A Humanistic Approach to the Psychology of Trauma
by Ilene Serlin and John T. CannonChapter 16 of the book Living with Terror, Working with Trauma: A Clinician's Handbook
edited by Danielle Knafo, published by Jason Aronson, 2004
A humanistic approach to trauma focuses on the transformative therapeutic agents that help individuals move from "victim" to "survivor" and "thriver" in the face of trauma. A depth qualitative study of those transformative factors among participants identified as survivors or thrivers reveals themes of meaning and confrontation with death. Case vignettes illustrate how a humanistic clinician helps individuals find meaning in their lives and move beyond prior levels of functioning to transcendence.
How can suffering elevate us? How can it bring us closer to our truth and our humanity? These questions are at the heart of the humanistic psychological exploration of trauma. Humanistic psychology offers a philosophical and experiential perspective on how the experience of trauma can bring us closer to our humanity. This chapter will give a brief overview of humanistic psychology as it relates to trauma, followed by case illustrations. During the Loma Prieta earthquake in 1989, I (Ilene Serlin, coauthor of this chapter) volunteered at a San Francisco shelter that housed mostly elderly residents. I also participated with the Red Cross in their collaboration with the local psychological associations. After several days of being a participant-observer in the daily life of the shelter, I gathered the stories that I heard at the bedsides. My coauthor, John Cannon, then analyzed these stories for themes of psychological qualities that distinguished "thrivers" from "survivors" and "victims." These themes will form the basis for a humanistic approach to the psychology of trauma.
A HUMANISTIC PERSPECTIVE ON TRAUMA
What is trauma and why is it so disturbing? From a humanistic perspective, a traumatic event is a disruption so serious that it threatens our existence, shaking the foundation of who we are and who we once were. It makes us face our basic helplessness and mortality. Trauma confronts us with the reality of death, ripping through our sanitized lives and our monumental denial of death. Noted philosopher Ernest Becker (1973) says, "The idea of death, the fear of it, haunts the human animal like nothing else; it is a mainspring of human activity – activity designed largely to avoid the fatality of death, to over come it by denying it in some way that is the final destiny for man" (p. ix).
Trauma is a wake-up call, reminding us that everyone dies. "To speak of 'the meaning of human life' is to speak also of death, for the fact that we all die is an inescapable part of our lives" (Gillman, 1997, p. 17). It is only by confronting death, however, that we can find the courage to create (May, 1975).
Every trauma that we experience shatters our sense of coherence and meaning. Since ancient times, rebuilding or creating new meaning from traumatic events has been central to all healing processes (Frank, 1963) and expressive therapies (Gersie, 1984; Moreno, 1977). Meaning is patterned as a story, inner narrative, or myth that provides a coherent explanation for why events happen and shows us the lessons that can be drawn from them.
How do we explain the recent spectacle of a flaming space shuttle hurtling through the air? It is incomprehensible to us; we have no current mythology to explain chariots of fire. Most traditional psychology and debriefing approaches to trauma do not help us either to confront death or to discover new meaning. The focus of these approaches is to restore a sense of normalcy and personal control in life. While restabilization is obviously necessary, it is not enough.
The humanistic approach to trauma encourages us to confront our death anxiety, to discover new meaning and identity, and to move from beyond prior levels of functioning to transcendence (Calhoun and Tedeschi, 1998; Carver, 1998; Decker, 1993; Egendorf, 1982; James, 1902; Parappully, Rosenbaum, van den Daele, and Nzewi, 2002; Updegraff and Taylor, 2000). According to Decker (1993, p. 41),"Trauma has demanded that we question our ordinary perspectives, search for a more expanded self-concept, and re structure our value hierarchy." Recent research shows that trauma can bring growth and greater well-being" (Ickovics and Park, 1998, p. 238). This "better-off-afterward experience" (Carver, 1998, p. 247) is called "thriving" or rebirth. "Out of the ashes, at times literal ashes of loss and death… a phoenix-like process of internal restructuring may be set in motion which can have a liberating, regenerative effect upon the survivor" (Shabad and Dietrich, 1989, p. 467).
Humanistic psychology helps us deal more realistically with two central paradoxes of the human condition: freedom and fate (Schneider and May, 1995) and uniqueness and unity (Schneider, 1999) that are at the heart of the psychology of trauma. We struggle to understand with our rational senses and ask, Why was I in this place at this time? Why did I live and my neighbor did not? Did I do right? Did I do wrong? How could God allow such a terrible thing to happen? Is there evil? Is there a God?
