Integrating a Trauma Perspective into Community Work After Group Violence
October 1, 2002
In just the past decade, we have experienced many instances of devastating community violence around the world-events in places such as Rwanda, Bosnia, Kosovo, Sri Lanka, Angola, New York, Washington, D.C., and Oklahoma City. Intentional interpersonal group violence results in great losses. A major element of healing after such violence is the restoration of the community to self-sufficiency-and the recovery from psychological trauma is a large part of the process.
But what is the role for traumatologists, trauma workers or psychotherapists in situations such as those in Rwanda or New York? It may be surprising to learn that some community workers in such settings are strongly opposed to trauma work. Perhaps this is because trauma work is equated with the professional clinical treatment of individuals or small groups with posttraumatic stress disorder.
While most can agree with the research that documents extensive PTSD in these settings, there is great disagreement on where the generally very limited resources for psychosocial assistance should be directed. When trauma specialists arrive at the scene and identify large numbers of people as suffering from PTSD and offer expert treatment, the community may feel stigmatized, overwhelmed and helpless-an unintended effect. In the process of offering help, sometimes a victim mentality or identity is created-implying that local or indigenous helpers have little to offer.
Also, a major proportion of available resources sometimes is devoted to a small number of recipients.
To be most useful in situations where large numbers of people have been traumatized, trauma workers must broaden their perspectives on what needs to be healed and on the approach to healing. Psychological trauma includes more than PTSD. Group violence has a deleterious impact on survivors' identity, spirituality and world view. The damage to people's ability to trust and feel safe, and thus their relationships with others, often is profound. Group violence and victimization can substantially diminish people's ability to regulate their feelings and to participate constructively in society. Complex trauma prevails.
Knowledge from research, both experimental and clinical, can be used to help people address these painful effects, in ways that reach beyond psychotherapy and beyond clinical symptoms. In Rwanda, Ervin Staub and I have been applying basic principles of connection with one's own experience and experiences with others, and with exposure treatments, to promote a community-based approach to healing.
Drawing on the work of Pennebaker (2000), Foa and Rothbaum (1997), Resick and Schnicke (1996) and our own work (Saakvitne, Gamble, Pearlman & Lev, 2000; Staub, 1989), we have developed a model that seems to be helping people heal. Go to the Web site, www.heal-reconcile-Rwanda.org, to view a series of psychoeducational minilectures that addresses the origins and prevention of group violence; psychological trauma; and healing.
After extensive and often lively group discussions of the lecture material, we invite people to write, draw or think about their personal experience vis-à-vis the particular topic. We introduce basic principles of empathic listening, responding and support. Participants then move into small groups to share their personal experiences with one another.
The discussions are quite moving; people often state that for the first time they are sharing with others their painful memories and experiences. The approach has achieved preliminary empirical validation in a controlled experimental study (Staub, Pearlman, Gubin, & Hagengimana, manuscript in preparation).
In the past three years, we have shared variations of this approach with diverse groups of Rwandese. Social service workers have integrated the approach into their ongoing work in the community, with positive effects on their service recipients' trauma symptoms and on the orientation to the other group (Staub et al., manuscript in preparation).
In addition, we shared the Risking Connection model (Saakvitne et al., 2000) with community leaders, encouraging them to develop and share with their constituents ways of providing respect, information, connection and hope (RICH) as a source of support in the newly inaugurated community justice (gacaca) process. We have worked with these people and with Rwandese journalists to help them understand the importance of preparation, support and processing as means of minimizing retraumatization during the gacaca.
The psychosocial needs after group violence are extensive. In these settings, professionals often engage in turf wars. I believe that there is room for people with a wide range of skills and knowledge to help. Ideally, those who are skilled in specific trauma therapy techniques such as eye movement desensitization and reprocessing, and cognitive-behavioral exposure therapy-as well as those who work from other theoretical orientations-will find ways to apply their approaches to large groups of people without relying on continuing involvement of highly trained professionals. The field of traumatic stress studies has much to offer, and there is the opportunity to offer our knowledge and skills in ways that are collaborative and empowering, respecting the affected population's needs, abilities and resources. In this way, we convey the hope that is at the core of human interconnection and healing.
Laurie Anne Pearlman is a clinical psychologist, president of Trauma Research, Education and Training Institute in South Windsor, Conn. and co-chair of the ISTSS public education committee and complex trauma task force.
Foa, E. & Rothbaum, B. (1997). Treating the Trauma of Rape: Cognitive Behavioral Therapy of PTSD. NY: Guilford.
Pennebaker, J.W. (2000). The Effects of Traumatic Disclosure on Physical and Mental Health: The Values of Writing and Talking about Upsetting Events. In J.M. Violanti, D. Paton, et al. (Eds.), Posttraumatic Stress Intervention: Challenges, Issues, and Perspectives, pp. 97-114. Springfield, Ill.: Charles C. Thomas, Publisher.
Resick, P.A. & Schnicke, M.J. (1996). Cognitive Processing Therapy for Rape Victims: A Treatment Manual. Newbury Park, Calif.: Sage Publications Inc.
Saakvitne, K.W., Gamble, S.G., Pearlman, L.A. & Lev, B. (2000). Risking Connection: A Training Curriculum for Working with Survivors of Childhood Abuse. Lutherville, Md.: Sidran Foundation and Press.
Staub, E. (1989). The Roots of Evil: The Origins of Genocide and Other Group Violence. New York: Cambridge University Press.
Staub, E., Pearlman, L.A., Gubin, A. & Hagengimana, A. (manuscript in preparation). Healing, Forgiving, and Reconciliation: An Intervention and Its Experimental Evaluation in Rwanda.