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Refugees & Torture Survivors

Capacitar Wellness Programme - its Application and Efficacy with Multicultural Torture/Trauma Survivors - an Irish experience
Monica Chambers SRN, SCM

The Centre for the Care of Survivors of Torture /Spirasi is based in north inner city Dublin (Ireland) and has a total of 50 staff and 31 active volunteers. In 2010 Spirasi provided services to almost 1000 clients of whom 300 were new referrals. Since its inception in 2001 this Centre has provided multidisciplinary rehabilitation to over 3000 survivors of torture. International research shows that 10-35% of asylum seekers have been tortured. From 2004-2010 the total number of torture survivors seen by Spirasi equates to 9.6% of the asylum seeking population in Ireland.

The Capacitar Wellness Programme became part of the multidisciplinary holistic approach to the care of survivors of torture adopted by this Centre, as part of an internationally recognised form of best practice, in 2005. The programme continues to be offered as a self-care and empowerment intervention to individual clients as part of 'stage one' trauma work - stabilizing and resourcing - and in combination with Psycho Education to short-term and support - single and mixed gender - groups. It is offered in combination with Psychotherapy and Art Psychotherapy for individual clients. It forms part of our Interpreter Training Programme, our Therapists' and Staff Training Days.

Before working with this group I had prepared myself through lengthy interviews with two Guatemalans about Mayan spiritual beliefs and healing practices. I convened the group through a letter of invitation mailed to them by the staff of the center. This I followed up with a phone call to introduce myself and to remind them of the first gathering. My intention had been to have a monthly gathering with them.

Referral is through Multidisciplinary Initial Assessment.

It has been our experience that this non-invasive, non-intrusive approach is particularly beneficial for

  • Stage one trauma care - stabilizing and resourcing of clients
  • Individual clients for whom touch would be culturally inappropriate, or are still too traumatised to tolerate touch, as in Reflexology, Chinese Massage or Acupuncture, also offered at this Centre
  • For those on Humanitarian Leave to Remain, who are in the asylum process for many years. These practices help contain these clients while they live in a state of prolonged uncertainty and instability
  • For those 'alienated form themselves, their general well-being and their bodies' (Courtois, 'Complex Trauma, Complex Reactions' p 420)
  • For those who need a culturally appropriate intervention
  • For those who cannot 'feel' their bodies
  • Client commitment to regular self care empowers, builds, strengthens and adds to their own resources and capabilities
  • This programme can be used in the absence of an interpreter
  • It is experiential and engages client's attention and participation
  • It offers choice to clients whose decision making ability has been deliberately thwarted and provides
  • 'Safety, affect regulation, skill-building, self-care, education and support' which according to Courtois (2004) (p 418) are essential in the 'stabilization' stage of recovery

CONCLUSION

In this Centre, the Capacitar Wellness Programme is viewed as an appropriate intervention in the holistic model of care offered to our client group. Since there are many factors influencing our client's general well-being and lifestyle (such as the asylum/legal process), there is a high number who will be only accessing the stabilization and resourcing interventions.

A research project conducted in 2009 by a Master's student from Trinity College Dublin on one of the mixed gender Capacitar/Psychoeducation Resourcing groups showed very favourable results. Data revealed that group therapy, using a combined approach of Capacitar and Psychoeducation is associated with favourable outcomes in range of symptom domains for our client group.

Monica Chambers SRN, SCM,
Complementary Therapists, Capacitar Tutor
Centre for the Care of Survivors of Torture
Spirasi,
Dublin 7

Work with Guatemalan Women Refugees and Survivors of Torture
Patricia Farrell OSF, MSW

I worked with a group of 15 Guatemalan women who were either survivors of torture or immediate family members of survivors of torture. All of the women had close associations with a Center for the Treatment of Survivors of Torture and most had received individual or group psychotherapy there. My own interest in working with the group stemmed from my experience at the center as a graduate student intern in clinical social work and as an ongoing volunteer therapist. I was specifically interested in working with Guatemalans because I wanted to learn more about Mayan culture and spirituality and to grow in my skill at adapting Capacitar practices for use in cultures less familiar to me. I wanted to work specifically with women because I was currently working with one Guatemalan woman whom I thought could greatly benefit from the Capacitar body-mind-spirit practices and I wanted to expose her to their benefits.

Of the 15 group members, nine had had a direct experience of torture and six were family members of torture survivors. There was a wide range of difference in the amount of time the various women had been in the United States. One had been in the States most of her life and felt more identified with American culture than with Guatemala. One woman had arrived only a few months before. The majority, however, had been in the States between five and fifteen years, were clearly very culturally Guatemalan, and were still struggling to adapt in one way or another to life in the U.S. All were more comfortable in Spanish, though a few spoke English quite well. Our work was all in Spanish. Only one of the women was from an indigenous background. The others were all Latinas. There was a considerable range of difference in the degree of healing that had taken place in these women's lives. Several were still in therapy while others had formally completed a therapeutic process. Two women seemed quite psychologically disturbed. Although all the women had close association with the Center, most of them had never met each other.

