7.1. CASE STUDY PRESENTATIONS
Oznur Acicbe:
Resilience Factors of Turkish Speaking Women Refugees in Switzerland…………………………………………………187
Pia Andreatta:
Without a Trace: Group Work With Missing Relatives in Complex Post War Context…………………………………………………187
Jorge Aroche, Mariano Coello, Shakeh Momartin:
Treating Trauma in the “Age of the Brain”: Trials and Tribulations in the Application of a Bio-Psycho-Socio-Cultural Approach in the Real World…………………………………………………187
Martin Auerbach:
Posttraumatic Growth and World Assumptions among Holocaust Survivors…………………………………………………188
Özden Bademci:
The Story of a Baby Born into a Refugee Family as Seen Through Two Years of Infant Observation…………………………………………………188
Rosa Maria Bramble Weed:
Immigrant Latina Workers at WTC Ground Zero: A Socio-Cultural Approach to Long Term Impact of Trauma…………………………………………………188
Graham Connell-Jones:
Drug Modulated EMDR Treatment for Borderline Personality Disorder…………………………………………………189
Rose Marie Durocher:
Hilda Meets her Children: Psychosocial Challenges for the Reunification…………………………………………………189
Ayse Aybil Goker, Hatice Gunes:
Remembering and Reconstructing The Displacement And ‘Home’ After 30 Years: A Voice of a London Turkish Cypriot Woman…………………………………………………189
Uwe Harlacher, Lone Jacobsen, Linda Nordin:
Single Subject Design as Research Tool in Exposure Treatment for Complex PTSD…………………………………………………190
Sheila Hayman:
“Write to Life”: Therapeutic Creative Writing with Survivors of Torture…………………………………………………190
Angelika Koshal:
Traumatherapy with Complex Traumatized and Drug-Addicted People in Substitution Treatment…………………………………………………190
Adrienn Kroo:
Tortured Refugee Women – Identity, Body, Attachment and Sexuality…………………………………………………191
A. Omari Meeks:
Pathways to Wellness: Defining and Replicating Resiliency in West Bank through Bronfenbrenner's Person-Process-Context Model…………………………………………………191
Brittmari Nordström Kinnaman:
The Treatment and Recovery of “Sahra”, a 16 Year Old Analphabetic East African Girl. One of the Severely Traumatized and Separated Adolescents Receiving Treatment in my Clinic – Stockholm Child and Adolescence Psychiatric Clinic…………………………………………………191
Bodil Pedersen:
Trauma Theory and Daily Life…………………………………………………192
Sandra Rafman:
The Value of a Human Rights Perspective in Addressing Ongoing Upheavals, Traumas and Losses of Disaster-Affected Children: A Comparison of the Play Narratives of Young Children Living in Haiti or in Canada during the January 12 Earthquake…………………………………………………192
Ebru Salcioglu, Metin Basoglu:
Control-Focused Behavioural Treatment of Female War Survivors with Torture and Gang Rape Experience: Four Case Studies…………………………………………………192
Carla Schubert:
Psychotherapy with Traumatized Refugees and the Interpretation of Dreams…………………………………………………193
Jon-Håkon Schultz, Lars Weiseath:
Cleansing Rituals for Traumatized Child Soldiers in Northern Uganda…………………………………………………193
Abigail Seltzer:
“I Stood by a River” – Integrating EMDR and Sensorimotor Psychotherapy in the Treatment of Torture Survivor…………………………………………………193
Helge Kr. Smebye:
Rescripting of Profoundly Shameful Traumatic Imageries in Traumatized Refugees: Scripting Dialogues between Patient and “Personal Companion”…………………………………………………193
Helge Kr. Smebye:
Using Visual Illustrations in Psychoeducation for Brewin's Dual-Representation Theory of PTSD: Validating Shameful PTSD Responses in a Traumatized Ex-Elite-Soldier…………………………………………………194
7.2. MEDIA PRESENTATIONS
Sevcan Sönmez:
Representation of Traumatic Memory in Turkish Cinema…………………………………………………195
Jana D. Javakhishvili:
Mock TV News Report in Georgia as both Result and Cause of Societal Trauma…………………………………………………194
Judy McLaughlin-Ryan:
Use of Video Feedback PTSD Affect State Regulation in Group Setting…………………………………………………195
Carol Tosone, Caroline Rosenthal Gelman, Charles Figley, Lynn McVeigh:
Vicarious Learning Approach to Training Trauma Clinicians…………………………………………………195
7. CASE STUDY AND MEDIA PRESENTATIONS
7.1. CASE STUDY PRESENTATIONS
Acicbe Oznur, Maltepe University
Resilience Factors of Turkish Speaking Women Refugees in Switzerland
