KAREN F. CARR
Those who serve in dangerous places are neither giants nor flawless heroes. Instead we are our church’s living letters, demonstrating the grace, love and power of God through our willingness to give our lives in service to others.
“Today is the day you die” were the first words heard by Phyllis Sortor (2015) just after she was seized by armed men in central Nigeria. She was struck in the face, dragged, taken to an isolated place, and threatened with death multiple times. She was held hostage for 11 days and was finally released after a dramatic series of promises and delays. During her captivity Phyllis experienced fear, exhaustion, despair, and certainty of death. For some, this would be reason to end their missionary career.
Trauma was not new to this 71-year-old woman. She was the daughter of missionaries in Mozambique, where she was born and raised. Her grandparents were missionaries in Korea during the Japanese occupation, and she often heard spiritually formative stories about her grandfather’s arrest and subsequent death in a prison camp. She had been on the mission field for 16 years and knew how to live in the bush and “rough it.” She had experienced two home invasions, one involving physical assault. She had suffered through the illness and death of her husband, a deep grief. Some might have been marked by these experiences with increased vulnerability, but Phyllis said these traumas made her stronger and more resilient.
In the midst of her exhaustion, fear, and despair, Phyllis started praying to God, “Save me, save me, save me.” She began to talk with one of her captors, motivating him to shift from threatening to kill her to vowing to protect her. She spoke forcefully to herself: “Take control of yourself and show these captors what kind of person you are—a strong woman, a leader, a missionary.” She wanted her captors to see her as a person to be respected, not reviled. She sang hymns, prayed, and reflected on the suffering experienced by Jesus. She held on to the belief that God was keeping her, despite continued threats and dangers. She had an underlying joy and assurance that held steadfast despite her bleak external circumstances.
While not all missionaries experience the particular traumas that Phyllis did, trauma is often a part of the lives of missionaries. In this chapter I explore the types of crises that many missionaries experience. I examine unique aspects of counseling missionaries and ways to contribute to their resilience.
A study (Schaefer et al., 2007) comparing missionaries with the US population found that missionaries in West Africa and Europe had encountered more severe trauma than the general US population. In West Africa, 92% of male and 85% of female missionaries reported one or more severe traumas in their lives. In Europe, 82% of male and 73% of female missionaries reported one or more severe traumas. In comparison, in a sample of the general population of the United States, 61% of men and 51% of women reported one or more severe traumas. The differences were more pronounced when comparing these three populations with those who had experienced three or more severe traumas (see table 16.1).
Table 16.1. Percentage of population with at least three traumas
% of population with at least three traumas |
Men |
Women |
US general population* |
10% |
5% |
Missionaries in Europe† |
47% |
30% |
Missionaries in West Africa† |
71% |
64% |
*Data from the National Comorbidity Survey (Kessler, Sonnega, Bromet, Hughes, & Nelson, 1995)
†Missionary study results (Schaefer et al., 2007); N = 250
Schaefer et al. (2007) reported that the most common traumas for West Africa missionaries were serious illness (61%); car, train, or plane accidents (56%); unexpected death of family member or close friend (51%); immediate exposure to fighting, civil unrest, or war (48%); burglary (41%); serious threat or harm to family member or close friend (38%); seeing another person seriously injured or dying as a result of accident or violence (34%); and evacuation (31%). For missionaries from Europe, the most common traumas were car, train, or plane accidents (66%); unexpected death of a family member or close friend (54%); and burglary (38%).
Since the time of this study, missionaries serving in sub-Saharan Africa have seen a rise in terrorist threats, including burning of churches, kidnappings, and bombings and shootings in public locations targeting Westerners. Recent events with missionary victims include mass shootings by al-Qaeda affiliates in Mali, Burkina Faso, and Cote d’Ivoire as well as kidnappings in Burkina Faso and Nigeria.
Reactions to trauma are varied and dependent on many factors, including the nature of the trauma, personality, pretrauma experiences, belief systems, support networks, and culture. While there may be a tendency to assume that those experiencing trauma will have long-term negative reactions, posttraumatic adaptation is a more common response, with many aspects of resilience being manifested (Bonanno, 2004; McMackin, Newman, Fogler, & Keane, 2012).
Many of the initial responses to trauma are common and understandable reactions to abnormal events. Lists of common reactions to trauma for adults, adolescents, and children can be a helpful resource for those clients who would benefit from normalizing their responses to trauma. However, some may develop more pathological responses to trauma, including acute stress disorder, posttraumatic stress disorder, generalized anxiety, depression, or other complications warranting referral to trained mental health professionals.
Despite the high rate of exposure to trauma for missionaries in the Schaefer et al. (2007) study, the rate of posttraumatic stress disorder (PTSD) was surprisingly low. Overall only 4.8% of missionaries fulfilled the criteria for PTSD (5.4% in West Africa and 2.2% in Europe; p. 536).
Dolan (1998) articulates a common progression for those who suffer trauma. She describes a movement from victim self-identification to survivor to celebrant. She points out that many people assume that being a survivor is the final stage of trauma recovery. Her research and experience reveal that those who remain in the survivor stage experience a low-grade depression and general pessimism about life. However, it is possible to experience genuine joy despite experiences of horrible suffering. For various reasons, some people may linger or remain in the victim or survivor stages. Therapeutic interventions may be needed to assist further recovery.
In Dolan’s (1998) paradigm, the purpose of the victim stage is to acknowledge that something terrible has happened. Movement begins when the victim acknowledges that a bad thing has happened and begins to identify or express the associated feelings. The task of this stage is for counselees to find the courage to tell someone else what has happened to them, to honestly and fairly assess what was their responsibility and what was not, and to let go of shame.
