-Jamuna Maharjan Shrestha
The damage to relationships is not a secondary effect of trauma, as originally thought. Traumatic events have primary effects on psychological structures of self, as well as on the systems of attachment that link individual and community.
Trauma is a normal reaction to an abnormal situation. Most people experiencing trauma cannot verbally express what happened to them. They feel shocked or frozen, can’t breathe, feel loss of body sensations, have difficulties in making decisions and experience intense anger, betrayal, and isolation.
In this context, Common Threads offers an effective way to express feelings and emotions, without the need to verbalize. Common Threads is an art based psychotherapy that helps to deal with traumatic experiences in a structured manner, so as not to relive those experiences, but to reprocess and discharge them. It involves expression of emotions through stitching and sewing on a piece of fabric, which are called story cloths. With every stitch, the body and mind reprocesses the entire traumatic experience, thereby helping the person to heal. Common Threads approach was devised initially for group work. However, I have found that this approach is effective in individual settings as well.
During my experience of working with the urban refugees of Kathmandu, I have encountered many cases where a verbal approach to counseling was unsuitable. Here is an example of how Common Threads helped one of my clients to recover from her traumatic experience. In this particular case, I decided that it would be appropriate to use Common Threads in an individual setting.
Sahara (pseudonym), became a refugee 10 years ago, after she had to flee from her country Pakistan. Among the three categories of Islam: Shiya, Sunni and Ahemdia, Sahara belongs to the Ahemdia category, a small minority not recognized in Pakistan. They live under constant fear of threat to their lives, which was why she left the country.
Sahara belonged to a well-off family and was the only daughter, with two younger brothers. Her family did not discriminate her as a girl, rather taught her to be independent, regardless of gender, religion or any other factors. She remembers her mother telling her to learn to change, cope and adapt according to the situation.
As she came to Nepal with her family (husband and two sons), she soon adapted with the local culture and beliefs. She had a zeal to learn new things and quickly learned Nepali and English languages. She also learned about family planning and did not want to have more children owing to the difficulties of refugee life. Her family supported her ideologies, but the Ahemdia community in the refugee camp did not, as family planning is not an acceptable practice in the Muslim community. Females of the community spread rumors about her and excluded her from their group. During these times she often missed her family, most especially her mother (her primary caretaker) and felt lonely, because it was hurtful to be rejected by her own kind. When her husband and children were not allowed to enter the Ahemdia mosque to pray, it affected her immensely.
Sahara was going through a tough time due to this exclusion, when she heard the news of her mother’s death. She always longed to return to her home country Pakistan and share her experiences with her mother. But this sudden loss triggered depression in her and the relationship with her husband was disrupted. In Asian culture, as family members live close together, a web is formed, where each member of the family contribute in maintaining an ecological balance in the web. When one part of this web is broken i.e. when someone close or a loved one is lost, the balance is disrupted and this might cause trauma. The profound disruption in basic trust, the feeling of shame, guilt and inferiority, and the need to avoid reminders of trauma that might be found in social life foster withdrawal from close relationships.
Because of her loss, Sahara lost her appetite, had disturbed sleep and did not want to go out or make contact with anyone. She would always remember the moments shared with her mother and sometimes hear her voice teaching her to cook and sew. Despite being the kind of person who could not see others being hurt, she suddenly felt the urge to hit people. This contradictory nature between one’s personality and experience is common among traumatized people. Because of their difficulty in modulating intense anger, survivors oscillate between uncontrolled expressions of rage and intolerance of aggression.
She would also feel irritated with the smallest of noises, even her husband’s voice. She tried to cope with this by lying alone in bed and hitting her head on the wall. One day she felt so irritated that she attacked her husband, blaming him for their lives as refugees. After this event, her husband reported to UNHCR and they referred her to me. When I met her, she looked weak and had lost a lot of weight. She had not combed her hair or groomed herself.
After some sessions of counseling, she started opening up to me and shared her grief. Memories of her mother came flooding back and she would often cry, feeling overwhelmed with emotions. I listened to her from my heart, with courtesy and attentiveness. Then I encouraged her to practice Common Threads and prepare a story cloth expressing the issues about her mother, which was bothering her the most. Considering her comfort and safety, we went to a safe place, where I asked her to picture what she wanted to portray in the story cloth and draw it on a piece of paper first.
During the sessions, she always used to clutch a piece of scarf in her hand. She told me that it was her mother’s scarf, given by her mother as a representation of herself before she fled from Pakistan. She used this scarf in the story cloth and made her mother’s image in it. When she sewed the face, she recalled a lot of things and had an emotional discharge. As she sewed the eyes in the cloth, she recalled her mother’s attention to detail; sewing the nose reminded of her mother smelling food, while sewing the lips reminded her mother’s soft spoken words that inspired her. I observed that Sahara had a high level of concentration while doing Common Threads. This helped her discharge the pain from her heart which may not have occurred in a conversation. Common Threads helped her heal gradually, as well as honor her mother’s memory in the process. As the story cloth started coming together, I could see an increase in her self esteem. She was surprised to find that the thing bothering her the most, when expressed through sewing, became positive. The process took about 3 months to complete, after which her condition improved and her relationship with her husband was better. Her aggression reduced and she was eating normally, smiling and taking care of her children.
“Even though my mother is not present with me physically, this representation will always remain with me for the rest of my life. I will keep this on the wall above my bed”. She is thankful to Dr. Rachel Cohen, who developed the concept of Common Threads. After some time, she received her exit permit from Nepal Government and is now re-settled with her family in the US.
With this case, it can be reiterated how it’s easier to release trauma when objects are used, rather than talking about the same thing several times. In this case, the different colors of threads and cloths, needle, scissors, pins, and other objects used by Sahara helped her. Sewing a story is helpful in processing the imagination into a narrative form. It balances the remembering with being in a safe, affirming, non-anxious present. However, we need to keep in mind that experiential dramatization or acting out of past traumatic events without reprocessing can increase rather than decrease distress and should be avoided. It is important to learn tools to create a safe place, coping strategy, face traumatic events, and rebuild social relationship and trust.
At difficult times, there is often no time or opportunity to honor the losses. In such cases, I have found that Common Threads is an effective therapy as it provides plenty of time to remember the positive and meaningful moments of traumatic incidents, or of the little things and the stories behind the relationship, person or thing that was lost.
(Ms. Maharjan is currently working at TPO Nepal as Clinical Manager. Her areas of expertise include psychosocial counseling, psychotherapy, supervision to counselors, program and training design, case management and co-ordination with clients and their family.)