holistic point of view, they're always interrelating in our
consciousness. From the top down like the way we perceive our
relationship to a higher power has an influence on our world view, how we
see the world and make meaning. It also has an influence on our identity
and whether we're spiritual or we're not, whether we're christians or I don't
know, any kind of identity we feel we have.

And this will influence our thoughts, our concrete thoughts, our day to day
thinking. It will somehow have an influence on that. And our thoughts of
course can have an influence on our thinking and how we relate to others.
And this will eventually have an influence on how we choose to act on a
physical plane.

There is also a bottom up relationship. Things that happen to us, a car
accident or war or a normal thing, falling in love or having a child.
Whatever happens to us on a physical plane will have an influence, or to
our physical body will have an effect on how we feel, how we think, how we
derive meaning from life. And also eventually, if there is an incongruence
with our spiritual orienting system, we will also sense that. It will somehow
get us this nagging feeling. It somehow is connecting.

It's probably hard to discern at first if there is something that happens to us
and it doesn't feel completely congruent with our spiritual beliefs we may
not be able to very easily figure out what is going on for our recovery.

Now we've come to conceptualize this. We can think of these areas of
relevance as if they were boundaries we have around ourselves like if we
were a little chick in an eggshell. This world view, these emotions, these
thoughts. We create a sense of safety like a boundary around us that we
feel comfortable in living like our conceptual space.

Our box. Like some people say think outside the box. Well, what is in the
box? That's where we are. We feel safe where we know about.

We added some cracks because nobody has a completely safe, brilliant
powerful energy around them. They have these cracks. Everybody has
some vulnerabilities. They may not have such vision or they may not have
such good speech or they were bullied at school or they are in poverty or
you know. Could have all kinds of vulnerabilities.

In a day to day normal life, we are aware of some of these vulnerabilities
but they don't really hinder us in our life. So we're used to sensing they're
there, but we have found ways to work around them.

So these boundaries give us a sense of identity, a sense of being
ourselves. And our awareness is always moving around, checking
subconsciously or semi consciously are we okay? Are we fine? Do we
have a sense of ourselves? And usually what comes back is yeah, we're
fine. On a normal day. So this provides a sense of continuity.

Okay. Now we're going to switch to something different. We're talking
about psychological trauma. Everybody understands that, right? So we're
just going to briefly review the DSM definitions of diagnostic criteria for post
traumatics stress disorder, which you know is a main disorder of people
who underwent trauma.

I would like you to read this real briefly because we'll need that in an
exercise we're going to be doing. You're all familiar with it. Anybody is not
familiar? You all know this right?

So what I would like to stress regarding this is you know the DSM had an
evolution, right? It used to be more like... they used to see trauma more
like an extraordinary thing that would happen to somebody and now they
have a feeling that it could happen to anybody. It actually happens more
often than what they thought.

They've changed the wording so that trauma now is seen as something
more physical like it's more like you death or injury as more of a threat to
the physical entity. So in a way, there's kind of having less attention on the
fact that some traumas could be very traumatic that are not that physical.
For example if your parent betrays you, neglects you, there may not be an
immediate wound that you could put your finger on. But it may be just as
disturbing in the long run on these levels of meaning.

Briefly so we could get a sense of the importance of all this, we put some
statistics on this. Lifetime trauma, psychological trauma, actually happens
to seventy-five percent of individuals in the US. And ninety-four percent of
those experience some symptoms of PTSD and twenty five percent of
those develop full blown PTSD.

Car accidents, life threatening car accidents, actually happen to twenty
percent of the population. So trauma is pretty common, actually. More
common than previously thought. And what we think was interesting for
our presentation is only fifty percent of individuals that undergo cognitive
behavioral therapy are actually able to get rid of their diagnosis.

So cognitive behavioral therapy helps, but it's still, there's still something
missing in order to help people further.

I'd like you to think of someone you know who has experienced a trauma,
and we will apply that to the model. Anybody, a client or friend. Any
trauma that you could think of. It doesn't need to comply with the DSM
definition. Anything you feel was a trauma. Yes?

Student: [can't hear/can't understand].

Speaker: That works. He said he was getting his degree in clinical
psychology and he was walking on the street from the hospital and a truck
struck him. It took him two years to regain his brain faculties. So that was
a very strong trauma for him. Anybody else? Real quick? Yes?

