Still less than three days since the most intense, prolonged, potentially catastrophic experience of my life.  What have I learned ... both personally and as a therapist?  Gratitude ... of course.  Gratitude to the mountain rescue service, gratitude to my wife & family & friends, gratitude for my health, for the extraordinary beauty of this world, for being able to walk, to breath, to smile.  And gratitude can even help me process what happened better. 

And what else?  The day after I was helicoptered off the mountain, I drove home.  It's nearly a five hour journey and I stopped by the shore of Loch Cluanie in Kintail.  I walked for two hours up to the gentle summit of Carn Ghluasaid.  A very different day.  Clouds well above the tops.  Classic Highland hill walking.  A stalkers' path, ridges, snow, sunshine rippling on the loch down below, hills away into the distance, beautiful.  Nobody in sight over the whole landscape except a delightful little lizard on the track that I stopped to chat to!  Then sort of surreal ... as I walked over the plateau at the top of the mountain, I saw a man ... roughly my age ... sitting, legs outstretched, with his back against the summit cairn.  Here we were, meeting, kind of "in the middle of nowhere".  Very simple.  The camaraderie of hill walkers.  I sat down beside him and we ate lunch together.  I told him the story of my rescue ... less than 24 hours before.  And yes I was beating myself up a bit about my bad decision making.  He was experienced on the hills ... had climbed nearly all of the 283 currently listed Munros (compared with my more modest 100 or so).  Quietly he said "If you keep walking for long enough, something a bit like this happens to all of us."  Healing, warm, accepting, somebody who knows.  I thanked him, wished him very well, and walked back down the hill.

And what are the lessons I've learned ... without beating up on myself too hard?  Well, maybe four things to learn and four things to celebrate.  First, of course, the huge "Don't commit to going down or up a route with no clear exit unless I'm very clear that (if it goes wrong) I will be able to get back out again."  Secondly, become even more skilful with my equipment.  I'm a bit clumsy with mobile phones as, because I work from home and my age, I nearly always use landlines.  I plan to switch to making more of my personal/domestic calls by mobile and to using it more routinely.  Mobiles are great technology and I want to master them better.  And the same with my walking GPS.  I'm OK with it, but mostly I use map & compass.  The GPS is a back up which I look at occasionally to confirm that I'm where I think I am on the map.  I want to be able to use it better to pinpoint and read the precise grid reference for my location.  Of course there's the thorny question of ice axe & crampons.  I had both ... they were in the car.  Would having them in my pack have made a difference?  Probably not, but they should have been there.  And what about involvement of others?  As a pretty regular solo walker, I let people know where I'm going and I usually also leave a printout on the dashboard of my car showing my planned route.  It's not enough.  I would quite likely have been dead and cold before rescuers got to me, if I had had to wait until my wife raised the alarm after I failed to check in by phone at our agreed time of 8.00 that evening.  Hence the value of the personal location beacon (PLB) which can raise the alert rapidly even when I'm out of mobile range.  My wife & son would then be rung as my recorded next of kin.  What I need to ask them to do next is to ring the Mountain Rescue who are involved to tell them what route I planned to take ... the PLB may not be broadcasting accurate information if I'm down a gully. 

And a fourth lesson?  This is more for me as a therapist.  I always remember a delightful comment on "management by wandering about" in Peters' & Austin's classic book "A passion for excellence".  It's a long time since I read it, but they said something like "The good manager creeps about until he catches somebody doing something right, and then he praises him."  The gender bias rather dates the remark, but the point is that a variety of friends have responded to hearing what I've been through.  It's so interesting the variety of their reactions.  I notice how affirming it is to be validated.  I made a life-threatening mistake and then recovered from it.  Some friends particularly pointed out and praised the recovery.  As a therapist, I want to notice this.  I don't think I do this as fully as I could ... really feel into how my client, my patient, has come through their traumatic challenging experiences.  Look for what I can praise & validate about how they have survived and make sure I let them know.  They're likely to be battered and self-doubting enough as it is; they probably could do with the nourishment of being affirmed.  As pretty much always, of course, it's likely to be worth checking how they experience what I've said.

And four celebrations?  So much!  I celebrate keeping my 62 year old body fit and strong.  I celebrate finding that I could think clearly and act decisively when I was looking at potential death pretty close up.  I vastly celebrate my relationships, my dear darling wife and children, my friends.  And I celebrate that when I saw a possible rapid end to my life, I didn't have regrets, just gratitude & love.  I tear up thinking of these things.  Who knows where my mind would have got to if I'd been stuck on that steep, cold slope for four or five hours, not just two.  I was unlucky and then I got lucky.  And it's a weird privilege to face my death like this and come away unscathed and, I pray, wiser.   

