Applying Spiritual Values and ResourcesIn the Management of Traumatic Stress Rev. John E. Jamieson, Ph.D. Observation of recent traumatic events, from Oklahoma City to Littleton, has led to the conclusion that there is a need to evaluate the role that spiritual and religious values and resources may play in the management of traumatic stress. In viewing the news reports about these recent events, it became evident that, in almost every situation, the community at large sought comfort, support and understanding from their personal religious community. Many news stories reported on the numerous memorial services held for the victims. Others dealt with the clergy s involvement in the recovery process for grieving survivors. Conversations with observers of these events often moved back and forth between expressions of horror at what had happened and expressions of religious hope and concern for the survivors. As time passed, the "human interest" stories started exploring the personal reactions to the events, some of which included significant spiritual growth by an awakening of spiritual awareness, which provided new hope and the strength to move ahead. Altogether, these various pieces of information form a pattern of behavior that seems to sustain the premise that there is value in utilizing religious or spiritual beliefs and practices to provide support for the recovery process for victims, rescuers and observers of traumatic events. In a nation that is busy at the work of seeking personal spirituality, there remains an often repeated misconception often held by mental health professionals that religious professionals, who are perceived as dealing in myths and mystery, have little to contribute in a time of crisis. The practical evidence of recent events would seem to challenge this assumption. It has been reported and confirmed that, in Oklahoma City, as the first rescue units were arriving on the scene, the religious faithful were gathering in a church within sight of the disaster to pray for the victims and survivors as well as for the safety of the rescuers. This was not an organized event but rather a spontaneous response by people who cared very much for their neighbors and friends who were involved in the tragedy. While this example does not directly address the theme of this article, it does demonstrate an intrinsic value that is perceived by the populace at- large in the rituals and beliefs of the numerous religions and spiritual groups among us. In their book, Critical Incident Stress Management (CISM) (Second Edition), George Everly and Jeffrey Mitchell (1999) state that, "The chaplaincy, or other religious-oriented crisis response elements, including pastoral counseling, may also house the CISM program because of their universal value to primary, secondary, or tertiary victims of crisis who are desirous of such intervention. In the same work they also note that targets for referral could include, but not be limited to: 1) Medical services; 2) Psychological services; 3) Psychiatric services; 4) Religious or spiritual services; 5) Family support services; 6) Financial aid services; 7) Career counseling; and 8) Legal services. The authors also suggest that in some instances, several of these services will need to be combined to best serve the patient in distress. In these references, Mitchell and Everly take a first step in the formal recognition of the value available in religious or spiritual support services. In another publication, George Everly (1995) asserts, "No one should underestimate the spiritual needs of individuals who are exposed to traumatic events. CISM trained clergy personnel play a vitally important role in the management of psychotrauma." This is an important assertion because it establishes the spiritual needs of individuals as an important priority for the continuing management of traumatic stress. What kinds of religious or spiritual services are of potential value? The answer to this question will depend upon the specific beliefs, convictions, and practices of the individual affected by traumatic stress. In general, there are at least four kinds of services that have demonstrated value in the incidents mentioned at the beginning of this article. These services would include funerals, memorial services, spiritual fellowship and pastoral counseling. Funerals often serve as the initial point in the recovery process from grief. In the ritual of the funeral, the reality and inevitability of death are squarely faced. This can move the survivors from denial into one of the later steps of the grieving process. Because in many religions the emphasis of the funeral is equally focused on hope in a future state, the ritual can begin enabling the affected individuals to gain a broader perspective on the loss suffered which helps them to normalize the events surrounding the death. Sensitive clergy who understand that normalizing emotional reactions to what has happened is a critical component of the recovery process can structure the funeral ritual to accomplish this goal. When people understand that the grief and anger they feel are "normal" reactions to an "abnormal" set of circumstances, they are able to more easily put aside the crippling emotions and begin the recovery process. Memorial services actually fulfill