Heart Circle Sangha || Ridgewood, NJ

Teaching Council in Sri Lanka

A post disaster culturally sensitive and spiritual approach to group process based on neuropsychological research

By Joan Hogetsu Hoeberichts, LCSW, LMFT, CGP, MBA

Abstract

In response to the December 26, 2004 tsunami in Southeast Asia, a method of treating trauma with group therapy, called Council, was introduced to Sri Lankan para-professionals working for Sarvodaya, a local non-governmental organization (NGO), by American psychotherapists associated with Heart Circle Sangha, a Zen Buddhist temple in New Jersey. Working together, Americans and Sri Lankans incorporated meditation and culturally congruent spiritual ritual that made the group process acceptable to the survivors who were Buddhist, Muslim, Hindu and Christian. Based on neuropsychological findings, the theoretical foundations for using Council to prevent and treat Post Traumatic Stress Disorder are described.

Teaching Council: A Model of Post Disaster Group Therapy

"In a real sense all life is inter-related. All men are caught in an Inescapable network of mutuality, tied in a single garment of destiny. Whatever affects one directly affects all indirectly."

~ Dr. Martin Luther King, Jr.

Introduction

The tsunami of December 26, 2004, devastated hundreds of thousands of lives in Southeast Asia, leaving people without a home, family or community. There were an estimated 35,000 deaths in a population of 19 million. Parents lost children and children lost parents. Entire villages were destroyed. In early 2005, hoping to help, I contacted Sarvodaya, a large Sri Lankan non-governmental organization (NGO) and offered to work with them to create a training program for Sri Lankan counselors. Our hope was that we could create a nucleus of trained counselors to lead support groups in the villages for those with the most severe losses.

Without emotional support, the risks to individuals, families and society seemed staggering. Almost every family in Sri Lanka had lost either an immediate family member or one of their extended family. We were aware that trauma may leave parents unable to adequately parent their children and that lack of adequate parenting results in subsequent trauma to the next generation (Hesse and Mains, 2003) with patterns of violence flowing from the unresolved trauma (Schore, 2003). In addition to the trauma from the tsunami, there is an ongoing civil war between the Liberation Tigers Tamil Elam (LTTE) who want to establish a separatist state in the north and east and the Sinhalese government who controls the south and west and are opposed to any loss of territory. This war continues to inflict additional traumatic losses.

Our task was complicated by the Sri Lankan culture's unfamiliarity with Western psychotherapy and a resistance to it. Although there are a few Professional Counselors in Sri Lanka, they have a role that is much more limited than that of therapists in the west. They are employed by the government or they work as volunteers in institutional settings with special populations such as rape victims, disabled or disturbed children or families in conflict. The predominant religion is Buddhism; the other major religions practiced in Sri Lanka include Hinduism, Christianity and Islam. The culture is open to religious practice, but tension and distrust exist between the different religions. I hoped that Sarvodaya and a US team of experts in grief and trauma, working together, could create a spiritually-imbued model of psychotherapy that could transcend religious differences so that people of all religious beliefs might find comfort and healing. Since spiritual beliefs are central to individual identity and are sustained by the Sri Lankan culture as part of the social fabric which binds individuals to their identity group (Turner, McFarlane, and Van der Kolk 1996; Volkan 2006), I hoped we might create a spiritual process including enough elements of therapy to be both healing and culturally acceptable.

Our work would rest on the research of McFarlane and Van der Kolk (1996) which suggests that religion provides a larger perspective offering meaning in the face of terrifying events. We would draw on the knowledge that religion and ritual allow individuals to move beyond their personal suffering. Since spiritual practice may provide a shift in perspective permitting individuals to transcend the personal self and connect with a Universal Self, God, Allah, Oneness or Unity of Being, they can move to a sense of shared losses, communal suffering, with a resulting desire to connect and help others. Connecting and helping effectively counteract the personal powerlessness experienced in disasters. A sense of community is healing because it provides meaning and a reason to live for those whose lives are torn apart by traumatic events.

In addition to our concern for the survivors of the tsunami, we were also motivated to reduce the transmission of trauma to future generations of Sri Lankans. Hesse and Mains (2003) describe how unresolved loss can have second-generation effects. When an individual experiences an overwhelming event that causes terror and dissociation, the neuropathways of the brain are engraved with the sequence of a trigger leading to terror and dissociation. Subsequently, any trigger that evokes an element of the original event may cause the brain's neurotransmitters to take the same path. If the parent's trauma goes untreated, the parent may have frequent episodes of dissociation triggered by events resembling the original event. When the parent dissociates or appears terrified for no reason apparent to the child, she creates a disturbed environment in which her children may form a disorganized attachment to her. Disorganized attachment in a child is characterized by contradictory behavior. An example of contradictory behavior is a child approaching a parent for comfort and then turning away and averting his gaze just before reaching the parent. The child feels a complex mixture of yearning for love and comfort and fear of what he will receive. Such disorganized attachment limits a person's ability to form healthy relationships throughout life (Siegle, 1999). This unresolved trauma has been shown to create a predisposition to violence (Shore, 2003). Many parents in Sri Lanka had their children torn from their arms by the tsunami wave, and hundreds of children lost one or both parents leaving thousands of traumatized parents and children. In addition, thousands more lost their homes and all their possessions, leaving them and future generations of Sri Lankans vulnerable to this transgenerational transmission of trauma.

