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Healing trauma with
Belief
metaphoric cards
Survivors of disasters can fall into a vortex of
helpless despair – or climb a healing spiral using a
variety of resources. One effective tool to aid
recovery is the deck of COPE cards
Affect
by Dr. Ofra Ayalon
Social Crisis and disaster are part situation. The rage can be to becoming a victor? Some
of life. We are exposed to turned against inwards or do it by taking an active role
dangerous environments against others. in resolving the trauma,
through war and terrorism, assuming responsibility for
ecological, natural or Trauma, then, can create a self-healing, assuming
technological disasters and vortex that pulls people responsibility for healing
urban violence. Poverty, down and tempts them to others. Others may choose
racial persecution and adopt the victim identity, to compassion and forgiveness.
physical or sexual abuse also the detriment of all previous One dramatic example is the
cause suffering and trauma, personal achievements and forgiveness rituals engaged
as do individual crises such future plans. When the in by the Amish community
as loss and death of dear ‘traumatic narrative’takes in Pennsylvania after six
ones, destruction and loss of over, it becomes the centre of girls were killed by a local
home, abandonment and our thoughts, feelings and milk lorry driver3. Some
betrayal. relationships. The price for survivors focus on altruistic
adopting victimhood is work and lobby for important
The trauma vortex giving up control over one’s social causes. One example
Imaginative/ Survivors of such disasters life. One example was H, a is Mrs. G, the mother of a
metaphoric are often left feeling helpless survivor of an Israeli school murdered girl, who wished
or depressed, plagued with disaster, where adolescents to spare the life of her
guilt or anger, caught in the were held as hostages and 22 daughter’s murderer and
Cognitive
trauma vortex. This metaphor, of them killed. Twenty years made it her life mission to
reprocessing
coined by Peter Levine1, later, H still signed all his fight against the death
describes the whirlpool of letters as ‘victim of the penalty in California4.
chaos in the aftermath of Ma’alot massacre’. He visited
trauma. Also called the ‘black the graves of his schoolmates There are healing methods
hole’of trauma, it is a every day, apologising to that will help traumatised
downward spiral that traps them for his survival2. individuals manage their
the traumatised, who may hyperarousal and contain
find it difficult to control From victim to victor their explosiveness and
their sensations, images, Adifferent outcome of hypersensitivity. This can be
feelings, thoughts and trauma can be a healing done by shedding light on the
behaviours. Their essential spiralthat pulls people up. pull of the trauma vortex, and
needs for safety are shaken, People are apt to find inner providing knowledge and
as is the right to exist hidden resources, and practice of coping resources.
without danger, the sense of transform their priorities by It is, however, imperative to
competency and the ability to attending to family, social understand the nature of
control one’s destiny. Anger and spiritual values. traumatic reactions and how
Physical and rage mount, coupled with individuals and groups
(body/mind) a deep sense of powerlessness How do we make the choice vacillate between the two
at their inability to right the to move from being a victim vortices, from hope, optimism,
22 therapy today September 2007
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energy and altruism to BASIC Ph coping modes creative ways of expressing Getting started
fatigue, frustrations, In the process of researching painful memories. Images in The first step toward
disillusionment, polarised for ways of promoting the COPE cards elicit recovery and healing is to
thinking and back again5. resilience and healthy ways personal hidden memories or reach physical and
of coping, we have developed fantasies related to the psychological safety and
COPE – the art of healing a new model of ‘coping traumatic experience. Any security. In this safe space, it
When trauma is beyond resources’acronymed BASIC COPE card (or combination is possible to vent feelings by
words, we look for non-verbal Ph. This is a holistic of several cards) can function verbal and nonverbal means,
and psychologically safe multimodal framework that as an opportunity to surpass to share dreams, nightmares
methods of expression and contains six modes of coping dire reality and find solace and other traumatic
sharing. People are relieved resources: Belief systems, in imagination. reactions. When appropriate,
when offered the opportunity Affective expression, Social 5. Cognitive reprocessing mourning and memorial
to approach their painful support, Imagination/ means using cognitive skills rituals can promote positive
experiences step by step, creativity, Cognitive processing, to make sense of the trauma affirmations of resilience.