So there are many lessons and as Garnefski & Kraaij found in their research using the "Cognitive emotion regulation questionnaire (CERQ)", "positive reappraisal" with challenging experiences is so routinely associated with better outcomes.  Look for affirmative answers to the four questions "I think I can learn something from the situation", "I think that I can become a stronger person as a result of what has happened", "I think that the situation also has its positive sides" and "I look for the positive sides to the matter".  Watch out too for how I could easily beat myself up for my life-threatening mistake on the hillside.  Of course I must learn from it, but that doesn't have to come through sackcloth & ashes.  It ties in with the importance of self-compassion - see, for example, Leary et al's "Self-compassion and reactions to unpleasant self-relevant events: the implications of treating oneself kindly" and Neff et al's "Self-compassion, achievement goals, and coping with academic failure", although specific self-compassion interventions following trauma are still in their infancy - see this year's paper "‘Being kinder to myself ': A prospective comparative study, exploring post-trauma therapy outcome measures, for two groups of clients, receiving either cognitive behaviour therapy or cognitive behaviour therapy and compassionate mind training".  For me, as often happens for our clients too, a key "intervention" to reduce excessive self-blame wasn't from any "sophisticated therapist" colleague so much as from the kind, fellow hill walker on the top of Carn Ghluasaid who said "If you keep walking for long enough, something a bit like this happens to all of us." 

And what about so-called "posttraumatic growth"?  It's early days, but this currently stands out for me (with my very fortunate outcome) much more than any "posttraumatic stress".  I've written about this area before, for example in the blog posts "Writing (& speaking) for resilience & wellbeing: personal growth" and "An intriguing and encouraging development in therapeutic writing".  In the first of these posts I said "Richard Tedeschi and Lawrence Calhoun at the University of North Carolina have been particularly active in researching this area of possible posttraumatic growth (Tedeschi and Calhoun 2004; Calhoun and Tedeschi 2004). They highlight: "Most of us, when we face very difficult losses or great suffering, will have a variety of highly distressing psychological reactions. Just because individuals experience growth does not mean that they will not suffer. Distress is typical when we face traumatic events. We most definitely are not implying that traumatic events are good - they are not. But for many of us, life crises are inevitable and we are not given the choice between suffering and growth on the one hand, and no suffering and no change, on the other. Posttraumatic growth is not universal. It is not uncommon, but neither does everybody who faces a traumatic event experience growth. Our hope is that you never face a major loss or crisis, but most of us eventually do, and perhaps you may also experience an encounter with posttraumatic growth."

They also explain: "what is posttraumatic growth? It is positive change experienced as a result of the struggle with a major life crisis or a traumatic event. Although we coined the term posttraumatic growth, the idea that human beings can be changed by their encounters with life challenges, sometimes in radically positive ways, is not new. The theme is present in ancient spiritual and religious traditions, literature, and philosophy. What is reasonably new is the systematic study of this phenomenon by psychologists, social workers, counselors, and scholars in other traditions of clinical practice and scientific investigation. what forms does posttraumatic growth take? Posttraumatic growth tends to occur in five general areas. Sometimes people who must face major life crises develop a sense that new opportunities have emerged from the struggle, opening up possibilities that were not present before. A second area is a change in relationships with others. Some people experience closer relationships with some specific people, and they can also experience an increased sense of connection to others who suffer. A third area of possible change is an increased sense of one's own strength - "if I lived through that, I can face anything". A fourth aspect of posttraumatic growth experienced by some people is a greater appreciation for life in general. The fifth area involves the spiritual or religious domain. Some individuals experience a deepening of their spiritual lives, however, this deepening can also involve a significant change in one's belief system."

This is thought-provoking and potentially wise territory. New possibilities, deepening of relationships, an increased sense of strength, appreciation of life, existential and spiritual change. Tedeschi and Calhoun developed the "Posttraumatic growth inventory" as a questionnaire to explore these possibilities. They write that they are happy for the scale to be employed for research purposes as long as financial gain does not occur from its use. See their website at UNC Charlotte for more information and freely downloadable research papers. Clearly it is important to employ this measure sensitively and only when it seems it might be indicated e.g. if the client themself seems open to looking at possible posttraumatic growth. This might occur after they have already written and/or talked more directly about what happened and shared the emotions and thoughts associated with the trauma.   I can certainly see how the "Posttraumatic growth inventory" is very much relevant for me here.