Refugees may face a variety of pre- and post-migration stressors that make them susceptible to mental health disorders and adjustment problems. Thus, unlike economic migrants, asylum seekers and refugees come to a new country not on their free will but from necessity as a consequence of the accumulated persecution and intimidation they have experienced. They have suffered many traumatic events such as loss of family, friends, home, community, country and language. Even long after they have been granted refugee status they may continue to find themselves subjected to poverty and discrimination as well as a loss of self-esteem, status and identity. However some can demonstrate remarkable resilience and fortitude in facing psychological pain, dislocation and hardship. In spite of having been abandoned by the protective authority who now threatens their safety and security, they remain in contact with a life force, that enables them to tolerate and endure these privations and losses without becoming overwhelmed by them. Consequently, they are enabled to make the best of the situation in which they find themselves, using whatever help is available to rebuild their lives. Although refugees face similar challenges; their stories, as well as their resilience factors, are different. The purpose of this presentation is to highlight common challenges and the resilience factors of three Turkish speaking women refugees in Switzerland, through their own voice, collected by in-depth interviews.
Andreatta Pia, University of Innsbruck
Without a Trace: Group Work with Missing Relatives in Complex Post War Context
I want to illustrate group interventions with relatives who are missing family members after armed conflict. Working with Internally Displaced Persons (IDPs) in a refugee camp in Sri Lanka, where disappearances happened to a tremendous amount during the war, I want to discuss specific strategies concerning ‘grief without a trace’. Mental health and psychosocial work in this context is dependent on the political and human right situation, as well as trauma patterns. Decades of war led to Sequential Trauma coming from forced displacement, life threatening events, loss and often ambiguous loss after disappearance, as well as Collective Trauma as loss of communality and therefore tearing of the ‘social fabric’. In the context of chronic effects of war, ambiguous loss leads to individual and cultural bereavement. On this basis I want to follow questions how to intervene after ambiguous loss with groups and individuals, clinical states between ‘hope and fear’, the quick emotional changes between traumatic grief and avoidance of grief, states of being overwhelmed versus tolerance of ambiguity, to work with the need of information seeking, to be with no closure of stories and the importance of traces or a body. Not pretending to have a fixed manual how to intervene, I want to formulate core principles for group work out of my practical experience and discuss strategies.
Aroche Jorge; Coello, Mariano; Momartin, Shakeh, Service for Treatment and Rehabilitation of Torture and Trauma Survivors
Treating Trauma in the “Age of the Brain”: Trials and Tribulations in the Application of a Bio-Psycho-Socio-Cultural Approach in the Real World
The last decade has seen phenomenal advances in brain science and in our understanding of the biology of trauma. This has resulted in many ingenious applications to assist survivor recovery. At the same time the field of trauma, particularly in the context of trauma generated by human rights violations, has become more aware of the effects of trauma at different levels of society, and about the implications of culture for understanding how trauma affects people, families and communities, and how healing and social reintegration can be assisted.
These are exciting developments, yet their practical application and integration into a coherent approach to service provision in the real world poses significant challenges for agencies seeking to ensure that their clients benefit from their inherent potential. Similar challenges face researchers trying to evaluate approaches that integrate interventions that span biological, psychological, community and culture dimensions.
This paper will utilize the experience of STARTTS to discuss the potential of an approach that aims to integrate interventions derived from new developments in neuroscience with orthodox psychological interventions and community approaches in their work with traumatized refugees from various cultural backgrounds settling in Australia. The conceptual, practical, and ethical challenges involved will be illustrated by case studies and service data. Participants will discuss how to continue to address these challenges to ensure that the benefits of new developments in the understanding and treatment of trauma can reach our most disadvantaged clients.
Auerbach Martin, AMCHA
Posttraumatic Growth and World Assumptions among Holocaust Survivors
Holocaust Survivors suffered from extreme traumatization in their childhood and young adulthood. Much has been written about the psychological aftermath of the Holocaust on the survivors. Many reports stress the negative sequellae and posttraumatic symtomatology, others present a complexity of vulnerability and resilience shown by survivors coping with current stress and adversity.
The growing interest in and clinical reports of posttraumatic growth has added an additional viewpoint to our understanding of the complex psychological world of Holocaust survivors.