These questions of meaning and faith take us inevitably to the realm of religion or spirit. Anthropologist Geertz (1973) observed that religion's role is to formulate "conceptions of a general order of existence" (p. 19). An ordered existence is coherent. Its opposite is chaos, which is intolerable.
Trauma plunges us directly into chaos. "To paraphrase Genesis, we would be exiled, and to be in exile is to tumble into chaos" (Geertz, 1973, p. 23). Chaos is associated with punishment for the original sin in the Garden of Eden, as well as a loss of innocence. The loss of innocence is one of the most pernicious effects of trauma, particularly after experiences such as the Holocaust, when basic faith in humanity or God is shattered. Moving beyond innocence and despair to a new way of knowing, called a "second naiveté" by Ricoeur (1967, 1976) and "radical amazement" by Martin Buber, Franz Rosenzweig, and Abraham Heschel, is a profound psychological and spiritual challenge. Psychologists working with this group have shown evidence of "vicarious traumatization,"sometimes sharing the cynicism and hopelessness of the victim (Pearlman and Saakvitne, 1995), and sometimes demonstrating a "deep existential sense of shame" at what they see (Danieli, 1994). Some cope by relying on God or religious beliefs (Hood, Spilka, Hunsberger, and Gorsuch, 1996). Humanistic psychology, which has a strong philosophical and spiritual dimension, can help both victims and caregivers work directly with these issues.
When thrown into existential crisis, one's world crumbles. Nothing is what it appears to be. Trauma is experienced subjectively as the confrontation with nothingness, death, and terror. It can be terrifying to feel as though one is living in a universe with random death and suffering. How do we summon the courage to keep choosing life? How can psychologists help? (Serlin, Aanstoos, and Greening, 2000).
FROM DECONSTRUCTION TO RECONSTRUCTION
Human beings have always told stories. Telling stories helps us gain perspective on our lives. Narrative, as the psychological use of storytelling to rebuild coherence, has gained increasing attention as both a form of psychotherapy (Epston, White, and Murray, 1992; Howard, 1991; Omer and Alon, 1997; Polkinghorne, 1988; Rotenberg, 1987; Sarbin, 1986; Schafer, 1983; Spence, 1986) and a method used in the human sciences (Polkinghorne, 1988; Howard, 1991; Erikson, Erikson, and Kivnick, 1986). Life stories of highly generative individuals show that they rewrite their narratives more optimistically (McAdams, Diamond, de St. Aubin, and Mansfield, 1997). Telling the story of the disruption and the reconstruction of a meaningful life can provide a narrative to deal with the existential sense of loss and help recover meaning, faith, and courage (Epting and Leitner, 1992; Feinstein and Krippner, 1988; Howard, 1991).
Humanistic psychologists have studied those transformative factors that help victims of natural and human-made disasters become survivors and finally thrivers (Cannon, 2002). While most of the psychological literature focuses on the pathology of trauma, Cannon and Serlin analyzed transcripts of survivors of the Loma Prieta earthquake for a clear understanding of those transformative moments in which survivors become thrivers. Analysis of the transcripts revealed themes that helped them transform disaster into meaning: work, courage, independence, relationships, family, and spirituality. Through reflecting on these themes, survivors were able to clarify their priorities and make changes in their lives (Cannon, 2002).
THE PRESENT NEED FOR HUMANISTIC PSYCHOLOGY
As we write, America [is] in the midst of a new war in the Middle East. Despair, a sense of meaninglessness, and conduct disorders are increasing among high school students (Fox and Serlin, 1996). Use of psychological services and psychiatric medication at college counseling centers has increased significantly, with doubled rates of depression and suicide attempts (Goode, 2003) Consulting rooms are filled with driven thirty-year-olds having panic attacks (Serlin, personal communication, 2003). People are experiencing a new stress and vulnerability in almost all aspects of life. In response to the destruction of the Columbia space shuttle, one man said, "It was a wakeup call… We're not perfect. Bad things happen to us." Another said, "So many Americans are delusional… They think they are invincible. It's horrible what happened to the space shuttle. But maybe in the end, by reminding people in this country they are not all-powerful, it will do more good" (Gettleman, 2003, p. A21).