This leads to the survivor stage, in which counselees develop an understanding that they have lived beyond the time at which the traumatic experience occurred. The tasks are to acknowledge and appreciate the strengths and resources that have allowed their survival and eventual well-being, and to forgive and be forgiven for any wrongdoing associated with the trauma.
Finally, in the celebrant stage, counselees are able to more genuinely express gratitude and joy. The celebrant has found a capacity to embrace life in its fullness. Being a celebrant does not mean that one celebrates the suffering or the trauma itself, although some may come to a place of being able to say they are grateful for the experience because of the character change it has produced. The purpose of the celebrant stage is to live a life characterized by fullness, joy, and authenticity. The tasks or challenges are to continue to take risks and choose life despite discomfort and unfamiliar territory, and to devote time and energy to positive, healthy choices.
Dolan’s (1998) description of victims, survivors, and celebrants has some similarities to Mancini and Bonanno’s (2012) descriptions of responses to potentially traumatic events. Possible trajectory outcomes include chronic distress (victim), recovery (survivor), and resilience (celebrant). Chronic distress is characterized by the presence of posttraumatic symptoms and functional impairment, which may be long-term. The recovery trajectory includes milder symptoms and functional difficulties but gradually subsides as the person returns to normal pre-crisis functioning. The resilience trajectory includes mild symptoms, minimal impairment, healthy coping, and positive emotions such as enjoyment of life. Mancini and Bonanno state, “Indeed, a hallmark characteristic of resilient persons is their capacity for generative experiences despite adversity” (p. 82).
McCord (2015) states, “It’s in these places of disappointment where we develop patience, obedience, and a deepening sensitivity to God’s spirit. . . . We would prefer a sense of competence, the strength of our own agency, yet Christ calls us to follow Him and trust that He, the Good Shepherd, will lead us well” (p. 118).
Sometimes when I read the list of traumas most often experienced by missionaries, it washes over me in an academic and theoretical haze. However, when I stop to reflect on my personal experience as a missionary serving with the Mobile Member Care Team (MMCT; www.mmct.org) in West Africa, I realize that in a 15-year timespan I personally experienced seven of the eight most common traumas listed.
While serving as clinical director for the MMCT West Africa team and living in Cote d’Ivoire and Ghana, I was diagnosed with ovarian cancer, was trapped in the middle of fighting, witnessed a child being killed in a car accident, lost missionary friends to malaria, knew a missionary friend who was beaten and shot at, woke up to discover thieves had robbed us in the middle of the night, and was evacuated from a civil-war situation to another part of the country. Each of these traumas had significant impact on me, shaping and stretching me and taking me on a winding path.
What often felt like setbacks turned out to be openings for new aspects of ministry direction or character formation. Though I had often questioned whether I had the strength or perseverance to serve long-term in the face of personal trauma, none of these things had the power to remove me from the place of God’s call. However, my perspective and reactions to those traumas (strongly related to my theology of suffering) shifted as I listened to and reflected on transformational words from the Bible and influential words from leaders and friends.
As a missionary psychologist, both experiencing trauma and caring for traumatized missionaries, the most powerful lesson and most challenging command from Scripture for me to implement was to forgive. I could hold on to the righteous rage directed toward rapists who attacked a young missionary girl I knew and had shared a meal with the night before, or I could release the poisonous rage back to God, knowing that I would never know this perpetrator or hear him ask for forgiveness. This was my choice. And that choice determined how the traumas I experienced or heard about ultimately affected me.
Spiritual resilience. In Trauma and Resilience, Frauke and Charlie Schaefer (2012) describe four pretrauma spiritual characteristics that make missionaries more resilient:
1.An acquired healthy biblical theology of suffering provides a sturdy framework of support through inevitable struggles after trauma.
2.A practiced ability to forgive will facilitate letting go of debilitating anger, hurt, bitterness, and resentment.
3.Familiarity with accepting and expressing strong feelings in relationship with God and others will allow for connecting, healing, and regaining of hope more quickly after adversity.
4.Security and openness in a few relationships, particularly with other believers, will provide a much needed safe place to help sustain missionaries in vulnerable times. (p. 36)
Schaefer and Schaefer (2012) then describe four posttrauma spiritual resources that positively affect the recovery process:
1.Experiencing God’s presence in “the valley of the shadows,” however weak or veiled, is key to assuring Christian believers of the enduring relationship with the author and sustainer of their lives.
2.Expressing strong feelings in lament to God is a way to reconnect with him.
3.Finding a path from anger and bitterness to true forgiveness frees the person from being trapped in an ongoing, self-destructive bond to the painful past.
4.Experiencing God’s grace can help someone rebound from the self-condemnation that trauma can cause. (pp. 136-37)
Schaefer and Schaefer (2012) have also developed a Spiritual Resilience Checklist that can be found in appendix A of their book (reproduced in table 16.2 below).
Pretrauma resilience. Phyllis Sortor, the missionary kidnapped and held hostage in Nigeria, was asked to reflect on what contributed to her resilience in the midst of and following her traumatic experiences (P. Sortor, personal communication, May 26, 2016). Her first response was commitment. She had a determined, deeply held conviction that God had called her to serve in Nigeria, and she was fully committed to that call no matter what happened to her. She also reminded herself of the examples of Paul and Jesus, meditating on what they had been through, and recognizing that although they had been through even more than she had, they had kept going in their ministry. Despite being certain at times that she was going to die, Sortor always had hope. In fact, this was one of several seemingly contradictory feelings that harmonized in her heart—certainty of death paired with abiding hope, terror in companionship with peace, despondency laced with joy, guilt coupled with assurance. And a never-ending certainty that God was keeping her.
