Positive Psychology, Spirituality,

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Positive Psychology, Spirituality, Health
Trauma

• Joseph Ciarrocchi, Ph.D.
• Loyola College in Maryland
• Pastoral Counseling Department
• 410-617-7632
• jwc_at_loyola.edu

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Phenomenology of PTSD
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References

• Baumeister, R. F. (1991). The Meanings of Life.
  New York Guilford Press.
• Ciarrocchi, J.W. (1995). Why Are You Worrying?
  New York Paulist Press.
• Emmons, R. A. (1999). The Psychology of Ultimate
  Concerns Motivation and Spirituality in
  Personality. New York Guilford Press.
• Janoff-Bulman, R. (1992). Shattered Assumptions
  Towards a New Psychology of Trauma. New York
  Free Press.
• Nolen-Hoeksema, S., Larson, J. (1999). Coping
  with Loss. Mahwah, NJ Erblaum
• Snyder, C.R. Lopez, S. J. (Eds.) (2002).
  Handbook of Positive Psychology. Oxford Oxford
  University Press.

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PTSD Definition DSM-IV

• Experienced, witnessed, confronted
• Event involving
• Actual or threatened death
• Serious injury
• Threat to physical integrity
• To self or others
• Response involved intense fear helplessness or
  horror

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PTSD (1) Re-experiencing (1)

• Memories, images, etc.
• Dreams
• Re-experiencing
• Exposure-related psychological reactions
• Exposure-related physical reactions

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PTSD (2) Avoidance -- 3

• Thoughts, feelings, talk
• Activities, places, people
• Inability to recall
• Diminished interest
• Interpersonal detachment
• Restricted affect
• Sense of abnormal future

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PTSD (3) Arousal (2)

• Sleep problems
• Irritability
• Poor concentration
• Hypervigilance
• Startle response
• DURATION
• 1 month

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Acute Stress Disorder

• Dissociative (3)
• Numbing, detachment
• Awareness (in a daze)
• Derealization
• Depersonalization
• Amnesia

• Same as PTSD
• Re-experiencing
• Avoidance
• Arousal
• Time Frame
• 2 Day minimum
• 4 Weeks maximum
• within 4 weeks of event

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Recovery as Meaning Making

• Janoff-Bulman, R., Yopyk, D. J. (2004). Random
  outcomes and valued commitments Existential
  dilemmas and the paradox of meaning. In J.
  Greenberg, S. L. Koole T. Pyszczynski (Eds.),
  Handbook of experimental existential psychology
  (pp. 122-140). New York Guilford Press.

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Victimization involves both losses and gains

• Common reactions in the very same survivors
• Tedeschi Calhoun distinguish five gains
• Relating to Others
• New Possibilities
• Personal Strength
• Spiritual Change
• Appreciation of Life

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What doesn't kill us makes us stronger (Nietzsche)

• Redemptive value of suffering
• greater sense of
• personal strength
• self-reliance
• self-respect from having been "put to the test"
  and coped successfully

• Appreciation-related evaluations
• Appreciation of life
• Relating to Others
• Spiritual Change
• Between 75 and 90 of survivors report benefits
• the incidence of debilitating chronic PTSD is
  relatively low
• 5-15 of victimized populations.

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Survivors re-prioritize

• Shift from a concern with the meaning of life to
  a focus on meaning in life
• Know they dont have complete control
• but they do have control over choices they make
  about how to live
• Become committed to living
• By formulating and completing goals, they create
  value
• Essence of expectancy-value models
• Against the backdrop of a meaningless world,
  survivors create a life of meaning

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Meaning and Emotion

• Comprehension-based meaninglessness is likely to
  be manifested in anxiety and anxiety disorders
• Significance-based meaninglessness is likely to
  be manifested in depression
• Life without value or significance is one without
  commitment, direction, purpose, or fulfillment
• Emotionally experienced as hopelessness and
  despair.

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Skeptics vs. Believers

• Brewin, C. R. (2003). Posttraumatic stress
  disorder Malady or myth? New Haven, CT Yale
  University Press.