starting by using symbols Physical behaviour8,9. These narrative as it unfolds in
and metaphors. One of the six modalities merge into one reaction to the visual images Any COPE card or
most effective tools in in our worldwide trauma- of the cards. This is yet combination of cards can
eliciting healing metaphors coping training programs, another mode of gaining serve as a trigger for the
is a set of illustrated cards and are represented by six control over posttraumatic narration of the event and
called COPE cards, that COPE ‘hand’cards (see issues and painful memories. responses to it. Using the
belong to a specially previous page): The purpose of re-telling the COPE Cards provides an
designed genre of associative traumatic story is to re-visit opportunity for recounting
cards (the OH-cards series). 1. Beliefsystems refer to the scene in safe mode personal recollections of
faith in God or a supernatural (thereby releasing its grip of traumatisation in a safe
COPE cards, initiated by power, trust in other human terror andhorror), analyse environment, since
myself, painted by the beings or trust in oneself. and understand the demand metaphoric stories triggered
Russian artist Marina Faith and hope are well- of the situation, and plan by the visual images of the
Lukyanova and issued by documented mental coping strategies of rescue and cards are one step removed
the German publisher resources with trauma10. coping. from anguished reality. This
Moritz Egetmeyer, represent 2. Affectis the feeling 6. Physical (body/mind) ‘creative distance’facilitates
an international joint effort aspect of consciousness. The coping modes. The trauma recall and the working
to deal with the heart symbolises love and is stored in the body. Levine1 through of trauma
consequences of traumatic hate, fear and courage, grief suggests the use of body experience. The use of image
events and help heal psychic and joy, jealousy and awareness and somatic and imagination serves as a
wounds6. The 88 cards compassion etc. This coping experience for unfreezing the protective screen against
enable their users, whether mode involves chiefly the somatic trauma and being overwhelmed by
playfully or therapeutically, ability to recognise feelings regaining body-mind control. intense emotions. When the
to access deep feelings and and name them, and then to These methods are used to memories become too much
narrate their experiences. By express them by verbalising build a flexible balancing of to bear, one can always
using COPE cards, (telling, writing, dramatising) tension and relaxation, return to the imagined story,
participants can learn to or by nonverbal activities, establish body-boundaries or look for other cards that
identify their own particular such as free play, dance, and re-examine the may serve as anchors for a
ways of coping with crisis, painting, sculpting or music. relationship between sense of thriving, surviving
stress and trauma. The 3. Socialcoping skills focus personal space and trust. and healing.
experience of randomly on interaction with others.
selecting cards and dealing Such interactions include the The other projective- Identifying coping skills
with the associations they giving and receiving of metaphoric cards in the set, This activity aims to discover
evoke can elicit new ideas support by family members, which support verbal and our normal ways of coping.
and possibilities, instead of friends and also professional nonverbal expressive and also identify those
repeating familiar patterns helpers. In the aftermath of methods, help to access coping modes that are
of thought and response. trauma, there is a strong repressed experiences. We blocked in times of crisis.
COPE cards help us reach need to bear witness – the have found this multimodal What resources would be
our inner pain and discover traumatic experiences need approach most effective in required to make them
our inner strength. Asort of to be acknowledged, helping people cope with available in times of need?
‘virtual training’takes place expressed, listened to, trauma and negotiate ways
in dealing with challenging witnessed by caring others, of resolving conflicts in 1. Spread the six COPE
situations, in surfing beyond tolerated, contained, treated situations of violent armed ‘hand cards’face up on the
time and space, in and healed. conflicts, suicide prevention table, and identify each of
experimenting with possible 4. The Imaginative/ and domestic violence. In them according to the BASIC AN
Y
R
solutions to conflict-laden metaphoricmode is the key actual traumatic situations, Ph model (Belief, Affect, B
Y
R
issues – all within the safe to coping when traumatic people usually employ a Social, Imaginative, A
G
+/
world of image and experiences are ‘beyond combination of coping styles Cognitive, Physical modes). E
N
metaphor7. words’. It offers many to survive. 2. Pick six cards at random TO
S
therapy today September 2007 23
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from the COPE cards deck transformed by the use of all the fact that there was no In conclusion
and place them face down on six coping modes. real rope in the water.’ There is no one single
top of the ‘hand cards’, so Cognitivesolutions, the appropriate method of
that each ‘hand card’is The tsunami: examples search for information and coping for all situations, all
covered by one card. The following are examples understanding: ‘Two weeks people or all ages. Each
3. Turn the top cards up, one of the variety of coping after the tsunami, I still person, family, and
at a time, and reflect how modes emerging from COPE could not fall asleep. So community has their specific
they connect to the ‘hand cards work with survivors of night after night I searched combination of coping
card’that represents one the tsunami disaster in for information about modes, which constitutes
coping mode. Let the top Thailand11. The stories were tsunami on the web. Then I their basic coping language.