Volkan (2006) describes how transgenerational transmissions of trauma may occur when a massive tragedy that cannot be adequately mourned becomes the "fuel for new infernos that are deliberately started by people in the name of identity" (p.17). The civil war between the LTTE and the Sinhalese government has worsened considerably since the tsunami. What was for some years before the tsunami a tentative truce has become a bloody conflict with no apparent hope for peace in the near term. What Volkan calls "large-group identity issues" have been re-ignited and mistrust reigns. Volkan (2004, p.24) defines large group identity as a large group affiliation in which an individual's sense of ethnic, religious and/or national identity is closely tied to his "core" identity. He suggests that identity stretches backward through time so that all past wounds to the large group are part of what individuals in the group carry forward as their own. The large-group identity issues in Sri Lanka were activated post tsunami by conflict over sharing the millions of dollars raised for the survivors. The truth of the matter is impossible to know as both sides engage in inflammatory propaganda, blaming each other for the violent re-occurrence of war. Unless a path to peace can be established, this war will pass additional trauma through to subsequent generations by the impact of the shame, loss, humiliation and dehumanization imposed on the victims of both sides. Volkan describes how such feelings, experienced by the victims, are passed into the next generation by the parents. The children then become victims too, and continue the conflict through their identity with their own large group, projecting all their inner unresolved aggression onto the other large group. By inviting para-professionals from the Tamils in the north and east to join our Sinhalese counselors within a common spiritual container, we hoped to begin in a small way to ameliorate the impact of the continuing trauma and of the large group identity issues.

Project Beginnings

I first arrived in Sri Lanka, in February 2005, five weeks after the tsunami. I was to be there for three weeks exploring ways to partner with Sarvodaya (www.Sarvodaya.org). Founded by Dr. A.T. Ariyaratne in 1958, the Sarvodaya Shramadana Movement (which means "awakening through the donation of labor") is based on Buddhist values and inspired by Gandhi's principles of non-violence and the sustainable empowerment of people through self-help and collective support. Using a system of student volunteers, Ariyaratne began by organizing community projects in the villages which empowered the local villages and increased their economic well being.

Over the last 50 years, the Sarvodaya network of villages, districts and national headquarters has become a powerful force in Sri Lanka. Village empowerment begins when Sarvodaya is invited into villages by village leaders. Sarvodaya's first step is to hold a Shramadana adult camp program which is the beginning of village training in the ways of community empowerment. The adult campers are inspired to contribute their labor in order to meet commonly identified village needs such as roads, wells, canals, pre-schools, orphanages, etc. During camp, which lasts 5 to 7 days, future village leaders are identified. Support services are provided by various Sarvodaya ancillary organizations. Sarvodaya Rural Technical Services works with communities to build clean water and sanitation facilities, roadways, houses and alternative energy sources. Sarvodaya Economic Enterprise Development Services (SEEDS) offers banking, micro loans and financial services with the goal of eliminating poverty. The Sarvodaya Boarding School for Deaf Children provides education for deaf village children. Sarvodaya Community Health Services provide health clinics to the villages through volunteer doctors and nurses.

The Sarvodaya Legal Services Movement (SLSM), the organization which is home to our project, was founded by Ariyaratne's daughter Charika Marasinghe, PhD. to provide free legal support to village families through a network of volunteer lawyers. Their goal is to keep the villagers out of court through legal guidance, family counseling and mediation. Already on board when the tsunami hit was a small staff of five volunteer family counselors. SLSM held clinics in many villages after the tsunami to help those whose homes had been washed away. Since many property deeds had been lost in the tsunami, the clinics provided the necessary documentation so that the villagers would be eligible for government aid. This network, already in place, provided us a promising structure for organizing effective support groups in the villages.

Working with Marasinghe, we proposed to develop a team of Sarvodaya counselors. Sarvodaya committed to recruiting a total of 22 counselors to work in the 22 Sarvodaya districts impacted by the tsunami. I committed to finding a team of U.S. therapists who were expert in grief and trauma and who also followed a spiritual practice. We agreed that group therapy would be the natural vehicle for the spiritual/therapeutic process we were designing, which Marasinghe named The Psycho-Spiritual Healing Programme (PSHP). We believed group process would be efficient, allowing more people to be treated at once, and that it would serve to rebuild community connections which were badly damaged by the tsunami. At that time thousands of displaced persons were living in temporary housing, and community structures were largely lost or dysfunctional because the villagers were not placed in the same camps. However, we were not confident that a group therapy process would work in the Sri Lankan culture. Marasinghe shared her concern that it was not the norm in the culture of Sri Lanka to keep confidences, and she was apprehensive that whatever was spoken in the groups would, in short order, be common knowledge in the villages. Conscious of my ignorance of the Sri Lankan culture, I worried that the US team would stumble unknowingly into cultural crevasses. Was it, I wondered, a form of hubris on my part to imagine we could teach them anything of value?

Sudhir Kakar (1985), an Indian psychoanalyst from south India, which is very close culturally and physically to Sri Lanka, writes of the cultural divide between the foundational beliefs of western psychoanalysis and norms of the east. Many cultural and family practices which we in the west would consider troubling, neurotic, and unhealthy are the cultural norm in Southeast Asia. Kakar writes, for example, that children sleep for many years with the mother in the parental bed, and then shift to the bed of another family member when a younger sibling is born. One of our Sri Lankan colleagues, a professional counselor herself, in the context of a unit on childhood trauma, told me that she was four when her sister was born. Replaced by her baby sister in her mother's bed, Shanti went to sleep with her father. She did not like her sister much for a long time, but she became her father's favorite. Constrained by my western sensibility I did not ask how long she continued to sleep with her father nor whether it was a family bed or separate beds for the parents. Kakar writes of children sometimes sleeping in the mother's or parents' bed until adolescence, challenging our beliefs that such prolonged physical intimacy between parent and child is too sexually stimulating for children and that individual differentiation of child from parent is always a hallmark of healthy development.

