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Addendum D
Addendum D: 8 Tips, Tools, and Techniques for Natural Disaster Intervention

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The next 8 sections contain additional tips, tools, and techniques related to natural disasters

1 of 8 How to Stabilize Your Family

I often share some strategies with my clients that will be helpful in the time of a natural disaster crisis. These tips are helpful for everyone although I find them especially helpful for clients like Tom, who have stress after going through a natural disaster. This particular tip is directed at helping the client stabilize their family.

In the middle of the crisis you can do the following:
-provide for everyone’s physical safety and security
- keep the same level of control and discipline that you are usually comfortable with
- be aware if your own personal issues or fears are affecting your evaluation of the situation
- be open to receiving assistance. Get as much help as possible
- allow others to help or take control when it is necessary

Here are a few suggestions for your client to help provide support to individuals and their family:
- Engage your family in conversation to reestablish a sense of control and normalcy.
- Ask questions about what others understand about what is happening.
- Make sure that everyone’s thoughts and feelings are clear and acknowledged.
- Show that you are trying to help through your words and actions.
- Don’t contradict others’ feelings or making false assurances.
- Use active listening by repeating back what they have said to ask for clarification. You can even ask "Is that what you mean?"
- Provide a clearer picture in words in order to avoid a misunderstanding of a situation.
- If family members are fading, help refocus them or if they are fearful or over excited help them relax.
- When needed, you can help manage serious reactions.
- Share with others what will happen next, as far as you know.

Question: One way your client can provide support to individuals and their families is to…

2 of 8 Guidelines for Site Visits

One thing my clients facing trauma often find difficult is returning to the site of their traumatic event. For Jackie, who lost her home to a hurricane, found it extremely difficult to return to the site of her old home. I offered the following suggestions to help her make the return to the site of the trauma less stressful. Here is a list that I shared with Rita:

- Plan your visit out ahead. Ask yourself what you want out of the visit. What problems do you have with the site? If you find yourself avoiding the site, ask yourself why.
- Work on developing your ability to monitor your arousal level.
- Work out a specific plan to lower your arousal level.
- Practice the visit, even handling possible meltdowns, before you go. To help, make sure to ask yourself what you will do if you become upset.
- Include someone who you really trust in your plan. It is most beneficial to tell them specifically what you want them to do for you.
- Slow down and take the visit one step at a time.
- To keep calm use breath, self-talk, imagery, and movement.
- Be open to your friend’s suggestions and their support.
- Monitor your arousal level and bring it back down to a manageable level during each step.
- Know when you need to back up or back off and do it.
- Once you reach the middle of the site, take a moment to sit down and return yourself to a fully present state.
- Spend enough time walking around the location in order to look at it from different perspectives.
- Remind yourself "that was then, this is now". Focus on seeing the difference between then and now.
- When you are ready, leave the site.
- talk about the experience whether it be through talking to your friends, writing about it, drawing it, etc.
- Any feelings that come up, whether they are old or new, are normal. Make sure to remind yourself of this.
- Make sure to celebrate and acknowledge your courage, accomplishment, and daring.
- Think out what you want to do next. Ask yourself if you want to do another visit. Ask yourself if you want to share your experience with your therapist. Do you want to write a journal entry or do you have another ritual that you want to use to accomplish your visit goals?

Question: What is the first step for your client when they are visiting the site of their trauma?

3 of 8 Talking to Children after a Crisis

When dealing with a natural disaster, it can be especially traumatic for children to experience. When Tom and his family survived the earthquake that destroyed their home. I shared the following information with Tom to help him talk to his children about the natural disaster.