Student: [can't hear/can't understand].

Speaker: She's saying she has a client that was hit by a car three years
ago and had experienced the same type of injury in long recovery. Difficult
recovery.

Student: [can't hear/can't understand]

Speaker: Excuse me? In coma for three months.

Student: [can't hear/can't understand].

Speaker: Oh, you were in a coma, too.

Student: [can't hear/can't understand].

Speaker: There's a worksheet in the back of your handouts that you can
make notes on this exercise. It's designed to help you apply what we're
saying. So we'll go through the trauma and then talk about the five levels
we're describing. But we're going to hop back and forth a little bit to keep
ourselves awake.

But we're going to go to the example of Danielle's car crash. Okay.
Danielle is a white mother. She's a single mother. She's thirty-eight years
old. She was married to Joe, who died in a car crash eight years ago.
Right after her son, Joey, was born.

She was devastated at the time but she then recovered and felt that she
was okay as a single mother. She goes to church, and she had met
several men at church, but she decided she wasn't loving them enough to
decide to spend a life with them. So she decided to stay by herself. But
she had adjusted well, and she enjoys her independence.

Her closest or only living relative is her older sister, Julie, who is a born
again Christian, has six children, is married, and helps her with child care,
and they're very close.

So one night, driving back from work--she has to work late and a lot of
hours--Danielle's car is totalled by a drunk driver. She has a fractured hip.
A fractured left leg and whiplash and some other injuries. Julie comes and
visits her at the hospital and instead of being able to comfort her, she starts
getting really angry and blames her for driving really late at night.

And well, you shouldn't have done that. Why do you have to do this?
You're being careless of late. Why do you have to work so much? You
should have married somebody, one of those nice guys at church so that
you and Joey would be taken care of. What if someone happens to you?
Have you thought that Joey would be an orphan? You really need to take
care of your self.

So she gets really upset, and that's pretty disturbing to Danielle, and she
doesn't know why at the moment. So months later, Danielle's physical
injuries are healing. She recovered from the whiplash, and she's able to
drive, but she won't drive. She can walk with a cane, but she doesn't want
to drive. She suffers from a lot of anxiety, intrusive thoughts, a lack of ...
crying. Confusion. All the symptoms of PTSD. Severe headaches. And
she doesn't want to drive.
So her boss tells her because her sister's been driving her tells her you
have to get better or you're going to lose your job.

So she goes back to the doctors and they tell her really, there's no
physically reasons for you not to drive. So there must be psychological
reasons. Why don't you ... we're going to give you this prescription and you
should go get counseling.

So Danielle goes to a counselor and he immediately diagnoses her with
PTSD and starts cognitive behavioral therapy. And after several sessions,
Danielle is able to drive. However, all of the other symptoms persist. She
still has the nightmares. She still has the anxiety attacks. She still has all
of that.

So going back to our model of the pyramid, we can see the car crash
happened on the physical level, right? But it has a chaotic efect... it's
disturbing her emotions, her thoughts. But it also has an effect on her
meaning level and her spiritual orienting system.

Like we said in an ideal situation or in a normal life all of these areas are
interconnected and have a flow going between them. Now all of this stuff is
coming up because there's a disturbance. There's an impact by trauma to
all of these levels.

So we go back to our circle, our eggshell world view picture and we can
see what happened is all the pre existing vulnerable areas, the cracks that
we saw, the little hair line cracks, are torn open after this impact. After this
shock. So a lot of the things that were making her feel vulnerable are not
huge. They've become huge. And she no longer feels a sense of herself
in this protective world view or boundary or energy or whatever.

She no longer feels a sense of herself because it's cracked open. It
doesn't feel protective. She doesn't understand what is going on. She
doesn't have that same sense that she felt before. She feels unsafe. So
we can visualize this as if her eggshell has been cracked by the trauma,
not just on the physical but on all those other levels that are sometimes
more important than the physical.

Okay so now we're going to analyze quickly what happened on each of
those levels. So we can see on the physical where she had to deal with
medical, physical therapy, medical, financial, legal issues, transportation,
child care, that's very obvious.

On the psychological level we know she feels anxiety, guilt, inadequacy.
She's afraid she's going to be disfigured and she feels this weird distance
from her sister, which is making her feel even more uncomfortable.
Because usually her sister was a very supporting presence in her life.