Her words are familiar. Brown (2007) conducted a study of 30 missionaries who had experienced traumas such as robberies, evacuation, rape, carjackings, and war. He only interviewed those who had stayed or returned to their field of service, curious to know what had contributed to their resilience.
First, Brown examined which factors were present in the missionaries before their traumatic experiences. He discovered four themes, which he described as a strong personal “call” to be where they were, preparedness from birth, words from God, and sturdy relationships. These four themes warrant further unpacking to better understand what might contribute to the trauma trajectories and resilience of missionaries.
Clear sense of call. The notion of having a call comes up repeatedly in conversations with missionaries who reflect on what contributes most to their resilience (Brown, 2007; Carr, 2012). A biblical example of this can be found in the commissioning of Barnabas and Saul in Acts 13:2-3: “One day as these men [prophets and teachers of the church of Antioch] were worshiping the Lord and fasting, the Holy Spirit said, ‘Appoint Barnabas and Saul for the special work to which I have called them.’ So after more fasting and prayer, the men laid their hands on them and sent them on their way” (NLT). It is interesting to note that the call came directly from the Holy Spirit and yet was received, affirmed, and implemented in the context of prayer, fasting, and Christian community.
Receiving a call may sometimes be confused with having a passion. Certainly identifying our passion can be an important part of the discernment process. Passion motivates, inspires, delights, and energizes. A call without passion may become a grim, teeth-gritting, works-oriented duty that lacks grace. However, a passion without a call is often an emotional response that may be unstable and may fail the missionary in the difficult or traumatic times. Passions may or may not be founded on realistic expectations of self or others. Ultimately, resilience is affected by one’s motivation for serving. Those who feel that they are fulfilling God’s purpose for their lives are better able to endure loss, hardship, and disappointments than those who came for other motivations, such as attraction to the job, a sense of adventure, or pressure from a spouse or family. The problem with these motivations is that one may not end up in the job one came for, the setting may not be adventurous or romantic at all, and coming because of pressure from a family member often leads to a sense of resentment later on.
Henri Nouwen (1988), a priest and author, spent some time gazing at a statue called Christus auf Palmesel (Christ on a palm-donkey) and wrote:
As he rides into Jerusalem surrounded by people shouting “hosanna,” cutting branches from the trees and spreading them in his path (Matthew 21:8), Jesus appears completely concentrated on something else. He does not look at the excited crowd. He does not wave. He sees beyond all the noise and movement to what is ahead of him: an agonizing journey of betrayal, torture, crucifixion, and death. His unfocused eyes see what nobody around him can see. . . . There is melancholy, but also peaceful acceptance. There is insight into the fickleness of the human heart, but also immense compassion. There is a deep awareness of the unspeakable pain to be suffered, but also a strong determination to do God’s will. Above all, there is love, an endless, deep and far-reaching love born from an unbreakable intimacy with God and reaching out to all people, wherever they are, were, or will be. There is nothing that he does not fully know. There is nobody whom he does not fully love. (p. 135)
The ultimate example we have of following a personal call from God is Christ himself, whose call is rooted in his acceptance by the Father and intimate relationships in the Trinity. Counselees can be encouraged with the truth that they are invited into this relational dialogue to seek out and listen to God’s voice as they make decisions about their future.
Preparedness from birth. This is what we sometimes jokingly refer to as coming from “hardy stock.” In essence this refers to the kind of family background, life experiences, and cultural influences that shape one’s work ethic, attitude toward hardship, and response to suffering. Those who are strangers to hard work and setbacks seem to struggle more with the daily stresses of missionary life such as heat, humidity, power cuts, traffic, pollution, language learning, corruption, lack of water, inefficient infrastructure, and exposure to poverty. The steady eroding of coping mechanisms that may occur with the constant daily pounding of environmental and cultural stressors creates a vulnerability affecting the ability to manage a traumatic situation. In contrast, those who have learned to roll with the punches and endure minor setbacks with humor and perspective will be better situated to enter a traumatic situation with personal determination that is rooted in constant surrender of their will to God’s.
Words from God. The ability to discern what God is saying relates to the condition of one’s spiritual formation. For example, one missionary was held hostage for many weeks in a small cage. After he was released, he expressed gratitude that he had memorized so much Scripture, because he was able to recall verses that were a source of comfort and strength to him during his captivity. Scripture memorization or access to Scripture during traumatic events is often cited by missionaries as an invaluable resource and source of encouragement and strength. Some may also feel that God is speaking to them in the midst of crisis situations or afterward, bringing words of healing and perspective. Those who have given priority to spiritual formation will have access to powerful words of healing and nourishment as they enter times of dryness and spiritual darkness.
Sturdy relationships. A strong social-support system provides the backbone of trauma recovery. Two key areas of support contributing to resilience are team cohesion and a consultative leadership style (J. Fawcett, 2002, 2003). The level of social support as well as the perception of organizational support during and after a crisis affects one’s ability to cope with it and one’s overall resilience (Forbes & Roger, 1999; Keane, Scott, Cavoya, Lamparski, & Fairbank, 1985).
Posttrauma resilience. Brown (2007) described four self-identified posttrauma factors that most contributed to missionary resilience: being part of a supportive network, having supportive and directive leadership, quickly finding a new ministry focus, and experiencing the closeness and protection of God.
