In April (2019) I presented for a half-day on The Therapeutic Use of Metaphor in EMDR at the EMDR Canada conference in Vancouver, BC. Being in Canada got me thinking about intergenerational trauma and I’ll tell you how. A big shout out to my Canadian friends and colleagues – they run an excellent EMDR conference and are a wonderful group of people! You can learn more about the therapeutic use of metaphor in EMDR therapy here.
Before the conference, I was able to spend a few days exploring Vancouver itself. I was very struck by what I learned about the First Nations people and the Unceded Territories. Particularly moving was my visit to UBC’s Museum of Anthropology. This was full of powerful images, incredible history, and great learning. In the gift shop, I bought a card which has the image you see here – Laurence Paul Yuxweluptun’s Portrait of a Residential School Girl.
Yuxweluptun, who was also in the residential school system, honors the child with his painting. The young girl shows the “enforced conformity” of residential schools, through her white blouse and clipped back hair European hair. In contrast, her face has spiritual markings of strength and protection. A halo, which is also covered in Indigenous designs, is behind her head. The central message intended is that no matter how hard European settlers try to eradicate and conform Indigenous peoples, this will never be possible to successfully achieve. It is a very striking image.
More than 80 residential schools existed across Canada – starting in the 1870s and lasting until the 1960s and 1970s. Parents were forced, after 1920, to enroll their children or face prison. The purpose of the residential school system was to “kill the Indian in the child,”, by breaking children’s linguistic, spiritual and cultural attachment to their traditional cultures. It is also clear that sexual abuse, sexual assault, rape and child neglect, as well as the trauma of loss and separation from family and community were consistently rife issues in this system. By 2015, over 30,000 students claims submitted to receive compensation for sexual abuse “as part of the Independent Assessment Process, set up under the Settlement Agreement” had been concluded, with a further 6,000 in the process (Truth and Reconciliation Commission of Canada)
Naturally, this got me thinking about intergenerational trauma – in Canada, Australia and back home in Northern Ireland. As Francine Shapiro said, “The past affects the present even without our being aware of it.”
As therapists, we need to be aware of intergenerational trauma, what it is and how to work with it. We need to take detailed trauma histories of both our clients and their own origins.
The intergenerational transmission of trauma is known through old wisdom. The presence of such a phenomenon has long been known to First Nations peoples as “blood memory” and “soul wound”.
What is intergenerational trauma?
This animation was launched at The Healing Foundation’s #OurFuture Youth Webinar on 24 July 18. It has been created as a new education resource that explains where Intergenerational Trauma comes from and how it impacts young Aboriginal and Torres Strait Islanders (https://healingfoundation.org.au/intergenerational-trauma/). I think it explains it quite well.
At its simplest, the best way to define intergenerational trauma is to take the words of Yehuda and Lehmer (2018) :
“On the simplest level, the concept of intergenerational trauma acknowledges that exposure to extremely adverse events impacts individuals to such a great extent that their offspring find themselves grappling with their parents’ post‐traumatic state. A more recent and provocative claim is that the experience of trauma – or more accurately the effect of that experience – is “passed” somehow from one generation to the next through non‐genomic, possibly epigenetic mechanisms affecting DNA function or gene transcription”
So, according to Yehuda and Lehmer, intergenerational trauma has two parts
- people who have been through traumatic experiences can then have an impact on their children (for example, this could mean that the children may develop PTSD without having been exposed to a traumatic event). Yehuda’s work on the children of holocaust survivors’ points to this.
- the effect of the trauma that the parent has experienced is passed on through epigenetic means (essentially, part of the parental DNA changes and this is then passed on to the children and can be identified in the DNA of the children). The word used here is ‘provocative‘ because there is some disagreement about this.
It is worthwhile to hear this explained by Rachel Yehuda directly.
This explanation, covering both the environment and genetics, is convincing. This is similar to the familiar nature/nurture debate.
Dr. Yehuda remains in the role of the scientist, following the evidence rigorously, and not getting overly excited. However, there are alternative views on epigenetics and some criticism with regard to these findings.
