Innovations in End-of-Life Care
an international journal of leaders in end-of-life care

Bringing Together Families to Cope with the Effects of Trauma

An Interview with Isa de Jaramillo

Dr. Isa de Jaramillo, a clinical psychologist living in Bogotá, Colombia, has been working with groups of people who have been traumatized by unexpected events—both natural disasters such as volcanos and earthquakes, and the aftereffects of terrorist acts and civil war. Dr. de Jaramillo founded the Omega Foundation in 1987 to address the need to speak more openly about death, to train health care professionals to care for dying patients and their families, and to offer patients and families psychological support near the end of life and during bereavement. The Omega psychologists see patients at home, on an outpatient basis, as well as working with people on site, in the ruins of a volcanic eruption or an earthquake. Dr. de Jaramillo also founded Lazos, literally "Links," a community-based grassroots bereavement organization similar to Compassionate Friends in the United States.

Dr. de Jaramillo and her team of psychologists share the meaning-centered framework of bereavement articulated by Dr. Neimeyer in his editorial in this issue of Innovations. Dr. de Jaramillo's approach is grounded in the belief of the healing power of words, ritual and community. Specifically, her methods aim to help people integrate the unspeakable, i.e. the experience of trauma, into their personal stories, an act that she believes is ultimately what allows survivors to continue living. The first step of their short-term, intensive intervention involves creating small groups, each of which is led by one or two psychologists. The group leaders help each survivor find words to retell his or her experiences, and then engage with the group intensively for one to two days of bereavement activities. In the group, the participants have the opportunity to retell and sometimes create a more complex group memory of what happened. In addition, they work together to create rituals that are grounded in the local context. Many of the survivors she and her team have worked with have been people of exceedingly modest means, sometimes illiterate and without access to many outside resources. Dr. De Jaramillo and her team attempt to design a local intervention that uses metaphors and images connected to the worlds these people inhabit. The Omega trauma team aims to build on the existing resources so that after they leave, these individuals have a way to continue the work of making meaning of the traumatic events they have witnessed.

Dr. de Jaramillo has been engaged in clinical work and crisis intervention to address human suffering, trauma, sorrow and grief for more than 30 years. In the following interview conducted by Anna Romer, EdD, Dr. de Jaramillo discusses the crisis intervention group work she and members of her team have conducted with survivors of trauma of all kinds and reflects on the implications of this experience for clinicians and families affected by the events of September 11th and their aftereffects. [Citation: Jaramillo I, Romer AL. Bringing together families to cope with the effects of trauma: An interview with Isa de Jaramillo. Innovations in End-of-Life Care. 2001;3(6), www.edc.org/lastacts ]

Please describe the range of situations you and your team have responded to in Colombia.

Sixteen years ago, a huge volcano exploded and completely wiped out a town called Armero, killing 25,000 inhabitants. I had the privilege of working full-time in an improvised hospital setting where they took care of the people dying from gangrene. I worked there until the last person died. In January 1998, an earthquake shook the town of Armenia and killed 2,000 people. I went there as the leader of a group with 22 other psychologists. We had worked together as a team for some time, conducted an intense 20-hour training for this event, and then we went to work with the population. We sat in the ruins with no food and no water, the earth still shaking. We divided the survivors up into working groups according how many loved ones each had lost. We worked for several days in very poor conditions with these people.

I have also worked with people affected by terrorism. For instance, in 1989,1990, 1991, and 1992 there were many bombings in shopping centers, in the streets, in airplanes, everywhere. This terrorism was linked to the drug cartel lord Pablo Escobar, who was later killed. During those years, bombs were everywhere. The population learned to live with the bombs and I worked with the survivors—the families, the communities, the schools. I see the political violence, drug wars, and poverty that exist in Colombia as conditions deeply connected to the complex international problem of drug use and drug demand from many other countries. These multifaceted issues are directly linked to the problems of terrorism. Just as it is important for survivors to create a meaningful story of their experience, we who care for them also need to have an explanatory framework for these horrendous events in order to do this work.