Being part of a supportive network. Just as having sturdy relationships prior to trauma contributes to resilience, being part of a strong support system during and after the crisis is associated with many aspects of posttrauma recovery; conversely, low levels of social support are correlated with low emotional well-being (Watson & Brymer, 2012). While professional support is important, it cannot take the place of supportive community. One role of a counselor may be to encourage clients to explore or discover their natural networks and to strengthen existing supports (Mukherjee & Alpert, 2006). Ultimately, recovery can only happen in the context of relationships (Cohen, 2006).
Having supportive and directive leadership. Many crosscultural workers reference the presence and attitude of their leaders as being a critical factor in how they coped with various traumas and stressors. For example, a missionary doctor was driving when a young person suddenly ran in front of his vehicle. Though he tried to swerve to miss him, the child was hit and died. The car rolled, and the passengers were seriously injured. The doctor was filled with guilt, although there was nothing he could have done. After doing all he could for the family and answering questions from the police, he returned home. Soon after arriving home, his field leader called, listened to him, and communicated assurance and support. The next day, when I met with him for crisis counseling, his description of his leader’s support, profound in its simplicity, became a central theme because it offered hope and stability to him in an otherwise overwhelming and horror-inducing experience. The significance of this contact was also formative for the leader who had initially resisted the idea of directly contacting the driver, feeling that others were more qualified to help him and his input was not needed.
Conversely, there are examples of missionaries who experienced trauma and lament but whose leaders did not contact them, did not show up, or did not acknowledge what happened to them. Research shows a negative association between expressions of bitterness or disappointment in leadership during times of crisis and ability to adapt successfully to the losses of the trauma (G. Fawcett, 2003). This may be related to the actual support given by the leadership as well as the person’s perception of, and trust in, his or her leadership in general.
Quickly finding a new ministry focus. Brown (2007) found that, particularly for missionaries who had to evacuate from their places of service, having the option to invest in new ministry opportunities contributed to their longevity and well-being. Those who were in limbo and experienced inactivity had more struggles. Strategies employed during chronically dangerous situations that are associated with resilient outcomes include actively seeking information, shifting expectations and focus, creating specific routines related to life’s necessities, and maintaining an attraction for life (Watson & Brymer, 2012). It stands to reason that those who are able to participate in goal-directed activities where they can find meaning and purpose beyond their own needs will flourish.
Experiencing the closeness and protection of God. Many missionaries I have worked with in crisis counseling have talked about an incarnational experience of the “peace that passes understanding” when going through a traumatic event. This has not meant that they did not experience physical harm. In fact, many were beaten or threatened or robbed or nearly killed, but there was a strong sense of God’s presence and protection nonetheless. Phyllis Sortor (personal communication, May 26, 2016) found herself going back to an old familiar hymn, the words resonating with strengthening force: “Oh Jesus, I have promised to serve thee to the end. Be thou forever near me, my Master and my Friend. I shall not fear the battle if thou art by my side.” Once again we find a blending of contrasts. The soul is crying out for what it needs—God’s protection and closeness—and feeling the comfort of that, while potentially also being in the midst of a reality that is crushing and extremely painful.
Counselors may sometimes take a somewhat narrow view of the ways they can contribute to helping missionaries, thinking primarily of assessment and counseling interventions. There are, however, many ways that those trained in counseling skills can contribute by sharing their knowledge and skills with those in unique positions to be primary supports to traumatized missionaries. The Spiritual Resilience Checklist in table 16.2 provides a list of considerations.
Consultation to mission leaders. Counselors are in a unique role to encourage the development of priorities that will promote staff care. Some of the key areas to reinforce are related to encouraging relational support, developing a theology of suffering, developing a theology of risk, and affirming or clarifying the call. It is possible that the counselor will have opportunity to address these things in the context of a counseling session, but more likely the counselor’s role will be as a consultant to mission organizational leaders, helping them to develop resilience by encouraging development in these areas.
Encourage relational support. Counselors are often told by peer caregivers that they do not know what to say or do when they are in the presence of someone who is suffering. A counselor can coach the supportive community to use the power of their comforting presence to give the person a supportive space from which to find clarity and meaning in the midst of their suffering. Although the one who is suffering is often asking questions, the comforter may find that any answers they try to provide fall flat and do not actually address what is behind the questions. These questions are often forms of lament rather than an intellectual pursuit. Suffering is often expressed in agonized questions that do not have an answer. As Pat Russell stated, “It is not a problem that demands a solution. Suffering is a mystery that demands a presence” (as cited by Shaum, 2012, p. 15).
Many agencies may think primarily of building and strengthening relationships from within their own organization. However, networks formed across organizations and cultural groupings will bring additional resources, skills, and practical help to crisis situations. Relationships that are broken or riddled with unresolved conflicts will be less than adequate in the midst of a crisis. Proactive nurturance of a loving Christian community will strengthen the resilience of the agency and individuals as they face traumatic events.