Okay. Now we're moving on to the thought level, the concrete thought
level. This is where the obsessive thoughts start being generated. How
could this have happened to me? Maybe I should have done something
different. Should I have gotten married like my sister tells or should I have
not worked at night or should I have gotten a job during the day. Maybe
there would have been less drunk drivers on the road. Was supporting
myself a bad decision?

So she's getting these obsessions and catastrophizing. I'm never going to
get in a car again. This is way too dangerous. So all these things are
happening on the level of thought. On the concrete thought level.

So now I'd like you to go to the trauma that you chose and see if you could
separate in your mind real briefly what happened the physical part that they
had to deal with, the emotional part, and the thought part. And if anybody
would like to share, I'd appreciate that.

Yes.

Student: [can't hear/can't understand].

Speaker: Uh huh. Mhmm. So that's more on the feeling and the thoughts
yeah.

Student: [can't hear/can't understand].

Speaker: So you're saying ... I have to repeat it for the video. You're
saying your client was paralyzed on one side and so they had trouble
walking and a lot of physical symptoms and also memory loss and so forth.
And on the emotional level, he felt inadequate. On the mental level he was
asking himself ... did I understand that right? He was more or less thinking
about the future happenings of something or if he would have done things
better?

Student: A little bit of both. And he drank.

Speaker: He drank when he ... okay.

Student: So what if I could get on pain medication [can't hear/can't
understand].

Speaker: So he was like problem solving in his mind. If I wouldn't have
done this, maybe this wouldn't have happened. What can I do now? Can I
get off the medication and getting these thoughts. Obsessing a little bit in
the mind.

Anybody else? No? You?

Student: [can't hear/can't understand].

Speaker: Mhmm. Yeah. He's saying after his accident when he was in a
coma and all that, there was a lot of physical stuff. A long time in the
hospital and emotionally, have to go fast so I'm not explaining everything in
detail as much. But emotionally he was very aware that people were very
nice and came to see him at first, but then after six months, he could really
see who were the friends and who were not the friends when he was longer
in the hospital I guess.

And most of his PTSD symptoms were he wanted ... he was anxious to get
back to work and his normal self, or as close as possible to function and be
active again. And that's very valid.

So we're going to move on to here. So it maybe may look like the case we
chose doesn't have such a severe injury but that doesn't mean it couldn't
happen to somebody with a severe injury. We just chose one that is like
not so heavy so we could move on to describing the things about the
meaning and spirituality. But it could as well apply to any rehabilitation
situation.

So on the level of meaning, there's a big body of research on what is called
the assumptive world. The assumptive world is really our world view. It
contains what we really have decided about the world. And some people
have given it thought after experiences or traumatic experiences. They
have given it thought.

And some people just follow what their parents or their society or their
culture thinks. So they're just more imbedded in that cultural thinking. So
all this literature tells us that it's very important to be very aware of our
assumptive world and if trauma happens, it's very likely that our
assumptions about the world are going to be exposed and we're going to
have to need to deal with them.

So the three main assumptions--there could be others--of course our
variety of assumptions that we hold--but the main assumptions that the
researchers have realized that we hold dear is that the world and people
are benevolent and safe basically on a daily basis. That life is meaningful
and events make sense. Because there is some kind of justice and that
they have some kind of control over life. This is how they normally feel.

And they also feel that they're good and capable and moral human beings.
However, when trauma happens, these things are somehow torn apart and
they seem to be illusions to a certain degree.

I had a counselor who told me she was working with families of the war
veterans of Iraq and these were very religious people. And that they were
constantly praying in their congregation to keep their children safe. She
was helping them ... she was a grief counselor after a child had been killed
in the war. She said she didn't know what to do with these people who
were so religious and had been so sure that their prayer was going to keep
their child safe.

Then it happened that it actually didn't. So in addition to being so sad that
their child had died, they now had this conflict that their community,
everybody was so sure that they could I mean ... we prayer is very
effective. We know prayer can heal, it can do miracles. But it is not a 100
percent. Sometimes we pray and we don't get what we're praying for.

So this lack of control, this kind of randomness that slips in there is very
difficult for people to tolerate    And once they experience a trauma,
people feel prayer never works. I don't feel any control. They go
completely overboard to the other side. So we have to realize these are
building blocks of the person's world view. As if they are the rafters of the
roof hold the roof together. And if the trauma strikes it down, and be
dripping and dripping until we fix it again. Right?

