Linda Garbutt provides a personal illustration of her therapeutic model for recovery from trauma through reflection
This article describes the therapeutic use of reflection to assist recovery from trauma. Many people find themselves in unpleasant situations that they could not have anticipated including, for instance, being hospitalised after an accident. They have then to find ways of coping not only with the trauma of the accident but also with what is sometimes a prolonged period of recovery in unfamiliar surroundings.
I had been working as a counsellor for many years and was engaged in doctoral research into the concept of an internal supervisor and reflective practice (Garbutt, 2009). In my research I had constructed a three-stage practice model for developing an internal supervisor through reflective writing that is described in Bolton, 2010, p121. During this period I had a serious accident and was hospitalised for two months. While in hospital I used a process of reflection to assist my recovery, drawing on my work as a researcher and practitioner as well as my experience as a patient. Since I am blind, I kept an audio journal of my reflections as a means of managing that experience. Two years later I transcribed the recordings and developed the therapeutic model presented here. Extracts from my hospital reflections (which took the form of prose poems) are used to illustrate the therapeutic model.
The objective of this model is similar to that of the practice model (Bolton, 2010): that is, to facilitate the expression and processing of experiences, thoughts and feelings. I found that the process contributed to my recovery from trauma, helping me to acknowledge, accept and manage the loss and grief I experienced. As with the practice model, the process involves three stages:
As early as possible in the day, record or write down whatever comes to mind about the previous 24 hours, moving to a more in-depth exploration of the most significant topic or issue which has emerged from the initial reflection.
As soon as possible after writing the reflection or making the recording, read or listen to it and make any amendments or add any new points.
This stage is optional and may be undertaken around two years after the trauma, providing an opportunity to bring closure to the trauma. The first step in this stage is to transcribe the recording, if necessary. The next step is to read the transcript, noticing what was included and what was left out of the reflections. The final step is to choose whether or not to share the reflections with others who have been involved.
Illustrations of the Therapeutic Model
I adopted the phenomenological approach to analysing the reflections, by reading through the poems (reflections), extrapolating major themes, and then classifying each poem under one of these major themes. My analysis of the 82 poems, which had been written over a period of two months, revealed that, as might be expected, the process of recovery was a dominant theme. In addition, four types of experience were the focus of the poems. These were physical, psychological, emotional and existential. More than one of these aspects was found in two-thirds of the poems. The topics reflected upon included near-death experience, changed perspectives, professional relationships, strong feelings, sleeping/not sleeping and visitors. The poems are numbered chronologically, indicating when they were recorded during the two months I was in hospital.
The analysis of the reflections revealed that the theme of the process of recovery was present from the early poems to the final reflection. The following extracts illustrate the move through this process.
The reality of my situation is captured in the following poem, touching on physical, psychological, emotional and existential issues:
Broken bodies, broken lives:
That is what it feels like
Not just the hurt of the break in the bones
It is the break in the life
So many threads and stones snapped and fractured
Will they repair?
The bones will repair, how will the life repair?
What will be the same, what will be different?
Never be the same because even repairs
Are experienced as being hard.
Could be worse, could be better
It is bound to be different.
How can bodies, how can minds repair bodies, repair lives?
An awareness of the recovery process was evident at an early stage:
Yesterday was a change
I felt (pause) myself.
That is a funny thing
You only know when you feel better
How different you felt before…
The following poems explored the recovery process, acknowledging both negative and positive experiences. The first poem captures the significance of reflecting back and projecting forward, since this enabled me to understand that changes had occurred and may happen again in the future:
Yesterday was a difficult day…
…So, what about yesterday?
The last day of the first three weeks.