Table 16.2. Spiritual resilience checklist (Schaefer & Schaefer, 2012, pp. 146-47)
Sound Theology of Suffering |
|
□ |
Has the person (have I) grappled with his or her (my) theology of suffering, and are the resulting assumptions biblical? |
□ |
Does our (my) organization encourage and promote a sound theology of suffering? |
Intrinsic Religious Motivation |
|
□ |
Does the person (do I) have a habit of attending community worship and prayer? |
□ |
Does the person (do I) have at least two close Christian friends for mutual support and sharing openly and deeply? |
□ |
Does the person (do I) have a regular habit of personal prayer and studying the Bible? |
□ |
Does the person (do I) have a regular practice of participating in spiritual retreats, contemplative prayer, and receiving spiritual direction? |
Ability to Face and Share Uncomfortable Feelings |
|
□ |
Is the person (am I) authentically and honestly talking about difficult life experiences and surrounding feelings? |
□ |
Does our (my) organization support honest sharing of uncomfortable feelings, or are there indirectly communicated messages that “good Christians” should not have certain feelings? |
Knowing and Extending Forgiveness |
|
□ |
Does the person (do I) have experiential knowledge of receiving forgiveness from God and from others? |
□ |
Is the person (am I) aware of the forgiveness process and able to distinguish forgiving from excusing or glossing over injuries? |
□ |
Does our (my) organization encourage and promote giving, experiencing, and knowing forgiveness? |
Knowing and Receiving Grace |
|
□ |
Does the person (do I) have a deep experience of being loved and valued by God? |
□ |
Is the person (am I) accepting of human brokenness as a common experience and able to love others (myself) when the brokenness is visible, rather than being overly condemning? |
□ |
Does our (my) organization encourage a culture of openness, vulnerability, and support as its members deal with their brokenness? |
Supportive Relationships with Other Believers |
|
□ |
Does this person (do I) have at least two close Christian friends? |
□ |
Does this person (do I) give growing and maintaining close relationships a measure of priority over ministry work? |
Agencies can work proactively to strengthen interpersonal relationships. This may translate to encouraging participation in workshops focused on interpersonal skills. It may involve sending mediators to service areas to address conflicts before opposing sides become intransigent.
In addition to coaching leaders to reinforce relational networks in the ministry locations, counselors should pay special attention to the relationships between leaders and their staff. Regular and frequent communication from leadership will build trust. Following a crisis, communication from the leader that acknowledges the impact and significance of the trauma is essential. If at all possible, traveling to visit the traumatized missionary and providing onsite supportive presence will be highly significant and may be more remembered than any professional trauma intervention. Sadly, perhaps even more memorable will be the absence of a phone call or visit following a trauma (Brown, 2007).
Encourage development of a theology of suffering. If missionaries are encouraged to work toward developing and embracing a biblical theology of suffering, it will pave the way for them to respond to inevitable crises in resilient ways. It will also foster the hard work and arduous journey required for growth and recovery in the aftermath of crises. All too often, a North American posture toward pain is to avoid it completely or to move through it as rapidly as possible. A biblical view of suffering acknowledges that suffering is sometimes God’s path to accomplish the greatest good for the kingdom of God (e.g., Ps 119:67; Rom 5:3-5; 2 Cor 1:9; 4:8-11, 17; 12:7-10; Phil 3:8-11; 2 Tim 2:10; Heb 12:10-11; Jas 1:2-4; 1 Pet 1:6-7; 4:1). Shaum (2012) states, “If I were to help the person find a solution to his or her pain as quickly as possible, I might be undermining the redemptive work God wants to do through a prolonged period of endurance” (p. 17).
In Brown’s study, 74% of those interviewed mentioned that they had advanced in the development of a biblical view of suffering following their traumatic experience. A theology of suffering is organic. It requires an intentional, ongoing commitment to examine our highly influential cultural beliefs in light of scriptural truth. Christians may have stated beliefs such as “As a Christian, I will suffer” (a biblically based truth), while harboring an underlying core belief that God will spare them from certain types of suffering. This core belief will be challenged and perhaps shattered when the suffering one hoped would never happen becomes reality. Christians may begin to wonder if they are being punished or abandoned by God and may struggle with feelings of anger and rejection because of the sacrifices they have made.
Traumatic experiences give us opportunity to reexamine our personal beliefs about suffering and to go deeper in our reflections about who God is, what it means to experience the fellowship of Christ’s suffering, and what grace is in the midst of suffering. This is why we as counselors cannot just give someone a prewritten theology of suffering, but we can facilitate a process whereby his or her theology of suffering is shaped by pain and the Holy Spirit’s counsel and wisdom in response to those experiences.
Develop a theology of risk. Sanders (2007) observed, “The greatest achievements in the history of missions have come from leaders close to God who took courageous, calculated risks” (p. 12). Mission leaders are in a unique and often very difficult position as they wrestle with making decisions about sending staff into high-risk areas. Frank discussions about theology of risk might include decision-making criteria for field assignments, ongoing care, evacuation, and follow-up care. Tolerance for risk varies individually and is highly subjective, and yet the impact of individual decisions on the wider community is profound. Attitudes and decisions about risk are spiritually relevant with many practical implications.
For example, a team is based in a country with increasing terrorist attacks and threats. Does the decision to stay or leave depend on the home office leadership, or should it be made by the team? What if some team members want to stay and others want to leave? What should be the criteria for staying or leaving? What if one person is determined to be a martyr for questionable motives? What if another is ready to die for Christ for pure reasons? What if some want to leave because they are afraid or because they are being pressured by or want to respect the wishes of their home church or family? What if the national leadership is asking the team to leave because they are creating more danger for national believers by staying? These are some questions that leaders and missionary workers can start to discuss prior to traumatic events. A thorough examination of the decision-making process and choices made by early believers in the book of Acts will reveal that there is no one way prescribed in Scripture for how Christians should respond to risk. Sometimes believers flee from danger, and other times they move directly into it.