Not Everyone Agrees
The research carried out by Dr. Yehuda et al. (2015) is certainly an interesting read and not the only research on epigenetics. It claims that
“This is the first demonstration of an association of preconception parental trauma with epigenetic alterations that is evident in both exposed parent and offspring, providing potential insight into how severe psychophysiological trauma can have intergenerational effects.”
However, the sample size (n=22) is very small and cannot be generalized to a wider population. It is also necessary to conduct a more longitudinal study to examine the impact and transmission of intergenerational trauma across more than one generation. This is acknowledged by Yehuda et al.
“It is also necessary to investigate multiple generations to differentiate among exposure effects, epigenetic inheritance, and social transmission”
Josie Glausiusz, a participant in the Yehuda et al study (2015), has asked
“How does one separate the impact of horrific stories heard in childhood from the influence of epigenetics?”
Glausiusz quotes both John Greally (Professor of Genetics and Pediatrics at the Center for Epigenomics at Albert Einstein College of Medicine in the Bronx, New York), and Rafael Irizarry (Professor of Applied Statistics at Harvard and the Dana Farber Cancer Institute) who raise questions and doubts about what they view as inconsistencies in the design and method of Dr. Yehuda et al.’s research.
Yehuda et al. responded and in a paper published in 2018, state the following :
“There has been great interest in the possibility that effects of trauma might be passed from parent to offspring through epigenetic mechanisms. This topic has stimulated discussion and controversy in the scientific literature, the popular press, and culture at large. This article describes the initial observations that have led to recent examinations of epigenetic mechanisms in association with effects of parental trauma exposure on offspring. Epigenetic research in animals has provided models for how such effects might be transmitted. However, the attribution of any specific epigenetic mechanisms in human studies of offspring of trauma survivors is premature at this time.
The article describes some of the ways in which initial epigenetic findings in the offspring of trauma survivors have been represented in the popular media. Reports have ranged from overly simplistic and sensationalistic claims to global dismissals. The authors discuss the importance of clarity in language when describing epigenetic findings for lay audiences, the need to emphasize the limitations as well as the promise of research on intergenerational transmission of trauma effects, and the importance of countering popular interpretations that imply a reductionist biological determinism. Scientists have an obligation to assist in translating important research findings and nascent avenues of research to the public. It is important to recognize the ways in which this research may unintentionally be received as supporting a narrative of permanent and significant damage in offspring, rather than contributing to discussions of potential resilience, adaptability, and mutability in biological systems affected by stress.”
The key points to note here are that:
- Previous research pointed to initial observations regarding epigenetic mechanisms related to the effects of parental trauma exposure on their children.
- Epigenetic research relating to animals shows possible transmission models but it is premature to state that epigenetic transmission happens in humans
- Reporting of the original findings have been simplistic and sensationalist and have lost accuracy despite the fact that this is essential to maintain.
- There are limitations as well as potential promise in the research on intergenerational transmission of trauma from parents to their children
- It is vital that research findings in this area are not misinterpreted in a way that is reductionist or limiting so that children of trauma survivors are not seen as being permanently and significantly damaged.
- The discussion needs to uphold a narrative of resilience, adaptability, and mutability in biological systems affected by stress.
So, what does it mean for therapists?
As therapists, we are in the business of helping people to heal from trauma.
Therapists must uphold a narrative of resilience, adapatibility, and mutability in biological systems affected by stress.
This is a central guiding principle behind the work that we do. However, we need to be well informed so as to provide the best therapeutic interventions possible.
So, how should we proceed? Here are some suggestions.
- We do not need to get caught up in the debate about epigenetics – that will become clearer in time. However, it is clear that intergenerational trauma does exist. Clients can have adverse experiences by virtue of being exposed to a traumatic family environment. Intergenerational trauma describes the transgenerational transmission of parents’ traumatic experiences to their children and even grandchildren.