So these are the main assumptions. This is what happened to Danielle.
She thought that people would be reasonable and that if she was
responsible on the road that nothing would happen to her. She felt a sense
of control that was maybe a bit exaggerated.

But it was positive because it helped her handle her life. Right? If we can't
just go around the world constantly being afraid and feeling like we're
powerless. In a way, this is a healthy thing to believe. But when trauma
happens, these things are torn open and we think maybe we have no
control at all. Oh my God.

So now she feels more vulnerable than she did before. And she also feels
that people were more unpredictable. She felt that people were generally
nice. And now she's there's this guy that drank and drove and crashed
through her car so she doesn't trust people anymore. And life no longer
seems fair. She felt she was playing by the rules. She was driving
carefully. She was doing all the right things. And she was driving carefully.
It still didn't protect her from harm, from all this suffering she went through.

So most of the things she believed about the world, her assumptions about
the world have really been broken. And so that makes her feel confused.
She no longer knows what to expect from life.

And there's another effect that you're probably aware of. And this is the
effect of blaming the victim. If somebody has something happen to them,
it's very often that people unconsciously want to say you brought it upon
your self. Because that makes them feel safe. That if they act by the rules,
it isn't going to happen to them because the other person somehow
messed up.

And it's interesting to me always because let's say someone was raped.
The first thing that comes to mind is why did you walk through that dark
alley? A lot of people, that's the first thing they think. They don't think well,
what monstrous rapists are walking around dark alleys, right? The first
thing you need to do to protect your self rather than saying those people
need to be locked away.
So in this case, even Danielle thought if I drive carefully, nothing's going to
happen to me because Joey he was driving pretty recklessly so somehow
he was a little to blame for his accident. [can't hear/can't understand].

And this even happens on a spiritual level. Those around you are not
empathetic to your problems. For example this counselor with the war
veterans. She said that it was very hard for the family because they didn't
get much help from the congregation because prayer helps. Keep praying.
God is testing you. Like the only answer they had. And it didn't really bring
them any relief.

Here we put up some slides. You could maybe scribble on a piece of
paper if you have a client. People at these times often create this rigid
boundaries. Feel self righteous like I have control. I know what to do. If I
follow the rules, I'm going to be safe. So in reality this does not apply to
what reality is. We know there's an element of randomness.

Then on the other side are the people who have recently been traumatized
and their world's torn apart so they are exaggerated. It's real what
happened to them but their world view is in a state of turmoil that is also a
little bit on the exaggerated side. People don't live like that all the time. So
reality is kind of somewhere in between where they have a more flexible
sense of self in a world view.

Unfortunately after trauma, if people have started evaluating their
assumptions about the world like all people are basically good people they
realize that maybe those were illusions, that all people weren't as perfect
as they thought they were.

Okay. So just real quick here. The fourth level, the level of the abstract
mind is where we hold our answers to existential questions, like what do we
believe about life and death, how much freedom and responsibility do we
have, how much control do we have about life. And when what they used
to believe is no longer true, they go into existential despair.

And because they no longer know how the world works. And not having a
sense of how the world works is extremely painful and very often can
trigger suicidal thoughts. In the bottom of their heart, people think I don't
have any purpose in my life. I don't know how to make my life work. So I'd
rather be dead because I don't know how to deal with it. I simply don't
know.

As counselors, we can help people address these broken assumptions and
reconstruct them. We can go to them and see bring them back to what
reality is. It's not as random. It's not as horrible or usually as chaotic. I
mean people experience these on a daily basis.

If you'd like to take a moment to think of your clients. And how this would
affect their assumptions about the world, did it change the way they thought
about the world or did it confuse them about how the world works. Right
after they experienced the trauma.

Anybody? You all understand? This is all clear to you?

Student: They'll all be blaming themselves for [can't hear/can't
understand] like everything's random. [can't hear/can't understand] like
he's a slacker. [can't hear/can't understand].

Speaker: She's saying that this person started blaming himself for what
happened. He used to feel he was a slacker and he maybe wasn't
responsible so he blamed himself. That's a valid way to try to get some
control because he could see okay if I messed up I could have some
control by changing my actions, so next time, it won't happen to me. That's
a valid way to get some reconstruction going on in their meaning.