There are other practices which are hard for us to understand. It is common for Asian families to get an astrological reading before the birth of a child. We heard stories in our first workshop of a mother who was given a very bad prediction for her child and who therefore gave her child away. It seems that this is not at all uncommon. In another widespread custom, many families give their oldest child to the grandmother to raise when a younger sibling is born, believing that child and family will be better off. Another norm unfamiliar to us is that adults live with their parents until they are married. Even after marriage they may continue to live with their parents, sometimes moving only when they can afford to build or buy their own home. Our concept of the developmental task of adolescent and adult separation seems not to apply. In another example of cultural dissonance, I was distressed by the view of most Sri Lankans at every level of society that the tsunami was the result of bad karma created in a previous life. It felt to me like blaming the victim. In the case of the many lost fisherman who, in their daily work, had routinely broken the Buddhist precept against not killing any sentient being, their deaths were viewed to be a result of bad karma created in this life. Eventually, however, I came to recognize that this belief was soothing to them because it meant that the tsunami could not be helped and was beyond blame. It allowed them to accept their fate. Even the belief that the fisherman may have caused their karmic deaths by fishing was a way of accepting their predetermined fate because they knew the fisherman had been handed their livelihood by their fathers and grandfathers and had no choice.

A deeper, more pervasive issue relevant to the cultural divide raised by both Kakar and Moncayo (1998), has to do with the primacy of the individual in western culture and in psychoanalytic theory as opposed to the norm in Asia in which the individual is subsumed by the family, the community, the corporation, and the society. Moncayo states that, particularly in North America, psychoanalysis was adapted to the ideology of individualism and the entrepreneur. On the other hand, says Kakar, in Asian cultures, Hindu persons in particular are "dominated by relationships; all affects, needs and motives are relational and their distresses are disorders of relationships" (p.445). By introducing group therapy we might be providing a structure well-suited for therapeutic work in Sri Lanka or one that could be harmful. There was no way for me to know. I had to trust that my Sri Lankan colleagues would guide me.

In addition to the cultural divide, I was concerned about the dynamics of working through translators. Would we be able to teach the basic psychological concepts we believed they would need to know to be able to contain a healing group process? I had never worked professionally through a translator, but I did have knowledge of other languages and therefore knew how difficult it could be to achieve an accurate translation. The culture is reflected in the language and in a culture that is not psychologically minded I wondered if our concepts would translate meaningfully. Some of my concerns were borne out as, in our first workshop, there was difficulty translating "anxiety" and we learned there is no Sinhalese word that exactly translates to "trauma".

Before I left Sri Lanka that first time, we held a three day workshop. Invited were the Sarvodaya District Co-coordinators, the five volunteer Sarvodaya counselors who were already on staff, two Buddhist nuns, the President of the Sri Lankan Professional Counselors Association, and a Roman Catholic nun who was also a counselor and members of the staff of Sarvodaya. The first two days were devoted to co-ordination of relief efforts and to a discussion of the spiritual questions that arise in the face of natural disasters. The third day I was invited to present our ideas of working therapeutically in groups.

I had decided to teach a way of doing group process based on the Native American council. As a Zen teacher and priest, I have been using "Council" in my own Zen community for about ten years. I have found that it is a very simple way of processing complex group and individual issues in a safe and satisfying manner which is described by Zimmerman and Coyle (1996). The form utilizes a "talking stick or talking object" which the speaker holds when talking. In Sri Lanka we have used a stone about the size of a potato. Right from the beginning the weight of the stone in the hand seemed to facilitate talking of heavy things. The instructions to the group from the leader are that they must speak from the heart and listen from the heart. This instruction is not explained further, but they are encouraged by the leader to speak about their own experience, feelings and thoughts and discouraged gently from offering advice or judging each other. The leader also guides them not to speak to one another while someone is holding the talking stone. A serious tone is set at the beginning of the group by the ritual described below. I proposed that it would be possible to teach para-professionals to lead such groups effectively because of its tight structure and simple techniques.

The theoretical foundation and rationale for the particular group structure and techniques used in this disaster work come largely from recent neuropsychological research on attachment and trauma. Siegel (1999, 2003) has made a most persuasive case for the importance of emotional connection in healing trauma. He argues that compassionate and caring human connections allow the self-organizational processes of the mind to move towards complexity. Siegel defines complexity as the ability to balance the two fundamental processes of differentiation and integration. Whereas complex states of minds are stable, flexible and adaptive, minds stressed by unresolved trauma tend toward either rigidity or chaos. Complex minds, Siegel reports, are less reactive, more open and aware, more connected to other minds. Rigid and chaotic minds tend to respond from habitual patterns formed during earlier trauma. They may turn more quickly to defend against imagined danger by unleashing anger, violence and rage. Such minds have more difficulty with relationships and with work. They are less able to self-regulate emotion and they block input from other people in order to maintain their self-organization (2003, p.40-43; 1999, p.208-238).

Siegel (2007) defines mind as "a process that regulates the flow of energy and information." He says further that "our human mind is both embodied -- it involves a flow of energy and information that occurs within the body, including the brain -- and relational, the dimension of the mind that involves the flow of energy and information occurring between people" (p.5). Our minds are constantly being modified by our relational interactions with others. Effective treatment entails what Siegel (1999) calls "contingent communication," where one person perceives and makes sense of the signals of another person in a timely fashion. Where contingent communication exists, a person "feels felt".