- Clearly this is not about blame, but it is about recognizing that a traumatic family environment can have a devastating impact on those who grow up within it. The devastating impact of traumatic experiences, including war, genocide, and ongoing oppression, can alter a person’s capacity for being attentive and present, having an ability to love, to form attachments, or parent well.
- As therapists, we need to ‘unpack’ this family history and make sense of it – both for our own work as therapists and how we might proceed (think of the trauma minefield) and for our clients deciphering their own history.
- A simple practical but powerful way to do this is by the use of a genogram. This invites both discussions and can greatly aid clarity given its visual nature. Therapists need to be aware of how to work with genograms and the different forms of notation used in these. This work should be done slowly as part of a gradual unpacking and to notice new patterns of insights that emerge. Find out exactly how to take a trauma history in this post.
- We need to actively listen to the stories that get told that the stories that a family has ‘created and lived by’. As Dan P. Mc Adams has said “People tailor their life stories for particular audiences. The recipient or audience for a story may crucially influence the stories form.” Stories are constructed in particular ways and clients can become ‘prisoners’ of particular family narratives. We need to gently help them unpick the locks of the chains that bind them into what seems like the perceived truths of certain stories. We need to look out for what may have become a dominant narrative in a family system and one that has been passed down. This may not accord with the client’s current experience or reality or future wishes. This is where resilience and adaptability come in.
- As stories are told, we need to watch and listen for emotional tone and somatic reactions in the client. Where do they become upset, frozen, tearful or caught in words? What metaphors do they use in their language that tells us that metaphor is necessary because it is the only way to express the inexpressible? We need also to be able to use various mediums to enable a story to be told, and not just words.
- We need to be trauma-informed as therapists and to be able to help clients stay within a window of tolerance. We need to be able to moderate and modulate the pace of the sessions and to help clients self-soothe. We need to navigate slowly through the trauma minefield.
- We need to have an awareness of human developmental stages and what ages the client is telling their story from. How a six-year-old will understand recount an event is different from that of a sixteen-year-old.
- The therapeutic work needs to be collaborative. It needs to rely on and work with the wisdom, input, and suggestions from the client throughout the therapeutic process, coupled with the professional knowledge and expertise of the therapist.
- Finally, the therapist needs to have a clear plan which entails working to an ending from the first session, and not engaging in a lengthy process that will re-traumatize the client or that will involve being in therapy for years? The process is about resolution and healing.