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Comorbidity Axis I

• Vast majority of people with PTSD also have a
  least one other diagnosable disorder
• Most common is depression
• in some groups, such as Vietnam veterans,
  substance abuse is also common

• Both depression and substance abuse are more
  likely to be consequences of having developed
  PTSD
• Comorbid anxiety disorders are more likely to be
  independent of the trauma and of PTSD

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Comorbidity Axis II

• What is traditionally called personality disorder
  is the product of exposure to repeated trauma
• particularly in childhood and involving
  emotional, physical, and sexual abuse

• Many have concurred that it may be productive to
  view these more pervasive symptoms as a form of
  complex PTSD
• Judith Herman, Trauma Recovery
• cause severe relationship problems
• self-destructive and impulsive behavior

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Causal Puzzles

• Does trauma cause PTSD?
• 50 to 75 of women and 60 to 80 of men
  experience a high-magnitude traumatic event at
  some point in their lives
• Yet only a minority of these develop PTSD

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At risk before a trauma

• Effects are quite small in themselves
• Female
• Low SES background
• Lack of education
• Low IQ
• Psychiatric hx
• Childhood abuse
• Other adverse childhood events

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Risks before a trauma

• For civilians, a person's age and whether belong
  to a minority ethnic or racial group is largely
  irrelevant to the risk of PTSD
• In worse combat situations younger age and
  minority status are risk factors
• Controlling for combat exposure, all ethnic
  differences disappear

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Risks during the trauma

• Dissociation
• Temporary breakdown in consciousness
• Commonly used by torture victims
• Normal and pathological responses
• Daydreaming, depersonalization, derealization
• Decreased heart rate and physiological responses
• Good predictor of PTSD
• Mental defeat
• perceived loss of all autonomy
• giving up efforts to retain one's identity as a
  human being with a will of one's own
• Predicts poor response to exposure Rx

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Risks after a trauma

• Have the biggest impact
• Levels of social support soon after a trauma
  predict the way symptoms develop over the next
  few months
• only the presence of negative social support
  counts
• Coldness, lack of sympathy, criticism
• positive social support appears relatively
  unimportant
• Paradox
• Expressing positive support is surest way of
  eliminating negative reactions
• Negative reactions from family members stand in
  the way of recovery when trauma victims are
  treated with psychological therapy

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Power of negative social support

• Strongly related to the women criticizing
  themselves
• Self-criticism, in turn, closely linked to shame
• Shame is powerful predictor of how symptoms
  develop over time
• Anger also important predictor
• more specifically anger with others
• predicts a slower recovery from PTSD
• Contra Freud anger-in

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Role of beliefs

• Beliefs about the future
• Beliefs about symptoms and reactions to the
  trauma
• Irremediably ruined
• Will never have anything to look forward to again
  
• Specific negative thoughts
• Irritability means their personality has changed
  for the worse
• Numbing means they will never be able to relate
  to others again
• Flashbacks mean they are going mad
• All related to slower recovery

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Role of coping strategies

• Attempts to suppress symptoms of all sorts doomed
  to failure in long run
• Creates the white-bear effect
• Which increases mental symptoms

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PTSD as an Identity Disorder

• . . . the meaning and impact of the event extends
  beyond the simple perception of danger or
  helplessness to a more complex reflection on its
  wider consequences, on its attendant
  humiliations, and on what victims' reactions both
  at the time and afterwards say about the kind of
  person they are (Brewin, 2003, p. 63)

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Seven core identity themes in PTSD(Brewin)

• Self as powerless
• I stood and watched
• Self as inferior
• Why cant I get over this?
• Shame guilt common
• Self as nonexistent
• I died in Vietnam
• Im of no consequence
• Self as futureless
• Unable to see personal future

• Other as abandoning
• Being alone
• No one can understand
• Abandoned by God
• Other as betraying
• Could not count on this person
• Undermines basic trust in others Erikson
• Other as hostile
• Person just wanted to see me suffer

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Reconstructing positive identity

• Many survivors willing to talk about what they
  have gained
• Admit that they are glad the event happened to
  them
• Previous negative identities contradicted by
  positive information about how survivor dealt
  with the unexpected challenge
• Exceeding his or her own and others'
  expectations.
• May result in an incompetent self being
  supplanted by a competent one
• "A survivor who has accomplished her recovery
  faces life with few illusions and often with
  gratitude. Her view of life may be tragic, but
  for that very reason she has learned to cherish
  laughter . . . . Having encountered evil, she
  knows how to cling to what is good. Having
  encountered the fear of death, she knows how to
  celebrate life. (Judith Herman cited in Brewin,
  2003, p. 85)

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Positive self-views

• Im a stronger person having lived through this
• Enjoy spending time with my family
• Wake up daily grateful Im alive

• Try to make more of a contribution
• Do more things I regard as truly important
• For first time in my life appreciate my good
  fortune

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Trauma Rx Old New

• Standard treatment generally involves two
  elements
• Used separately or together
• Detailed and repeated exposure to traumatic
  information
• Modification of maladaptive beliefs about events,
  behaviors, or symptoms

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Why two treatments?