The author will present clinical vignettes from the psychotherapy with Holocaust Survivors in AMCHA, the Israeli Center for Psychosocial Support of Holocaust Survivors. The focus of the presentation will be on the importance of clarifying and paying special attention in the therapy to the world assumptions of the survivors and to various aspects of their posttraumatic growth.
Bademci Özden, Maltepe University
The Story of a Baby Born into a Refugee Family as Seen Through Two Years of Infant Observation
As a part of my MA programme at the Tavistock Clinic (UK) I did an infant observation with a refugee family on a weekly basis for two years. They didn't speak English at all. The family's life was one of considerable deprivation and obvious financial hardship. They lived on social security. It felt like they were living in a bubble unable to cope with each other and the foreign culture in which they lived. The baby was their second child. The mother was highly irritable, intrusive and showing a great deal of anger and hostility to the baby.
During my observation I became more aware of how the refugee condition affected many facets of the family's life from the most tangible external objects to a wide spectrum of psychological dimensions. Although the baby was quite alert and responsive for the first six months, he eventually shut himself down under the impact of the rejection.
The paper explores some of the thoughts on the impact on the baby of being born into a refugee family with vivid extracts from observations, whom I observed over a period of two years. Two years of an infant observation categorically showed how impact of trauma can be passed on from one generation to another.
Bramble Weed Rosa Maria, Integral Enrichment
Immigrant Latina Workers at WTC Ground Zero: A Socio-Cultural Approach to Long Term Impact of Trauma
Issues: In the days and months following the terrorist attacks on September 11th 2001, between 18,800 and 35,000 people worked or volunteered in recovery efforts which officially ended in July 2002. Most cleanup workers were first generation immigrants to the United States. Latina workers constituted a significant number of those who cleaned office buildings, as they took advantage of the opportunity to help and gain income. Long term exposure to debris, asbestos and witnessing human suffering contributed to their disproportionately suffering from health hazard and post traumatic stress disorder.
Almost ten years after the events of 2001, medical reports indicate asthma and other chronic lung conditions remain a significant burden for rescue and recovery workers responding to the attacks on the World Trade Center. Latina workers suffer long term effects of occupational hazard such as lung complications, coughs, asthma, and lower airway disease. Psycho-social stressors related to loss of employment, housing, income for dependents overseas and fear of deportation is prevalent. These factors contribute to social isolation, depressive symptoms and risk of intimate partner violence among Latinas who worked in ground zero. Description: A case study of an immigrant woman who witnessed the attacks on the WTC as well as worked in recovery will illustrate the socio-culturally integrative approach, which addresses the trauma of migratory experience, validates their story of their contribution of rebuilding hope in the midst of terror, which many Latina workers believe were “forgotten” or “invisible”. Lessons Learned: Culturally informed services are provided in Spanish, integrating cultural values to process healing, restoration of hope and human dignity. Recommendations: Further research is needed to address the long term affects of trauma on this vulnerable population, service advocacy in terms of health care and compensation.
Connell-Jones Graham, Raphael Healthcare
Drug Modulated EMDR Treatment for Borderline Personality Disorder
From my clinical work over the past 4 years a case series of 15 women patients, all detained in a secure hospital for periods of up to 30 years discharged after EMDR therapy. Some cases discussed in depth, others factor analysed as case series. Drug modulation permitted intensive therapy. The factors of complex stress disorder are beeing discussed and its simlarity to borderline personality disorder. The effects of long term instititutionalisation after detention in security. The responsible clinician as “goaler and therapist” as well as therapeutic pitfalls are being explored. The psychopathology of the flashback is contrasted with the psychpathology of the alter (dissociative identity). Prognostic factors and outcomes are being presented. The implications for personality disorder as a diagnosis contrasted with complex PTSD will be evaluated.
Durocher Rose Marie, Program for Torture Victims
Hilda Meets her Children: Psychosocial Challenges for the Reunification
Clients seeking asylum face a harrowing legal experience and often experience serious symptoms of PTSD and Major Depressive Disorder. In addition, if these clients are parents and separated from their children, their symptoms are exacerbated by extreme anxiety as to the welfare of the children they left behind. Parents frequently face a separation of two to nine years, due to the court schedules and visa preparation and other factors. This has serious consequences for the mental health of the parent and children. When finally, reunification is about to take place, it is often a time of high excitement. The reunion is usually idealized, with little thought or preparation for the changes in the children and in their own life that will affect the successful reintegration of the family. The parents are often in denial of the challenges and hazards that they will face in this reunification, namely, social, cultural, economic, as well as the developmental stages of the children.