Facilitated discussions about theology of risk may expose some beliefs that are not actually biblically correct. Hampton (2016) describes 12 myths about risk that are common to Christian workers living overseas. For example, one myth is that “we are always safe in the center of God’s will.” While this may refer to a kind of “spiritual safety” as described in verses related to God’s protection and care, it may translate erroneously to a belief that those who are following God’s purposes will never be harmed. Confusion, crisis of faith, and anger are common for those who live by this myth and then experience traumatic events. Christian workers can be helped to identify risk myths and, in the context of discussion, begin to rework their beliefs into a more scriptural foundation that will contribute to their long-term well-being when going into high-risk situations.
Training programs. As counselors, we cannot respond directly to every traumatic situation that missionaries will face. One way to replicate our skills is to focus on training missionaries and leaders in how to care for one another.
Training that focuses on further developing relational skills is an essential component of pre- and post-crisis resilience. One example of this is Sharpening Your Interpersonal Skills (SYIS; www.itpartners.org), a week-long training program that enhances listening, grief management, and conflict resolution skills (Williams, 2002).
The Mobile Member Care Team (MMCT; www.mmct.org), an organization I was privileged to be a part of, served Africa from 2000 to 2017, primarily through providing member care training. Sharing of resources was one of the distinctives of this organization. A key goal of MMCT was to build a network of trained peer caregivers who would support each other in crises (Jerome, 2001; Jerome & Carr, 2002). Ideally, networks of peer responders are multicultural and from many different mission organizations, facilitating more diverse and deeper relationships as well as strengthening community supports. In response to crises, our belief is that more people are served and the community is strengthened if care is provided inter-organizationally.
Training programs that develop crisis response skills in leaders will contribute to pre- and post-crisis resilience. The content of a crisis response training program might include the typical impact of crises, the potential pathological effects, how to make initial contact, and how to provide one-on-one psychological first aid. The workshop might also include personal assessment of attitudes toward suffering and risk. Other possible topics are when and how to make referrals and ethical issues such as confidentiality and boundaries. The following recommendations will help to ensure quality control in peer-to-peer crisis training:
Develop an application process that requires participants to explain why they want to take the training.
Ask for leader and peer references providing endorsement of participants’ skills and the community’s willingness to engage with them as crisis responders.
Provide a 1:4 staff-to-participant ratio to ensure adequate attention to personalized coaching and mentoring.
Provide training that is highly skills based and that models skills, allows for practice, and provides feedback.
Commit to ongoing, qualified mentoring and coaching after the formal training program is completed.
Following an MMCT Crisis Response Training, there was a renewed eruption of fighting in Côte d’Ivoire, and about 200 missionaries were evacuated from the country (some of them for the third time). They were scattered to at least four surrounding West African countries. In each of these locations, peer responders who had been trained by MMCT were involved in providing practical help in housing, food, and childcare as well as emotional and social support and the opportunity to talk about the crisis the missionaries had just experienced. MMCT staff provided coaching and mentoring from a distance. The feedback we received from the recipients of the peer debriefing affirmed that the care they received contributed to their perception that they were well cared for and ultimately enhanced their resilience and ability to recover from this trauma of war and evacuation.
With support and input from trained counselors, missionary peers can be equipped to serve each other in effective ways. Because counselors cannot be in every place that missionaries are serving, and because peers can better identify with the unique situations that missionaries face, it makes sense to invest our skills and energies in this kind of replication model.
Counseling traumatized missionaries. Phyllis Sortor (personal communication, May 26, 2016) was released 11 days after she was taken hostage. For some, this symbolized the end of her crisis. However, what happens in the aftermath of a crisis has a critical bearing on the recovery process.
Phyllis Sortor described how she was joyfully greeted by those who had been intimately involved in the negotiation process. She returned to the United States and was reunited with family members and friends and her home church. She was given opportunity to debrief, and she met with a counselor to talk about what had happened to her. A group debriefing that included all those who had been involved in her release brought a sense of stability and normalcy into her life. This was done in a familiar and safe location, and each person shared what their experience had been for each of the 11 days. This helped Phyllis to feel that her experience was a shared one, as opposed to her feeling scrutinized and on the hot seat. It was instrumental in breaking through her isolation.
Yet she also had unmet longings. When she was first released, she asked if she could go back to Hope Academy, where she had lived and worked for years, to let her friends know she was safe. She was not allowed to do that, possibly for safety reasons. When she was sent back to the United States, it was presumed that she would never return to Nigeria. From a logical standpoint, and for reasons of safety, many would likely endorse that choice. But Phyllis was driven by something more than logic and freedom from risk. She keenly felt the Lord’s call on her life to return to Nigeria. Her leaders wisely asked her to do additional work related to the healing process. She journaled about her experience and was gripped with a horrible fear of going back. God spoke to her in the midst of that time through an African American preacher who spoke about the resurrection and God’s power to roll away any stone that blocks us from peace and joy. She experienced a deeply cleansing healing combined with a clear call to return to Nigeria. More conversations with her leadership led them to support her return. Phyllis Sortor’s story brings home some unique issues for missionaries entering into a counseling or trauma recovery process.
Sorting out God’s call, personal risk, and the expectations of others. Bonhoeffer (1997) wrote:
Who stands fast? Only the man whose final standard is not his reason, his principles, his conscience, his freedom, or his virtue, but who is ready to sacrifice all this when he is called to obedient and responsible action in faith and in exclusive allegiance to God—the responsible man, who tries to make his whole life an answer to the question and call of God. Where are these responsible people? (p. 5)
Depending on our own theology of suffering and risk, as well as our cultural values related to comfort and happiness, it may be difficult to understand why a person would choose to return to a high-risk situation. For some, looking from the outside, the sacrifices made by missionaries are too great or are unnecessary. To be an effective counselor for missionaries, personal biases must be examined. Consider the following questions: What is your own tolerance for risk and pain? Do you feel it is always in a person’s best interests to be in the safest place he or she can be? How do you understand and talk with someone about the call he or she has received from God?
