Best Practices
Philip G. Monroe, PsyD
Carol King, M.Ed
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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.
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When humanitarian aid hurts…
◦ Linda Polman, The Humanitarian Crisis
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Ever hear of the burned over district?
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Counselors: DO NO HARM
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Don’t assume you already know all you need
to know
◦ about trauma and recovery
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Instead: listen and learn before you act
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Listening
Listening
Listening
Listening
has
has
has
has
a
a
a
a
historical context
cultural context
political context
religious context
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How do you define trauma healing? Recovery?
What does trauma recovery look like in
settings that downplay public displays of
emotion?
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
Dimensions of trauma on the Harvard Trauma Questionnaire (HTQ)
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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
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Before you go!
◦ Learn the history of trauma (and US involvement)
◦ Discover NGOs already there, make connections
◦ Look for potential resources/barriers to work
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Go/Connect
◦ First listening trip to solidify prior case map
◦ Build objective 1, 2, 5 year realistic goals
◦ Discover alliances/silos
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Build
◦ Bibliographies, a lexicon of trauma, initial to
intermediate interventions/trainings
Don’t create new models...utilize existing
indigenous models and modify where needed
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Created by Rhiannon Lloyd & Joseph
Nyamutera (1994)
http://www.lerucher.org/Content/Reconciliation/Resources.html
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Benefits:
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Spiritual base, Cross centered
Focus on sharing stories
Rwandans trained to lead them
Supports mixed ethnicity attendees
Participant accounts of healing
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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
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Quaker founded peace initiative for Great Lakes
Region of Africa
Benefits
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Indigenous
Seeks community support and involvement
Detailed manual
Attention to group process and building safety
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Teaches listening skills
Emphasis on faith and prayer
Multi-ethnic participation
Evaluation of program – Burundi 2007
 Beginnings, closings, starters, energizers, evaluations
http://aglifpt.org/Program/hroc.htm
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Drawbacks
◦ Educational focus but…
 limited information on managing symptoms
◦ Trained facilitators
◦ Follow-up
◦ Referrals for those unable to attend or continue
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Authors: Hill, Hill, Bagge, Miersma (2004)
◦ http://www.scripture-engagement.org/node/17
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Benefits
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Short chapters, simple terminology
Discussion oriented
Translated into dozens of languages
Field-tested in multiple countries
Scripture based concepts
Addresses topics: grief to reconciliation
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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
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Prolonged Exposure
◦ Foa, Prolonged Exposure Therapy for PTSD, 2007
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Cognitive Processing
◦ Resick et al, Cognitive Processing Therapy for Rape
Victims, 1993
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EMDR
◦ Francine Shapiro
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CISM/CISD
Narrative Exposure Therapy
◦ Frank Neuner, Maggie Schauer, Thomas Elbert
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Be wary of quick fixes
Differentiate: psychological first aid v.
recovery efforts
Follow-up; Support trainees
Do work in community
Self-care!
Contextualize
◦ 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
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Download issues?
◦ Email
[email protected]
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Healing Trauma in International Settings