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Addendum C
Addendum C: Natural Disaster and Trauma using the Future-Pull Approach

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Often when dealing with trauma, especially when dealing with the trauma of natural disaster, we tend to look into the past in order to cope with our trauma. With this technique, I encourage my clients to focus on the future in order to help influence their actions in the present in a positive way.

With the future-pull approach, clients are re-oriented from revisiting the past to focus more on future-oriented thinking. Here are a few tips to use to make the future-pull approach successful with your client.

Tip 1: Methods
I begin by redirecting my clients from their past to their future and to turning their problems into preferences. To do this requires a subtle redirection from thoughts of the past (reflections, complaints, problems, pain, etc) to positive thoughts about the future (longings, solutions, hope, etc). Focus on communication that…
- turns problems into preferences
- rephrases what the client does not want to what they do want
- reorients from the past to the future
- focuses on the presence of something instead of the absence of something else
- encourages your client to focus on small leaps rather than big changes

Tip 2: Expectancy Talk
With clients that have been through trauma, not only is it important to have them focus on the future rather than the past but it is also important to encourage a positive view of their future. To do this requires using phrases and questions that create a belief in a positive or improved future. Phrases like: "How quickly?", "Yet", "So Far", "After", "Before", "When", "Will".

While in a session with Jackie, the 30 year old who was traumatized by a hurricane, using expectancy talk led to the following discussion:
Me: Thinking realistically, how long do you think it would take to lift this depression?
Jackie: If something really helped I think days or a week.
Me: When this improvement happens, who would be the first person, other than you, to notice you feeling better?
Jackie: At work they might notice since I would probably get my work done on time and speak up more at meetings.
Me: Who else?
Jackie: Probably my brother since he tends to notice that stuff.
Me: What do you think he would notice?
Jackie: He can always tell by my voice if I am in a bad or good mood.
Me: Have you found a way to diminish your flashbacks or stop your cutting?
Jackie: …
Me: Do you think when the dissociation lessens, you will be more connected to people and the world?
Jackie: I think that I would be more myself
Me: How have you acted when you feel disconnected?
Jackie: I am definitely more quiet and alone with my thoughts. Usually I stay alone.
Me: So when things get better you will be more talkative?
Jackie: Yeah.

Tip 3: Exploring Preferred Futures
Another important way to guide your discussion with your trauma client is to assist them in exploring a future without the problems they face with PTSD. I ask "If your problem disappeared, what would be different?" I focus on each aspect of their life like their actions, thinking, relationships, daily life, etc.

You can also use the Miracle Question which was implemented by Steve de Shazer. With the Miracle Question, engage your client in creating a scenario in which the situation that created his or her trauma never existed. I usually begin by saying "Imagine that when you awake tomorrow the problem that created your trauma never existed." It is important that the person is invested in the experience. I then proceed to ask what they first notice that makes them realize that the miracle happened and then how others would notice that the miracle happened. This is how the conversation went when I used the Miracle Question with Jackie:

Me: Imagine when you wake up in the morning and the natural disaster that you lived through had never happened. It is a miracle. Really visualize this scenario. What is the first thing that alerts you that the miracle has occurred?
Jackie: This heavy feeling in my heart would be gone.
Me: What feeling would replace this heavy feeling?
Jackie: Hopefully peace or even happiness.
Me: With this different feeling, what, if anything, will you do differently?
Jackie: I would love to be with my son. The little things like watching him read or playing outside with him.
Me: In this scenario, how would your son know that you are better and different than you are now?
Jackie: He would see that I am using a softer voice to talk to him and that I smile at him more.
Me: How do you think these behaviors would affect him?
Jackie: He wouldn’t be sad as often and he would be less fussy.
Me: What would happen if he acted that way?
Jackie: I think I would give my son more attention
Me: And how would this affect your day?
Jackie: I would feel more relaxed and get a sense of closeness with my son. If I deliberately start smiling more to him and talking in a softer voice maybe he will be happier.
Me: It is worth a try.

Tip 4: Letter to Your Future Self
With clients who have suffered trauma after a natural disaster, like Jackie who is living through the trauma of surviving a hurricane, I encourage them to write a letter to there future self. Here are the guidelines I give my clients:
- Write a letter from your future self to your current self from a happier place where you have resolved your issues that are troubling you now.
- Have your future self describe where you are, what you are doing, what you have gone through to get there, and so on.
- Your future self can include the crucial things you realized or the steps you took to get to where you are. Write about crucial points that led to your future.
- Give your present self some advice, and words of encouragement, from the future.

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Addendum D
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