In this workshop, cases of family reunification that have occurred utilizing the protocol developed by the Program for Torture Victims in Los Angeles, California, for preparing the parent, will be presented. Common difficulties and challenges will be illustrated through the use of these clinical vignettes to elicit audience discussion.
Goker Ayse Aybil, Yeditepe University; Gunes, Hatice, Sabanci University
Remembering and Reconstructing the Displacement and ‘Home’ after 30 Years: A Voice of a London Turkish Cypriot Woman
How survivors remember trauma has long been debated in psychology and most of our knowledge about the nature of trauma memory derives from cognitive approach. Despite the success of cognitive theory, it can be argued that it puts a great emphasis on cognitive processes produced by individual's own mind. In the real life when people are traumatized and if especially massive traumatization is at issue, remembering painful recollections are unexceptionally influenced by social, political and institutional ‘realities‘. The data of this paper were collected in North London during the period Greek and Turkish Cypriots informants faced various political challenges that affected their ‘personal memories’ and the way they perceived each other in the context of their lives in North London. Referenda for the UN's proposed plan – known as Annan Plan – took place on the 24 th April 2004 and the result of it was 65% acceptance by Turkish Cypriot s and 76% rejection by Greek Cypriots. For some London Cypriots, as for Ayşe, the rejection of the Annan Plan by Greek Cypriots played a major role in reshaping of her deep, previously unrecognized anger and sadness. This paper will use one specific case to demonstrate how ‘personal memories’ as well as identifications were actually reconstructed through changing social, political interest of a state by focusing on data collected before and after referanda.
Harlacher Uwe; Jacobsen, Lone; Nordin, Linda, Rehabilitation and Research Centre For Torture Victims
Single Subject Design as Research Tool in Exposure Treatment for Complex PTSD
RCT is specialized in rehabilitation of torture victims suffering from complex symptoms, herein PTSD due to multiple traumata/ torture. There is a lack of evidence-based treatments for this kind of complicated PTSD and the ambition of the center is to develop such a treatment based on an adaptation of the principles of prolonged exposure therapy (Foa, 2007). We differentiate between PTSD-reactions provoked by specific triggers and reactions that are mediated by memories. For the specific triggers the intensity of the reaction is covarying with the intensity of the trigger. The reactions to memories are occuring with a given intensity irrespectively of the trigger intensity. The first type is addressed by graded in vivo-exposure to eliciting triggers and the second by imaginative exposure-techniques. Outcome is measured following a single subject design, i.e. systematic daily registration of the degree of discomfort (SUD-scale), induced by thinking of a trigger/memory. The treatment-approach, measurement-method and results will be presented and discussed.
So far we observe no decrease in SUD-scores during the 2 week daily preregistration (baseline) period. After initiating treatment for one of the two registered situations, a decrease in SUD-scores for the treated but not for the untreated situation can be observed; i.e. it seems that there are no generalization-effects.
Hayman Sheila, Medical Foundation for the Care of Victims of Torture
“Write to Life”: Therapeutic Creative Writing with Survivors of Torture
‘Write to Life’ is a creative writing group at the Medical Foundation for the Care of Victims of Torture in the United Kingdom. Founded twelve years ago it is, so far as we know, the longest continuously running therapeutic writing group for survivors of torture in the UK, and possibly anywhere. The writing programme is run as a collaboration between skilled professional writers and the MF's clinicians. Writing in this way, where the writer reworks a story or poem from its initial form as a memory or experience, into a finished piece of work with a structure and a narrative, has been shown to have measurable benefits to physical as well as psychological health. Our presentation will provide an overview of the structure of this program of work, our approach and the observations we have made about its therapeutic effect.