Systematic Retelling of the Experience

Can you describe your approach to working with survivors of traumatic events?

For each of these traumatic experiences, I meet with my team of psychologists when I get the request for an emergency intervention. Sometimes we offer our services rather than waiting to be asked. We meet as a group to design a protocol for the intervention, having in mind the specific context of the trauma, the type of population involved, and the available resources. We tailor the intervention to the specific situation.

Generally, we conduct relatively short-term group interventions. We prefer small groups, each one led by one or two psychologists. In situations where there are many losses, or many people highly traumatized, and the load is particularly intense, then I send two psychologists to lead each group of survivors.

First, we introduce ourselves to the survivors and explain what we will do, why we will do it, and for how long, so that they don't have false expectations. We must be very clear from the outset about what we can provide. We use critical incident debriefing techniques and the healing power of rituals. The first thing we do is facilitate their recollection of the event. This process involves a reliving of the traumatic experience.

We ask each person to tell the story of what happened. Our hope is to help them integrate the experience. In the case of a group trauma, such as an earthquake, it can be analogous to putting together a one-thousand-piece puzzle. As we start the recollection of the experience, each person adds a little bit. For instance, one person may recall, "When the roof fell down and the house beside mine fell down, then I went out looking for water." And someone will add, "You were crying for help, I went and I gave you the pail with water." And the first woman may say, "Yes, but I was in front, and I couldn't hear you…."

We try to have them relive the whole experience. Each person adds one more piece of the story. Sometimes, as they listen to others, each person then gains a more thorough reconstruction and so understands more clearly what happened. We believe it is helpful for participants to know what happened and how it happened, whether it is a natural disaster or a bombing.

First, the story is told—what happened, when. Little by little, the emotions start to flow. We encourage and validate the expression of feelings no matter what the feelings are. We take pains to avoid creating a sense of victimization. In other words, we do not use clichés. We do not try to say things, such as "Oh, poor you, I don't know how you survived." On the contrary, we listen closely and take the retelling process very seriously. One of the antidotes to victimization is to help people gain control of the terrible events. You do not want them to feel they will always be passive subjects of a terrible drama.

In a situation such as a terrorist attack, how do you help people feel as though they have some control when the event is the result of conscious, willful action on the part of its perpetrators?

We cannot change what happened, but we can change how people make sense of it. Survivors of a terrorist attack experience a sense of chaos. So, we have to start by rebuilding a sense of order and control. The trauma feels as though a world has been destroyed—his world, her world, the physical and emotional worlds, their inner assumptive worlds. One's assumptions in life are shattered by the event. For example, up until this point, the person believed, "I am safe at home; my children have nothing to fear; we are not at risk." If then, a member of the family is kidnapped, or a bomb destroys the home, the ordinary perception of reality is altered. With terrorism, the sense of safety and security is lost.

So, we work with these survivors to develop some sense of control over those things that are traumatic. When a person experiences trauma, he or she often finds it hard to put the experience into words. The experience feels unspeakable. People have told me, "I cannot find words to tell you what I lived." Then I say, "Try, just try. Let's give you some time. Let's try to put into words what you are feeling inside. If you can't find the right words, I can try to help you. Maybe you can draw a picture you feel inside you now. Or, maybe you could just write the words that come to your mind. Don't worry. We have plenty of time." Other questions that can open or unlock the expression of feelings are:"What has been the worst for you so far?" or, "What or who helped you at that time?" Now, sometimes people are mute because they are in shock. Sometimes all you can do is sit by them and respect their timing.

If a person can put her experience into words once or many times, and if she can place events in time, for instance, that was last night; this was this morning, etc., she can slowly gain a sense of control over the experience. Then, she can, slowly over time, master the experience, instead of the memories mastering her.

We run small and large groups. The size of the group clearly affects what can happen. In small groups of 3 to 5 people, each one has a chance to tell his or her own story. So we say, "Each of you will have all the time that you need, and we're all going to listen carefully, because another person's turn will then come later." To the listeners, we assign this task of attending fully. So, we all listen to this story. We share what she or he says. We pay full attention and in this way, we validate the story.

