Burnout, vicarious traumatization and its prevention.
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Previous studies on burnout and vicarious traumatization are reviewed and summarized with a list of signs and symptoms. From the author's own observations two histories of caregivers working with torture survivors are described which exemplify the risk,implications and consequences of secondary trauma. Contributing factors in the social and political framework in which caregivers operate are analyzed and possible means of prevention suggested, particularly focussing on the conflict of roles when providing evaluations on trauma victims for health and immigration authorities. Caregivers working with victims of violence carry a high risk of suffering from burnout and vicarious traumatization unless preventive factors are considered such as: self care, solid professional training in psychotherapy, therapeutic self-awareness, regular self-examination by collegial and external supervision, limiting caseload, continuing professional education and learning about new concepts in trauma, occasional research sabbaticals, keeping a balance between empathy and a proper professional distance to clients, protecting oneself against being mislead by clients with fictitious PTSD. An institutional setting should be provided in which the roles of therapists and evaluators are separated. Important factors for burnout and vicarious traumatization are the lack of social recognition for caregivers and the financial and legal outsider status of many centers. Therefore politicians and social insurance carriers should be urged to integrate facilities for traumatized refugees into the general health care system and centers should work on more alliances with the medical mainstream and academic medicine. (+info)
The physical and psychological effects of torture in Kurds seeking asylum in the United Kingdom.
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There were over 2000 applications for asylum from Turkish nationals to the UK in 2003. A large proportion of these were person of Kurdish origin, many of whom claimed to have suffered torture. We sought to evaluate the physical and psychological effects of torture in those with physical injuries. A total of 97 Kurdish asylum seekers requiring medical evaluation for evidence of torture were examined and interviewed in the presence of an interpreter. Physical injuries, pain, disability and psychopathology were documented for each. A wide variety of injuries and psychological disorders were documented. Posttraumatic stress disorder, major depression and organic brain damage were present in a substantial proportion of those surveyed. Methods of torture not previously documented were revealed. There are long term healthcare needs of this population, which are complex and require a multidisciplinary approach. Survivors of torture may be disadvantaged in the asylum process because of organic brain damage or major psychological disturbance. (+info)
New treatment approaches: integrating new media in the treatment of war and torture victims.
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The diagnostic process and treatment of victims of war and torture is associated with a number of difficulties. This article will provide an overview of three different approaches on how the new media may be integrated into the treatment of survivors of torture and war to face some of the challenges. Illiteracy is a common problem and makes it difficult to apply standardized psychological assessment procedures. Also, the majority of survivors of torture and war do not have access to any psychotherapeutic treatment due to geographical limitations or limitations concerning psychotherapeutic treatment capacity. Furthermore, chronic psychological disorders such as (complex) Posttraumatic Stress Disorder (PTSD) are often seen with comorbid chronic pain disorders, which present a therapeutic challenge. The Treatment Center for Torture Victims, Berlin, in cooperation with the University of Zurich, developed a number of approaches to address these challenges: 1) MultiCASI - to standardize the diagnostic process an audiovisual diagnostic tool was developed which allows illiterate individuals to answer standardized psychological questionnaires whithout the help of interpreters; 2) A virtual treatment center for posttraumatic stress disorder for traumatized patients in Iraq and other Arab speaking postconflict countries; 3) Utility of Biofeedback (BF) in chronic (somatoform) pain and in traumatized patients: to address the chronic pain syndrome presented by most survivors, a biofeedback supported cognitive-behavioral therapy approach was developed and successfully tested in a pilot study. (+info)
Psychological evaluation of asylum seekers as a therapeutic process.
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Torture survivors are often reluctant to tell their stories. They typically make every effort to forget this painful, traumatic experience. Often they do not share with family, friends or healthcare professionals the fact that they have been beaten, raped or subjected to electrical shocks and other terrors. Talking means retrieving memories, triggering the feelings and emotions that accompanied the torture itself. Furthermore, refugee torture survivors feel that people won't understand or believe their experiences. However, survivors who escape their country may need to reveal their torture experience as they apply for asylum in the host country. When they prepare for the asylum process, it may well be the first time that they talk about the torture. Mental health professionals are often called upon to evaluate survivors and prepare affidavits for the asylum process, documenting the effects of torture. This creates a unique and priviliged opportunity to help survivors to address the devastating consequences of torture. Winning asylum is essential to recovery for a torture survivor in a country of refuge. Psychological evaluations of the consequences of torture can present information and evidence to asylum adjudicators which significantly increases understanding of the survivors' background and experiences as well as their manner of self-presentation in the courtroom or interview. They can empower the torture survivor to present his/her experiences more fully and confidently. Even apart from winning asylum, the process of the evaluation has many potential benefits for the survivor's emotional well-being. This includes helping the survivor understand the necessity of telling the story, illuminating the often poorly perceived link between current emotional suffering and past torture, facilitating the development of cognitive and emotional control, and healing the wounds of mistrust, humiliation, marginalization and fear. (+info)
Treatment of torture survivors - influences of the exile situation on the course of the traumatic process amd therapeutic possibilities.
