The work of Christian missionaries has never been easy. They’re often sent to regions characterized by ethnic violence, civil unrest, and personal insecurity.

The populations they serve, and in many cases the missionaries themselves, can suffer deep emotional, psychological, and spiritual pain from living in conflict. Pat Miersma works to address such trauma in a healthy, biblically centered way.

As a global trauma healing consultant for SIL Counseling, she’s used her background in mental health nursing and post traumatic stress disorder to treat pastors, missionaries, and local people who have endured with crime, bombings, and sudden evacuations. In 2001, SIL teamed up with leaders in sub-Saharan Africa to use translated Scriptures to help victims of violence across the region.

Those efforts grew into Healing the Wounds of Trauma: How the Church Can Help, developed by Miersma, another SIL counselor and two SIL linguists. Since its release over a decade ago, the book has been translated into more than 173 languages and used in 68 countries. SIL partners with the Wycliffe (Miersma’s on its board of directors) to provide resources in native languages. In 2010, to accommodate the ongoing growth of this work, the American Bible Society agreed to provide the structure for developing the now global ministry.

Pat Miersma

Pat Miersma

Miersma witnessed conflict firsthand at a young age, as an Army nurse during the Vietnam War and a missionary to Ethiopia during the country’s Communist revolution and subsequent famine in the ‘70s. Before returning to the mission field with her husband Harry, she dedicated her nursing studies at Biola University and UCLA to working with veterans with post-traumatic stress disorder.

This month’s CT cover story focuses on veterans with PTSD. Miersma’s work reminds us that people across demographics and cultures, and even missionaries, live with lingering hurt and pain.

How does culture play a role in healing?

People who come from more community-oriented cultures are at an advantage because they do so much in community and would think it is very strange to go through any process alone—they always include others. However, at times, some from these cultures haven’t been exposed to the idea of being very honest about their inward feelings such as anger. It may be a very hard concept for them, because if you express your anger, it is considered either disrespectful to God or your elders, or it implies some kind of weakness.

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When I introduced this curriculum in Asia, my perception of some Asian cultures was because of their desire to maintain face and harmony, they might not be as open to being expressive about their feelings. However, because we use Scripture as the basis for this curriculum, and we mostly do this workshop with Christians who believe that the Bible is God’s word, they are willing to reexamine their culture’s beliefs in light of the Bible.

In the workshop, we say, “What does your culture say? What does Scripture say? To what extent is there a difference there? What do you think?” Very often their culture offers things that are very helpful, but when there is disconnect we think about it, pray about it, and talk about it together, so we don’t force people to change their beliefs. We trust the Holy Spirit to do the changing in his time. Forcing people who have been traumatized is not only wrong but is counterproductive to what you are looking for. In time, most people are willing to go down that path because they are eager for healing even if they wouldn’t identify it as such.

What types of relationships are hardest for women survivors of trauma?

One piece of feedback we’ve heard from both men and women is how important our lesson on fatherhood is. Your relationship with your father affects your image of God. People have told us “If you don’t deal with that, you might as well not do the other lessons.” They feel that that’s really key, especially if it’s a culture that has a lot of absent fathers or fathers who have suffered from substance abuse or physically abused their children.

I know in every single culture I’ve worked with—and there’s been dozens and dozens—both men and women will find that it is a powerful lesson. They may have been believers, gone to church, and heard the Bible preached for a long time, but no one has connected those dots around and brought Scriptures discussing “God as our father,” to help them think through “What is the image of God as your father? What is your image of your own father? How does one impact the other?”

After we’ve discussed that, we’ll say “Okay, now let’s look at what does the Bible teaches about God as our father. He’s not like any other earthly father, no matter how perfect. He’s different.” I’ve found that everywhere I’ve been—Africa, Asia, the Middle East—they’ve found it very powerful. Even if they know those Scriptures by heart, they’ve never personally applied in quite that way.

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You’re an American who has grown up with significantly less trauma than many of the folks you have worked with. How do you identify with them?

The first thing is listening and then building relationships with people that we know in those cultures or people who have worked there a very long time, who understand those cultures much better than we ever could and asking them to tell us.

In every workshop, we start with a story. We have participants read the story out loud and then ask open-ended questions so all the way along, we’re not telling them, they’re telling us. The facilitator might say, “Okay, this is written from the perspective of several East African villages. Is there anything like this where you live? And when this happens, what happens to so-and-so in the story? How might a pastor in your culture might respond?”

I’m constantly relying on the person inside that culture who can teach me so I don’t unnecessarily stick my foot in my mouth and make assumptions, though l do, even though I’ve been in missions since 1973. I’m still very American, and I forget it’s not necessarily that way it is for everyone.

How do you avoid retraumatizing people when they go through your curriculum?

When we invite people to the workshop, we try to be clear with the types of people we are looking for. Probably everyone you choose has been traumatized in some way, but we don’t want them to be so raw from their own trauma that the workshop will retraumatize them. Our first concern is not to do any more harm.

For instance, someone that was just raped a month ago, who we knew for a fact that had never dealt with any of it or you could tell that they from the way they were living that they were highly dysfunctional, they would not be a good candidate for the workshop. They’d be unable to finish it because they’ve got too much pre-workshop work to do. We would be at risk of triggering more trauma for them.

On first day…I’ll say, “One thing we’re concerned about is that we don’t just want you to have bad memories retriggered. We want you to know that some of the lessons may be hard for you, and nobody has to stay in the room. If you feel this and this and this, we want you to feel free to leave or ask someone to go with you. We have someone in the room who will follow you and will sit with you and listen to your story and pray with you. Then we’ll set up a time when we can talk through it more, if that’s what you would like to do.” We put all the safety nets in beforehand.

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I’ve taught the rape chapter many times and I’ve had instructors, leaders in their community, who have never dealt with their own rape themselves until they taught the lesson and then they broke down, but it was handled so well by the staff.

To what extent do you think Americans underestimate the amount of trauma people in their congregation have experienced?

I wouldn’t know how to measure that. I do know that churches seem to be a lot more aware of the types of trauma. Maybe my perspective is a little skewed because when I go and see the churches on a regular basis, I’m speaking about that topic and the people who come are those who are working with a refugee group or women who have been abused. However, I sense that there is a very great distance between 10 or 15 years ago and now in that the churches I visit are much more aware of trauma even in their own communities, like domestic violence, addiction, and suicide.

If you’re aware that someone you know has experienced trauma, how or when should you bring that up if they haven’t mentioned it to you before?

If you know them well, you should tell. I would say, “You seem to be struggling. You seem like there’s something heavy on your heart.” If there’s a trusting relationship, most people will open up. Most people instinctively have a need to tell their story. There’s all kinds of literature out about the power of telling your story. If we can do it in a healthy way people can gain release and begin the healing process.

However, I’m hesitant to push people if they don’t want to talk about it…. it can be counterproductive. If they are in danger, you’re going to be more assertive, but you want to balance that with presence and availability to help them. If they’re resisting and you’re concerned about that, you probably want to have some resources that you can offer them. If you want to make referrals to your friends, I usually encourage people to start with websites because it usually it gives them a little more knowledge.

Click to read more about trauma counseling in Central African Republic and Democratic Republic of Congo.

Morgan Lee reports for Christianity Today’s news team. She moved to Chicago from New York City last year, takes trapeze lessons, and hosts casserole parties in her backyard. Follow her at @Mepaynl