When the group is larger, let's say, 15 or 20 people, we cannot take this same intensely personal approach. Instead, we offer an explanation of what they can expect from themselves, and we hope that being able to anticipate the effects of trauma will have a calming, or soothing effect. For instance, I might say, "We are going to talk about what happened briefly and then I'm going to describe some of the possible reactions you might be feeling. I'm going to write them on this paper or in the sand in the floor. I am going to name them out loud. I will then review them, one by one." Then I will address each person individually. We will validate every case, and we will ask them, "Which of these natural reactions have you experienced?"

We try to create a cohesive experience for them because it is essential in the middle of the chaos and confusion of the trauma. If the volcano is still erupting or the earth is still trembling, or there are more bombings, up to this moment, the primary task has been just to survive, no matter how. This debriefing may be the first time that this person has been asked, or given permission, to connect with his or her own inner experience.

As each person starts telling what he or she has felt, they go on and on; it is like turning on a water faucet. Once you open it, it keeps coming, and you can't close it. It's difficult sometimes to cut people off, once you have given them permission and the opportunity to open up.

These people are experiencing a combination of grief and trauma. First comes the trauma, of course, but they are mixed up. We have to identify all the losses each has suffered, but also the traumatic reactions each may have. For instance, we may say, "I can see you are feeling like a zombie. You just go on and on and it seems you cannot feel anything inside." We explain to them why they are feeling like that. If these are poor people, we will not use a computer analogy, but instead may speak of a tape recorder, in which someone is trying to play two or three tapes at one time. We will then start taking one tape at a time; some of these tapes will be cut or broken, and we will try to put them together, so that what comes out is a little bit more coherent over time.

You cannot imagine the impact of our presence in the midst of these chaotic events. The survivors don't want us to leave, or to let us go. They hold on to you and say, "Please, please, please, I have something else to tell you. Can I look for you? Where are you staying?" Sometimes, after the day's work, in the evening we work with the people that we have identified as at high risk of committing suicide or of having a psychotic break because of the magnitude of the trauma. This is why it is important to have psychologists available to do this work. We tell them, "We are available for you now. Your world has crumbled. I am here for now, and we can trust each other by now. I'm not going to disappear the way your house (or your loved one) did." This approach allows for a personal response. We believe that tailoring the response to the individual person is absolutely necessary in these difficult circumstances.

Our main contribution to these people, regardless of the source of trauma, is to listen, to share, to value their experience and so help them feel valued. As psychologists, we aim to tolerate the chaos and confusion. We do not become upset or part of the chaos, even in the middle of the chaotic event. We keep calm. We are present and we hold their hands strongly. If I have to help a person cross the street, for instance, I say, "Hold on to me. I am here. You can hold on to me." The respect we have for their experience will not be destroyed.

Burnout

In the face of terrorism or brutal murder, what do you and the psychologists you work with do to help yourselves not become upset and, thereby, ineffective?

First, I think that the answer has to do with planning and personal training. At the moment we have six clinical psychologists doing this work together at Omega. We all are women. Before we begin an intervention, we prepare together and speak about our fears. After we return, we conduct a debriefing for ourselves about the experience. If I perceive that somehow this person or this group or this experience is overloading a psychologist, I talk with her personally.

But the more you do, the more you can do. At the beginning, for instance, we were not dealing with terrorism. We might have been called in to help a family in which two people have committed suicide. Or there was a car accident—three people died, mother and the children, and the father and brother are alive. Twenty years ago, that kind of experience used to overload us emotionally for several reasons. It was difficult for us to prepare for the experience and we lacked adequate training, self-confidence, and a repertoire of possible responses. The next day, the events replayed themselves like a film in our heads, day after day, again, again, again. At that time, we were traumatized by our involvement as helpers.

Now we respond differently. We are fragile and vulnerable, but I must tell you with much pride, I think we can tolerate an enormous amount of suffering and chaos.

How do you account for this change?