In this project, it was hoped that such contingent communication would create an environment in which a group mind is created, sharing resonance and cohesion in the present moment, much like the way mind is formed in infancy between the mother and child. Over time, it is further hoped that the co-construction of shared experiences will guide the group's minds towards greater complexity and healing.

With about thirty people present, we sat on the floor of a large open, covered patio. The overhead fans created a cooling breeze in the Sri Lankan heat. Outside was a lovely pond surrounded by the lush tropical garden of the retreat center. Wishing to be culturally sensitive in conducting the one day workshop, I opened with the traditional Sri Lankan lighting of an oil lamp and began my presentation with a guided meditation. In the center of the patio was a simple altar to hold the small oil lamp accompanied by an image representing each of the four major religions of Sri Lanka: Buddhist, Hindu, Christian, and Muslim. These elements of spiritual ritual -- meditation, the lighting of oil lamps, and the altar -- have remained a fundamental part of our process. As a part of the ongoing program, the counselors have felt free to modify it, making it meaningful to their participants and themselves.

Their response has affirmed our understanding that the rituals of religion are indeed a valuable part of the healing process following a disaster. Prayers, meditation, and ritual provide a sense of endurance, a sense of shared suffering, and a sense of hope. Because religion extends backward into time, there is a sense of those who have gone before and suffered, and a conscious or unconscious awareness of the potential of regeneration (Turner, MacFarlane, Van der Kolk 1996). In multicultural societies inclusiveness is critically important. Each survivor must feel part of the ritual and being included in the ritual empowers the individual and will allay mistrust of the program. But in the early stages, it was evident that we had much to learn. Eleven people volunteered to be in an inner circle for the group process, ten women (including all five Sarvodaya counselors), and one man. I asked the remaining people, mostly men, to sit behind the first group in an outer circle so that they could hear what was being said. Almost no one complied. Some left; others leaned against the wall too far away to feel part of what was going on. A couple of men leaned against a pillar close by and chatted. This resistance from the men was hard to interpret. Were the men reluctant to participate for reasons of gender? Did they regard this as something only women do? Were they being consciously or unconsciously disrespectful in order to make it clear they were not going to be a part of this process being led by a white foreign woman? It made sense to me that they would mistrust a new process they did not understand. Klein and Schermer (2000) discuss the "severe and protracted mistrust and suspicion" of both the treatment process and of its leaders in trauma treatment. I wondered, too, were the men resistant to experiencing the feelings that talk of tsunami experiences would engender in them? Perhaps being asked to listen was being asked to remember experiences they would prefer to forget. We knew that intense images and disturbing memories are sequelae of any traumatic event.

Using prayer as a means of connection to both the culture and the transpersonal, I offered an opening blessing, "May all beings in Sri Lanka find peace and happiness." I then explained the procedure and tenets of Council: the stone is passed from one person to the next; the stone may be passed without speaking; only the person holding the stone speaks; we listen from the heart; we speak from the heart; what is shared in this process must be kept confidential and not shared outside the group present. I explained that I thought this process might work for the village survivors and that it could be a vehicle for healing. I invited them to try it out by telling their personal stories. The giving of testimony can be seen as a way of giving meaning to a disastrous event and to the hardship that follows (Agger and Jensen, 1990). Making private suffering public, in a community in which all are suffering similar pain, is enlivening and deepens the felt sense of community. It imparts strength to each from the whole. Herman (1992) speaks of the therapeutic value of telling the story of trauma. In retelling the story, the traumatic event is reintegrated into the patient's personal history, giving it meaning and context. "'The action of telling a story' in the safety of a protected relationship can actually produce a change in the abnormal processing of the traumatic memory" (p.183). Survivors naturally resist mourning because of the intensity of the pain of the loss. Yet only through mourning can the inner life reawaken and can a return to functional living be affected.

Although most in the inner circle did use the Council to process their own pain and fear, I was not encouraged that it would be immediately useful in the villages. Amongst those who used the process effectively was a woman whose brother had lost his wife and two children. He now lived with her family and spent all his time drinking, which upset her family. She had asked him to keep the door to his room closed when he was drinking, but he tried and then said he felt too lonely and needed to keep it open. As she talked about her brother's losses, her own pain was evident. Her tears flowed freely sometimes making it difficult for her to talk. Again I noticed signs of resistance from the group. Some in the group could not stay with her story and appeared to need psychological distance which they garnered by chatting to one another. Although I asked the group to pay attention to the speaker and refrain from speaking while she was speaking, the combination of working through a translator and of knowing neither the culture nor the participants made me hesitant to intervene in a more determined way. I was most certainly not ready to do then what I have since been able to do, i.e., to ask them directly how they were experiencing her story.

There were other stories. However, the group seemed to have difficulty tolerating the anxiety aroused by listening to them. Much advice was offered to one another to be strong. There appeared to be a lot of judgments of the survivors around issues like drinking and "laziness," by which they seemed to mean not coping well. As the culture strongly values stoicism, they were expressing beliefs supported by the culture, but they were also distancing themselves from the victims in a dissociative or intellectual defense. As long as they could judge the victims, they did not need to experience the pain involved in understanding their own pain. Nor did they need to experience their own guilt and shame in surviving. I was discouraged and had little hope that any of them would be able to use the process by the end of the day to work with villagers in the field. Nonetheless, despite the resistance, the experience seemed appreciated by the participants. They said they were happy to have had an opportunity to tell their own stories and to be heard.

In retrospect, the most important part of the workshop was my own learning about where they were and what needed to be taught. It was clear that they could not begin to counsel others without first connecting to their own feelings. The idea of admitting to their own feelings, especially dark feelings such as anxiety, anger, sadness, shame and guilt, was very foreign. Yet, if they were not comfortable talking about their own feelings they would not be able to elicit or allow the village survivors to talk authentically about their experience or their feelings. There was much work to be done.