Some therapists like to keep points like this in a journal or pin them to a noticeboard.
"Mwaka huu, ""Utumizi wa Matibabu ya Metaphor katika EMDR"" ni sehemu ya mkutano wa EMDR Canada huko Vancouver, BC." Kuwa nchini Canada kunanifanya nifikirie juu ya majeraha ya kati ya vizazi na nitakuambia jinsi. Mngurumo mkubwa kwa marafiki wangu wa Canada na wenzangu <unk> wanaendesha mkutano bora wa EMDR na ni kikundi cha watu wa ajabu! Unaweza kujifunza zaidi juu ya matumizi ya matibabu ya metaphor katika matibabu ya EMDR hapa. Kabla ya mkutano huo, niliweza kutumia siku chache kuchunguza Vancouver yenyewe. Nilishangazwa sana na yale niliyojifunza kuhusu watu wa Taifa la Kwanza na Maeneo Yasiyopitishwa. Kwa mfano, nilitembelea Jumba la Makumbusho la UBC la Anthropology. Ilikuwa imejaa picha zenye nguvu, historia isiyo ya kawaida, na elimu kubwa. Katika duka la zawadi, nilinunua kadi ambayo ina picha unayoona hapa <unk> Laurence Paul Yuxweluptun's Portrait of a Residential School Girl. Yuxweluptun, ambaye pia alikuwa katika mfumo wa shule ya makazi, anamheshimu mtoto huyo kwa mchoro wake. Msichana huyo mchanga anaonyesha "kufuata kwa kulazimishwa" kwa shule za makazi, kupitia blouse yake nyeupe na nywele zake za nyuma za nywele za Ulaya. Kinyume chake, uso wake una alama za kiroho za nguvu na ulinzi. Mwangaza, ambao pia umefunikwa kwa michoro ya Wenyeji wa Asili, uko nyuma ya kichwa chake. Ujumbe wa msingi unaokusudiwa ni kwamba haijalishi jinsi wahamiaji wa Ulaya wanavyojaribu kuondoa na kurekebisha watu wa asili, hii haiwezekani kamwe kufikia mafanikio. Ni picha yenye kuvutia sana. Shule za makazi zaidi ya 80 zilikuwepo kote Canada kuanzia miaka ya 1870 na kuendelea hadi miaka ya 1960 na 1970. Baada ya mwaka wa 1920, wazazi walilazimishwa kuwaandikisha watoto wao katika shule hiyo, la sivyo wangekamatwa. Kusudi la mfumo wa shule ya makazi ilikuwa "kuua Kihindi katika mtoto", kwa kuvunja uhusiano wa lugha, kiroho na kitamaduni wa watoto na tamaduni zao za jadi. "Ilikuwa wazi pia kwamba unyanyasaji wa kingono, unyanyasaji wa kingono, ubakaji na kutelekezwa kwa watoto, pamoja na majeraha ya kupoteza na kutenganishwa na familia na jamii, zilikuwa ""matatizo ya kawaida"" katika mfumo huu." "Kufikia mwaka 2015, zaidi ya wanafunzi 30,000 waliwasilisha madai ya kupokea fidia kwa unyanyasaji wa kijinsia kama sehemu ya mchakato wa tathmini huru, ulioanzishwa chini ya Mkataba wa Usalama, na wengine 6,000 katika mchakato (Komisoni ya Ukweli na Upatanisho ya Canada) ""Kwa kawaida, hii ilinifanya nifikirie juu ya majeraha ya kizazi cha kati nchini Canada, Australia na nyumbani huko Ireland Kaskazini." "Kama Francine Shapiro alivyosema, ""Mungu anajua wakati wetu wa sasa, lakini hatujui wakati wetu wa sasa, na tunahitaji kujua jinsi ya kukabiliana na hali ya sasa.""" Tunahitaji kuchukua historia ya kina ya majeraha ya wateja wetu na asili yao wenyewe. Uhamisho wa kati ya vizazi vya majeraha unajulikana kupitia hekima ya kale. Uwepo wa jambo kama hilo umejulikana kwa muda mrefu kwa watu wa Mataifa ya Kwanza kama "kumbukumbu la damu" na "majeraha ya roho". Mshtuko wa akili wa kizazi kwa kizazi ni nini? "Kama ilivyoelezwa katika makala ya ""The Healing Foundation's #OurFutureYouth Webinar"" iliyochapishwa tarehe 24 Julai, 2018." "Kama chanzo cha