Koshal Angelika, Private Practice, Bonn
Traumatherapy with Complex Traumatized and Drug-Addicted People in Substitution Treatment
Many international studies demonstrate that the problem of drug-addiction is very often found in combination with complex traumatization (Schmidt 2000; Felitti, Dube et al. 2003; Langeland et al. 2006). PTSD and other trauma symptoms cause a lot of psychophysical dysregulation. So the psychiatrist Khantzian (USA) postulated already in 1985 the hypothesis of “Selfmedication” in cases of addictive disorders. Janina Fisher (2000), Trauma Center Boston, described drug addiction being connected with early traumatization as a “compensatory strategy aimed at self regulation”. Working with drug addicted people for many years it became very obvious that a high percentage of them are using drugs for affect regulation, (to calm down after being aggressive caused by an argue or by getting triggered, to reduce strong inner tension, or to sleep without nightmares etc.). Alcohol and drugs do reduce the mentioned symptoms for a while. To learn to cope in a more adaptive way, addicted people need to learn alternative strategies to regulate their emotions. This can be done by using the trauma stabilization techniques and in special cases doing traumatherapy later on; working with EMDR; 4-Field-Technique or others. Practical experiences started 1990, show several successful treatments and that a substitution treatment does not disrupt traumatherapy.
Kroo Adrienn, Cordelia Foundation for the Rehabilitation of Torture Victims
Tortured Refugee Women – Identity, Body, Attachment and Sexuality
The aim of torture is to cause severe pain and suffering in order to undermine the values, beliefs, and self-concept of the victim. Torture, due to its intentional nature, also destroys the fundamental trust of the survivor, and distances the person greatly from other human beings. The internalization of the torturer's attitude also has severe consequences concerning the survivor's self image, self-esteem, and identity. Torture intrudes into the most private and intimate parts of a human, and attacks the one place where a person's intimacy, integrity and inviolability is supposed to be guaranteed, the person's body and mind. The complex and long-lasting after-effects of torture stem from the deliberate, repeated and brutal invasion this “sacred place”, the human body. Sexual torture is a form of psychological warfare, and involves the destruction of sexual identity. It is applied worldwide and causes long-lasting shame, humiliation, and fear among survivors. In my presentation I will present the case of three tortured refugee women and the relationship between torture, identity, body identity, attachment and sexuality in their cases. The case studies stem from my therapeutic work in Hungarian refugee shelters, and intend to present the reality and common features of female torture survivors.
Meeks A. Omari, The Chicago School of Professional Psychology
Pathways to Wellness: Defining and Replicating Resiliency in West Bank through Bronfenbrenner's Person-Process-Context Model
In times of war, attention is naturally drawn to the maladies of human behavior, particularly the violation of human rights and dignity. These violations are the precipitating forces behind the trauma experienced by victims of warfare. Yet there is a beacon of hope, the integrity of the human psyche and the positive adaptive behavior known as resiliency. Focusing on Bronfenbrenner's Person-Process-Context Model (PPCM), this paper looks to operationally define resiliency in an effort to formulate a replicable model for psycho-social treatment in the Levantine conflict zone or “mobilize the resilient capacities of trauma survivors [to] function as a healing and reparative context” (Harney 2007, p. 75). Using the Joint Advocacy Initiative (JAI) of the East Jerusalem YMCA as case study for the potential an ecological perspective can have on mapping “pathways to wellness” (Cowan 1994), PPCM and the programmatic successes of the JAI are reviewed to address the question “under what circumstances is resilience best facilitated?”
Nordström Kinnaman Brittmari, Stockholm Child and Adolescence Psychiatric Clinic
The Treatment and Recovery of “Sahra”, a 16 Year Old Analphabetic East African Girl. One of the Severely Traumatized and Separated Adolescents Receiving Treatment in my Clinic, Stockholm Child and Adolescence Psychiatric Clinic
Before coming to Sweden, Sahra's entire family was killed. Her Stepfather and brother were mutilated and killed because they were albinos. Her mother and sister died trough arson while Sahra was working in a nearby village. Alone without protection, she was gang raped and fled. Sahra was later ”befriended” by a woman who helped her come to Sweden to be saved and start over. At the airport Sahra was picked up by persons active in a trafficking network where she spent a few months locked in an apartment. Being resourceful, she managed to escape and was then placed by the migration board and social welfare in a foster family.
Sahra was referred to us by a health clinic after refusing a gynecological examination.
Encountering Sahra in a state of distrust and desperation raised several question around treatment interventions. A good sign was that she connected fairly easy and could talk about her PTS symptoms. Initially she suffered more from bereavement than her PTSD.
The treatment process included stabilization, bereavement work, symptom reduction interventions, psycho education about trauma reactions, education in physiology, sexuality–pregnancy, trauma focus and orientation in everyday life.
In this presentation I especially want to discuss the importance of resilience, social support system and early relational aspects for recovery.