Trauma is pervasive; no one is immune. Not an isolated incident, trauma is a series of echoes and constant assaults on the nervous system. The presence of dread in everyday life has been described as "pre-traumatic stress." Trauma cannot be separated from dramatic social and political contexts and requires multidisciplinary understanding (Stewart and Fitzgerald, 2001). A psychological response to trauma must be respectful of the cultural context in which it occurs (Owusu-Bempah and Howitt, 1995). The psychology of trauma involves prevention as well as treatment. Helping others deal with the paradox of freedom and fate is a realistic preparation for the future. For example, some trauma preparation programs in Israel have brought death education classes into early school curriculum and use role-play and other experiential methods to teach children coping strategies (Ayalon, 1988). How do we live with trauma at this time, and how do we respond with psychological and spiritual maturity? The wake-up call that shattered our American innocence and destroyed it.' meaning systems on September 11 can hopefully prepare us for a changed world.
EXISTENTIAL AND HUMANISTIC PSYCHOLOGY
What gives us the courage to rebuild shattered lives? The philosophy of existentialism, influenced by the darkness of the war and the Holocaust, fully acknowledged the dark and tragic aspects of life (Binswanger, 1936; Kierkegaard, 1945). The ability to create despite death was, however, also part of the human condition, according to existentialist psychologist and psychoanalyst Rollo May. He bridged the more pessimistic European existential psychology and the more optimistic American humanistic psychology (Rogers, 1951).
While humanistic psychology acknowledges life's limitations, it also focuses on the potential for change. The "capacity to transcend the immediate boundaries of time, to see one's experience self-consciously in the light of the distant past and the future, to act and react in these dimensions, to learn from the past of a thousand years ago and to mold the long-time future, is the unique characteristic of human existence" (May, 1958, p. 67). Some humanistic psychologists choose to emphasize the capacity for free will (Allport, 1937; Murray, 1938; May, 1969; Wertz, 1994), and others emphasize the uniqueness of each human being. "Because each individual is a product of a unique genetic endowment, a singular history of meaningful experiences, and a never-repeated developmental progression, the totality of his or her person hood or the critical choices each makes will be unique" (Allport, p. 297).
Victor Frankl, the humanistic psychiatrist who was confined in four concentration camps during the Holocaust, found his own way to make meaning from his experience. He developed an approach called logotherapy, which was based on the fact that "in some way, suffering ceases to be suffering at the moment it finds a meaning, such as the meaning of a sacrifice" (Frankl, 1959).
Abraham Maslow, a founder of humanistic psychology and the past president of the American Psychological Association (APA), brought the study of transcendence into the field of psychology (Maslow, 1962, 1971), calling for a new kind of individual who could meet the challenges of the postwar era. "To put it bluntly, we need a different kind of human being… who is comfortable with change, who enjoys change, who is able to improvise, who is able to face with confidence, strength, and courage a situation with which he has absolutely no forewarning" (1962, p. 56). Maslow called this kind of individual a "self-actualizer." Long before the coaching or positive psychology movement became popular (Seligman, 1998), humanistic psychology used the language of self-actualization to describe how individuals transcend trauma.
Given humanistic psychology's emphasis on the uniqueness of each individual and each encounter, the value of spontaneity (Perls, 1992) and personal ways of knowing (Polanyi, 1958; Serlin and Criswell, 2001; and Serlin, 1997), it follows that its clinical approach is nonprogrammatic. There are no manuals. Humanistic psychology is a process, a Socratic dialogue (Buber, 1958; Friedman, 1985) that resists quantification, manualization, and pathologizing of others people (Greening, 2001).
THE SURVIVOR OR THRIVER PERSONALITY
Research on the quality of thriving in adults and children is a recent phenomenon; the last ten years saw a shift in focus from "child survival" to "child survival and development." Child posttraumatic disorder was first named in the 1987 revised edition of the American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders-Third Edition. Humanistic psychologists believe that this diagnosis is simplistic and does not identify the qualities of strength or coping that help psychologists foster these qualities in people who experience trauma. The qualities that differentiate a survivor from a victim have been described in terms of optimism, resilience, or hardiness. Optimism is a "generalized expectation of successful outcomes that is expressed in renewed efforts to attain goals, despite the disruption constituted by stressful circumstances" (p. 95). Resilience is defined as "Resourceful adaptation to changing circumstances and environmental contingencies" (J. H. Block and J. Block, 1980, p. 48). Hardiness (Kobasa, 1979; Maddi and Kobasa, 1981) is characterized by commitment, control, and challenge, and has been correlated with health (Maddi and Kobasa, 1994). The evidence suggests that hardiness protects physical and mental health, even as stressors mount. One critical aspect of hardiness is coherence, defined by Antonovsky (1979) as "confidence that… there is a high probability that things will work out as well as can be reasonably be expected."