I should say we have all become stronger, without becoming hardened. We have grown emotionally and each one of us has perceived changes as a result of this work, both in her professionalism and in her private life. We have shared unforgettable lessons in doing this work. It has been a rewarding learning process that has truly shaped our lives. Each of us knows what her strengths and limitations are. We have learned to tolerate criticism from the others and to accept advice and support. We learned day by day, in these 15 years (1987-2002) of commitment that as we can never stop being moved by suffering and tragedy. We have to recognize humbly that, in many cases, all we can offer is our compassionate presence. Paradoxically, we can now do more, with less personal suffering.

The last five or six times that we have done this, when we arrive home at 3 o'clock in the morning, I say to my colleagues, "I must congratulate you." I must because I observe them, also I work with them. I observe how they are the whole time. It is not magic, but hard work. When we go to sleep, I ask them, "How are you today?" Maybe I give them a hug or show support in some other way. I am not a saint or a spiritual leader, nor really an academic researcher, but rather a clinical psychologist deeply committed to her task.

What allows you to sustain this kind of effort, year after year?

After I arrive home from this type of intervention with victims of catastrophes, such as terrorism, or kidnappings, I feel this strong inner need to sit or walk alone for a while. I give myself permission to review the whole experience, day by day, and hour by hour, to remember, digest it, and to cry.

My family is very supportive, and very respectful of my work and my need to recoup afterwards. I have a huge family, and that's my main source of power and strength. I have a husband, 38 years of marriage, four children, and many grandchildren, some of whom live in the United States. They know that when I arrive, I need some time alone for myself, so I don't talk to anyone. I stay alone a little bit. In my inner world, in my own private personal way, I say goodbye to the people I've been working with. I also grieve over those losses of mine, in some way.

Then, the next day, I meet with my team, and we make a sharing session in which we drain all the emotional impact of these intense interventions. We speak about the specific events and the people, the interplay, what we saw, what we heard, and the way it impacts our private lives, our emotional, spiritual, and professional lives. Sometimes I get a cake at the end, and a glass of wine, and I say, "Let's toast to us, to our capacity for giving." And we have a glass of wine and a piece of cake.

The following day, here I am in my office again, as always. I come to my everyday job, which I adore. I have not had the time to write up my experiences. I work in my office with my clients every 45 minutes and I arrive home exhausted, literally exhausted. In spite of the exhaustion, I have a deep inner satisfaction, a mixture of pride and tears. This work gives me a personal and spiritual sense of well-being. It's a secret and silent conviction that what I did was enormous, beautiful, and helpful.

What evidence do you gather that you have helped the people who have suffered these catastrophes? Do you follow up over the long term to evaluate your effectiveness.

We receive letters, comments, calls, rewarding messages from many people and from institutions. We have not been able to do long-term follow up or to evaluate our effectiveness in any formal way, but we would like to. One of the most frustrating aspects of this work is not being able to establish a longer connection with the people we work with. It is intense, but sadly, short. Except, of course, for those patients we see in private practice. But we also have learned than little help is much more than no help. Our goals and expectations must be modest. Ultimately, "perfect is the enemy of good."

Lazos: Self-Help Group for Parents

It is very helpful if the survivors continue to meet as a group after our intensive intervention. In that way, they can share their grief with others who can understand some of what they have been through, when nobody else knows or perhaps understands about their loss. It is very important and is the rationale for a parent-self help group such as Lazos.

How did Lazos get started?

Six years ago, I had many couples that came for private help after the death of one of their children. Some children had been kidnapped and never returned, some had died a natural death, and some had had accidents. When a child dies, it is a very high risk situation for the couple itself. Death of a child causes enormous pain and suffering. I had been seeing these couples individually for one to two years, and one day, I thought, "Why don't I get them together?" So, I invited the nine couples to meet as a group once.

Each couple was well along with the grief recovery process. I introduced the idea by saying "Let us build something that will help us and other people who have lost a child. Let us put to use the energy and love that remains, though your children are gone. Perhaps you can help other parents who do not have access to a private psychotherapist like me."