elimu, kitabu hiki kinaelezea jinsi ""trauma ya kati ya vizazi"" inavyotokea na jinsi inavyoathiri vijana wa asili na wa visiwa vya Torres Strait (https: healingfoundation.org.au)." Nadhani inaelezea vizuri sana. "Kutokana na hali hii, ni muhimu kutambua kwamba ""mzazi"" ni ""mzazi"" na ""mzazi"" ni ""mzazi"" na ""mzazi"" ni ""mzazi"" na ""mzazi"" ni ""mzazi"" na ""mzazi"" ni ""mzazi"" na ""mzazi"" ni ""mzazi"" na ""mzazi"" ni ""mzazi"" na ""mzazi"" ni ""mzazi"" na ""mzazi"" ni ""mzazi"" na ""mzazi"" ni ""mzazi.""" "Kama ilivyoelezwa hapo juu, ""mfano wa majeraha ya kizazi cha pili"" ni ""mfano wa majeraha ya kizazi cha pili"" - ambayo ni athari ya majeraha ya kizazi cha pili, ambayo ni athari ya majeraha ya kizazi cha pili, ambayo ni athari ya majeraha ya kizazi cha pili, ambayo ni athari ya majeraha ya kizazi cha pili." Kazi ya Yehuda juu ya watoto wa waokokaji wa maangamizi makuu huonyesha jambo hilo. Matokeo ya majeraha ambayo mzazi amepitia hupitishwa kupitia njia za epigenetic (kimsingi, sehemu ya DNA ya mzazi hubadilika na hii hupitishwa kwa watoto na inaweza kutambuliwa katika DNA ya watoto). Neno linalotumiwa hapa ni "kuchochea" kwa sababu kuna kutoelewana kuhusu hili. Ni jambo la thamani kusikia hili likfafanuliwa moja kwa moja na Rachel Yehuda. Ufafanuzi huo, unaohusisha mazingira na chembe za urithi, ni wenye kusadikisha. Hii ni sawa na mjadala wa asili ya kawaida na malezi. Dk Yehuda anaendelea kuwa mwanasayansi, akifuata uthibitisho kwa uangalifu, na bila kusisimuka kupita kiasi. Hata hivyo, kuna maoni mengine juu ya epigenetics na baadhi ya ukosoaji kuhusiana na matokeo haya. Si Kila Mtu Anakubali Utafiti uliofanywa na Dakt. Yehuda na wenzake. Kwa kweli, ni muhimu sana kusoma na kutafakari juu ya epigenetics. "Imeelezwa kuwa hii ni maonyesho ya kwanza ya ushirika wa majeraha ya wazazi kabla ya mimba na mabadiliko ya epigenetic ambayo ni dhahiri katika wazazi wote walio wazi na watoto, kutoa ufahamu wa uwezekano wa jinsi majeraha makali ya kisaikolojia yanaweza kuwa na athari za kizazi. ""Hata hivyo, ukubwa wa sampuli (n = 22) ni ndogo sana na haiwezi kuenea kwa idadi kubwa zaidi." Pia ni muhimu kufanya utafiti zaidi wa muda mrefu kuchunguza athari na maambukizi ya majeraha ya kati ya vizazi katika vizazi zaidi ya moja. Jambo hilo linatambuliwa na Yehuda et al. "Josef Glauzs, mshiriki wa utafiti wa Yehuda et al (2015), aliuliza: ""Je, mtu anaweza kutenganisha athari za hadithi za kutisha zilizosikilizwa katika utoto na ushawishi wa epigenetics?"" Anaelezea John Greeley, Profesa wa Genetics na Pediatrics katika Kituo cha Epigenomics katika Chuo cha Albert Einstein cha Tiba huko Bronx, New York, na Rafael Irizarry, Profesa wa Takwimu za Matumizi katika Harvard na Taasisi ya Saratani ya Dana Farber." Yehuda et al. "Kama ilivyoelezwa katika makala ya ""Mwanzo wa Ugonjwa"" ya mwaka 2018, athari za majeraha ya kiakili zinaweza kupitishwa kutoka kwa wazazi hadi watoto kupitia utaratibu wa epigenetic." Kichwa hiki kimesababisha majadiliano na mabishano katika fasihi ya kisayansi, vyombo vya habari vya kawaida, na utamaduni kwa ujumla. Makala hii inaelezea uchunguzi wa awali ambao umesababisha uchunguzi wa hivi karibuni wa utaratibu wa epigenetic kuhusiana na athari za mfiduo wa trauma ya wazazi juu ya wazao. Utafiti