Hardiness, optimism, and resiliency build what Siebert calls the survivor personality (1996). The survivor is one who "has survived a major crisis or challenge; surmounted the crisis through personal effort; emerged from the experience with previously unknown strengths and abilities; and afterwards find(s) value in the experience" (pp. 4-5).
THERAPIST TRAINING PRINCIPLES
According to humanistic theory, the most important agents of therapeutic change are the personality of the therapist and the therapist-client relationship (Bugental, 1987; May, 1989). The following are therapeutic guidelines that emphasize the development of the personal qualities of a healer in the therapist and the transformative potential of the healing relationship (Maslow 1965; Rogers,.1951). The ability to face mortality can lead to creativity and boldness in the face of death; life-changing events can be transformative; trauma involves the whole person; normalcy is socially constructed; and the human condition means living with uncertainty. Uncertainty is not a mental disorder for psychologists to treat. May (1975) described the leap of faith needed to deal with uncertainty and to leap into the unknown. Existentialists have called this the anxiety of nothingness.
A humanistic approach totrauma requires:
This case was chosen because of its importance to the new psychological challenges posed by globalization. Given the enormous loss of sense of place, culture, and traditional safety nets, people are increasingly disoriented and in states of chronic stress. Insurance code 309.29 lists Adjustment Reaction, Culture Shock, as a mental disorder. Psychotherapists who work with such displaced people may need to help them confront their pasts, which may include human-made trauma and death, and support them to create a meaningful new life and identity.
Margarita is a graduate student in her mid-thirties. She has been in the United States since she was an infant and left Nicaragua with her mother. Her mother is from a wealthy family in Nicaragua and her father is a Caribbean revolutionary "international terrorist" who fought with the Sandinista Revolution. Margarita struggled to understand herself, to establish her identity, and to assert her independence. To do this, she had to confront lingering shadows of death, meaninglessness, fate, and isolation.
Trauma haunts her. It is not a single event in her life, but an ongoing presence, containing echoes of earlier traumas. Her most recent traumatic shock is culture shock from a recent life-changing experience. Margarita went back to Nicaragua to come to terms with her past. She stayed three and one-half years, digging deeply into the culture of her family and village. The culture shock began as soon as she arrived. "My first experience began with assimilating to the farm life on the opposite side of the road of Sandino's hometown, called Niquinohomo (Masaya), where my granny is from. This area is very indigenous. After being an only child in San Francisco, I found myself feeding ten mouths, including family and plantation workers."
The most powerful moment came when she found her father. "I met my father for the first time when my mother visited and took me to him. Miguel was shot during the revolution by Contras, while walking towards his tank. His troop got infiltrated and he was the only one to survive. Dad was trained in Spain, Brazil, and Bosnia in the areas of agriculture, ecology, biological and guerrilla warfare. Later, he would gain the title of 'international terrorist.' …found him at his mother's in Managua, unable to walk or speak coherently. 'I'm sorry I… I wasn't there.'"
Beginning to understand and carry her father's legacy, she now combined it with her own talents for poetry and drama as the activities director of a school back in the United States where she brought together black and Latino, elitist and poor children in an annual music contest. Empowering the youth was what she called "Doing Dreams." Being a conscious bridge between two worlds was "perturbing." It was, however, clearly her path and her calling. Asked what her legacy would be, she said that she would combine her mother's organizational abilities to make things happen with her father's socialist beliefs for a strong determination to make things "right by people."
The return to the United States was surreal and shocking. One thing that kept her sanity and gave her perspective was writing. She noted, "I didn't just need to deal with the present, but also had to accept my situation as a real part of life, realizing that so many others in my country had learned at infantile stages to adapt to harsh challenges of survival.
Seeing her legacy as the intricate blending of her mother's and father's projects and culture helped her make her own bridge to "doing [her] dreams" with "immense momentum of determination to make things happen." She left much stronger in her sense of self. "Nicaragua fully blessed me in gaining strong cultural identity, understanding my people and working through a sense of survival."