When a missionary is exploring whether or not to return to a high-risk location, a number of factors can be explored in the counseling context. To what extent has the person worked through the trauma? What is the person’s current resilience level, and how might he or she respond to future exposure to trauma? What support system will the individual have upon returning to the location? What level of support does the individual have from leadership to return? How much support does the individual have from his or her home sending church? How does the family feel about the person’s return? How are the reactions of others affecting the person?
In some cases missionaries may choose to return to high-risk situations despite the objection of their family members. This creates additional stress for these missionaries but is only one factor among many for them to consider, especially if they have a strong sense that God is calling them to a particular place and this call has been affirmed by trusted and competent members of their organization and Christian community. In other cases missionaries may feel called to high-risk areas, but external factors may overrule this sense of call. Examples include a lack of support from their mission leadership, disagreement by their support system, or closed doors because of war, deportation, or visa refusal from the country in question.
A family prepared for years to go to a particular country. They sold their house, raised support, and did language learning and further education to prepare for fulfilling God’s call for them to go to this country. Just months before they were scheduled to go, war erupted in the country, closing all doors to their entry. As they waited for some kind of clarity and direction, they had questions such as “Did we hear God correctly?” “Why is this happening?” and “What do we do now?” In these situations, missionaries may feel confused, angry, and hurt. These are all understandable reactions and are important to process for effective trauma recovery.
In our independent cultures in the West, we often do not think about the role of the extended family or home church in the trauma recovery process. In many cases, the home church leadership has an important role in ongoing decisions related to the well-being of missionaries; therefore they should be involved in the recovery process along with the leadership of the sending organization. Extended family may include parents and adult children of missionaries. For example, parents of a missionary couple may strongly object to their grandchildren being taken into a high-risk area. Although this objection may not stop the family from going, the impact of the parents’ disapproval may have ongoing ripple effects that surface quite significantly during and after a traumatic event. Counselors might consider offering family sessions to work through these complicated reactions.
Common issues in missionary posttrauma counseling. Several themes may come up when counseling missionaries who have experienced trauma. While these are not exclusive to missionaries, they may be particularly weighty given the nature of living crossculturally and in high-risk settings. It may be helpful to initiate discussion in these areas, whether the missionary brings them up or not. Common issues in missionary posttrauma counseling include anger, anxiety/fear, grief, guilt/self-blame, and meaning making.
Anger. Wangerin (1992) wisely observes, “When those who are grieving ask passionate questions, remember that their questions do not come from an inquisitive mind but from a disappointed soul. Questions asked in anger often don’t have answers because they aren’t questions, they are accusations” (pp. 216-17). Anger, rage, and fury can all be elements of the missionary’s response to trauma. The anger might be at a person responsible for the trauma, a teammate who did not respond well after or during the trauma, leaders who have failed to respond adequately, a corrupt or failed government, or God.
All of these anger responses are natural and common, and yet the victim may need to receive permission to acknowledge and express these feelings. The anger may be more intense than the situation merits, indicating perhaps a buildup from historical issues. Gentle exploration of the anger in the context of an umbrella of grace that ultimately leads to forgiveness will bring a cleansing of emotions that may become toxic if suppressed. One must resist the temptation to give answers to the “why” questions and instead listen with the purposeful intention of responding in ways that facilitate the person choosing pathways of healing. If the person is choosing self-destructive paths or behavior that is damaging to his or her relationships, gentle but firm redirection is needed.
Anxiety and fear. Intense fear is a common aspect of many traumatic experiences. There will be lingering fear and anxiety following the traumatic experience. That is just a biochemical reality! Missionaries may feel guilty that they have felt fear, quoting passages that admonish us to “fear not.” I have not had much success in stopping fear by telling myself to stop feeling that way. As I look at 1 Peter 5:7, it seems that the Lord is acknowledging that we will feel fear, and then he is giving us an option for what to do with it: “Give all your worries and cares to God, for he cares about you” (NLT). It is his love, kindness, and massive competence in carrying our burdens that gives us the courage to surrender something we can never control. Yes, fear will be a common occurrence after trauma, and counselees will need practical help for how to respond to it. Deep breathing, muscle relaxation, mindfulness, grounding, imagery techniques, and centering prayer are all ways for the person to experience freedom from paralyzing anxiety (see Schaefer & Schaefer, 2012, pp. 118-33). In some cases, referral to a psychiatrist for medication evaluation may also be appropriate if the fear has become debilitating and recurrent.
Grief. McCord (2015) writes:
Many of us initially follow Christ to dangerous lands full of zeal, convinced of our own strength, commitment, and ideals. We know, cognitively, theologically, that Christ is with us. Along the way, we lose our earthly foundations. We experience failure, loss, and suffering. We come to the end of ourselves and find that Christ is still with us. We learn to walk with Jesus in humility, limping as it were, trusting His presence to accompany and guide us. We learn that Christ alone is sufficient and our souls rest in his light even while the darkness swirls around us. (p. 202)
Oftentimes counselors working with missionaries will discover that the trauma they have just experienced is only one of many crises. If a counselor asks missionaries to list the losses they have endured, both tangible and existential, he or she may be astonished at the volume they will produce. Counseling received after a trauma may be a missionary’s first opportunity to actually process and begin to grieve losses sustained both pre- and postcrisis. Because grief is most commonly associated with death, individuals may be surprised to realize that they are grieving multiple losses but have not had a name for the sadness they have been experiencing. When our team left Cote d’Ivoire during the war and relocated to Ghana, we lost our home, our friends, our sense of safety and security, our ministry momentum, our local advisory council, and a sense of familiarity. These were all losses associated with the trauma of war that also needed to be processed.