wa epigenetic katika wanyama umetoa mifano ya jinsi athari hizo zinaweza kupitishwa. Hata hivyo, sifa ya yoyote maalum epigenetic taratibu katika masomo ya binadamu ya wazao wa waathirika wa majeraha ni mapema kwa wakati huu. Makala hiyo inaelezea baadhi ya njia ambazo matokeo ya kwanza ya epigenetic katika wazao wa waokokaji wa majeraha yamewakilishwa katika vyombo vya habari maarufu. Ripoti zimetoka kwa madai ya kurahisisha kupita kiasi na ya kuvutia hadi kufutwa kazi ulimwenguni pote. "Wanahusika wanajadili umuhimu wa uwazi katika lugha wakati wa kuelezea matokeo ya epigenetic kwa watazamaji wa kawaida, haja ya kusisitiza mipaka na ahadi ya utafiti juu ya usambazaji wa kizazi cha athari za majeraha, na umuhimu wa kukabiliana na tafsiri maarufu ambazo zinaonyesha ""kuamua kwa biolojia.""" Wanasayansi wana wajibu wa kusaidia katika kutafsiri matokeo muhimu ya utafiti na njia mpya za utafiti kwa umma. """Ni muhimu kutambua njia ambazo utafiti huu unaweza kupokea bila kukusudia kama kuunga mkono hadithi ya uharibifu wa kudumu na muhimu katika watoto, badala ya kuchangia majadiliano ya uwezo wa kubadilika, kubadilika, na kubadilika katika mifumo ya kibiolojia iliyoathiriwa na shinikizo,"" alisema, akiongeza kuwa utafiti wa awali ulionyesha uchunguzi wa awali kuhusu utaratibu wa epigenetic unaohusiana na athari za mfadhaiko wa wazazi kwa watoto." Utafiti wa epigenetic unaohusiana na wanyama unaonyesha mifano ya uwezekano wa maambukizi lakini ni mapema kusema kwamba maambukizi ya epigenetic hutokea kwa wanadamu. ripoti ya matokeo ya awali yamekuwa rahisi na ya kuvutia na wamepoteza usahihi licha ya ukweli kwamba hii ni muhimu kudumisha. Kuna mapungufu na matumaini ya uwezekano katika utafiti juu ya uhamisho wa kizazi cha majeraha kutoka kwa wazazi hadi watoto wao, ni muhimu kwamba matokeo ya utafiti katika eneo hili hayaeleweki vibaya kwa njia ya kupunguza au kupunguza ili watoto wa waokokaji wa majeraha wasionekane kuwa wameharibiwa kabisa. - Majadiliano yanahitaji kutetea hadithi ya upinzani, uwezo wa kukabiliana, na kubadilika katika mifumo ya kibiolojia iliyoathiriwa na mkazo. Kwa hiyo, hilo linamaanisha nini kwa wataalamu wa tiba? Kama wataalamu wa matibabu, sisi ni katika biashara ya kusaidia watu kupona kutoka kwa majeraha. Wataalamu wa tiba lazima wategemeze hadithi ya uimara, kubadilika, na kubadilika katika mifumo ya kibiolojia iliyoathiriwa na mkazo. Hii ni kanuni kuu inayoongoza nyuma ya kazi tunayofanya. Hata hivyo, tunahitaji kuwa na habari nzuri ili tuweze kutoa matibabu bora iwezekanavyo. Kwa hiyo, twapaswa kufanya nini? Hapa kuna madokezo fulani. - Hatuhitaji kuambukizwa katika mjadala kuhusu epigenetics <unk> kwamba itakuwa wazi zaidi kwa wakati. Hata hivyo, ni wazi kwamba kuna maumivu ya kihisia-moyo yanayotokana na vizazi mbalimbali. Wateja wanaweza kuwa na uzoefu mbaya kwa sababu ya kuwa wazi kwa mazingira ya familia yenye kuumiza. Mshtuko wa kizazi huelezea maambukizi ya kizazi cha wazazi ya uzoefu wa majeraha kwa watoto wao na hata wajukuu. - Ni wazi hii si kuhusu kulaumu, lakini ni kuhusu kutambua kwamba mazingira ya familia ya kuumiza inaweza kuwa na athari mbaya kwa wale ambao kukua ndani yake. Matokeo mabaya ya uzoefu wa kiwewe, ikiwa ni pamoja na vita, mauaji ya kimbari, na ukandamizaji