This client confronted death on many levels and discovered renewed life in herself. She confronted absurdity in the form of the surreal culture clash and senseless killings and found meaning in her bridge-building work. She faced the tragic and heroic faces of her fate, but found freedom in her own life. Finally, she found her unique identity in the midst of a rich community and kept them all in balance. This therapeutic approach corresponds to the four challenges of existential psychotherapy as outlined by Yalom (1980): life (and death); meaning (and absurdity); freedom (and determinism); and community (and aloneness).
A humanistic psychotherapeutic approach helped her to find her own voice. Therapy was egalitarian and included mentoring. I (coauthor Ilene Serlin) connected her with graduate-student organizations specializing in multicultural agendas that gave her more support to transform her trauma into a vocation as a "wounded healer." Wounded healers represent an example of turning trauma into helping others. Margarita described it as "I bring my stuff here, but am learning life skills… I do not leave this door feeling disempowered." For this student, that meant claiming her nonverbal, non-Western roots of the African Yoruba religion. Listening to tribal music, she danced and noted, "We make the magic at midnight – the world is calling out for us as healers, women, elders." She described how the immigrant experience deprived her of female role models, as her aunts and cousins "all went to school, worked, intermarried… had to show success, own a car, a home, individuate and live on their own."
She heard her grandmother's voice inside her urging her to marry a white man and reclaim an upper-class life in the United States. As the therapist, I joined her story, laughing and crying along with her. The connectedness was experiential. According to Margarita, the "feeling was immediate, there was an immediate commitment to her and to the space we created together. Therefore, I was able to make a commitment to myself." The commitment helped her feel "safe," which she "needed to be her authentic self, and encounter my own optimism and resilience." I shared stories of my own ancestors and their immigration experience and the common existential task of going back to one's roots for nourishment, while moving forward into a new identity in a new country. I became, in Margarita's words, a "bridge" helping her move through different worlds. Since trauma results in so many aspects of splitting, having a bridge is essential. It helped Margarita "transcend boundaries of what America puts here, and putting in place my own boundaries to survive." To do this, she learned to draw on psychological and spiritual resources, some from her own heritage: "In our traditions, we're spiritual people. The voice to navigate through the society and bridge has to come from there." Margarita's spirituality was not "up," but "down here, from the earth and the heart."
The dialogue was framed not as a therapist treating a disorder in another person, but as shared universal human experience. Through opening to a spiritual and archetypal perspective, we were both able to move beyond personal disruption into a transcendent experience.
Loma Prieta Earthquake
Natural disasters do not face us with problems of human evil, but they do confront us with other dilemmas of death, meaninglessness, fate, and isolation. Crisis intervention with survivors of the earthquake elicited the following stories of how they transformed trauma into thriving. These elderly residents were scared and were having difficulty sleeping. Because I (coauthor Ilene Serlin) helped them set up their sleeping cots, I talked to them as they went to sleep, developing a strong therapeutic rapport and trust. Being flexible allowed me to establish a context for the therapeutic conversation, as well as to have access to a time for effective use of relaxation and imagery. In contrast, a later program that was created by a local psychological association and the Red Cross set up counseling services far away from the area in a parking lot, with sign-up sheets on desks. Consequently, very few people attended.
Residents in the shelters freely shared their fears. All experienced danger and the potential of death. Some overcame this with altruism, by focusing on helping other people:
I wasn't feeling emotionally scared. I was calculating the possibilities and it seemed quite possible that the house would fall apart, it was so violent. I was just trying to think what is the best place to go, where should I put this lady so that it's safest for her. I really was thinking what to do with her more than about me.
A shy student learned to reclaim life and be present in the here and now:
I used to be really quiet and wouldn't say anything and if somebody bugged me I wouldn't say much. But now I just say what's on my mind. I don't think there's time to sit around and just get mad about stuff and not say anything. The time is here and now to speak your mind.
Another responded to death as a challenge: "And when the earthquake happened… felt ready to die… I felt like 1 was being called to be as brave as I possibly could."
Cannon (2000, 2002) observed that "the survivors celebrated life. They understood that when it was their time to go, it was their time to go. In the meantime, they chose to celebrate life" (p. 145). The survivors also gained meaning from their experience. One survivor who had lost her husband was advised by authorities to evacuate her apartment. She responded by finding a meaningful alternative:
I figured I'd go to O'Brien Army Hospital where I used to work… I was a nurse there. And I'd help out there… So I went there, and the guard screamed at me at the gate and says, "What do you want?" And I said, "I'm going to volunteer here. I worked here." So they let me in, and I went to my old unit.