Everybody understand yeah? Now we're going to give the stage over to
Louis and we're going to discuss the spiritual orienting system.

Speaker: Thank you. Okay. Now we're going to see what happened to
Danielle at a spiritual level. And the first thing that you should know is that
not everyone will be affected at the spiritual level especially if the trauma is
not very significant, very extraordinarily difficult.

And people who are very embedded in spiritual community and those who
have a very traumatic really really earth shattering experience are going to
be dealing with events or beliefs at a spiritual level.

For Danielle, the first thing for her was to get back to driving. Survival is
first. Her primary concern was for survival. Once she was able to drive
even when she still had the anxieties and fears and everything else, as
soon as she was secure that she could feed herself and her child, then is
the time that a spiritual crisis will unfold for her.

And that happens often with your clients. You will see that spiritual issues
will not appear until several months into counseling. So she will start
thinking where was God when that irresponsible driver hit my car? It's not
only that but she had been told that God was good, protective.

Let's make her a regular Christian. We know that denominations, their
beliefs are not the same. But basically they believe that if they follow
certain commandments, certain rules that are in the bible, reminded by the
preacher, the pastor in the community, they will somehow be protected in
this life and saved in the other one.

Christians also believe that if they give their heart to Jesus or accept that
Jesus has paid for the sins of all of humanity, then they are double safe
because he's already done a lot of the expiation work, the purification work
and they are basically good people from then on.

So with these beliefs in mind and thinking that God is omnipresent and all
powerful and benevolent, where was he looking at if he's present in the
drunk driver that hit my car? Was he in the drunk driver that killed my
husband eight years ago? All those beliefs will disturb her seriously.

It's not only that she will be wondering about these things Sunday mornings
concern whether she will continue to go to church. But also concerns us at
the upper level will also have a very strong concern with our sense of
identity. So for Danielle, the spiritual congregation, the ten
commandments, the bible, are like landmarks to establish her spiritual
position in life and society.

This correspondence ... let's say. I will call it a correspondence. I know
where to go when I have landmarks that are fixed. The position of the
door, where the audience is, I know that the computer screen is here. How
to behave in this room. I have a sense identity here. A presenter and I'm
being nodded. That means I'm doing okay. So I know who I am. Okay?
[Laughter].

So for Danielle, it's the same thing. Over the years, she's been going to
church. She's been behaving as a good girl. Things have been going
along well with her. So she's well positioned in her sense of self. Then this
traumatic event happens.

It is as if I come in one day. Let's say I've been doing this for my entire life.
I cannot see the door. I cannot see the rest of the things. And before I
open my mouth, you throw tomatoes at me. [Laughter]. If it happens once,
it's going to be traumatic. But if it happens twice like it happened to her
husband and eight years later to her, then I'm going to be very insecure
about what I'm going to do next. I don't know if I'm a presenter anymore. I
don't know. Who am I?

So for her, that's the extent of the damage to her sense of identity. As lily
said, if she doesn't know how to play the game anymore, she better not
play the game. She might start to develop suicidal deviation. Yes?

Student: It would also be an impact on her spiritual being, her view [can't
hear/can't understand]. Because different people can have different views.
Constantly tapping into what people believe of God, what they believe in
the bible. And that can also change. They have that negative feelings.
Maybe [can't hear/can't understand] about it.

Speaker: Yeah. It can go in different directions. We'll see what we can
do as counselors, the possible directions for her to go once she recognizes
that there is a spiritual crisis. Let's move to the next one.

She will go through a thorough examination of her core beliefs and this
examination may make her go close to the religion she's close to or it may
cause her to shop around for a new one. Or develop her own sense of
spirituality based on taking beliefs from different denominations. So
different religions.

She will need a lot of space and time and a lot support on her mentality
around her to be able to go through this process. This is something that a
lot of people are not very good at providing. Because often those held
together by those beliefs are not working for that person so they will often
unconsciously scape goat that person if she starts rattling their boat much.

The task of the spiritual leaders is pretty much to make her see the light
again, to go back to the basic beliefs. And they might not work for her at
least at that time. So she may enter into conflict if she goes and talks
about this to her priest. Spiritual leaders can be very compassionate but of
course they have a strong faith base. Basically they will try to sell it back to
the person who is in distress.