1. Finding a Private Space
Often talking in the privacy of your home is the best way to make the child feel comfortable. Wherever the space is, it should be a safe space. Often it is better to not talk with other siblings.
2. Staying Calm
Often with the trauma of natural disasters, children feel self-doubt and uncertainty. Your calmness lets the child know that it is ok to talk about the situation and that whatever they talk about will be accepted.
3. Being honest with yourself
It is also important that you are in touch with the issues, your own feelings and reactions to the child, and the situation. If you are having an issue handling the situation, reach out for help.
4. Speaking at the child’s level
Trauma is a deep and complex situation to deal with so it is important that when you are talking to the child you use words, concepts, and gestures that they understand. Provide the child with information but do not overwhelm them or offer them information that will confuse them.
5. Reading between the lines
When having your conversation, pay attention to the cues of the child such as behaviors and reactions during the conversation. Some things to pay attention are signs of fear and agitation and their attention span. Sometimes the messages will be subtle.
6. Validating the child’s feelings
You can go a long way to help the child by helping them clarify their feelings. It is important to validate the child’s feelings, whatever they may be. To help them express their feelings by putting words to the feelings and seeing if they fit.
7. Listening well
In order to be a good listener make sure to use gentle, probing questions and comments, maintain good eye-contact, use focused questions when appropriate.
8. Show that you believe the child
In order to show the child that you believe them by showing confidence, trust, and faith in what they are saying.
9. Dispeling fault
Be sure to remind the child that it is not their fault. Since people in trauma tend to distrust and blame themselves, it is important to be proactive.
10. Exploring fears
Help empower the child to share their questions, assumptions, and fears by asking questions that open up the discussion.
11. Providing information
Information about the incident (the natural disaster) or actions that could be taken should be shared. What is important is not to preach or not pay attention to the timeliness of giving information.
12. Walking through the process
To help children deal with the uncertainty of trauma, it is helpful to share certain processes so the child can better predict and plan.
13. Exploring resources
Help the child identify resources they have available to him. Focus on whom, when and how to reach out for support.

When having a conversation with a child about the trauma of the natural disaster, there are a few things that it is best not to do. Here is the list that I usually share with my clients who want to talk to their child about their trauma:
- Don’t make false promises
If you are unsure about something or are not sure if it is true, then explain that to the child.
- Don’t fall apart
When talking to the child, make sure to maintain emotional control. It is important to send the message that you can handle and can be trusted with whatever information the child gives you.
- Don’t pass judgment
Pay attention to your facial expressions, body language, inferences, and questions which give away signals of judgment.
- Don’t become an inquisitor
Rather than trying to drill out information from the child, help them feel comfortable enough to reveal what they want to share.
- Don’t preach
Keep the focus on the child and refrain from ranting, blaming, and sharing your opinions.

Do you have a Tom that would benefit from these tips to help talk to their child about trauma?

Question: What are the five things that your client should avoid while talking to a child about trauma?

4 of 8 Helping Loved Ones

Often family members are left out of the loop on the progress of individuals as they process their trauma. Jackie, came in and talked about how her mother felt a distance from Jackie and that she never shared with her mother. Jackie told me that she didn’t want this to hurt her relationship with her mom. I offered her to following tips to help her share her experience with her mother.

- It is important to not assume that they are getting all they need because you are trying. Remember that sharing with them as much as you can is just a step for them just like it is for you.
- When describing the trauma and the natural disaster, offer the basic information without overwhelming them with details that could upset them. Offer up the facts of the incidents. For example, instead of saying "I saw blood, entrails, decapitation, etc." you can share with them "I saw people hurt very badly".
- Include your feelings and reactions and what the event meant to you when describing the natural disaster to your loved one.
- Share with them as much as you can about the reactions that you continue to have. For example, share if you are experiencing flashbacks or nightmares. Make sure to include how these reactions make you feel.
- In your discussion, describe how your reactions affect your relationship with them.
- Tell them how you are working to get better. Make sure to explain to them how they can help you and encourage them to continue to be patient.
- Learn more about how your behavior affects the by directly asking them. See if there are any actions you can take to help them.

Do you have a client who is struggling to share their trauma story with a loved one that can use these tips?

Question: What is one of the tips your client can use to share their experience with a loved one?

5 of 8 Stop Flashbacks

When Jackie was in my office and was having a flashback, she was speaking as if the hurricane was happening right now. I stepped in and told her "stop, Jackie. It is not happening now. What you perceive at this moment is a memory of what happened to you years ago. You are remembering when you were in the hurricane years ago." Here are three exercises that I shared with Sally to help her control and stop her flashbacks.

Exercise 1: Timeline Mantra
While this may seem like a simple exercise, it is extremely effective. During one of our sessions, I shared with Jackie, "the flashback is a memory and not a repeat of your trauma. It is important to remind yourself that it is a memory. You can do this by using clear words and expressing them in your head, saying them out loud, listen from a voice recorder, or writing it on a piece of paper." Encourage your client to plan out a few ways for him or her to get the message across.

Exercise 2: Digital Mantra
I explained to Jackie that if it is more effective for her, she can add to the simple mantra in the timeline mantra that accurately express the truth of her situation. Jackie added to her mantra and she ended up with "I am remembering what happened to me over 3 years ago. It hasn’t happened since and it’s not happening now. It was terrible and it is terrible to remember. And I am grateful it is a memory and no longer really happening." It is important that your client does not include details about their trauma because that could intensify their flashback.