These parents were enthusiastic and so we created Lazos, as a self-help group, run by parents, not psychologists. The parents and I wrote a guide, or a carilla based on their experience. As I said, "I'm not an expert on having lost a child. Unfortunately, you are the experts. So with your experience, let us write this carilla that will be of use to other parents who find themselves in your situation." I also made a video, called, "When you Lose a Child," which is sold to support the group.

I am the only psychologist involved, but I do not go to the meetings. I get together with them once a year, run workshops and serve as a consultant. I sometimes fundraise for them by giving lectures. I support their efforts, but I am not integral to their groups, which they run themselves.

What kind of training or experience are the parent leaders expected to have?

Two years must have elapsed since the death of the child, before a parent is eligible to be a group leader or coordinator. Many of these parents have benefited from some psychotherapy. The idea is for the leaders to be in the process of rebuilding a life. I don't know if a parent will ever recover from the death of his or her child. Maybe it is more accurate to speak of relearning to live, relearning one's way around in a world forever changed. But the leaders are people who have done a good job at relearning; they have suffered and they can share that painful learning with other newly bereaved parents.

I meet and work with the coordinators, and then the coordinators go and work with their own groups. The first group of leaders was called the seed group—each couple from that original group runs one of the other groups. There are several groups in Bogotá. These groups are in many cities in Colombia, and I am trying to expand this network that so that when something happens—an ambush or something like that, in a very far distant place, the families can meet, and have something to grasp in the middle of the chaos, loneliness, and helplessness of their traumatic experience.

How many groups are there now in Colombia? How many people are involved in the country as a whole?

We have groups in 6 cities. In Bogotá, a city of seven million people, we have 8 groups, but I do not have the exact numbers for the total number of groups nationally. We have not been able to publicize this free resource, so many people are still unaware of it.

These groups are functioning with very few materials. Although, one of my main problems in Colombia has been the lack of financial resources, I have found the human resources—the parents—everywhere. If you give them an opportunity, each parent may be a coordinator or a helper to somebody else.

I have given thousands of lectures on grief to many, many people. Sometimes grieving parents attend and after they have been bereaved six months, one year, two years, they want to help somehow. So we train and orient them about cases in which they could help, and people start helping a little bit.

Do you believe that the act of helping is also therapeutic for them?

Yes. When you help somebody, you help yourself, of course. When you receive somebody's pain, when you relive an experience, you are integrating yourself, as well. When you give someone hope in the middle of a dark night, it's your own hope you're conveying. Of course, if you don't have hope inside, you cannot give it.

Case Example: Families of the Soldiers Killed in Patascoy

Can you describe specifically what you did with the families of the soldiers who died in the explosion of landmines set by the guerrillas?

In 1995, I went with three other psychologists to assist the parents and families of 31 soldiers killed in a guerrilla ambush in Patascoy, in the southern part of Colombia, near the Ecaudor border. In fact, we went to two towns in which the families lived, Ipiales and Tumaco, and conducted separate interventions with each group.

In Patascoy, trucks filled with soldiers were traveling on a canyon road between two mountains. The guerrilla had put some bombs in the road, so when the trucks crossed, the bombs exploded into a mass of fire. The soldiers died immediately, and gruesome images were flashed to television screens all over the world. These 18 to 20-year-old boys were burned. You could see their hands holding the bars of the truck and their bodies were grey ashen statues. When I saw these images on television, I said, "This is not right. Why are they showing these pictures? These images disregard the fact that each one of these soldiers is a human being, has died, has brothers and sisters, parents whose hearts are broken, wounded at this moment."

I first called the journalists, and finally the defense minister. I said, "Listen, I have to go work with their families. Lend me an airplane." So, they said OK. They are not very convinced sometimes of the psychological consequences of all this. But the government did respond. I flew in a small airplane with the wife of the minister of defense, and we flew very far from where I live. Three or four hours after I arrived, two of my psychologists arrived in an Air Force plane.