So they will counsel her in isolation. This will basically compound the other
things that are going on in her life.

I already said trauma doesn't always impact at the spiritual level.

We as counselors try to counterbalance and allow that space for clients to
go back to a spiritual sense of self. I'm going to describe the process that
we can go through briefly. We as counselors are positioned in a good
place now that we are in constructivism. Or scientific positivism. We try
not to engage in religion or spirituality. That is not our province.

But since we embrace multi culturalism, we can help our clients and
respect them no matter where they stand or come from. And because that
openness, expansion of our consciousness, we should be able to sit with
them and go through, help them reconstruct their meaning, point them to
community resources. There are spiritual community resources. There are
many denominations around.

You can go to spiritual groups, and there are hundreds of thousands of
places. Danielle may end up still being a Christian then adding to her ideas
a belief in reincarnation. See? Of course it will not be fundamental beliefs.
She can make her combination of ideas Karma. There are some beliefs
that can put her in an understanding of who she is and what can she do
better next.

That's it with this one. Also people might be undergoing spiritual crisis
when they have different sexual orientation or sometimes, even when they
have not had a very serious trauma, they may have a problem with
conventional denominations and we as rehabilitation counselors are right in
the position to help them.

Now the American Counseling Association has stated for the stand, we
shall work with the client's spiritual system and the only problem is that
when the system that they have been using to orient themselves to life
doesn't work anymore, they will have to reach outside their belief system.
And if they do that, we should be able to point to them community
resources as I said before.

And when we're working with clients who are undergoing a spiritual crisis,
it's very important to keep in mind these three different dimensions of
spirituality.

The beliefs about the transcendental existence of whether God exists and
how God relates to nature and the human being are the first to go, the first
to be disturbed, impaired when the crisis ensues. They cannot believe in
what they believe anymore. So this is often what has to be reconstructed.

But spirituality is much more than that. Spirituality also has to deal with the
spiritual community. Their spiritual community may provide them shelter,
acknowledgement, physical help. They can be a source of strength for a
person in a spiritual crisis. But as I said before, they might also turn
against them. If the spiritual community is very closed minded, your clients
may lose this aspect of their spirituality in the process of recovery.

This is what they never lose, the possibility of the perception of the sacred.
Going back to spiritual disciplines, meditation, prayer, the chi, recovering a
sense of connection with themselves and with a higher power, and
cultivating peak experiences. You probably know what I'm talking about.
They're sitting with your bible and your Koran and you pray for a couple of
hours when you're in meditation, and you feel that kind of expansion.
Peace. Certainty that something is around. The divine presence.

It doesn't always translate into action towards the world, but at least you
have a sense that there is something greater, a unity or a harmony that will
pervade or drizzle down into a sense of confidence the next day when you
go out. You need to cultivate that. It doesn't stay there for long, but if you
keep doing that, it becomes congruent force that snaps back, well not
snaps back, but pulls back your sense of identity and your relationship to
the higher nature, to the higher self.

Even if you don't know much about the spiritual disciplines, you can
encourage them to try different retreats, yoga trainings, study, bible study
courses. If you go to multiculturalspirituality.com, you can write that down
somewhere in there, you will find some guidelines to four different methods
for transcendence. Multiculturalspirituality.com.
Just a few things I want to remind you of. Don't open the spiritual
dimension unless they are ready for it, unless they show symptoms that
they are needing to deal with that. Because if you start to make them away
of these spiritual dissonances when they are still dealing with basic needs,
it's going to be too much for them.

Then once that you find out that the client is ready or when they have
stabilized their primary concerns or when they told you they feel uncertain
about spiritual concerns, then you can show them the pyramid and you can
say to them you have been dealing very successfully with these lower
levels. We have patched them. Do you want to work on the next level?

If they say yes, then you are free to go. Then you just ask them
respectfully that their world has changed. That there are many beliefs
spiritual beliefs that they can choose from. They can examine what works
for them, what has to be discarded, and what can be upgraded in their
spiritual outlook at life.

Okay. I finished my section. I give you Lily back.

Speaker: Okay. We're running a little late because we started late. Okay
so real quick. If anybody wants to share how this client you're describing,
how did they feel about their spirituality? Did they have any questions
come up about their spiritual issues?