Training Workshops 2005-2006

Six months later I returned with another group therapist, Gaea Logan, MA, from Austin, TX, to begin the first four day training workshop. We introduced group process to the now twenty-two counselors, most of who were brand new trainees and had done no previous counseling. After my experience the previous February, when the group had seemed reluctant to admit to difficult feelings and resistant to re-experiencing the pain of the tsunami, we decided to concentrate on providing them with a therapeutic experience. I believed they could not be effective counselors for tsunami survivors without first processing their own tsunami experience, their own grief and terror.

The counselors were already working in the villages conducting workshops and there was considerable value in what they were doing. Their workshops included meditations, games, and lectures. Although meditation was not a part of the lay culture in Sri Lanka, (as a rule only the monks meditated), it was strongly encouraged by Marasinghe. The villagers found the meditations calming. Research confirms that meditation changes the mind and regulates emotion. Their experience was supported in current neurological research by Richard J Davidson (Begley 2007) which shows that experienced meditators can train themselves to have positive mental states. They measurably increase their happiness, compassion and joy. By working mindfully with negative emotions meditators change their mind states to experience authentic positive emotions instead (pp. 213-241). Therefore we hoped teaching and encouraging the trauma survivors to meditate would help them cultivate a more stable and positive frame of mind.

The structured play in the village workshops led by the counselors brought the villagers together in fun. In one workshop, one of the best we observed, the game was to work in teams building a house out of straws. The women, all homeless and living in government temporary housing, laughed as their straw houses fell apart. However, at the end, each team had made a house of some sort that stayed together. The lesson articulated by the counselor was that working together even very hard things are possible. In other workshops, the participants played games such as two teams racing while carrying jugs of water on their heads. Although there was no lesson in this game they had fun, and utilized the principle that physical activity is restorative in helping trauma stored in the body move through it so that healing may take place (Levine 1997).

Some of the lectures, given by outside resources, teachers and Buddhist monks were helpful and engaging, but many were troublesome to our western ears. We heard one ex-principal exhort the audience of traumatized villagers to discipline their children so that they would not be spoiled. I checked with my Sri Lankan colleagues to see whether my reaction was a cultural reaction different from theirs, but they too shook their heads at his talk. An equally disturbing talk was given to a group of children at another workshop where the children were told the importance of being good. It was clear to me in observing the workshops that the villagers were anxious to tell their stories but were not being given the opportunity. One counselor, leading a workshop for about 70 villagers, invited people to speak at the end. She was expecting feedback on the workshop, but people stood up and began to tell of their tsunami losses. They went around the room speaking as if for the first time of their lost family members. Halfway around the room the counselor cut off the process because she had "run out of time". We were subsequently surrounded by villagers who wanted to tell us their story. This experience reaffirmed my belief that we had to give the counselors enough personal therapeutic process to allow them to experience their own pain, enabling them to be present to the villagers' stories.

After four days of observing workshops in the villages, we returned to the Sarvodaya retreat center and began our own workshop. We worked with the counselors in dyads counseling each other in structured exercises; we led psychodynamic groups; and we taught didactically about loss, grief, trauma, and defenses. We taught countertransference to the counselors using mindfulness of body sensations, thoughts and feelings to help them get in touch with their reactions to their clients. We also taught mindfulness as a way of recognizing their own and their clients' stress from the recent traumatic events. Research has shown that mindful awareness greatly enhances the body's functioning through better healing, improving the immune response, and reducing stress reactivity (Siegel, 2007). Jon Kabat-Zinn has been teaching Mindfulness-Based Stress Reduction at the University of Massachusetts Medical Center for 25 years. He defines mindfulness as "the awareness that emerges through paying attention on purpose, in the present moment, and nonjudgementally, to the unfolding of experience moment by moment" (Kabat-Zinn, 2003, pp. 145-146). Mindfulness practice has continued to be an essential part of all our workshops.

In this first workshop we chose to lead psychodynamic groups rather than Council because I wanted to maximize the therapeutic experience and believed at that time that that required more active and involved leadership than the Council process permitted. As we encouraged them to talk about what they were feeling in the room, they began to respond. We supported their acknowledgement of their own dark feelings by morning rituals. The first morning they were asked to write a paragraph beginning "My biggest fear is…." The second day the sentence began, "I am very sad about…" The third day the sentence began, "I am angry about…" We built a ritual around the notes, taking them to a sacred place in the retreat center and placing them under a rock. On the last day we burned them, symbolizing the impermanence of feelings. Once they were given permission to explore their dark feelings they stopped denying having them. The group appeared to enjoy this exercise very much.

We coached them in active listening techniques, such as mirroring, asking for more, asking open-ended questions and empathic responses like "That must have been hard" in an attempt to wean them of their defensive tendency to give advice and explain. Leaning on our spiritual underpinnings, we called what we taught, "Compassionate Listening" because compassion is a highly valued and familiar virtue in their Buddhist culture. (At this time all were Buddhists.) By working in dyads, we hoped each would get an experience of being the client and would experience first hand the benefit of this kind of listening. We developed exercises to help them remember the pain in their own lives to share with each other. One such exercise was for them to first draw a picture of a painful experience in their life and then to take turns telling their partner about it while the partner practiced active listening skills.

Sharing personal experiences in a meaningful and therapeutic fashion, they got to know each other and began to build trusting relationships with one another and with us. After that visit I decided to return to the Council process as the vehicle for them to lead groups in the village; still I believed they needed more therapeutic process themselves so they could understand what was required of them from the inside. To this end I asked the subsequent teams going from the US to provide them with as much therapy as possible and to provide didactic learning in specific areas like suicide prevention, working with children, trauma and grief.

