Rural psychotherapeutic trauma intervention contd ...
The work with children focuses on risk reduction and bolstering resilience through work with caregivers and by attempting to improve the conditions of the children. For example, the rate of sexual abuse and even child prostitution is high in the area, and the women have now established child care facilities for the children to be kept off the streets during the day. They have also started vegetable and herb gardening and try to identify families with children in particular need. The women have initiated sewing and other income-generating projects, with the aim of raising sufficient funds to send their children to school the following year.
It has become increasingly clear (and comforting) that the principles underlying much of the work in communities affected by violence are not dissimilar to those used in working with individuals from quite different settings who have survived traumatic experiences:
Re-establishment of trust
In keeping to a framework (albeit inconsistent) in making the community visits, keeping confidentiality, being non-judgmental and setting up other important safety practices, communities are gradually able to regain their trust in the facilitators, each other and themselves.
Telling the stories of the trauma in a contained environment
It is well-documented that the experience of reliving the trauma, in detail, within a contained relationship, is healing. This is certainly our experience of rural trauma work. Individuals are helped to unpack their painful stories, layer by layer, to a respectful group and with facilitators who are able to contain and help process the stories.
The participants are encouraged to reveal details never told before, with questions regarding the sensory experience (sights, sounds, smells, touch and taste), and personal reactions (eg "What was the worst part of it for you?"). Stories are retold, structured, boldly named (eg "the rape", not "the event"), and analysed in terms of the effect on all facets of the survivorís life (physical, behavioural, cognitive, emotional, social and spiritual).
The process of revealing the story in a group, with a less involved facilitator, but in the presence of others who survived the same or similar events, has enormous benefits in terms of trust, normalisation, and re-establishing oneself as a survivor, not a victim. Where indicated, individuals are referred for additional one-to-one counselling.
Normalisation and Coping Strategies
Group brainstorm sessions regarding effects of traumatic experiences on the individual, family and community are powerful in terms of psycho-education and normalising. Participantsí accounts of different coping strategies offer a richness of ideas for other group members.
Compensation and Justice
Although most South African victims of violence have not received appropriate compensation and justice for what has happened to them, many survivors report that being able to do something active for others has helped them cope with what happened to them personally.
Community groups offer a unique way of promoting advocacy, lobbying and preventive approaches. The Bhambayi womenís group has managed to lobby for traffic lights at a dangerous intersection where some members have lost children. The group has established a womenís forum to discuss ways in which women from both sides of the community may influence the peace process in their area.
Restoration of Hope
By listening to the stories of others and by engaging in joint projects, many survivors of voilence report a sense of hope for the future, where before they felt lost, alone and helpless.
Facilitators play an active, more directive role at the beginning of the groupsí lives, but increasingly hand over the direction of the group to participants. From early on, group members are encouraged to chair group meetings and hold their own separate meetings at a different time during the week.
Focused Intervention with Long-Term Support
Although dependence is not encouraged, much of the work tends to be long-term, with groups running from 6 months to 2 years, depending on their needs. Since most participants are survivors of continuous and complex trauma, trust takes a long time to establish and successive layers of experiences are unpacked according to the participantsí readiness to share their experiences.
Dealing with the Presenting Problem
Often, the least successful groups have been run where facilitators have clear ideas of the problems to be tackled and tend to prefer working with these to working with the presenting problems of each unique group. As facilitators, we tend to want to push the trauma work, whereas many community members have other, more pressing needs. Very few groups approach us wanting to work on their traumatic experiences, but present very urgent needs, such as the need for leadership skills, organisational skills or income-generating work. We try to work on these presenting problems, with parallel work on personal development.
Trauma work in South Africa cannot afford to focus exclusively on individual counselling. The situation in this country offers a variety of creative and unique ways of working towards improved quality of life for survivors of violence.
Many people ask us how we manage to retain a positive attitude in the face of so many painful experiences. We have repeatedly found that involvement in the work itself brings hope and optimism. We are continually amazed by the extent of peopleís loss and suffering, but alongside this, the extent of their humanity, dignity and empathy for others.
It is our experience that, with limited facilitation in terms of creating a space for natural healing and growth processes to unfold, people are able to not only recover from their past, but emerge with strengthened ability to cope and with more supportive community relationships. As one woman from Bhambayi has been repeatedly quoted as saying (translated from Zulu):
"I do not believe that these experiences were meant to break us. They were given to us in order that we might be strengthened. It is the same boiling water that hardens an egg and softens a carrot."
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