multiple functions. Primarily they are a time when the whole community can gather to remember and celebrate the individuals whose lives were lost. But, beyond this, they also serve as a cathartic agent to allow the community to begin to share the grief of those immediately affected. This can be accomplished by the sympathetic expressions of the gathered community, or by the conduct of the leaders of the service. The tangible sense of community that exists in large public gatherings also adds to the healing effect. A third spiritual service that can be helpful is that of spiritual fellowship. This can occur in small or large groups. The primary mechanism at work in this case is the shared beliefs and values that are reinforced during times of crisis as fellow-believers reach out to those more directly impacted by the trauma. It can take place across a kitchen table or in a religious (faith-based) support group, or in a larger venue of worship. Because victims of trauma often feel isolated and alone, opportunities for fellowship are important to help them avoid the withdrawal and social isolation that often are part of traumatic stress. Because those involved in this spiritual fellowship share the same beliefs, values, convictions and practices as the victim, it provides a normalizing reinforcement of the person s own values and beliefs. This process serves both to help avoid unnecessary suffering and to provide a foundation on which the recovery processes can be built. The fourth service, pastoral counseling, requires special training for the clergy in order for the process to be most effective. Unfortunately, few clergy are adequately trained to provide interventions for critical incident and posttraumatic stress. In some cases, pastoral counselors (like some ill-prepared mental health professionals) lack a proper understanding of the mechanisms of traumatic stress and as a result offer religious platitudes that can exacerbate the trauma by creating guilt, shame, or confusion. However, a properly trained pastoral counselor can help a traumatized individual recover from the physical, mental and emotional symptoms of traumatic stress by skillfully integrating sound psychological support with appropriate reinforcement of applicable religious doctrine and teaching. This approach can enhance the recovery of mind, body and spirit to achieve an integrated wholeness as the recovery process is completed. It is important that the counsel offered reinforces those spiritual values that will best enable the person to regain a state of wholeness or homeostasis. Such values may include forgiveness, reconciliation, hope, love, compassion, and generosity. The positive nature of these values is very significant because the person will often be overwhelmed with a sense of guilt or self-blame. Fear of criticism and a tendency to seek isolation from social contact are frequent symptoms of traumatic stress. If a counselor were to reinforce values that concretize blame or cause the person to feel they are being judged for what has happened, irreparable harm might result. Therefore, it is most important to reinforce positive, constructive values that are a part of the persons normal belief system so that they can gain strength from these values and reconstruct their life on positive principles. If the pastoral counseling is in the form of a support group, the same or greater care must be taken to assure that neither the facilitator nor members of the group allow the conversation to focus on destructive or negative values. Properly utilized, pastoral counseling has the potential to enhance and accelerate the recovery process by drawing upon the positive energy of existing beliefs, convictions and values, rather than having to teach new values that may conflict with the person s existing convictions. It is not a replacement for appropriate Critical Incident Stress Management any more than CISM is a substitute for appropriate psychological interventions. They each enhance the other and, taken together, provide a holistic approach to meeting the needs of those suffering the impact of traumatic stress. This article is not meant to be a thorough defense of the value of spiritual and religious support in the management of traumatic stress. Rather, it is intended to raise the challenge to researchers and practitioners alike to more fully evaluate the theoretical and clinical significance of spiritual and religious values and resources in the management of traumatic stress. Anecdotal evidence seems to suggest a spontaneous tendency (at least in some communities) to seek spiritual and religious support in times of crisis. If this can be more broadly substantiated, then experts in the field of traumatic stress will need to assess what needs to be done to optimize the effectiveness of this phenomena in caring for those impacted by trauma. Hopefully, research will give these spiritual values and resources clear significance as one part of the total array of options available in the management of traumatic stress.   References Everly, G.S., & Mitchell, J.T. (1999). Critical Incident Stress Management (Second Edition), Ellicott City, MD: Chevron Publishing Co. Everly, G.S., (1995). Innovations in Disaster and Trauma Psychology (Vol. 1), Ellicott City, MD: Chevron Publishing Co.