The way we process grief has the potential to lead us to greater intimacy with God or to isolation from him. Counseling looks at how a person is choosing to self-soothe. Is a person choosing things that draw him or her closer to God, such as quality times with friends, time in the Psalms, music, rest, and journaling? Or is he or she choosing comforts that give temporary relief but contribute to isolation from God, such as pornography, social isolation, workaholism, or alcohol abuse? An important aspect of Christian trauma counseling will involve helping the person to choose an individualized practice of grieving that ultimately leads him or her into deeper intimacy with the one true Comforter.
Guilt/self-blame. Many trauma survivors struggle with guilt or self-blame when they recount the story of what happened to them. This may be even more prevalent for missionaries who often have an acute sense of responsibility and a tendency to judge themselves. An important aspect of trauma counseling is to acknowledge and reframe (Carr, 2012). This comes from the original model of cognitive restructuring developed by Aaron Beck, a technique designed to help depressed patients see the inaccuracy of their negative thinking (Beck, Rush, Shaw, & Emery, 1979).
In 2002 our team was caught in the middle of civil war in Cote d’Ivoire. We were allowed to evacuate in our own cars. As we drove out of Bouaké, the streets were lined with Africans who were unable to leave. The silence was damning, the expressions hopeless, and our guilt acute. Missionaries who have to evacuate often wonder what will happen to the ones left behind. There is a sense of abandoning others. This feeling may be more intense after missionaries leave and then realize that they did not leave adequate resources behind (e.g., advance pay for any employees who had to stay). Guilt may be enhanced or diminished according to what national colleagues said to their expatriate friends before they left—whether it was a message encouraging them to leave or a plea to stay. Leaders may be particularly prone to guilt depending on how they made the decision for themselves and others to leave and how their followers or national colleagues have responded to them (e.g., with compliance or with resentment, criticism, and anger).
To acknowledge and reframe the above situation would mean giving space to recognize that feelings of guilt and abandonment are understandable and natural. Acknowledging the feelings gives room for the necessary grief. Reframing builds perspective and context. Reframing comments are more readily received and processed if the feelings of guilt have already been acknowledged. The counselor may make comments such as “It sure is natural to feel this way about having to leave behind people who are suffering.” This statement can be followed by a pause and then followed by “This was not your fault, and you could not control what happened.” Reframing might also include assurances that the decision to leave was not reflective of a lack of caring or commitment. Redirection of focus may help individuals see ways that they are still able to express care and support of those affected by their decision.
Sometimes a person’s guilt and shame might be based on actions or choices made in the midst of a trauma that were wrong, hurtful, or mistakes. An important aspect of the acknowledge-and-reframe intervention is assisting the survivor in gaining perspective. Mistakes may have been made and regrets inevitable, but learning and growth springs from those mistakes. Mistakes or missteps that seemed large in the midst of the crisis may now seem smaller in light of more important factors.
The counseling process can allow the person to identify areas of remorse and perhaps a need for repentance and forgiveness. The counselor can be an agent of grace, helping the person to receive forgiveness and release shame in order to progress in their healing.
Meaning making. As the intensity of emotions diminishes and the struggle for survival is past, a trauma survivor may be able to cognitively go to a place of extracting meaning from the traumatic event. If a question about significance or meaning is asked too soon, it will likely fall flat or seem pushy and insensitive. Careful timing and sensitivity to the person’s recovery process is crucial. Asking questions tentatively and respectfully, the counselor might explore such areas as the following:
What did you take away from this event?
What kinds of things did you learn from this time?
How has this event shaped or changed you?
What do you feel the Lord is showing you from this crisis?
In hindsight, what are some of the things you’ve gained from having gone through this trauma?
As Christians, we are sometimes able to see the ways God has redeemed suffering and used it for good purposes. It might be our own growth or the encouragement of another or our ability to help others. In some cases, however, we may never see a redemptive purpose of a trauma in our lifetime. By nature, God is a redeemer. Even Job who suffered more than most encourages us with his exclamation of this truth:
But as for me, I know that my Redeemer lives,
and he will stand upon the earth at last.
And after my body has decayed,
yet in my body I will see God!
I will see him for myself.
Yes, I will see him with my own eyes.
I am overwhelmed at the thought! (Job 19:25-27 NLT)
Bishop Ken Untener (1979), in a prayer titled “A Future Not Our Own,” wrote:
This is what we are about. We plant the seeds that one day will grow. We water the seeds already planted knowing that they hold future promise. We lay foundations that will need further development. We provide yeast that produces effects far beyond our capabilities.
We cannot do everything, and there is a sense of liberation in realizing this. This enables us to do something, and to do it very well. It may be incomplete, but it is a beginning, a step along the way, an opportunity for the Lord’s grace to enter and do the rest. We may never see the end results, but that is the difference between the master builder and the worker.
May we all have the grace and courage to invest in God’s kingdom by using our gifts in a spirit of humility. May we never lose the deep awe and respect for the sacred trust that has been given us to be companions to the wounded. For we ourselves are broken and inadequate, yet we are given the privilege to be instruments of God’s healing.
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