Engage and Comfort

Engage

Goal

Establish a human connection in a non-intrusive, compassionate manner

“Your first contact with a survivor is important. If managed in a respectful and compassionate way, you can establish an effective helping relationship and increase the person’s receptiveness to further help... Even a brief look of interest and calm concern can be grounding and helpful to people who are feeling overwhelmed or confused.” (www.ptsd.va.gov’s PFA Training Manual, Version 2)

While you will be unable to communicate interest and calm concern nonverbally, some simple words stating that you are here to help in any way you can goes a long way. Briefly introduce your name and role, and then stop talking about yourself for the rest of the time. As the opening video said, this is their disaster; it is not about you.

Comfort

Goal

Provide a comforting emotional support and presence

This vital stage is all about listening to the person’s pain and being a comforting, caring presence with them. One of your greatest tools in accomplishing this goal is active listening.

Video 1 (0:14 to 1:33)

Video 2 (0:7 to 1:59)

In their online tutorial of PFA, the University of Minnesota explains some helpful tips for active listening, for which you have already been trained as a 7Cups listener. You may find reviewing these tips helpful, as well as the reminders of what not to say.

Here are further tips for comforting survivors facing specific but common post-disaster situations:

Missing a Family Member (www.ptsd.va.gov’s PFA Training Manual, Version 2, pp. 33-34)

Coping while a loved one is missing is extremely difficult. Family members may experience a number of different feelings: denial, worry, hope, anger, shock, or guilt. They may alternate between certainty that the person is alive-even in the face of contradictory evidence-and hopelessness and despair. They may blame authorities for not having answers, for not trying hard enough, or for delays. They may also feel vengeful against those that they consider responsible for locating their missing relative or friend.

Resource: The American Red Cross has established a “Disaster Welfare Information System” to support family communication and reunification, and a “Safe and Well” website located at www.redcross.org. It provides a variety of tools and services needed to communicate with loved ones during times of emergency. You may try to identify other official sources of updated information (police, official radio and television channels, etc.) and share these with survivors, or direct them to investigate them on their own if they do not seem too panicky. It they do seem unstable, helping them identify these resources on the web may be the best support you can give. Just toss in some grounding instructions as you go!

Directive tip: Sometimes the evidence they have will strongly suggest that the person is dead. There may be disagreement among family members about the status of their loved one. In these instances:

• You should let family members know that these differences (some giving up hope, some remaining hopeful) are common in a family when a loved one is missing, and not a measure of how much they love the person or each other.
• You can encourage family members to be patient, understanding, and respectful of each other’s feelings until there is more definite news.
• Parents/caregivers should not assume that it is better for a child to keep hoping that the person is alive, but instead honestly share the concern that the loved one may be dead.
• Parents/caregivers should check with children to make sure that they have understood, and ask what questions they have.

Perhaps the most important thing, though, is simply being there to listen to survivors’ hopes and fears. Support, support, support.

When a Friend or Family Member has Died (www.ptsd.va.gov’s PFA Training Manual, Version 2, pp. 34-35)

Acute Grief Reactions are likely to be intense and prevalent among those who have suffered the death of a loved one or close friend. They may feel sadness and anger over the death, guilt over not having been able to prevent the death, regret about not providing comfort, or having a proper leave-taking, missing the deceased, and wishing for reunion (including dreams of seeing the person again). Although painful to experience at first, grief reactions are healthy responses that reflect the significance of the death. Over time, grief reactions tend to include more pleasant thoughts and activities, such as telling positive stories about a loved one, and comforting ways of remembering them. You should remember:

• Treat acutely bereaved children and adults with dignity, respect, and compassion.
• Grief reactions vary from person to person.
• There is no single “correct” course of grieving.
• Grief puts people at risk for abuse of over-the-counter medications, increased smoking, and consumption of alcohol. Make survivors aware of these risks, the importance of self-care, and the availability of professional help.

In working with survivors who have experienced the death of a family member or close friend, you can:

• Discuss how family members and friends will each have their own special set of reactions; no particular way of grieving is right or wrong, and there is not a “normal” period of time for grieving. What is most important for family members and friends is to respect and understand how each may be experiencing their own course of grief.
• Discuss with family members and friends how culture or religious beliefs influence how people grieve and especially how rituals may or may not satisfy current feelings of each family member.
• Keep in mind that children may only show their grief for short periods of time each day, and even though they may play or engage in other positive activities, their grief can be just as strong as that of any other family member.
• To emphasize how important is it for family members to understand and respect each other’s course of grief, you may say:

“It is important to know that each family member may express their grief differently. Some may not cry, while others might cry a lot. Family members should not feel badly about this or think there is something wrong with them. What is most important is to respect the different ways each feels, and help each other in the days and weeks ahead.”

When a survivor does want to talk with you about the loved one, you should listen quietly, and not feel compelled to talk a lot. Do not probe.