• Human reasoning is thought to be performed by two
  systems
• One is associative and automatic
• Making use of basic principles such as the
  similarity between elements or the closeness of
  two elements in time
• Conditioning models of learning

• Second system is rule-based and deliberate
• Tries to describe the world in more conceptual
  terms by capturing a structure that is logical or
  causal

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Prolonged Exposure

• Suppresses flashbacks by re-encoding into the
  verbally accessible memory system, or declarative
  memory
• Critical retrieval cues that were previously
  encoded only in the situationally accessible
  memory system, or non-declarative memory
• Arousal levels must be carefully managed during
  this process
• If too low, emotional retrieval cant take place
• If too high, person will avoid

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Cognitive Therapy

• Explore in a safe zone key interpretations that
  result in anxiety and depression
• Similar to standard CBT for those emotional
  reactions
• E.g., catastrophic thinking, overgeneralization,
  etc.

• Patricia Resick
• Write detailed account of events
• Read and re-read account daily
• Relive original emotions
• Challenge negative thoughts and interpretations

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Exposure as behavioral experiments

• Combining conditioning CBT
• Plan an event that represents form of exposure
• Predict the responses, including emotional
  intensity, coping ability, etc.
• Carry out the experiment
• Debrief the experience and contrast with
  predictions
• What is meaning of the experience for now?

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Cognitive therapy

• "I beg your pardon, I beg your pardon . . . but
  you know that in Paris serious experiments have
  already been performed with regard to the
  possibility of curing mad people by working
  through logical conviction alone? A professor
  there, who died recently, a serious scientist,
  fancied that such treatment should be possible.
  His basic idea is that there is no specific
  disorder in a mad person's organism, but that
  madness is, so to speak, a logical error, an
  error of judgment, a mistaken view of things. He
  would gradually prove his patient wrong, and
  imagine, they say he achieved results! But since
  he used showers at the same time, the results of
  the treatment are, of course, subject to doubt .
  . . Or so it seems." (Dostoevsky, F.
  1992/1866. Crime and punishment R. Pevear L.
  Volokhonsky, Trans.. New York Vintage Books. P.
  424).

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Integrating Rx strategies

• With apologies to Johnny Mercer

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Eliminate the negative

• Pain focuses attention more powerfully than any
  other stimulus
• Naturally people tend to want to remove it first
  before considering other effects
• There is one sure cure for cosmic explorations,
  grandiose ideas about God, man, death, suicide,
  and such -- and that is nausea. I defy a man
  afflicted with nausea to give a single thought to
  these vast subjects. A nauseated man is a sober
  man. A nauseated man is a disinterested man.
  (p. 213).
• It is astonishing how such a simple and
  commonplace ailment as pain and nausea can knock
  everything else out of one's head, lofty
  thoughts, profound thoughts, crazy thoughts, even
  lust. (p. 223).
• Percy, W. (1980). The second coming. New York
  Farrar, Straus and Giroux.

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Eliminate the negativeEvidence-based Rx for
negative symptoms

• Exposure
• Edna Foa
• Behavioral experiments
• Anke Ehlers, David Clark
• Cognitive processing
• Patricia Resick
• Eye movement desensitization reprocessing
• Francine Shapiro

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Pollyanna versus Eeyore

• Baumeister, R. F., Bratslavsky, E., Finkenauer,
  C., Vohs, K. D. (2001).
• Bad is stronger than good.
• Review of General Psychology, 5, 323-370.

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Eeyore Principlesuggested by Jennifer
Ciarrocchi

• Negatively valenced acts
• Greater impact than positive acts of same type
• Survival requires urgent attention to bad
  outcomes
• Less so for positive ones

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Reaction to events

• Bad wear off more slowly
• Greater upset at losing money than gaining same
  amount
• Neuroticism affects
• Bad and good moods
• Extraversion affects
• Only good ones

• Having one good day
• No effect on next one
• Having one bad day
• Affects the next one
• Trauma effects
• Single bad event has longer lasting effect than
  single great event

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Relationship effects

• Negative communication
• Greater impact
• On average, 5 times more powerful
• Gottman ratio
• Sex
• Good sex contributes 15-20 of variance
• Bad or no sex 50-75 of variance

• Other relationships
• Social attraction
• Negative social interactions more strongly
  influence interest in social connection
• As well as sexual interest