unaoendelea, yanaweza kubadilisha uwezo wa mtu wa kuwa makini na sasa, kuwa na uwezo wa kupenda, kuunda vifungo, au kuwa mzazi vizuri. - Kama wataalamu wa matibabu, tunahitaji 'kufungua' historia hii ya familia na kuifahamu - wote kwa kazi yetu wenyewe kama wataalamu wa matibabu na jinsi tunaweza kuendelea (fikiria uwanja wa mabomu ya trauma) na kwa wateja wetu kufunua historia yao wenyewe. - Njia rahisi ya vitendo lakini yenye nguvu ya kufanya hivyo ni kwa kutumia genogram. Hii inakaribisha majadiliano yote mawili na inaweza kusaidia sana uwazi kutokana na asili yake ya kuona. Wataalamu wa tiba wanahitaji kujua jinsi ya kufanya kazi na genograms na aina tofauti za notation kutumika katika hizi. Kazi hii inapaswa kufanywa polepole kama sehemu ya hatua ya unpacking na kutambua mifumo mpya ya ufahamu kwamba kuibuka. Tafuta hasa jinsi ya kuchukua historia ya majeraha katika chapisho hili. - Tunahitaji kusikiliza kwa bidii hadithi ambazo husemwa kwamba hadithi ambazo familia imefanya na kuishi kwa <unk>. Kama Dan P. Mc Adams amesema <unk>Watu huunda hadithi za maisha yao kwa watazamaji maalum. Mpokeaji au watazamaji wa hadithi wanaweza kuathiri sana fomu ya hadithi. Hadithi hutengenezwa kwa njia maalum na wateja wanaweza kuwa "wafungwa" wa hadithi maalum za familia. Tunahitaji kuwasaidia kwa upole kuondoa kufuli za minyororo ambayo inawafunga katika kile kinachoonekana kama ukweli wa hadithi fulani. Ni muhimu kutambua kwamba ni nini ambacho kinaweza kuwa ni hadithi ya kawaida katika mfumo wa familia na ambayo imepitishwa kutoka kizazi hadi kizazi. Hii inaweza kuwa si sawa na uzoefu wa sasa wa mteja au ukweli au matakwa ya baadaye. Hapa ndipo nguvu na uwezo wa kuzoea mambo unapoingia. - Kama hadithi ni aliiambia, tunahitaji kuangalia na kusikiliza kwa sauti ya kihisia na somatic athari katika mteja. Wanakasirika, wanakuwa na wasiwasi, wanalia, au wanashindwa kusema? Ni mifano gani wanayotumia katika lugha yao ambayo inatuambia kwamba mifano ni muhimu kwa sababu ni njia pekee ya kuelezea isiyoelezeka? Tunahitaji pia kuwa na uwezo wa kutumia vyombo mbalimbali ili kuwezesha hadithi kuambiwa, na si maneno tu. - Tunahitaji kuwa trauma-kuarifiwa kama wataalamu na kuwa na uwezo wa kusaidia wateja kukaa ndani ya dirisha la uvumilivu. Tunahitaji kuwa na uwezo wa kupunguza na kurekebisha mwendo wa vikao na kuwasaidia wateja kujituliza. Tunahitaji kusafiri polepole kupitia uwanja wa mabomu ya trauma. - Tunahitaji kuwa na ufahamu wa hatua za maendeleo ya binadamu na ni umri gani mteja anaelezea hadithi yao kutoka. Jinsi mtoto wa miaka sita atakavyoelewa hadithi ya tukio ni tofauti na ile ya mtoto wa miaka kumi na sita. - Kazi ya matibabu inahitaji kuwa ya ushirikiano. Inahitaji kutegemea na kufanya kazi na hekima, pembejeo, na mapendekezo kutoka kwa mteja katika mchakato wote wa matibabu, pamoja na maarifa ya kitaaluma na utaalam wa mtaalamu. Mwishowe, mtaalamu wa matibabu anahitaji kuwa na mpango wazi ambao unahusisha kufanya kazi hadi mwisho kutoka kikao cha kwanza, na sio kushiriki katika mchakato mrefu ambao utaumiza mteja tena au ambao utahusisha kuwa katika matibabu kwa miaka? Utaratibu huo unahusu utatuzi na uponyaji. Wataalamu wa matibabu fulani hupenda kuweka mambo kama hayo katika jarida au kuyaweka kwenye ubao wa matangazo.