Exercise 3: BEMADS Protocol
I shared the following with Jackie to help her with her flashbacks. Clients can use this technique when they are experiencing a flashback and need to reduce or stop it, are anticipating a situation that could trigger a flashback, or as part of their morning routine. Here are the steps for the protocol:
B- Body
Have your client focus on their internal senses and name the sensations they are feeling.
E- Emotions
Have your client identify what they are feeling emotionally.
M- Memory
Your client should remind themselves that this is a reaction to a memory and not an actual event that is happening now.
A- Attention
Encourage your client to focus their attention on external forces. Specifically identify at least three things you can sense.
D- Date
Your client should affirm the date. Have them include the year, month, and day.
S- Safe
Finally, your client can evaluate whether or not they are safe. When they affirm that they are safe, they can reassure themselves they are not in danger and they are simply having a flashback.

Question: What to the letters of the BEMADS protocol stand for?

6 of 8 Forgive Your Limitations

For my clients, like Tom and Jackie, who have been through a natural disaster and are coping with trauma, I often find that they are blaming themselves for what happened during the traumatic experience. I offer the following exercises to help them begin to forgive their limitations.

Exercise 1: Learn the Theory
While this may not seem like the typical way for a client to cope with their trauma, I have found that helping clients understand and encouraging them to research the neurobiological components of trauma. Understanding how the freeze response as a non-voluntary physiological response to threat (such as a natural disaster) can go a long way to helping your client understand that the traumatic situation they were in was not their fault.

Exercise 2: In Someone Else’s Shoes

Another exercise I often use with my clients facing trauma from a natural disaster is to have the put themselves in someone else’s shoes or rather put someone else in their shoes. I used this exercise with Jackie while is a session. I begin by telling them "consider how you would feel if your best friend or someone else you love were in the same traumatic situation. Would you hold him or her responsible for what happened? If you don’t hold him or her responsible, what is different? Is there a way you can direct this compassion for your friend toward yourself? If you would hold them responsible, what would you consider a fair amends? Would this be acceptable for you? "

Exercise 3: Talk with Others
I also fully encourage my clients to discuss with their trusted family and friends about their experiences with self-forgiveness. I found this technique very helpful with my client Tom. I also tell my clients "why don’t you talk to your friends and family about how they would feel if they were in your shoes. Would they find it difficult or easy to forgive themselves? Ask them why or why not."

If you have a client who is finding it hard to forgive themselves, could they benefit from one or ore of these techniques?

Question: What is one exercise you can use with your client to help them forgive their limitations?

7 of 8 Self-Blame

One issue that clients facing trauma deal with is self-blame. When Jackie, whose family had survived a hurricane but whose home was destroyed, came in for a session, she blamed herself and told me "what did I do to cause this? I hate myself. I just felt so shitty for so long about myself."

To begin, I tried to help Jackie by helping her see why she uses self-blame. I explained to her, "here are a few reasons why self-blame may seem like an upside". We then went through the following list of ways in which self-blame is an upside:
- If you feel blameless, it may be disconcerting because it means that the world is random and chaotic in which anything can happen.
- It can be easier and reassuring to believe that you are wrong instead of the whole world being wrong.
- It creates an allusion of control
- If you link your behavior to the cause of the trauma, then by controlling your behavior you can avoid the trauma.
- By linking your behavior to the cause of the trauma, it also gives you the power to protect yourself from the trauma and take precautions in the future.
- When you fell that you could have done something to prevent the trauma, it makes you feel safer and helps you control your fears and feelings of helplessness surrounding frightening events.
After going through this list, I gave an example to Jackie. I told her "For instance, you mentioned that your home was not hurricane proof and that was something you could do now. Self-blame of this sort can lead to responsible action."

After going through this, I also discussed with Jackie how self- blame can have a negative effect. I went through the following list of the downside of self-blame:
- If you see your behavior as the only cause of the trauma, you cannot see clearly the real danger.
- Self-blame can often stop you from feeling anger. This anger can help you feel in charge and in effect can be healing.
- It can be difficult for others to offer their help to you when you are blaming yourself. Not receiving the necessary help you need from others can be harmful.
- Furthermore, if you are blaming yourself you may often find it troubling to seek out help.
- One form of self-blame is survivor’s guilt, when you perceive others as having suffered less than you and thus feel responsible. This creates an unnecessary burden on yourself.
- When you blame yourself, others may conclude that your trauma came from your poor judgment or behavior, rather than because of the unpredictability of the world.
- Guilt from self-blame isolates you which in turn leaves you feeling bad, confused, and ashamed.