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Social support effects

• Negative or unsupportive social support
• Counts more heavily than positive or helpful ones
• For disabled or bereaved adults
• Positive social ties predicted only positive
  well-being
• Negative ones predicted both positive well-being
  and distress

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Religious Implications

• Were happy because, on average, many more
  positives happen in life than negatives
• But it takes many positives to make up for
  negatives
• Bad aspects of religion stand out much more than
  the good
• Even if good far exceeds bad
• Less than one percent of RC clergy tainted 99 in
  child sex abuse scandal and that in earlier era

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Implications (2)

• Religion spirituality have differential effects
• Attachment to God influences positive affect
• But has little effect on negative affect
• Positive relationship with optimism
• Spiritual struggles feeling alienated/punished
  by God
• Affects both positive and negative well-being
• Positive relationship with pessimism

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Implications (3)

• Early Christian spiritual writers emphasized
• Distinction between
• servile fear and filial fear
• Self-protective emotion versus
• Self-enhancing attachment emotion
• Seen as different developmental levels in growth
• Unless spirituality oriented toward positive
  relationship with God
• A striking negative event will have undue impact
  on spiritual life
• Grace-filled Gottman ratio?
• Requires continual spiritual gratitude

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Implications (4)

• Optimism
• The word optimism does not occur in the Christian
  Bible, its cognate confidence is found 142
  times in the Old Testament alone (Kittel
  Friedrich, 1985, p. 819 Theological Dictionary
  of the New Testament)
• Are Christians optimists?
• Not according to many theologians
• The optimist looks on the bright side, expects a
  happy ending. Hope, on the other hand, simply
  refuses the foreclosure of despair . . . .
  (Lash, 1996, pp. 210-211 The Beginning and End
  of Religion)
• Christians are happy pessimists
• G.K. Chesterton
• Putting it together Christians are hopeful,
  happy pessimists

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Conclusion

• Can we say
• Bad God is stronger than good God?

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Accentuate the positive

• Full life includes psychological well-being
  activating positive emotions which broaden
  build
• i.e., developing and strengthening coping skills
  for managing potential threats
• Also for developing resilience that copes with
  setbacks
• Positive emotions are pathways to this outcome
• Fredrickson, B. L. (2004). Gratitude, like other
  positive emotions, broadens and builds. In R. A.
  Emmons M. E. McCullough (Eds.), The psychology
  of gratitude (pp. 145-166). New York Oxford
  University Press.

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Accentuating the positive

• Positive emotions are increasingly described in
  positive psychology movement
• E.g., hope, joy, love, empathy, prudence,
  self-regulation, awe, forgiveness, humility,
  gratitude, transcendence (spirituality).

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Specific examples

• Just do it

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Wisdom Perspective

• Transformation begins with first coming to terms
  with my vulnerability and dependence in a world I
  do not control (C. Jung)
• Requires accepting co-journeyers
• Paradox
• Helplessness and depression result from lacking a
  sense of control
• Addiction is often a misguided path to attaining
  control
• Perspective is seeing the balance between what I
  can and cant control
• The Serenity Prayer duh!
• Again, virtue stands in the middle

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Wisdom Gratitude

• What makes gratitude hard?
• Lack of perspective
• Exaggerated belief in our self-sufficiency
• Reminds us of our vulnerability and dependency
• Violates hard-wired instinct for equity
• Tit for Tat automatic response
• Provo, UT to Chicago, IL
• 578 random Xmas cards
• 117 returned
• Only 6 admitted could not remember
• We feel bad
• If we under-benefit
• or, over-benefit
• Survivor guilt specific to humans not primates
• Humans alone worry about tragedy of the commons

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Practices for increasing positive emotions

• Practices mostly in their infancy with some
  exceptions
• Spirituality, forgiveness, gratitude, hope
• Traditional CBT creates some of these as
  by-product of reframing and cognitive processing
• E.g., optimism, hope, self-regulation
• Via processing distorted assumptions

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Latch on to the affirmative

• Identity disorder components of PTSD operate at
  broadest level of the personality
• Derives from multiple shattered assumptions
• Some very general The world is unfair
• Some very specific Women are out only for your
  money
• They act together to deflate accustomed roles and
  generate new dysfunctional ones
• E.g., Ill never have an intimate relationship
• Adding to sense of pessimism about future,
  helplessness, lack of control, etc.
• Combining many negatives into overall identity

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Affirmative roles

• No single strategy can produce affirmative,
  coherent role
• Process is slow, reflective one combining
• Interpersonal and social behavioral experiments
• Cognitive processing
• Spiritual/philosophical practices
• Identifying with coherent narratives that
  integrate persons values

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Neurophysiologic effects of identity integration

• Coherent identities work at both automatic and
  controlled levels of information processing
• Represents integration at its most complete

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Act your way into a new way of feeling
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Dostoevsky, F. (1991/1879). The brothers
Karamazov A novel in four parts with epilogue
(R. Pevear L. Volokhonsky, Trans.). New York
Vintage.