Do:

• Reassure grieving individuals that what they are experiencing is understandable and expectable.
• Use the deceased person’s name, rather than referring to them as “the deceased.”
• Let them know that they will most likely continue to experience periods of sadness, loneliness, or anger.
• Tell them that if they continue to experience grief or depression that affects daily functioning, talking to a member of the clergy or a counselor who specializes in grief is advisable.
• Tell them that their doctor, their city or county department of mental health, or their local hospital can refer them to appropriate services.

Don’t say:

• I know how you feel.
• It was probably for the best.
• He is better off now.
• It was her time to go.
• At least he went quickly.
• Let’s talk about something else.
• You should work towards getting over this.
• You are strong enough to deal with this.
• You should be glad he passed quickly.
• That which doesn’t kill us makes us stronger.
• You’ll feel better soon.
• You did everything you could.
• You need to grieve.
• You need to relax
• It’s good that you are alive.
• It’s good that no one else died.
• It could be worse; you still have a brother/sister/mother/father.
• Everything happens for the best according to a higher plan.
• We are not given more than we can bear.
• (To a child) You are the man/woman of the house now.
• Someday you will have an answer.

If the grieving person says any of the above things, you can respectfully acknowledge the feeling or thought, but don’t initiate a statement like these yourself.

Helping Parents/Caregivers talk with children about death (www.ptsd.va.gov’s PFA Training Manual, Version 2, p. 38)

• Assure children that they are loved and will be cared for.
• Watch for signs that the child may be ready to talk about what happened.
• Do not make the child feel guilty or embarrassed about wanting or not wanting to talk.
• Do not push children to talk.
• Give short, simple, honest, and age-appropriate answers to their questions.
• Listen carefully to their feelings without judgment.
• Reassure them that they did not cause the death, that it was not their fault, and that it
• Was not a punishment for anything that anyone did “wrong.”
• Answer questions honestly about funerals, burial, prayer, and other rituals.
• Be prepared to respond to the child’s questions over and over again.
• Do not be afraid to say that you don’t know the answer to a question.

Children and adolescents sometimes feel guilty that they survived while other family members did not. They may believe that they caused the death in some way. Families need to help dispel children’s sense of responsibility and assure them that, in events like this, they are not to blame for what happened. For example, you may suggest that a caregiver say:

“We all did what we could to try to save everybody. Daddy would be so happy that we are all okay. You did not do anything wrong.”

Note: Saying this once may not be enough; feelings of guilt may come up again and again, and a parent may need to provide constant assistance with a child’s ongoing worries and confusion about guilt.

Spiritual Issues (www.ptsd.va.gov’s PFA Training Manual, Version 2, pp. 39-40)

Survivors may use religious language to talk about what is happening or want to engage in prayer or other religious practices. It is not necessary for you to share these beliefs in order to be supportive. You are not required to do or say anything that violates your own beliefs. Often, simply listening and attending is all that is required. Things to keep in mind include:

• A good way to introduce this topic is to ask, “Do you have any religious or spiritual needs at this time?” This question is not meant to lead to a theological discussion or spiritual counseling.
• If requested, you can refer them to a clergy member of their choice.
• Do not contradict or try to “correct” what a person says about their religious beliefs, even if you disagree and think that it may be causing them distress.
• Do not try to answer religious questions like, “Why was this allowed to happen?” These questions generally represent expressions of emotion rather than real requests for an answer.
• A survivor may voice hope for a miracle, even in the face of virtual certainty that their loved one has died. Do not take this as evidence that they have lost touch with reality or has not heard what has been said, but as the survivor’s way of continuing to function in devastating circumstances. It is important to neither encourage nor discourage such hope.
• Every religion has specific practices to deal with death, particularly in regard to the care of dead bodies. These issues may be especially complicated when the body is not recovered. Ask survivors about their religious needs in this area. They may want a clergy member to advise them.
• If a survivor expresses anger associated with their religious beliefs (a sign of spiritual distress), do not judge or argue with them. Most people are not looking for an “answer,” but a willing, non-judgmental listener. If spiritual concerns are contributing to significant distress, guilt, or functional impairment, you can ask if they would like to speak with a religious leader.

Issues Related to Traumatic Grief (www.ptsd.va.gov’s PFA Training Manual, Version 2, p. 42)

After traumatic death, some survivors may stay focused on the circumstances of the death, including being preoccupied with how the death could have been prevented, what the last moments were like, and who was at fault. These reactions may interfere with grieving, making it more difficult for survivors to adjust to the death. These reactions include:

• Intrusive, disturbing images of the death that interfere with positive remembering & reminiscing
• Retreat from close relationships with family and friends
• Avoidance of usual activities because they are reminders of the traumatic death
• For children, repetitive play that includes themes involving the traumatic circumstances of the death

These reactions can change mourning, often putting individuals on a different time course than may be experienced by other family members. You may want to speak privately to a family member who was present at the time of the death in order to advise them about the extra burden of witnessing the death. Let them know that talking to a mental health professional or clergy member may be very helpful. For example, you might say:

“It is awful to have been there when Joe died. Other family members may want to know details about what happened, but there may be some details that you think will be too upsetting for them. Discussing what you went through with a professional can help you decide what to share with your family and also help you with your grief.”