The families were in two different settings and we went to each. Ipiales is in the mountains; the weather is cold, and the physical conditions there are difficult. The second group of families was in Tomaco, on the shore of the Pacific Ocean. These two groups of parents were from entirely different cultures. In Tomaco, there were enormous extended families, husbands with multiple wives, families in which the soldier was the son of one woman, but another woman was the person who raised him. Each soldier had a lot of brothers and sisters. It was a very complex family structure for each soldier.

In Ipiales, each soldier's family usually consisted of only a couple. In the mountains, these people do not live together in villages, but are spread out. They live in small houses, and each house has a cow, corn, and other crops. The families very rarely come down to town. They are peasants. They didn't know how to read or write. They only knew how to plant things or to milk the cow.

We went first to Ipiales. People from the army brought the families to me. The families were dressed in black, not because of the grieving experience, but because they usually dress in black. I have beautiful photographs. Normally, I do not allow anyone to take pictures of our practice. But in this case, the pilot of the plane had a camera, and he took some pictures of me sitting with all these people dressed in black.

Sometimes when we are engaged in this trauma work, after a public event, and CNN or other members of the media are looking to photograph the victims. I ask them to stay away because the work we have to do is slow and profound and cannot be interrupted. We do not allow journalists to take photographs, or conduct interviews while we are working. I say, "You can interview people on the streets, but right now these people are doing a job and we are committed to this joint work." In this instance, the pilot was not a member of the media, but rather part of our group, so his presence and camera did not feel intrusive.

Opening the Way for Grief

So, I created a group. I asked them, "Who did you lose?" It was terrible because they were not used to talking. They were afraid of me, a tall, blond, foreign-looking lady.

They all did start to tell me the names of their children, how old they were, and I said, "How did you learn your child had died?" Each one told me how, when, at what moment exactly, he or she was told the news of the death. They described how the army put their children's corpses in the black plastic heavy duty bags that we use for garbage. These parents didn't have the chance to look at their children. They have to assume that what is inside the coffin is his remains.

How did you proceed, given these difficult conditions?

I asked each family to bring photographs. Every solider has a photograph taken, so even these rather poor families each had a photo of their sons in uniform. I laid out all the photographs of these soldiers/children on the floor. I asked each parent to take the photograph of his or her child, show it to each of us, and tell us about this person and his or her relationship to him. I also asked them to tell us when the last time they saw him was, and what the last message they got from him was.

I gave a lot of time for each person. Working with 25 parents took me a whole day. They started naming all these things, sometimes they couldn't put it into words; I helped a little. The women cried more than the men. These people were reserved. I asked the group to identify what had happened to them. Then, I told them, "Your heart is broken. Do you know where your heart is?" I described the heart as having a wound because of the death of s son. I made many analogies, including one to a tree—the tree has four branches, your family has four branches, now it has fewer branches. What happens when a cow loses a calf? I used very simple examples from the natural world and the world of their experience.

Time and Ritual

The parents understood. Then I said, "Now you are going to tell me how you have felt." And first they made the account of the whole experience. But when I asked them how they felt, they said, "I don't know," and they didn't have words. So I had to ask them in a curious way. For instance, I said, "What time do you milk your cow?"

"At 4 o'clock in the morning."

"OK, when you go out to milk your cow, do you feel happy?"

"No."

"What do you feel? It's dark outside, no?"

"Yes."

"What do you feel?"

"I think of him."

In this way, these parents were able to start to create a space for their suffering and have their suffering recognized. So I said, "Every time you milk your cow at 4 o'clock, you may think of him. When you look at the stars or the moon, maybe you will think of him and feel a connection to your son."

We created a second ritual with some flowers I brought to the group. I gave each participant a flower. I used the image of picking a flower as another strategy for making their feelings of grief and loss "speakable." I was searching for the right images to reach these people whose daily lives are so connected to the natural world. I explained, "If you pick a flower, then you have two different parts that would like to be together. That's how you feel with your son. You would like to be together, but you can't, because once you cut a flower off the stem, you cannot put them together."