Pedersen Bodil, Roskilde University
Trauma Theory and Daily Life
There are two main trends in psychological approaches to human suffering related to what we term trauma. Although they have their respective limitations both approaches may help us explore and alleviate human suffering.
One trend of approaches primarily uses concepts like traumatic events and traumatisation and is quantitative and diagnostically based. Events and reactions are categorised as well as abstractly generalised, thus reducing and de-situating the complexities of personal suffering.
Another and less frequently used trend of approaches is primarily qualitative and subject-oriented. It explores the complexities of personal and situated meanings and practices related to suffering and resilience connected to ‘traumatic’ events. Here one challenge is to find ways of generalising knowledge.
This presentation is based on a large qualitative research project on the personal meanings of sexualised coercion. Inspired hereby it will explore the possibilities of developing theoretical understandings of the personal meanings of violent and/or overwhelming events. It will propose that personal meanings can be connected to the conduct of daily life. Events and reactions may thus be understood as violent and/or overwhelming events and experiences requiring re-evaluations and re-organisation of intersecting contexts of the conduct of daily life.
Rafman Sandra, McGill University Health Centre-Montreal Children's Hospital
The Value of a Human Rights Perspective in Addressing Ongoing Upheavals, Traumas and Losses of Disaster-Affected Children: A Comparison of the Play Narratives of Young Children Living in Haiti or in Canada During the January 12 Earthquake
Although at risk for traumatic grief and pervasive and persistent psychological consequences, disaster-affected children are not specifically included in the Convention of the Rights of Children. As the impact of a disaster reaches beyond borders to the communities of the Diaspora and to the human family, I explore how a human rights perspective can address clinical, theoretical and policy impasses in young children receiving timely and appropriate care. I present the play narratives and concerns of six children, aged three-to-eight years, seen at a metropolitan Haitian-Canadian community center within three months of the January 12, 2010, earthquake. Three children arrived following the earthquake and all had family presently living in Haiti. Parents, teachers, and community workers were interviewed as well. Whether living in Haiti or in Canada on January 12, children's narratives reveal their struggle to find their place in ruptured and changing family, scholastic, and cultural constellations, their awareness of stigmatization, and their confusion over conflicting moral, political, and religious explanations. Moreover, the ongoing catastrophe challenged many psychological first aid or trauma focused interventions. Aware when they are judged not to be within “our jurisdiction”, children should anticipate quality care, and the valuing of their experience, dignity and worth.
Salcioglu Ebru; Basoglu, Metin, King's College London & Istanbul Centre for Behaviour Research and Therapy
Control-Focused Behavioural Treatment of Female War Survivors with Torture and Gang Rape Experience: Four Case Studies
The war in the Democratic Republic of Congo has resulted in the deaths of over 4 million people. Thousands of women and girls have been kidnapped, raped, and tortured by foreign militia and army soldiers. In this session treatment of four Congolese female asylum-seekers in Turkey who were consecutively referred for treatment will be discussed. Two women were tortured and gang raped at their home and two teenage girls were kidnapped, held captive, tortured, and gang raped. All cases had severe PTSD and three had depression. In three cases that had two baseline assessments over three weeks PTSD and depression symptoms showed no change during the waiting period. After the second baseline the patients were given 6- to 12-sessions of Control-Focused Behavioral Treatment, which involved mainly live exposure to trauma reminders designed to enhance sense of control over trauma. Treatment achieved 43% to 94% improvement in self-reported PTSD symptoms and 60% to 90% improvement in clinician-rated PTSD symptoms. Significant improvement was also noted in depression and social disability. Improvement was maintained at 2 to 6 month follow-up. These results suggest that brief and effective treatment of female war survivors with torture and rape experience is possible, despite adverse psychosocial and economic circumstances associated with asylum-seeking in a developing country setting.
Schubert Carla, Centre for Torture Survivors in Finland
Psychotherapy with Traumatized Refugees and the Interpretation of Dreams
Background: The interpretation of dreams is an important therapeutic tool in psychotherapy. Moreover, narrating and interpreting dreams are used as healing practices in a number of cultures. Traumatic events affect negatively on dreaming but particular dream contents and structures can protect a trauma victims' mental health. Aims: To deepen the knowledge of cultural views and dream-work in psychotherapy with immigrants from other cultures. Method: Parts of the content of psychotherapeutic work with three patients from three cultures will be presented. The focus will be put on the interpretation of the patients' dreams and the integration of it in the psychotherapy process. Aspects of the cultural backgrounds of the patients that are important to consider and to incorporate in the interpretation of the dream content will be highlighted.