• "Try to love your neighbors actively and
  tirelessly. The more you succeed in loving, the
  more you'll be convinced of the existence of God
  and the immortality of your soul. And if you
  reach complete selflessness and the love of your
  neighbor, then undoubtedly you'll believe, and no
  doubt will even be able to enter your soul." (p.
  56).

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Dostoevsky, F. (1991/1879). The brothers
Karamazov A novel in four parts with epilogue
(R. Pevear L. Volokhonsky, Trans.). New York
Vintage.

• "And if the sick man whose sores you are
  cleansing does not respond immediately with
  gratitude but, on the contrary, begins tormenting
  you with his whims, not appreciating and not
  noticing your philanthropic ministry, if he
  begins to shout at you, to make rude demands,
  even to complain to some sort of superiors (as
  often happens with people who are in pain) --
  what then? Will you go on loving, or not? And,
  imagine, the answer already came to me with a
  shudder if there's anything that would
  immediately cool my 'active' love for mankind,
  that one thing is ingratitude. In short, I work
  for pay and demand my pay at once, that is,
  praise and the return of love for my love.
  Otherwise I'm unable to love anyone!" (p. 57).

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Gratitude as positive emotion Broaden-and-build
theory B. Fredrikson

• Broadened mindsets build enduring resources
• Negative emotions narrow
• Play is associated with joy
• Builds physical resources
• Builds social resources
• Builds intellectual resources
• Youth may have evolved to give complex organisms
  time to play (Panksepp)
• Similarly building are
• Exploration/interest envisioning/pride
  savoring/contemplation
• Are durable outlast emotional states

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Upward spiral (1)

• Positive emotions create an upward spiral
• Toward optimal functioning and well-being
• Should also undo lingering effects of negative
  emotions
• Loosens hold on negative moods
• Gratitude as antidote for
• Envy, resentment, regret, and narcissism
• The modern cynic says, Blessed is he who
  expects nothing for he shall be satisfied.
  Francis of Assisi says Blessed is he who expects
  nothing, for he shall appreciate everything,
  (G.K. Chesterton)
• Conversely, gratitude requires elements of
• Humility, compassion, justice
• Affirms a unity-of-virtues approach

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Upward spiral (2)

• People induced to feel positive emotions
• More helpful to others
• Even if they only observe or hear about others
  being happy or helpful
• Gratitude sets up positive contagion
• Identifies moral, prosocial behavior
• Motivates receiver to act prosocially
• Motivated gratitude, in turn, reinforces
  benefactor and beneficiary to act prosocially

65
Practicing gratitude

• Tracking grateful events
• Enduring effect
• Grateful acknowledgements
• Enduring effect

66
Spiritual Practices Recovery

• Ancient Wisdom for Modern Problems

67
Cancer and posttraumatic growth

• Breast cancer
• 50-90 report benefits
• Testicular cancer
• 76 report benefits
• Child/adolescent cancer survivors
• 60-95

68
Correlates of PTG

• Increased social support
• Increased optimism
• Increased stress levels
• Coping style correlates of PTG
• Positive reframing
• Acceptance
• Cognitive and emotional processing

69
PTG as a natural process

• Not everyone needs help finding benefits
• May be a natural process
• Benefit reminding becomes a crucial part of
  process if benefit finding is to be effective
• Opens door to importance of prayer, meditation,
  spiritual reflection as integral
• Along with gratitude and meaning making

70
Positive emotions spirituality

• Fredrickson thinks spirituality generates
  positive affect, which, in turn
• Generates resilience
• The key component in subjective well-being
• Ciarrocchi, J. W., Deneke, E. (2004). Happiness
  and the varieties of religious experience
  Religious support, practices, and spirituality as
  predictors of well-being. Research in the Social
  Scientific Study of Religion, 15, 209-233.
• Ciarrocchi, J. W., Deneke, E. (2005). Hope,
  optimism, pessimism, and spirituality as
  predictors of well-being controlling for
  personality. Research in the Social Scientific
  Study of Religion, 16, 161-183.
• Ciarrocchi, J. W., Dy-Liacco, G., Deneke, E.
  (2008). Gods or rituals? Relational faith,
  spiritual discontent, and religious practices as
  predictors of hope and optimism. Journal of
  Positive Psychology, 1-17.