card help you describe how triggered by the COPE cards started visiting schools and The effective way for the
you use the relevant coping as a response to the sharing my newly acquired therapist to help is to join
mode in your life, in a question: What helped you knowledge. That is why they the victims’basic language,
positive or a negative way. most during and after the sent me to this training.’ and then guide them in
For example: My disaster? Physicalactivity: ‘I had to developing additional coping
‘imagination’coping mode Belief in God or in immerse myself in the hard resources.
helps me detach myself from supernatural powers: ‘At the work of cleaning the debris
my worries (positive), and time of the Tsunami I was of the storm. This was the Ofra Ayalon, PhD is an
my ‘social’coping mode praying in the mosque. The only way I could manage my internationally renowned
makes me needy and over- wave arrived abruptly, anxiety and sadness.’ traumatologist, author and
dependant on others flooded the street, circulated Another teacher said: trainer in the field of trauma
(negative). the mosque and did not ‘Working with children, I and coping with terrorism.
4. Now, think of a time in touch it. Amiracle happened succeeded in calming them She is currently Director of
your life when you and I was saved with the down by engaging them in Nord Cope Center in TIVON,
experienced severe stress or grace of God.’ vigorous movements until Israel, and senior consultant
crisis. Turn the remaining Affectand expression of they tired, sat quietly, at the Community Stress
COPE cards face up and their feelings: ‘There was a breathed deeply and Prevention Center in Israel.
choose three cards that time when I experienced an relaxed.’ Email: [email protected]
describe this experience. immense feeling of pain
5. Try to identify which of inside me. It’s hard to
References
the coping modes you have explain. I could not find
1. Levine P. Waking the tiger: healing trauma. Los Angeles: North
employed to deal with that words to share my feelings
Atlantic Books; 1997.
crisis. Use the cards to tell with my friends. I did not
2. Desivilya S, Gal R, Ayalon O. Long-term effects of trauma in
the story of your coping. dare burden them with my
adolescence. Anxiety, Stress and Coping. 1996; 9(3):13-150.
6. Try also to identify those agony. That’s why these
3. ABC World News, October 2006.
modes that you have not cards were so important for
4. Personal communication, 1999.
used – and turn their me: they allowed me to deal
5. Ross G. Beyond the trauma vortex: the media’s role in healing
representative cards face with my own feelings, same
fear, terror and violence. Los Angeles: North Atlantic Books; 2003.
down. These cards represent as everybody else in our
6. The UK distributor of the COPE cards (and other OH-Cards) is
those coping modes that group. I am not ashamed
Steve Weir at Transform Your Life; www.transform-your-life.org;
were blocked by the any longer. It is a relief.’
tel 0114 221 5599.
traumatic event. Social skills: ‘I volunteered
7. Ayalon O. The HANDS project: helpers assisting natural
7. Find cards that will help to help people who were
disaster survivors. Community Stress Prevention. 2003; 5:127-135.
you reactivate those blocked hurt. Their suffering was
8. Ayalon O. Rescue! Community oriented preventive education.
modes. much greater than mine. By
Ellicott City: Chevron Publishing Corporation; 1992.
8. Reflect on the whole helping others I helped
9. Lahad M. Darkness over the abyss: supervising crisis
process of how you identified myself.’
intervention teams following disaster. Traumatology. 2000;
your existing resources for Imagination: ‘Do you want
6(1-4):273-294.
coping with crisis and how to know how I was saved
10. Frankl V. The will to meaning. New York: New American
you activated additional from death? As I was
Library; 1988.
resources. Share your drowning, I imagined a
11. Ayalon O. Children’s response to terrorist attacks. In: Knafo D.
reflections. Re-tell the story strong rope in the water. I
(ed) Living with terror, working with trauma. New York: Jason
of your traumatic seized it and pulled myself
Aronson; 2006.
experience, and how it was up. I was saved, in spite of
24 therapy today September 2007