Another team of two therapists Mary Cattan, MA, and Suzanne Hoffman, PhD, conducted workshops in November of 2005. They concentrated on providing the counselors with more therapeutic psychodynamic group processing, didactically improving the counselors' understanding of depression, suicide and trauma and deepening their skills of "compassionate" listening. In January of 2006 a third team, Jesse Harris Bathrick, MA, and Gretta Keene Sabinson, MSW, both experts in working with traumatized children using expressive arts therapies, came to teach a workshop focused on how to work with traumatized children. They led psychodrama groups, worked in large groups with drawing, painting and clay, told classical folk stories that elicited personal stories, and worked in dyads allowing the counselors to continue processing their own material. They taught the importance of play, the use of symbols and the way children can use various media to tell stories of difficult events which are hard to talk about.

Observing Groups in the Villages Prior to Fourth Workshop

In June 2006, 17 months after the tsunami, I returned with another colleague, Eric Aronson Psy.D., to teach the fourth workshop of the program. This time, with Sarvodaya's encouragement, we were determined to continue teaching them to do group work. Confirming indications from our American colleagues that the counselors might be ready to lead their own groups, Geethani Suriyabandara, Director of Sarvodaya's Psycho-Spiritual Healing Program, said the counselors had already begun leading groups in the villages.

The day after our arrival we headed to Kalutera: a village about two hours away where three of the original counselors were meeting with 30 villagers in a local temple. We were to observe the groups they were leading. One of the counselors began the workshop by lighting a large oil lamp and leading a ten minute meditation. She then asked the villagers to divide themselves into three groups, each group to be led by one of the three counselors.

Leading her group, another of the counselors, introduced a stone about the size of a baking potato and explained to the group that the stone was heavy enough to hold their sorrows and would facilitate their speaking of their problems. As she passed the stone, she invited each participant to light a small individual oil lamp after they spoke. In the center she had placed a simple altar with a Buddha image on it in accordance with the Buddhist beliefs in this part of Sri Lanka. This altar was surrounded by the oil lamps waiting to be lit. The group began with a short guided meditation by the group leader. She passed the stone to her left at the end of the meditation. The first speaker held it for a moment and then began to speak of her difficult life without her spouse, lost in the tsunami. After she spoke, she invited everyone in the tight circle of ten men and women to give the speaker supportive eye contact, allowing her to feel that she was not alone. Then she asked the speaker to return the eye contact, taking in their healing support. The speaker did so, nodded and then lit her oil lamp.

Eye contact, in Sri Lanka, as in many other cultures, establishes an individual's social presence and belonging. Avoiding eye contact connotes shame and a sense of not being part of the community (Argenti-Pillen 2003). By deliberately incorporating eye contact, this counselor invited full acceptance by the group of the speaker and her suffering. Palley ( 2001) writes of the way in which such non-verbal cues regulate body physiology and emotions, thus calming an over stimulated nervous system that trauma survivors often experience. Eye contact is also a powerful means of communicating empathy.

This ritual was followed by each member of the group taking the stone and speaking. If the speaker's material was particularly painful, the leader asked the group to breathe together in a silent supportive meditation. This process took about an hour and a half. At the end, each member was asked to speak about their experience. All the feedback was positive. Most people said they had not had such an opportunity to talk about their losses; although it was sad, they said they appreciated the opportunity to share their experience with others. All expressed a desire for more such groups.

The counselor created a powerful group holding container which worked from beginning to end. People opened up, shared deep sorrow, held each other's grief and gave support. The group became the counselor, and the leader allowed it to happen. She avoided the common practices of advice and explanation, and powerfully directed the group to provide what was needed.

I was impressed that our counselor had done such a consummate job of integrating what had been taught in all the prior workshops. She had apparently taken good notes during the one day workshop on the Council method which had taken place shortly after the tsunami eighteen months earlier. She had not only remembered the structure, but also incorporated the eye contact, the compassionate listening skills, and the use of meditation and ritual from subsequent workshops. She had introduced her own elements in a highly effective manner. And most important, her presence was very therapeutic.

These techniques are supported by current research into what heals. According to Siegel (1999), brain research reveals that mind is formed, shaped and re-shaped through relationships. Therefore, in a caring, connected group, a healing group mind is created that interacts with each individual mind in the group, causing and allowing healing to occur, moving the minds towards greater stability and flexibility. Conscious and unconscious use of eye contact is one of the keys in creating a healing and intimate connection. Sharing non-verbal signals is a right brain to right brain joining that creates attunement (Siegel, 2003). Pally (2001) suggests that nonverbal communication is more credible and more powerful than verbal exchange. Eye contact is intimate and honest. Words are more distant from what one feels. The passing of the stone from one hand to another enhances the strength of the use of body language. There is a natural nonverbal exchange of caring about each other as the stone is handed from one person to the next.

The other two groups led by the other counselors were not as successful. They attempted a process where the counselor was the authority, but they could not yet hold the group effectively. The circles were loose, people had private conversations, and the counselors gave a great deal of advice. Nonetheless, at the end the participants still expressed appreciation for the opportunity to get together in this way and to share the problems of their lives. The other two counselors had used the process less skillfully, but they were open to our feedback. I was encouraged that it would now be possible to prepare all the counselors to do effective group process for the survivors using the Council method.

