March 2013 - Volume 11 - Issue 1
REFLECTIONS, COMMENTS, LETTERS
A primer on single session therapy and its potential application in humanitarian situations
Single session therapy is a specific form of therapy conducted by professionals who seek to use their existing skill sets and knowledge base to address clients’ presenting concerns, within one session. The session takes place with the understanding that the session might be the only one. Such single session services are currently expanding in a number of high income countries. This paper calls attention to this therapy for potential adaptation to acute emergency settings, in low and middle income countries, where offering one session may be the only option. This paper describes: (a) single session therapy as adapted in recent emergency settings; (b) the single session model in high income countries; (c) its relationship with psychological first aid; (d) the development of the model and its evidence base; and (e) the model as an intervention and a service. While single session therapy holds promise for work in humanitarian settings, there is still a need for randomised controlled studies in humanitarian settings before this therapy may be considered as recommended, evidence based, humanitarian practice.
No end in sight: moving towards a social justice framework for mental health in continuous conflict settings
The occupied Palestinian territory (oPt) exemplifies a situation of continuous, protracted violence and conflict. This paper explores the application of the concept of posttraumatic stress disorder to this situation of ongoing violence. It argues that using an individualised perspective ‘through a trauma lens’, may not be the most appropriate approach to Palestinian distress, but that a model based on the concept of ‘social suffering’ may be a more holistic fit, exploring how individual and collective human suffering is associated with life conditions shaped by powerful social forces. Furthermore, the author asserts that an human rights informed, social justice framework is both a comprehensive and appropriate framework to address the mental health needs of populations affected by continuous conflict. She further contends that social justice is a core principle of public health, and that to truly incorporate social justice into their work, mental health practitioners must expand their traditional roles to include elements of activism and advocacy.
Therapeutic photography: fostering posttraumatic growth in Shan adolescent refugees in northern Thailand
Recent reviews of therapeutic photography have identified the technique's unique ability to transcend culture and language, both essential characteristics of international trauma therapy. This article describes a process, through which youth identified changes in self-perception after a photojournalism workshop, using an interpretive phenomenological analysis (IPA) approach and conducted in a Shan migrant community centre in northern Thailand. The authors (a) provide a broad overview of a form of therapeutic photography utilised within a humanitarian aid context, (b) examine the concept of posttraumatic growth (PTG) within a traumatised adolescent population on the Thai/Burma border and, (c) suggest the potential for a new domain of growth as it relates to the application of Tedeshi & Calhoun's conceptual foundation of PTG (1995), within a Southeast Asian context. Results suggest that perceptions of self, and one's role in the community, did improve within the context of this project. A discussion of the limits and merits of this approach is also presented.
The first decade of Intervention: facts, figures and trends
This paper aims to explore trends in developments in content and authors’ locations and perspectives in ‘Intervention, the International Journal of Mental Health, Psychosocial Work and Counselling in Areas of Armed Conflict’, from 2003 to 2012. Over this 10 year period, Intervention has published 139 peer reviewed articles, 73 field reports, 36 book reviews and 33 debate papers. The articles cover academic expertise, practical experience and debates on mental health and psychosocial interventions in the aftermath of both natural, and manmade, disasters. The authors of most papers (61%) originated from developed countries, versus 28% from low and middle income countries. Thematic analysis of the content of peer reviewed articles reveals shifting consensus and emerging new debates on mental health and psychosocial interventions. In the first years of Intervention, individual therapeutic approaches were more prominent than in later years, which saw more attention given to community based approaches. Another emerging theme is the trend to involve ‘beneficiaries’ in planning and evaluation of programmes, through participatory approaches. A significant number of peer reviewed papers (28%) describe policy development issues, such as guidelines (IASC) and processes of integration of mental health into general health care systems in post conflict settings. Recommendations are that the editorial priorities for the next years should continue strategies for increasing submissions from authors originating from areas affected by conflict, and increasing inclusion of perspectives of those who have experienced extreme events.
Lay counselling in humanitarian organisations: a field report on developing training materials for lay counsellors
Lay counsellors provide valuable psychosocial support in many different circumstances, such as manning telephone helplines for cancer patients, assisting people after crisis events or giving focused support to refugees or other vulnerable groups. This paper describes the process that a consortium of four humanitarian organisations followed to develop a training guide for lay counsellors as it was found that no common training curriculum existed. The process was comprised of the following steps: 1) review of existing literature on lay counselling; 2) a mapping report to identify organisations and existing materials available on trainings for lay counsellors; 3) a needs assessment to identify the needs of trainers; 4) development of first drafts of the training material; 5) pilot trainings to gain further understanding of needs and expectations of participants and trainers from different organisational contexts; and 6) adaptation of the training materials based on pilot trainings. The final materials consist of a variety of didactic methods and allow integration of materials as a supplement to existing trainings, or for use as independent training for lay counsellors, within a wide variety of settings.
Syrian mental health professionals as refugees in Jordan: establishing mental health services for fellow refugees
While the conflict in Syria rages on, one psychiatrist and several psychologists, all of them Syrian refugees, have founded ‘Syria Bright Future’, a volunteer organisation that provides psychosocial and mental health services to Syrian refugees in Jordan. This field report describes how the organisation assists families in settling after their harsh journey, in adapting to new living conditions and circumstances, coping with difficulties they encounter and strengthening their resilience. ‘Syria Bright Future’ does this by providing short term support and counselling, and by referring individuals and families to other international and Jordanian organisations, or to informal support networks of Syrian refugees for further assistance.
REFLECTIONS, COMMENTS, LETTERS
Mental health work with people affected by state terrorism in Uruguay: a personal reflection on 25 years work
In this personal reflection, the author describes her mental health work and experience with people who have suffered from the political violence that occurred during the dictatorship in Uruguay, 1973 – 1985. She presents a personal account of the socio-political processes and her experience as a psychotherapist, from then until today. The author argues that the psychosocial trauma that has been inflicted by the state cannot be healed by only ‘mental health’ work, as the process for reparation and justice in Uruguay has been very slow and painful. Furthermore, she has observed that the impunity granted perpetrators may re-victimise survivors, and further damage their mental health. Psychological work with people affected by state terrorism requires interdisciplinary analysis and, as the author argues, mental health professionals should join in the struggles of their patients. In Uruguay, as elsewhere in Latin America, psychotherapists have formed organisations to assist the survivors, and raised their voice within the public discourse. This has contributed to breaking the silence surrounding events, and has helped to come to terms with the psychological effects of state organised violence. In her work, the author has learned the importance of exchange of information between colleagues, including colleagues from other countries.