Another survivor who was traveling from another country gave up her vacation and overcame bureaucratic obstacles to volunteer with the Red Cross:
I didn't want to just sit around, you know, I came here for a vacation… there was a lot of cleaning up… and things that needed to be done…. I was watching one of the news broadcasts and they had the phone numbers up for volunteers and so I called it. …Their phones were jammed so I just came down here anyway.
One student expressed the sense of meaning that commitment to self and others provided:
I also have a little time left over. I'd like to help. I guess it's a feeling of purpose and accomplishment, that's why I'm here. Not because I feel like a saint or anything like that. Just give some purpose to my time that would otherwise be wasted.
Another student cried as he expressed how he drew a sense of meaning from the earthquake:
Right now? What I feel is important is finding myself what… sort of comes from within me… rather than… being on the fast track treadmill… what else is important is people… some of the most important things that I, I've seen this last week are the relationships that I've had with a few very, very special people… the relationships are true treasures… I'm doing a lot of reflecting about… what I want to do with my career… also what I want to do about spirituality.
Some found and expressed meaning through religion, such as a renewed interest in church or God: "I thank God every night for taking care of me and letting me get through each day." Others found meaning through a personal sense of spirituality. They also expressed their choice to live in terms of gratitude. Several of the elderly residents made comments like: "I had a full life… Grateful I lasted this long"; "I was shook up, but you don't want to stay shook up. You're just grateful you're alive. You're all in one piece"; and "Well, I feel very fortunate because we were all together… and that was a real blessing."
The dilemma of freedom and fate was taken up by a student in a group discussion:
We don't have control over certain things but we can make choices… It's like we're a boat and we've got a rudder to steer our way. We don't have control over the tides, we don't have any control over the wind, but we have a responsibility and an ability to keep our hand on the rudder and at least try to keep the ship from sinking or steering it the right way. Or choosing to go places where, you know, the weather is OK to the best of our ability.
Some reached out to others at a time of crisis. One spoke of her commitment to self and others that helped her through the isolation:
What struck me most was the attitude of the people in the building. Everybody came around. They were not only checking on me but they were checking on everybody else, and it was the first time since WWII that I have felt this same spirit of, we're all in it together to do the best we can… So everything that I had I cut in half and we shared.
Some of these residents showed wisdom, transcending the dualities of trauma. They were able to experience the paradoxical loss and celebration of life simultaneously. "It's OK to feel lousy. Yes we're grateful but it's still lousy and that's OK." "This is real and vivid and poignant… what happened to my home and my things has brought all of those… to life for me in a way that was never the case before. And I'm glad of that." Other expressions of transcendent moments were "kind of changed me into a better person. It may sound corny, but it's true"; "I realized I had a soul"; and "I saw this really, really beautiful warm light and it was enveloping and healing… I was really trembling and crying hard… I just felt this wonderful love."
During the crisis of the Loma Prieta earthquake, humanistic psychologists who offered counseling observed survivors who were confronted with death, meaninglessness, fate, and isolation. Some, who were thrivers, were able to become more authentically themselves and create a more meaningful life.
Humanistic psychotherapy demonstrated a flexibility to therapeutic role and context that allowed people to feel respected as successful human beings, not as psychiatric disorders. In humanistic psychotherapy, the transference reaction is not analyzed, as much as lived consciously. In the earthquake shelter on dark evenings, I (coauthor Ilene Serlin) became the granddaughter listening to the elderly transmitting their stories, the family friend who might help someone place a call. All were neighbors, sharing stories about family and other memories, and caring about each other. More important than playing a role, I was present. Bugental says, "Presence is immensely more than just being there physically… Presence is being there in body, in emotions. It is being totally in the situation… in relating, in thoughts, in every way. Although fundamentally, presence is a unitary process or characteristic of a person in a situation, accessibility and expressiveness are its two chief aspects" (Bugental, 1978, pp.36-37.) The conversation was client centered, as the flow of the narrative was established by the resident and no alienating forms or standardized questions were used. Questions of value and meaning were explored when initiated by the resident.
A humanistic psychology approach to trauma can bring human beings closer to truth and humanity. It does this by supporting trauma survivors in their confrontation with fundamental existential issues of death and meaning and by helping them move to new levels of psychological and spiritual growth. By transcending the trauma, survivors can become thrivers.
Thanks to Moji Agha and students at Saybrook Graduate School and the University of Santa Cruz for helping with data collection. Special thanks to the elderly at the Loma Prieta shelter and the Red Cross volunteers for their inspiring stories.