I think although I wanted to feel good about it
The reality is that the next three weeks
Although they are moving towards the end,
Three weeks still feels like a long time
And, if it is anything like the last three weeks, will be a long time…
The next poem illustrates how the expression of negativity can contribute to a movement to a positive view:
Another Kind of Relief:
…Disappointment I felt about my inability to accept,
My inability to be myself
My inability to concentrate, to think coherently over important things,
My relapse into focus on the smallest survival issues…
…Sighing, yes, disappointment indeed
Relief, too, that I know that I am improving,
And, that my brain is ok…
The poem below illustrates the challenging nature of the process of recovery:
Nearer and nearer to the end
The last week has gone, it seems to me, slower and slower.
Thinking about this, a human condition,
The nearer to the goal or end,
The nearer one gets towards it
The slower the time seems to go…
The following three poems describe the wide range of emotions felt as an aspect of recovery. The expression of these emotions through reflection can aid the process itself:
Feeling Like a Person:
…After I went for a walk I told everybody…
…It was so exciting talking to everybody and telling them.
…Oh, oh, I just cannot believe it, I just want to walk everywhere now…
…Not to undo this wonderful feeling of getting back to normal…
Excitement and Fear (Again):
…You are nearly there, you are there really,
You are so steady on the Zimmer frame.
Joy at this news and fear about crutches…
…Yes, I am absolutely one hundred per cent joyful about going home
And yet there is a little fear about leaving this safe, caring place
Where I have been now for seven weeks.
Seven weeks of my life…
Getting Back to Normal:
Yes, getting back to normal
The first thought, the smell, the taste, the experience of coffee…
…The reality is that I am still not really enjoying much food,
The thought of it, yes, but the reality, not so much
So, that is part of the recovery, I guess
Getting back to normal.
Getting back to normal will not be having this narrow focus…
…So getting back to normal is going to be a slow, slow process.
The final poem reflects on the overall experience and directs attention to the reality of the present and what has to happen in the future. Once again, reflection provides insight into what is involved in the process of recovery:
This week is the week I shall be leaving
After eight weeks. Letting go…
…So, although it is sad in one way that I won’t see them (staff)
In another way it is part of letting go of this episode of my life
And help me move back to my own life, in my own world
Out of the hospital into the world of reality, my world…
Alongside the recovery process, the reflections also identified other issues. I have selected examples to illustrate how such difficult and challenging experiences can be acknowledged and confronted. If ignored and left unprocessed, experiences such as a near-death experience may inhibit the recovery process.
Fear in the Dark:
It is scary to wake up and not feel well
In the dark, in hospital by yourself…
…Am I imagining this or is it real?
Whatever it is, I am scared
I cry a little, I worry a little
And then I buzz. I buzz the buzzer
The nurses come, they are matter-of-fact…
…And I can hear the steady stream of the oxygen.
Then it disappears as the wind HOWLS outside the room,
Rushing around the square
And then I hear the ‘ssss’, the gentle, slow hiss of the oxygen again.
And then I think it has stopped
I call for the nurse…
…Maybe I am going to die.
I don’t think so, but maybe I am…
…But it was a scary experience that fear in the dark
Of not knowing what was happening
And what would happen and what might happen
In the fear of the dark.
I found that reflection facilitated the emergence of alternative perspectives, as the following poem illustrates:
Minor to Major:
How the small incidentals of the small life
Lying in the bed in one small room
In the hospital
How the minor incidentals have become
The major focus of life…
…I became frustrated and agitated
About something which was inconsequential
This is the MINOR incident becoming the MAJOR catastrophe
In the context of a very small world.
Professional relationships were also reflected upon. These reflections are included as they illustrate the nature of an ‘intimate professional relationship’ (Garbutt, 2009), in which clear boundaries are maintained by the practitioner when dealing with either intimate physical or psychological problems. For example:
Intimate Personal Relationships:
Today I notice the parallel between nursing and counselling
The nurse and the counsellor, both know about,
To put it crudely, the shit.
I think this after my experiences of use of bedpan
How the nurses help the patient
To manage this excruciatingly private activity
To be done with dignity within that intimate professional relationship,
Not damaging the day-to-day interaction as human beings.
The counsellor offers this intimate, professional relationship to the client,
The client can say the worst, the most horrible stuff
That they want to get rid of
They evacuate the poison and the dirt
The mess and the horror.