Fourth Workshop

We began the fourth workshop by holding a large Council with all 22 counselors, emphasizing the importance of building connections between trauma survivors (Siegel, 1999). As we introduced the Council with the guidelines and rituals described earlier, we explained that the rituals could be modified by the group as they felt appropriate for their culture and for the religion and culture of the participants.

There was a lot of pain in the group and the counselors' connection to each other was evident as we passed the stone around the circle. Some chose not to speak. Others poured out their sorrow. After the stone had gone around once, we put it in the middle and asked anyone who wished to speak to take the stone. Several more people responded by picking up the stone and speaking. Then we passed the stone again around the circle for closure. Everyone spoke on the final round. The entire process took an hour and a half.

During this four-day workshop each of the Sri Lankan counselors led a group of peers using the Council model. I was pleased to observe how the leaders incorporated skills they had learned from all of our previous workshops at appropriate moments in the group. The leader often mirrored what the speaker said. Some leaders introduced various brief guided meditations. Familiar Buddhist chants were sometimes used for closing. Their growing self-confidence evident, they clearly understood what would work for their culture and did not hesitate to innovate as they saw fit.

After each group, they shared feedback with their leader to enhance each other's skills. They remarked on how the leader's style facilitated their speaking or how the style might have blocked their feelings or their ability to speak freely. The feedback was honest and helpful. Finally, at the end of the workshop, we all left for coastal villages where we again observed the counselors leading groups of villagers in the village temples. I was astounded by the numbers of villagers who appeared for the programs; in two days we stopped at three villages, and 30-50 people came to each of the first two programs. In the last village there were 80 people waiting for us.

This time, although the group leaders were all consistent in their use of process, a number of unexpected things happened. In the first village there were three simultaneous groups of ten or eleven women each. In one group, ten Muslim women and one Christian women were led by a Buddhist counselor. The Muslim women rejected both the use of the Talking Stone and the lighting of the oil lamp because they were not familiar Muslim rituals. The Muslim women wanted only the Quran on the altar, but in deference to the Christian woman, the leader asked that they leave the image of the Virgin Mary. The women agreed. The Muslim women's insistence on only their own ritual and religious symbols is explained by their group identity becoming even more intensified in times of crisis (Volkan 2004). Once this issue was resolved, observing from a distance I could see them begin to share their stories, cry and comfort each other. In another of the three groups a young woman slipped to the floor in a faint. It was hot and there was not a lot of air, but my guess was it was a dissociative fainting at the prospect of talking about the loss of her husband. She was struggling to raise her two young children without him. Cared for by the group, she eventually felt strong enough to talk of her loss and struggles and reported she had been subject to frequent fainting spells since the tsunami. About 20 minutes after the first woman fainted, another woman fainted in the third group. This woman appeared to be about 60 and very fragile. She too was revived and tended by the group and encouraged to talk in the group.

Observing her, I concluded she may have been more fundamentally disturbed, possibly psychotic, but she too was integrated back into the group by the other women.

Writing of the Sri Lankan culture, Argenti-Pillen (2006) describes such fainting spells as a common result of terror, violence, trauma or unbearable psychic pain. The victim, more often a woman but not always, falls down in a "spell," sometimes whispering "inna bariyo" which is translated as "can't stay here." Another such fainting episode occurred during our November 2006 workshop where the topic being discussed was peace. One of the counselors from the north crumbled to the floor in a faint. She was subsequently revived and the workshop continued, but with a delay to process the amount of stress they were all experiencing in their lives.

At the last village we arrived to find 80 villagers waiting for us. Luckily we had seven counselors as well and each led a group. In one group there was a young mother who had lost both her babies during the tsunami. She was unable to speak at all when the stone came to her. The counselor allowed her to pass the stone and asked everyone to meditate and hope that her immense pain would pass. The stone went all around without anyone speaking. My sense was they were communicating their support by not speaking, not wanting to divert attention from her grief. Then the counselor put the stone in the middle and asked anyone who wanted to speak to pick it up. After a silent pause, the woman's mother picked up the stone to tearfully tell how she had been carrying one of the babies when she had fallen in the rushing water and the baby was ripped out of her arms by the deluge. She also saw her daughter stumble and lose the other child in the same way. Although all the villagers were familiar with the story of this event, they were all crying silently as they remembered. After the grandmother spoke and after a further pause, other group members picked up the stone and shared their own stories of loss and hardship. Towards the very end, the young 21-year-old mother, spoke herself of her own deep loss.

Additional Theoretical Foundations for the Work

Observing these phenomena and reflecting on the theoretical thinking that undergirds our work, there are many foundational articles to apply. Marten DeVries, for example, asserts that mass trauma alters not just the psyche of the individual, but of the society as a whole (DeVries, 1996). A sense of safety is lost throughout the culture. In Sri Lanka, family is the heart of society. Families are very close and parents retain a strong influence on adult children. When families and communities are torn apart as they were in the tsunami and as they are today in the war, internal and external chaos ensues. Even familiar Sri Lankan rituals cannot completely provide the holding container. Funeral services without corpses do not provide the same sense of closure as they otherwise might.

"When cultural protection and security fail, DeVries writes, "the individual's problems are proportional to the cultural disintegration. The avenues of vulnerability resulting from trauma follow the routes vacated by culture: paranoia substitutes for trust; aggression replaces nurturance and support; identity confusion or a negative identity substitutes for a positive identity. Social bonding regresses to nationalism and tribalism, thereby permitting individuals to deny the experienced losses or to defend themselves against expected losses" (DeVries, 1996, p.408). In Sri Lanka, we may presume that the resumption of the civil war the year following the tsunami also illustrates this dynamic. Volkan (2006) contrasts this to Aceh province in Indonesia where because the government and the people in Aceh worked together to recover from the tsunami, trust was reestablished and peace has stabilized since the tsunami.