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Traumatized refugees often suffer from complex posttraumatic disorders with a high tendency of chronicity. This is due to severe and often repeated traumatization in the course of political persecution on one hand and uprooting and ongoing stress caused by leaving their home country and society and living under an adverse situation in exile on the other hand. This article shows how positive and negative factors going along with migration interfere with the course of the traumatic process and the therapeutic possibilities and how the therapeutic process can be adjusted to the situation. (+info)
Forensic medical examination of victims of trafficking in human beings.
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Trafficking in human beigns (THB) is recognized as a global public health issue as well as a violation of human rights. Trafficking has been identified to be associated with several health risks including psychological trauma, injuries from violence, and substance misuse. Public and media reports suggest that the morbidity and mortality associated with trafficking are substantial. The need of medico-legal healthcare for THB victims is being neglected. Forensic medical examination, as specific intervention, is a highly desirable element of ermegency health care provided for victims of tracking. Acting in such a way, the investigation should establish the facts related to the allegatation of trafficking, thereby assisting in identifying those responsible, but also contributing to the procedures designed to obtain redress for the victims. Local anti-trafficking policies and interventions, however, have not acknowledged these needs. Therefore, the agenda of anti-trafficking policies needs to be redrawn to include forensic medical assessment of victims for legal purposes. (+info)
Dance/movement therapy approaches to fostering resilience and recovery among African adolescent torture survivors.
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Dance/movement therapy (DMT) interventions, if designed to promote cultural relevance and community ownership, may enhance healing among African adolescent survivors of war and organised violence. The author posits a theoretical rationale for body movement-based approaches to psychosocial rehabilitation, and offers DMT's holism as evidence of transcultural applicability. Two distinct DMT iniatives with this population are discussed in terms of theoretical assumptions, implementation, and outcomes. Both efforts afforded creative means for discharging aggression and restoring interpersonal connection. The first of these programes engaged a community of South Sudanese refugee youths, resettled to the U.S., in a series of gatherings for traditional dancing and drumming that reconstituted a central culture-of-origin ritual. Anectodal evidence supports this psychosocial intervention's emphasis on group cohesion as a vehicle with both preventive and reparative capacities. Also a series of DMT groups with youths in Sierra Leone. All organized several years post-conflict, these interventions involved applying the DMT modality within a framework of Western psychotherapeutic conventions described in a series of groups with youths, all organized several years post-conflict, is presented. Programe evaluation revealed a drop in average symptom expression among a group comprised of former boy combatants who reported continual reduction in symptoms of anxiety, depression, intrusive recollection, elevated arousal, and aggression. The group's teenage males joined actively in improvisatory dancing and in other structured creative exercices. Theese former child soldiers later elected to demonstrate their wartime experiences through public presentation of a role-play. A report on this event illustrates the success of the process in overcoming stigma and enabling meaningful community reintegration. Thus, whether introduced in refuge or post-conflict, DMT approaches are shown to embody revitalizing psychosocial support in the aftermath of massive violence. (+info)
Integrating rehabilition of torture victims into the public health of Iraq.
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For the last three decades torture has been highly prevalent in Iraq. Surveys indicate that close to 50% of households have family members who have been tortured. The traumas of two subsequent wars further add to the traumatisation of the population as does the persistent violence. Re-traumatisation makes healing difficult. As a result trauma-related disorders are likely to be the number one public health problem in Iraq. In December 2004, the author was tasked with the responsibility of planning and implementing rehabilitation activities for victims of torture in Iraq. Basra, in southern Iraq, was chosen as the place for the first clinical treatment and rehabilitation Centre, the Al-Fuad Centre for Rehabilitation of Torture Victims (FRCT). The Centre was to function as a training institution for the entire country. In a effort to bridge the gap between vast needs and limited resources, the Centre has begun applying a public health perspective, which means to develop its work in relation to the concepts of illness prevention and health promotion. Treatment and rehabilitation, i.e the secondary and tertiary levels of prevention, can be multiplied through the training of professionals who will be able to establish treatment facilities in new areas of Iraq. By training GPs, psychiatrists and physicians and by expanding FRCT services to victims' families, signs and symptoms of trauma can be addressed at early stages of disorder and long-term illness averted. Human Rights advocacy and legal work at the Centre will address the primary level of prevention through diminishing human rights abuses. Finally, engaging in the reconstruction of the civil society alongside other NGOs and government authorities is to build democracy, which is a cornerstone of health promotion, especially so when the illness panorama is related to violence. (+info)