Anybody? No? Alright. Then we'll move on. So really quick, the
interesting thing about post traumatic growth and the literature about post
traumatic growth is that they went and asked people if they grew from their
trauma, like did they have a meaningful experience after they recovered.
What they tell us is they don't necessarily get rid of all of their symptoms,
but they experienced a growth in those more subjective and more abstract
levels of their self.

What we can see here is the initial therapy helps them patch up the more
imminent problems on the physically, emotional, and thought level, but it
might still leave a residue of chaos on those meaning and spiritual levels
which need to be addressed.

So the literature on post traumatic growth have come up with three areas
that people describe they have grown the most.

Their perception of self has changed because they have reevaluated their
existential concerns and they have reconstructed their shattered
assumptions.

They also feel that their philosophy of life has changed, that they have a
greater appreciation of small joys in life. But mostly, they feel they have a
sense of enhanced spirituality. And also they report that they have
changed in their relationship to others. And that probably is what our friend
was saying.

Most of those people that grew say they like to have less friendships, but
those that are deeper and more meaningful. So from a more superficial
level of connection, they go to a deeper level with a few people.

And this research tells us those who fail this growth really get depressed
and cynical and fall into existential despair. So it's very important to point
our clients in those directions.

And so the changes are subjective. People still feel vulnerable. But they
feel stronger at the same time. They mostly report these paradoxical
feelings, strong and vulnerable at the same time. Unsure but certain.
Many of these paradoxes come up.

So therapy that is only geared toward symptom reduction or happiness or
pleasure may not help the person grow because growth is going to be
difficult and it's still going to be painful for a while. And the literature also
tells us that people who achieve this growth on a higher, more abstract
levels then eventually their thoughts and emotions and their physical selves
heal or are better.

So the place where some experts say--especially Michael white from
narrative therapy--I don't know if you heard about narrative therapy--is the
level we grow the most is on the meaning level because we can decide
what we want to be about, what we want our world to be about.

Even in a most dire circumstances, we can choose what we want to
believe, what we want our thoughts to be. The attitude we want to bring to
life. And that is created at that abstract mind level.
Are you familiar with the book of Viktor Frankl who was in the concentration
camps, and he said that he forced himself to have a positive meaning even
in those horrible circumstances.

Okay. So after people go through evaluation of the world view and we saw
all these questions. Here we have a list of questions. We can imagine
what happens with their sense of boundary is that they patch up these
cracks with consciousness and they somehow have a more flexible sense
of self. It's no longer rigid but it's no longer cracked open and completely
vulnerable.

Their sense of self goes back into a state of flow. And these are some of
the questions people can ask themselves. Each of the five levels of
relevance have different therapies that are associated with them. Of
course on the physical level, we have physical therapy, massage,
behavioral therapy. To deal with emotions, we have emotional therapy and
gestalt therapy. Cognitive behavioral therapy and mindfulness deal mostly
with thoughts.

Then when we jump to the meaning level there's a different type of therapy
that can help people reconstruct meaning. More constructivist approach,
narrative approach, existential therapy. Those therapies are in a different
league than the other three. And of course we said practice, renewed
practice can very often help people connect to a sense of sacred inside and
all the other things he described.

And very briefly from a multi cultural perspective, trauma will have an
impact on this person's sense of cultural identity on all of the levels.
There's a physical component to our cultural identity of the race. There's
an emotional and thought component. Culture affects the way we make
meaning about the world. And also a sense of heritage of a spiritual or
religious culture that we also have with our that comes with our culture.

And these things may be disrupted by trauma and we should be aware of
this so we can help our client. In this sense, Danielle is a female. She is
more vulnerable because she is a female. This came up to her after the
crash really strongly. Should I have married a man to be protected? Am I
okay as a single mother? And all of those questions were and did come
up.
So in conclusion, we gave you this model. It is helpful to understand the
different levels of relevance of the human being and it will help you to
understand where's the spiritual beliefs and world view and identity. How
they relate to the other areas of relevance. This will help us understand
what happened in trauma and how we can help the person. And which
interventions may be most helpful.

Here we added in the appendix if you want to use it. Some guidelines on
journaling for each of the five areas. If you want to use that, give it to a
client or something.

All right. Thank you very much for coming to our presentation. [Applause].
This is our email address. If anyone wants to ask questions, we're running
a little late but you're welcome to ask.

[end of class].