Schultz Jon-Håkon, Lars Weiseath, Norwegian Centre for Violence and Traumatic Stress Studies
Cleansing Rituals for Traumatized Child Soldiers in Northern Uganda
The aim of this study is to explore the nature, meaning and understanding of local cleansing rituals performed on one traumatized former child soldier in Northern Uganda. How does the former soldier understand the ritual? How does he evaluate the effect of the ritual and to what extent can the ritual be compared with Western therapy such as Cognitive Behavioural Therapy? As a part of a 4 year longitudinal study, a former child soldier was observed through a local cleansing ritual performed to chase away evil spirits. He had been posessed by the spirits after he was abducted and forced to carry out several killings. In the terminology of Western psychology, his symptoms would be described as frequent nightmares, social withdrawal, concentration problems and re-living of the traumatic event to such an extent that he would be diagnosed as having Post Traumatic Stress Disorder (PTSD). Over a follow-up period of 3 years, he was followed with qualitative interviews, participant observation, diagnostic interviews and Harvard Trauma Questionnaire (HTQ). After going through the cleansing ritual, he reported a significant reduction in PTSD-symptoms both after 3, 14, 22 and 36 months. The study explores the ritual and analyses its potential power in dealing with traumatic symptoms. Implications for therapy and social work for immigrants in a Western therapy-setting are indicated.
Seltzer Abigail, Medical Foundation for the Care of Victims of Torture
“I Stood by a River” – Integrating EMDR and Sensorimotor Psychotherapy in the Treatment of Torture Survivor
I will be presenting the case of an Iranian refugee in the UK who was imprisoned for many years in Iran and subject to prolonged torture. I will discuss the use of integrated EMDR and sensorimotor psychotherapy in his treatment, and outline how standard treatments need to be adapted in the case of trauma arising from human rights abuses.
Smebye Helge Kr., Hospital of Østfold
Rescripting of Profoundly Shameful Traumatic Imageries in Traumatized Refugees: Scripting Dialogues between Patient and “Personal Companion”
Rescripting of traumatic imageries through patient-dialogue where patient plays the role of both “competent survivor” and “traumatized self” (Grunert e.a. 2003) was presented at a Norwegian PTSD-conference as a promising strategy for PTSD-patients (Hoffart, 2009). However, if the traumatic experience was profoundly shameful, this procedure was deemed a lot more problematic. A variation was developed by substituting “competent survivor” with “personal companion”. It was used to help a freedom fighter with PTSD and severe self condemnation for killing a young girl hidden in a military vehicle he destroyed during combat. Inspiration came from the narratives of other patients, including a young tortured man: During his most degrading torture, he had a vision of being visited by the major philosophical figure from his culture. The accepting appearance of this philosopher was in strong contrast to his feelings of total shame. A dialogue between the man and his philosopher was scripted. This helped redefine the meaning of the torture, gradually replacing the feeling of shame with pride. The philosopher was made a “personal companion”. The freedom fighter had no such vision. Here it was necessary to invent a person related to the incident as his personal companion. Scripting a dialogue with this fictitious personal companion helped reduce the intrusive impact of shameful memories.
Smebye Helge Kr., Hospital of Østfold
Using Visual Illustrations in Psychoeducation for Brewin's Dual-Representation Theory of PTSD: Validating Shameful PTSD Responses in a Traumatized Ex-Elite-Soldier
Helping foreign veterans and refugees understand the mechanisms behind their PTSD-responses is important but challenging. Language and culture differences challenge the development of a common understanding, especially when an interpreter is needed. The first goal in the Ehlers & Clark (2008) cognitive therapy for PTSD is: Identify and change idiosyncratic negative appraisals of the trauma and/ or its sequelae. Many refugees come to therapy with much shame attached to their past and present PTSD-responses. An ex-elite-soldier would seemingly attack both family and strangers when his PTSD-responses were triggered, without understanding what happened or why – leaving him utterly shameful. Brewin's (2001) dual-representation theory is illustrated by pictures from a news broadcast of civilians coming under gunfire. The functions of the SAM and VAM memory systems are vividly documented by the responses of a young girl: She first deserts and then protects her little sister during the attack. These and other visual illustrations help validate the patient's responses: He gradually realized that they were SAM-controlled responses reprogrammed during intense military training aimed at protecting others, not himself. Validating these shameful responses makes them more amenable to reappraisals. In time this will increase the possibility for bringing them under control of the VAM-system.