So then we picked the flowers, but before each broke the blossom from the stem, I asked each to speak to his or her son, and tell the flower what you would like to have told your son if you could see him now. I asked them to think of how they would say goodbye. Then, each person put the blossom and stem in a bucket of water. Tears flowed after this activity. It felt like a sacred ceremony. It was not religious, but it was a beautiful, rich, and meaningful way to make their feelings of loss and grief real.

Toward the end of the day, I asked each one to tell me how he or she felt, compared to the beginning of the day at 7 o'clock. They smiled. You cannot imagine how beautiful that was. I had brought boxes of paper tissues with me. High up in the mountains, they had never seen paper tissues! I gave each parent a box of tissues. I explained, "These tissues are used to clean your nose and your tears." This small but practical gift further acknowledged their grief and need.

During this day-long intervention, I allowed them to express a whole range of feelings including those which were extremely painful, very intense, and filled with powerful and distressing emotions. After a break, I suggested that they establish a support group.

Finally, I suggested, "Each Sunday after you come to the market to buy the groceries or bring your vegetables to be sold, you can meet at a particular corner of the town square. It's a private meeting, during which you ask each other how you are. And the other person has the obligation to listen to you." I try to set up a way for them to communicate back to me, but only two people knew how to write. So, I suggested that the teacher might send me a message on their behalf.

That day's meeting lasted until 10 o'clock at night. When my plane left, they were all waving their black hats, and I was crying. Then I went and next day I did a similar intervention with the community on the Pacific shore. It was a very different setting, but it was the same traumatic experience. Some of the images and analogies had to be different in order to work.

Did you hear from the group in the mountains?

I heard from the group, six years after the intervention, now one month ago. The local schoolteacher's daughter came to Bogotá to go to nursing school. She gave me a call. She said that not all, but 10 or 12 parents were meeting Sundays at 9 o'clock. The men were drinking a beer, and the women were having chocolate, but they were sharing somehow.

Lessons Learned

Living under a high level of anxiety, fear and uncertainty—things you can't control— how do you inject hope into people for whom danger may still be around the corner? Do you have any summary lessons about how you maintain that resilience?

I have admiration for the way your media has managed the images of the 11th of September, because you saw the destruction—they are powerful images. I cried, of course. But they didn't show the human remains, the grotesque parts of the whole thing. Here in Colombia, I am sorry to say, the media is not so respectful and then, the news are very traumatic both in the contents and in the way they are presented for you to look at.

In some way, you have to learn the lesson of living and adapting to a country at war. At the beginning, the reactions are disproportionate and immense. With time, you learn that the only antidote for that is to go on living, to go on loving, to go on engaging in projects, because they involve the future. When you start in a new project, you say there is a future. It is the opposite of the sense of hopelessness.

I always advise people, try to have family gatherings. Try to get together. Try to talk. Try to share. Try to hold each other, because what you need is to have at hand and at heart the people who are close to you. I tell people, "You are not lost. You are not alone, Talk with those you love."

The Power of Rituals

As you can see from the example of the work we did with the families of the soldiers who died in Patascoy, I believe in the power of making rituals. I have created hundreds and thousands of highly symbolic rituals. Sometimes I say, "Just light a white candle at 10 o'clock every day." People need rituals that are connected with time to orient themselves when they feel lost. So, they may say, "At 10 o'clock, I light my candle and I think of all the people who died, or I think of the enormous pain of this country, and I pray to God." If prayer is not in their vocabulary, I say, "Send some balloons of love to all…" I encourage them to visualize soothing images. For myself, I then blow out my candle and go back to work.

One needs to open some spaces to connect with oneself and one's pain. One has to acknowledge what has happened and that the terror is there. To me, sadness is a gifted door that opens the way for a person to connect in a healthy way with private wounds, situations, or trauma. Sadness has a way of shutting down other stimuli so that a person can make these important connections. You need those moments. You learn to love yourself with the pain, the longing, and the suffering. I am not talking about masochism or depression. I am talking about learning to live with a profound awareness of suffering, in a healthy way. In Colombia we say, "We learn to live with everything."

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