There is the metaphor.
Parallels with the Physio:
Just a thought
That, as the physio works on my leg
And pushes my knee, she takes account of the pain
That is expressed in my voice and face
So similar to challenging in counselling
When the decision how far to push the challenge to that person
Can be helpful or destructive,
A decision about how much someone can take
As part of their treatment and improvement
And what is the fine line between going over that
And becoming damaging or destructive.
The parallel between the physiotherapist and the counsellor.
Reflection on a range of feelings, including depression, despair and fear, continued throughout the process of recovery. For example:
Night Time Fear:
Feeling swirly, lying flat in bed
Feeling as if the darkness is moving around
Even though comfortable, even though settled
The night time fear is something different…
…In the early hours, around three o’clock
I was wide awake and had that feeling
Had to take deep breaths
And the fear in the dark
Swirling round like the darkness itself…
…So, I think it is the FEAR in the dark
That causes the fear in the dark
The fear of the dark, the swirling fear
The fear of going to sleep and not waking up
Is the fear I had last night.
Swirling fear, it swirls around my head
It swirls around my eyes, it swirls around my body
Swirling round, that fear
The fear itself is enough to take you away
Even though your body is ok…
…The fear of the night is too much to bear…
The issue of sleep arose throughout the reflections, connected to both the recovery process and the strong feelings experienced as a patient. The following poem describes the significance of sleep:
All through the night I think I am awake
I know that I am not awake all the night
I know I dozed, then it was sailing by
So one o’clock might have been when I finally went off to sleep…
…I thought I was awake all night
But when I checked next time it was five o’clock…
…So, this half sleep, half waking is uncomfortable
But not sleeping all night is not really the case
Sleepless nights not quite.
Visitors are very important to patients, being a vital link between the latter and the outside world. Reflecting on the experience of having visitors revealed the complexity of this relationship.
The purpose of visiting is for the patient to listen to the events of their lives
The visitors. The good patient listens to the visitor
About what they have done, what their families have done
What is happening in their lives.
The patient can only talk about what has happened to them
In the small world of their pain and injury or illness
With graphic details of bodily functions
And the frustration of restrictions of interest to nobody.
To make a success of visiting as the patient
Your role is to listen, to hear and enjoy
The lives of your visitors.
Putting this Therapeutic Model into Practice
The above presentation has demonstrated how a therapeutic model using reflective writing may be used to assist recovery from trauma. This model was developed from an established practice model for the development of an internal supervisor, and from my own experience of recovering in hospital from an accident. It has shown how the first two stages of the model (recording/writing reflections and listening to/reading the reflections later) helped me to initiate the process of recovery and the return to normal life, by allowing me to give expression to various aspects of those experiences. The optional third stage of the model, in which the reflections are analysed and may be discussed with a third party, can help to bring closure to the experience of trauma.
The clarity and simplicity of the three stages mean that this therapeutic model can be used and applied by any individual in order to assist her or his recovery from a traumatic experience. The therapeutic model is flexible and easy to adapt to the needs of individuals. Support and care workers could also be involved in assisting patients to use reflection. Some training in both the practice model and the therapeutic model of reflection could be offered. This would expand the knowledge and skill of practitioners and provide effective help to patients.
Linda Garbutt’s interest in therapy began whilst working with single homeless people which inspired and motivated her to train as a counsellor and then as a supervisor. She worked for twelve years as a counsellor in Primary Care in a large city centre surgery as well as developing an independent counselling and supervision practice and facilitating counsellor training and a range of short courses and workshops.
Bolton, G. (2001). Reflective Practice, Writing and Professional Development. London:Chapman.
Bolton, G. (2010). Reflective Practice, Writing and Professional Development. Third Edition.London: Sage.
Garbutt, L. (2009). Managing Psychotherapeutic Practice Between External Supervision Sessions: Understanding and Using the Concept of An Internal Supervisor. Unpublished
doctoral project, Middlesex University.