7.2. MEDIA PRESENTATIONS
Javakhishvili Jana D., Global Initiative on Psychiatry
Mock TV News Report in Georgia as Both Result and Cause of Societal Trauma
The research studying an impact of the mock TV news report, imitating invasion of Georgia by Russia, broadcasted by one of the leading Georgian TV channels (“Imedi” TV) to the population on March 13, 2010 will be presented.
The research implied content analysis of the fake news report as well as a round of semi-structured interviews with the different target groups: university students and professors, emergency physicians, grocery shops sellers, fuel stations workers and internally displaced people.
The study revealed massive panic among the population during the broadcast and immediately after it, even though at that time it was already known that the news were a fake. The following reactions were reported by the interviewees: confusion, fear, guilt, shame, psycho-somatic symptoms (mainly heart attacks and hypertension) and traumatic repetitive behavior: rushing to fuel stations and grocery shops to make supply of car fuel, products and water, trying to reunite with those family members who were not at home at the moment, etc. After eight months from the broadcast most of the interviewees reported feelings of being insulted by those who initiated the broadcast and decreased trust towards media.
The content analyses of the fake news report revealed the narrative originated from the war related societal trauma in Georgia, implying victimization and enemy image phenomenon.
McLaughlin-Ryan Judy, Private Practice, USA
Use of Video Feedback PTSD Affect State Regulation in Group Setting
This media presentation describes the usage of video feedback with groups comprised of patient's who are diagnosed with post traumatic stress disorder and addictive disorders. This presentation includes split screen video of both the client and the therapist, demonstrating affective and state regulating interventions that are attachment based. In other words, the regulating capacity of the therapist, as well as other group members, becomes a regulating mechanism for the patient who is learning methods of regulating his or her own dysregulated state and affective responses. Footage from PTSD/Addiction groups conducted in my Private Practice, and utilized for teaching purposes, will be viewed by attendees, with open discussion on the topic of the regulation of affect and state, with those diagnosed with PTSD. Goal of treatment is to increase self-regulatory capacities of the patient, while building an increased capacity for interactive community support.
Sönmez Sevcan, Yasar University
Representation of Traumatic Memory in Turkish Cinema
Collective memory is a significant concept and debating issue of recent years. The countries that have sorrowful past and wrongdoings in political and social aspect, try to confront with these realities. Remembering these traumatic experiences is a hard and irritating but important work, because, giving voice to one's traumatic past and recognizing it as part of one's history is a necessary step in escaping from patterns of suffering. For recovering, trauma should emerge, should be spoken and criticized. Turkey has many traumatic realities like military coups, tortures, unsolved murders, ethnic conflicts and forced migration from East to West.
Cinema helps society in remembering and curing the traumatic memories by representing them. Therefore, this study aims to show different representations of traumatic memories in the last ten years of Turkish cinema. Exploring this will reveal “How Turkish society show up its own social memory and bad happenings of the past?” The films will be analyzed by four main cinematic strategies in representation trauma, which Kaplan and Wang (2004) introduce as “cure, shock, witness and voyeurism”. These strategies are used in picturing traumatic facts, realities and they have different effects on viewers. From this perspective research sample films are Güneşe Yolculuk, Sonbahar, Yazι Tura, Eve Dönüş and Güz Sancιsι.
Tosone Carol, New York University; Rosenthal Gelman, Caroline, Hunter College School of Social Work; Figley, Charles, Tulane University School of Social Work; McVeigh, Lynn, New York University
Vicarious Learning Approach to Training Trauma Clinicians
Numerous methods are used to teach about trauma work with survivors of natural and man-made disasters, sexual and physical abuse, and neglect. As educators of clinical professionals, we have found training films to be the most effective and most well received by students. As a result, we have developed training videos for student clinicians that have been distributed by the Council on Social Work Education, the accrediting body for professional social work schools in the United States. One of these films is devoted to teaching students about work with survivors of sexual abuse and natural disasters. The format involves reenactments of two student clinician sessions, one involving a student from New Orleans working with a Hurricane Katrina survivor, and the other a student working with an adult survivor of childhood sexual abuse. Both sessions are followed by supervisory sessions with senior trauma clinician specialists. This format affords students the opportunity to observe other student clinicians in action, critique their interventions, develop self-reflection skills as a result of vicarious empathic engagement, and foster students’ critical thinking skills as a result of vicarious participation in the supervisory process.