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EmailMaintaining Sensitivity to Traumatic Life Experiences through Therapeutic Conversations
Danielle Simandl
Toronto
When it comes to sharing pieces of our lives with others, no equation could elucidate the best approach to acknowledging the intricate experiences that shape our very being, especially for Holocaust survivors. As such, nurses must be mindful of this individualized variable in order to provide optimal client care. Though Holocaust survivors share in their experience of suffering, “survivors are not a homogenous group”, as described in 2002 by David. Some clients prefer to suppress horrific memories while others find it therapeutic to share their experience during the war (Weinstein, 2002). Determining what is most appropriate for each individual should be continually evaluated by health care staff.
Experience
During my time at Baycrest Centre for Geriatric Care, I encountered a sweet soft-spoken man that I escorted to a diagnostic test one day. He mentioned that he had lived through both wars, but the hallway hardly seemed like the place to further explore the significance of these experiences. Coincidentally, I was assigned to him the next day, so I eagerly read through his files to better prepare for my role in his care. I discovered that he was a Holocaust survivor who had lived in a concentration camp during the war and lost all 70 members of his family. During a break in his regimented day, I attempted to engage in conversation to try and understand his experiences during the war. He was initially hesitant to respond and when a look of pain came over his face, I soon realized how difficult it was for him to talk about this time in his life. I felt absolutely dreadful. I had become so engrossed with the idea of having a therapeutic conversation with this man, that I lost sight of the purpose of our conversation; my interest in connecting with him had involuntarily taken precedence over his needs.
Analysis
There are numerous components considered fundamental to therapeutic conversations aimed at meeting client needs, but considering the context of my interaction, I will only be exploring the importance of building rapport, timing and responding to communication cues.
Building Rapport
The aim of building rapport is to ensure the client feels at ease relating information that could help health care providers understand what the individual is experiencing, both physically and emotionally (Arnold, 2003). Particularly with Holocaust survivors, establishing trust and allowing individuals a degree of control over their lives is tremendously important (Betts-Adams, Steinberg-Mann, Weintraub-Prigal, Fein, Souders, & Sookman-Gerber, 1994). Establishing any trusting relationship takes time to develop, but particularly in a population where caution with trust has meant survival (Betts-Adams et al., 1994). In the scenario mentioned above, one barrier to creating this level of trust was the limited amount of time we were scheduled to be at Baycrest. Time was a factor beyond my control but probably hindered a potentially trusting relationship. Thus, without the time to build a good rapport with this client and gradually gain his trust, the comfort necessary to discuss traumatic life experiences may have be lacking, deeming this topic inappropriate. One must keep in mind, however, that some patients develop this comfort within moments, while some may never feel comfortable despite the best actions and intentions of health care personnel (Bar-Tur & Levy-Shiff, 1994).
Timing of Conversation
Another component critical to successful therapeutic conversations is initiating these conversations at suitable times and appropriate places ( Arnold, 2003). Determining what this means precisely involves some judgment, but generally, private conversations are not suited for public areas and important issues should not be addressed when there are time constraints (Sundeen, DeSalvo, & Cohen, 1994). Initially I had used good judgment by avoiding a conversation about potentially traumatic experiences in the hallway waiting for the diagnostic test, but the following day, I should have recognized that he was tired from his physiotherapy before even considering a conversation of this nature. Therefore, timing is crucial to enhancing the benefit of a therapeutic conversation.
Communication Cues
Finally, responding to a variety of verbal and non-verbal communication cues can facilitate a positive therapeutic conversation ( Arnold, 2003). As mentioned earlier, some clients are more forthcoming with their experiences during the Holocaust as a means of coming to terms with those traumatic memories; in some cases, justifying their role as a survivor by preserving the memory of all those who suffered. On the other hand, some clients do not want to revisit those tragic days or prefer to repress wartime memories (Bar-Tur & Levy-Shiff, 1994). In my interaction, it may have seemed reasonable to ask about life during the war since he had initially brought up the topic; however, as soon as it became apparent that wartime memories seemed to invoke pain and a degree of disinterest in dialogue, his body language and tone communicated his apprehension, even though he did not explicitly express his anxiety. Because of this, I did not continue to explore his history, potentially preventing further distress. With the distinct variation that exists amongst clients’ coping mechanisms, being cognizant of communication cues can be instrumental in outcome of therapeutic conversations ( Arnold, 2003).
Implications for Practice
In order to meet the client’s needs, it is imperative that health care providers are in tune with their client’s history to appreciate where they are coming from, assess whether or not the client would benefit from engaging in a conversation and ensure the client’s needs, not the nurse’s concern, propagate this conversation. Reflecting on my own nursing practice, to avoid forcing a conversation onto someone who is unwilling or uninterested, I would first allow more time to establish a trusting relationship between myself and the client. I would try to assess how comfortable this person was talking about his life in general, not necessarily anything traumatic. If there seemed to be a comfort discussing family members, friends etc., I would try to observe any reference to traumatic experiences.
At this point, if it seemed the client wanted to discuss a previous traumatic life experience, I would ensure the time was appropriate by asking the client as well as taking daily routines into account. Finally, in terms of communication cues, I now feel far more confident recognizing the messages clients may inadvertently send and respond to those more quickly. In order to create a therapeutic environment, the nurse should strive to find a balance between tactfully encouraging those who might want to share and acknowledging that some client’s simply do not want to engage. Ultimately, recognizing that each client will have different coping mechanisms for past experiences and realizing that not everyone finds comfort in disclosing their suffering will best serve the needs of the client.
References
Arnold, E. (2003). Developing therapeutic communication skills in the nurse-client relationship. In Arnold E. & Underman Boggs, K (Eds.), Interpersonal relationships: Professional communication skills for nurse, 4 th Edition (pp. 233-265). St. Louis: Saunders.
Bar-Tur, L. & Levy-Shiff, R. (1994). Holocaust review and bearing witness as a coping mechanism of an elderly holocaust survivor. Clinical Gerontologist, 14, 5-16.
Betts-Adams, K., Steinberg-Mann, E., Weintraub-Prigal, R., Fein, A., Souders, T.L., & Sookman-Gerber, B. (1994). Holocaust survivors in a Jewish nursing home: Building trust and enhancing personal control. Clinical Gerontologist, 14, 99-117.
David, P. (2002). Aging Survivors of the Holocaust in Long Term Care: Unique Needs,
Unique Responses. Journal of Social Work in Long Term Care, 1, 73-89.
Weinstein, L.B. (2002). Holocaust testimony: A therapeutic activity for older adult holocaust survivors. Activities, Adaptation & Aging, 27, 27-37.
Sundeen, S.J., DeSalvo Rankin, E.A., Stuart, G.W., & Cohen, S.A. (1994). Nurse-client interaction: Implementing the Nursing Process. St. Louis: Mosby.