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Wisdom humility

• Most misunderstood emotion
• Its not the earth the meek inherit, its the
  dirt lyrics from Cest Moi, from musical
  Camelot
• Classical understanding
• The correct amount of self-esteem
• Neither under- or over-inflated
• Assessment is critical
• Are you dealing with inflation or deflation with
  a client?
• Many mistakes are made because of misguided
  assumptions
• All persons in recovery are egoists
• All persons in recovery have low self-esteem
• In truth, each person in recovery is unique
  

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Practicing humility

• Inflation remedies
• Perspective
• Acknowledging dependency on others
• Specifically, no such thing as self-made person
• Lots of gratitude practice
• Giving without recognition
• Medieval sculptors
• Spiritual exercises
• Reflect on filial fear

• Deflation remedies
• Recall past successes
• Give time to what person is competent in
• Take a survey
• Pie chart for shame and guilt events
• Spiritual exercises
• Reflect on made in the image and likeness of God

73
Compassion forgiveness

• Definition
• Ceasing to feel angry toward and ceasing to seek
  retribution against someone who has wronged you
• Fairness theory says in committing a wrong,
  people owe a kind of debt
• Forgiveness is releasing person from that
  obligation
• Forgiveness related to less psychological
  distress and physical illness in victims

74
Who forgives?

• Less severe offenses
• Closer the relationship
• When apology has been given
• Forgiving persons
• Religious persons forgive more easily
• Narcissistic persons forgive less easily
• People willing to give up the pay-off for holding
  a grudge

75
Downside to forgiveness

• Invites some people to offend again
• However, this is less typical than repairing the
  relationship
• Obviously not indicated in ongoing abusive
  situations

76
Practicing forgiveness

• Journal episode
• Write quickly without concern for grammar,
  spelling, and only for your own eyes
• Aim for 10-20 minutes
• Negative feelings usually increase initially, but
  eventually lower with repeated daily journaling
• Effect
• Provides perspective

• Big Book strategy
• Identify three things that you yearn for yourself
  as fulfilling and leading to flourishing, happy
  life
• Pray each night slowly and carefully that the
  offender receives these gifts
• Even if at first you gag on the prayer and dont
  mean it
• Repeat until the intense negative feelings are
  eliminated
• One week to years

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Big Book prayer example

• Dear God, please bless ______ with
• A loving, intimate, satisfying close relationship
• Abundant money and material goods both now and in
  the future
• Enormous success and recognition in work
• Divorce example three wishes
• Love and respect of our children, material
  abundance, many faithful and devoted friends
• Effect
• Reduces resentments

78
Wisdom Recovery as transforming meaning

• Only two possible reactions to new information
• Assimilation
• Incorporate meaning of events into current
  worldviews
• I wasnt alert enough to prevent the outcome
• Accommodation
• Change worldviews to incorporate the events
• Positive negative accommodation
• Positive
• Given random nature of events, live life to
  fullest
• Negative
• Given random nature of events, personal efforts
  are worthless

79
Dos and Donts of Integration
80
The right balance

• Dos
• Hope
• Create future memories
• Affirm wishing/wish to endure
• Gratitude
• All life as a gift
• Forgiveness
• Replaces anger
• Humility
• Replaces shame
• Wisdom
• Perspective/priorities
• See spiritual struggles
• As ambivalence

• Dont
• Impose solutions
• Solutions come from within person
• Minimize your role
• Benefit-finding benefit-reminding are part of
  natural process
• Reflecting back allows this process to go forward
• Our role in trauma recovery is not as expert
• But co-journeyers

81
I pray thee cease thy counsel, Which falls into
mine ears as profitless As water in a sieve.
Give not me counsel, Nor let no comforter delight
mine ear But such as one whose wrongs do suit
with mine. Bring me a father that so loved his
child, Whose joy of her is overwhelmed like
mine, And bid him speak of patience, If such a
one will smile and stroke his beard, Patch grief
with proverbs, bring him yet to
me, But there is no such man. For, brother,
men Can counsel and speak comfort to that
grief Which they themselves not feel but tasting
it, Their counsel turns to passion For there was
never yet philosopher That could endure the
toothache patiently, However much they writ the
style of gods.
82
Versus

• Serve God, love me, and mend.