Exercise: Making Words
After going over these lists, Jackie realized that her self-blame was actually stopping her from getting the help she needed. To help Sally stop self-blaming, I encouraged her to find words to describe the experience of trauma. I explained "Trauma is an emotional and physical experience. It is also not a thinking experience but rather an experience of fragmented images and emotions. Using words to describe these images and emotions can help you exercise control over your trauma. An essential part of resolving trauma is to express the meaning of the trauma."

Do you have clients facing trauma because of a natural disaster that self-blame that could be helped by going through these lists and exercise?

Question: What is one way that self-blame can harm a client facing trauma?

8 of 8 Describing and Tracking Sensation

The following is a conversation I had with Tom about describing and tracking his sensations. This is what I told him:
"When asked how you are doing by someone, you typically offer a vague response such as "okay" or "not so good". I want to encourage you to really think about what your body is telling you that made you respond with that answer. The way you distinguish sensation from emotion and from thought is your ability to locate the sensation in your body and experience it in a physical way. You can identify a sensation by asking yourself when I feel a certain emotion- such as anxiety- how do I know that I am feeling that emotion?

Describing and Tracking Sensation Exercise:
I used this exercise with Tom to help him better identify his sensations.
Have your client find a comfortable place and position to sit. Let your client know that if at anytime their sensation is too intense, they can slow down or stop all together. Have your client bring in an object that brings them comfort and is special. Have your client tune in to the sensations they are experiencing. Share with your client, "feel how the chair holds your weight. Notice your clothing on your skin. Notice how your feet are grounded. Try to feel a sense of groundedness within your whole body."

Have your client shift his or her focus on the safety object and on their body. Once your client has moved back and forth between the object and their body, have them focus on shifting to an inner sense of where the comfort of the object is experienced in their body.

Once your client feels comfortable with this part of the exercise, you can add this additional part to the exercise. I shared with Tom, "I would like for you to remember a time sometime in the past few days that you felt most like yourself. " I encouraged him to notice what bodily experiences he feels while he recalls the memory. Again, have your client shift back and forth between the memory and the current sensations he or she is feeling. Encourage your client to continue this pattern of recalling a memory and understanding their sensations. Gradually have your client recall memories of when they felt most like themselves further and further back in time: in the last week or two, last month, etc. When your client has gone through these steps successfully, have them open their eyes and return to the room. Have them look at the object in front of them and again return to shifting back and forth between observing the object and observing their internal experiences.

Tracking Your Rhythms of Expansion and Contraction Exercise:
For many clients facing trauma, like Tom, the traumatic situation lingers and the connection of new situations with the traumatic one stays. The key to dissolving the constriction of the traumatized event is to stay with the sensation until it begins to change. When your client contacts the sensation of the traumatic situation, it will begin to change simply because all sensation do. It will most likely go through an expansion and contraction, the sensation will oscillate between being worse and getting better. Once your client learns how to control this oscillation, they will begin to feel that their emotional pain is more manageable and finite. To begin the exercise, I told Tom, "I want you to remember an experience when you felt mildly uncomfortable. Imagine you are driving in your car, looking forward to getting home, when you have to come to a stop when the cars in front of you slow down. You are unable to see the cause of the jam. Now I want you to focus on what you are experiencing with your sensations. Pay attention to where your body feels irritated and continue to focus on the sensation until it shifts."

Do you have a client like Tom who is facing trauma after a natural disaster and can benefit from learning to understand and control their sensations?

The following exercise I have found to be effective with clients who are facing trauma after a natural disaster, like Jackie whose home was destroyed in a hurricane. It will help the client be able to be present, to see, hear, smell, and perceive their immediate environment fully.

I began the exercise by explaining to Jackie, "As you return to the outer world, allow your eyes to take in the information. It is normal for the nervous system to take in all the information out of interest, curiosity, and exploration. Trauma limits the exploratory, curious, searching, and looking of your senses. If there is someone else around as you return from your internal exercises, you may want to make contact with that person. This is natural to want to reach out and make contact with the environment when you are not in a traumatized lock-down. "

Question: Finish the sentence…
The key to dissolving the constriction of the traumatized event is to ___________________.

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