DeVries observes too that when the homeostatic systems that normally stabilize the community and help it manage stress break down, new social forms begin to take their place. Destructive new social forms are often found in gangs which substitute angry expressions of violence, unconsciously allowing their members to deny anxiety and grief. The many sub-groups engaged in the civil war between the LTTE and the Sinhalese government provide examples of this group displacement phenomenon.

Self-isolation accompanied by drug or alcohol abuse is another common outcome. According to Erikson (1963), the norm under conditions of social breakdown following disaster is that people absorb negative self-views based on the values of the old system. Alcohol abuse is a very large problem in Sri Lanka and may be understood as the response to the loss of healthy self-regard that flows from productive work and strong family ties. Grief-stricken in their loss of jobs and loved ones in a culture that supports not just productivity, but strong emotional control, many -- especially men -- retreat from their public sense of helplessness and shame into lonely addiction. Their broken families, often led by women, are then left to cope as best they can. In our project, the prevalence of women, both as counselors and as group participants is another manifestation of this effect.

Self-help groups have been seen to provide an effective alternative to self-isolation or violence in Africa and elsewhere following a community disaster (Janzen, 1982). DeVries (1996) suggests that self-help groups should be culturally harmonious. By holding the Sarvodaya groups in places of worship such as temples or mosques, and by using familiar rituals such as oil lamps and chanting of familiar prayers, we hope we are creating a holding environment for the groups that feel safe and appropriate. We see our groups as a form of self-help groups and the simplicity of the structure is making it possible for their use to be extended to the camps for the hundreds of thousands of persons displaced by the war.

Dembert and Simmer (2000) discuss the value of sharing stories in post disaster support groups. They assert that through listening to each other's reactions, group members experience a normalization of their own reactions. This has been particularly important in Sri Lanka where the general population understands so little about emotions and psychology. We noted a great deal of denial and shame about the emotions that naturally followed such a disaster and concur with Dembert and Simmer that the groups are helpful in ameliorating such negative feelings.

Responding to Change and Looking Ahead

In November of 2006 Mary Cattan, MA and Supavadee Thaveesaengsiri, LCSW traveled to Sri Lanka to deliver another workshop to the counselors. In the ensuing months, an upsurge in conflict between the Tamils and Sinhalese had forced thousands into refugee camps in the northeast and new trauma was occurring in this already battered country. Sarvodaya, therefore, as part of their strategy for peace, had recruited seven Tamil counselors, who were already working in that part of the country, to join the predominantly Sinhalese (and Buddhist) group of trainees. The Tamil counselors were Hindu, Muslim and Christian. While the basic format remained the same, the challenge would be to integrate the new counselors and facilitate safety among a group whose people were essentially at war with one another. Their languages and religions were also different, necessitating more inclusive rituals (for the Hindus, Christians, Muslims and Buddhists now present) and the use of two translators, one for the Sinhalese speakers, one for the speakers of Tamil. For the American team, the situation seemed daunting, yet Council continued to provide one of the most important spiritual containers. Understandably cautious, the Tamil counselors gradually opened themselves to the process, grasping the rock, allowing tears to flow. Teaching and supervision also progressed as planned; topics of suicide, grief, and trauma, and an introduction to family therapy were covered, with deep personal sharing both in didactic sessions and in Council. Just as we had hoped, yet scarcely dared to believe, the Tamils, working in concert with Sinhalese toward common goals, provided an environment where both sides could begin to develop relationships based in understanding and trust. With good educational backgrounds, some of the Tamils spoke a bit of English as well as Sinhala, while several of the Sinhalese counselors who worked in the north and east also spoke Tamil, so both sides worked hard to facilitate the flow of communication. Led by Mary and Supavadee, the group explored not only the differences of ethnicity and religion, but the even deeper commonalities of Sri Lankan culture and of human suffering that bound them together. Thus, our original goals of helping provide spiritual and psychological help for the grief and trauma of the tsunami was shifting to a broader focus: to provide spiritual and psychological support for the terrible trauma and grief of civil war. It had also evolved into a very modest peace-making endeavor.

In March of 2007 two more of the US Team, Jesse Harris Bathrick, MA and Margaret White, PhD, journeyed to Sri Lanka to present another workshop. They continued the shift towards dealing with the causes and effects of war and also responded to the increasing request for more help in working with families. They introduced the Cycle of Violence and Trauma, Sexual Abuse and Families with Alcoholism. They continued to provide therapy to the counselors through the Council process.

Suzanne Hoffman, PhD and I returned again to Sri Lanka in June of 2007. The need for working with large groups of survivors of the tsunami continued to diminish. The counselors in the south were now holding regular groups for widows and pregnant mothers. In the war zones of the north and east, trauma groups in the Council format were being held in the camps for displaced persons. In a new development ten of the 22 counselors we had trained were enrolled in a formal certificate program in counseling which appears to be equivalent to a masters program in a western university. It was clear that the use of counseling as an expedient means to relieve suffering has taken root in Sarvodaya as their counseling program was firmly implanted in the newly completed Sarvodaya 2007 strategic plan.

Looking to the future, they have asked us to continue to work with their counselors to provide additional training in family counseling. Though progress has been made in facilitating emotional growth and self-awareness in the counselors, much work remains to be done. Supervision, for example, is barely available. Nor is individual therapy for the counselors who are struggling with personal issues. Contingent on the ongoing success of our fund-raising efforts, it is our intention to fulfill their requests and to continue to learn from this challenging intercultural, inter-religious group experience of healing.

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