Healing Trauma in International Settings

Best Practices

Philip G. Monroe, PsyDCarol King, M.Ed

Listen…don’t assume you know Train…don’t do it yourself Utilize…don’t reinvent the wheel

A desire to serve does not mean you should go. A call does not substitute for a plan.

Successful Int’l Trauma Work?

When humanitarian aid hurts…◦ Linda Polman, The Humanitarian Crisis

Ever hear of the burned over district?

Counselors: DO NO HARM

When is helping hurtful?

Don’t assume you already know all you need to know◦ about trauma and recovery

Instead: listen and learn before you act◦ Listening has a historical context◦ Listening has a cultural context◦ Listening has a political context◦ Listening has a religious context

I. Listen…don’t assume

How do you define trauma healing? Recovery?

What does trauma recovery look like in settings that downplay public displays of emotion?

Key Question!

Material deprivation War-like conditions

Bodily injury (or threat of) Forced confinement/coercion

Forced to harm others Disappearance/death of loved ones

Witnessing violence to others Head injury

What kinds of trauma?

Dimensions of trauma on the Harvard Trauma Questionnaire (HTQ)

To train others you need a plan Find local trustworthy leaders Learn from them re: trauma in cultural context Connect with existing power/helping base

◦ Design intervention/training strategies Trauma education; narrative approach Grounding/stabilization Reconnection to community

◦ Continuous consultation and troubleshooting

II. Train others…don’t do it yourself

Before you go!◦ Learn the history of trauma (and US involvement)◦ Discover NGOs already there, make connections◦ Look for potential resources/barriers to work

Go/Connect◦ First listening trip to solidify prior case map◦ Build objective 1, 2, 5 year realistic goals◦ Discover alliances/silos

Build◦ Bibliographies, a lexicon of trauma, initial to

intermediate interventions/trainings

Build your country case map

Watson, P. J., Brymer, M. J., & Bonanno, G. A. (2011). Postdisaster psychological intervention since 9/11. American Psychologist, 66(6), 482-494. (p. 485)

If nothing else….Follow This Plan:

Don’t create new models...utilize existing indigenous models and modify where needed

III. Learn from existing models

Created by Rhiannon Lloyd & Joseph Nyamutera (1994)

http://www.lerucher.org/Content/Reconciliation/Resources.html

Benefits:◦ Spiritual base, Cross centered◦ Focus on sharing stories◦ Rwandans trained to lead them◦ Supports mixed ethnicity attendees◦ Participant accounts of healing

Model: Healing Wounds of Ethnic Conflict (HWEC)

Drawbacks◦ Some theology presented can be questioned

Discussion re: understanding God's will (pgs. 23-24)◦ Not trauma focused (symptoms?)◦ Possible to overemphasize reconciliation?◦ Lack of follow-up

HWEC, Con’t

Quaker founded peace initiative for Great Lakes Region of Africa

Benefits◦ Indigenous◦ Seeks community support and involvement◦ Detailed manual ◦ Attention to group process and building safety

Beginnings, closings, starters, energizers, evaluations◦ Teaches listening skills◦ Emphasis on faith and prayer◦ Multi-ethnic participation◦ Evaluation of program – Burundi 2007

Model: Healing & Rebuilding Our Communities (HROC)

http://aglifpt.org/Program/hroc.htm

Drawbacks◦ Educational focus but…

limited information on managing symptoms◦ Trained facilitators◦ Follow-up◦ Referrals for those unable to attend or continue

HROC, Con’t

Model: Healing Wounds of Trauma Authors: Hill, Hill, Bagge, Miersma (2004)

◦ http://www.scripture-engagement.org/node/17

Benefits◦ Short chapters, simple terminology◦ Discussion oriented◦ Translated into dozens of languages◦ Field-tested in multiple countries◦ Scripture based concepts◦ Addresses topics: grief to reconciliation

Drawbacks◦ Starts with “Why do we Suffer” theological

question Better? What does God think about injustice?

◦ Small book, could rush to “reconciliation”◦ Light on trauma symptom education◦ Not informed by latest psychological literature

HWT, Con’t

Prolonged Exposure◦ Foa, Prolonged Exposure Therapy for PTSD, 2007

Cognitive Processing◦ Resick et al, Cognitive Processing Therapy for

Rape Victims, 1993 EMDR

◦ Francine Shapiro CISM/CISD Narrative Exposure Therapy

◦ Frank Neuner, Maggie Schauer, Thomas Elbert

What about Psychological models?

Be wary of quick fixes Differentiate: psychological first aid v.

recovery efforts Follow-up; Support trainees Do work in community Self-care! Contextualize

Final Thoughts

◦ Richard Mollica, Healing Invisible Wounds; Global Mental Health: Trauma & Recovery

◦ Jennifer Dawson, African Conceptualizations of PTSD and the Impact of Introducing Western Concepts (web article)

◦ B. Mesquita, Emotions in Collectivist and Individualist Contexts. Jnl of Personality & Social Psychology (2001)

◦ www.headington-institute.org ◦ www.traumacenter.org

Resources You Should Know

Download issues?◦ Emailpmonroe@biblical.edu

www.wisecounsel.wordpress.com