Before working with this group I had prepared myself through lengthy interviews with two Guatemalans about Mayan spiritual beliefs and healing practices. I convened the group through a letter of invitation mailed to them by the staff of the center. This I followed up with a phone call to introduce myself and to remind them of the first gathering. My intention had been to have a monthly gathering with them.

Our first session was a four-hour workshop. We began with introductions and a simple Mayan ritual in which each woman lit a candle and invited the presence of spiritual guides and/or loved ones, living or deceased. We then worked with Tai Chi and commented on their reactions. I taught them the fingerholds to manage strong emotions as well as the bioenergetic practices to protect themselves. After a break we did the guided visualization designed to help a person create a safe place to which she could return at any time. The women debriefed in pairs. We then commented in a large group, had an evaluation and ended with a ritual during which the women reverenced the four cardinal directions and chose a flower and candle to take home with them.

I observed the women relax noticeably during the time we were together. They all responded very positively to the experience and talked eagerly about coming the next time. One woman even suggested that they meet every week. However, no one came for the following scheduled session, for whatever reason. Shortly after that I also moved from Chicago and it was no longer feasible for me to continue the effort.

I was aware from the women's comments during the workshop that two things were particularly significant to them. First of all, each of them was quite socially isolated and it was very important for them to have the opportunity to get together with other Guatemalan women. This was mentioned several times. The other thing that was very striking to them was the invitation to do something to consciously take care of themselves. And they did experience the Capacitar exercises as a very real way of taking care of themselves. The invitation and permission to do so seemed very empowering.

I found it challenging with this group to manage the diversity. Because the women were all Guatemalan, I had expected to find a more culturally homogeneous mix. The other thing I hadn't anticipated was the clash of some of the expectable trauma reactions manifested in the group. A number of the women didn't want to talk about or be in anyway reminded of the trauma of their torture. A couple of others, however, tended to frequently steer conversation in that direction, like a moth to the flame. It was a challenge to contain their need to talk about it. I learned through this experience something of the value of maintaining the focus of doing the body-centered healing practices. It is a way to treat the trauma while maintaining a safe environment for those who have a high need for denial and avoidance of traumatic stimuli. While doing the exercises the women were able to relax and to feel pleasure in their bodies.

Work with Hispanic Refugees and the Uninsured
Jayne Ader, Therapist, Wisconsin

Our Outreach Clinic provides free services for the uninsured. About eighty percent of our patient population is Latino. The majority of this population speaks only Spanish. On a daily basis sixty percent of our patients attend the clinic for the first time.

The clinical team was finding that many patients come to us with high levels of anxiety, stress, and depression. This is demonstrated through both emotional and physical manifestations. Many people feel overwhelmed by the fast-paced North American culture. People feel isolated by the language and cultural barriers. Separation from family and cultural support systems greatly enhances this isolation. Due also to the intense manual labor that any of our patients participate in on a daily basis they come to the clinic with severe muscular tension.

Thus we are constantly seeking effective ways of helping people learn or reconnect with skills to work through both their physical and emotional issues. For this reason I chose to offer the Capacitar modalities to our patient population.

History: Three different approaches were used to share these valuable practices. The same day that the patients came for medical attention the Nurse Practitioner or other providers would refer the patient to me to teach one-on-one practices, such as acupressure, Thought Field Therapy, and visualization. The patients could immediately use the practices to address their current issues. As part of the community outreach project we offer a Neuromuscular Integrative Action (NIA) course. This allows the people to engage in a positive exercise experience. NIA combines positive imagery with dance, yoga, and movement. At the end of each NIA course we have been able to integrate Tai Chi movements. It is a way to enhance the meditative aspect of NIA. The third approach was to offer various Capacitar classes in which the community could participate. In these classes I used the Tai Chi movements, Fingerholds, Deep Breathing exercises, Acupressure, Visualization techniques and hand-foot massage.

Outcomes: Most participants experienced a change in their physical or emotional state. The following comments give indications of these changes:

Pre-Capacitar Comments:

  • I come with a sore neck and I would like to avoid taking Ibuprofen.
  • I feel depressed and suffer from low energy.
  • I feel the need for connection. I felt isolated.
  • I have had a headache for three days.

Post-Capacitar Comments:

  • My neck feels much better. I do not need a pill now.
  • I feel energized.
  • I feel hopeful.
  • This is the first time my head has felt so clear in a while.

Evaluation: In the courses offered to the community there were 20 participants in total. Five of these participated in more than one course. Six Capacitar courses were offered. Twenty Tai Chi segments were added to the NIA course. Over 100 people were taught practices one-on-one.

I continue to seek ways in which the modalities that I have learned can best meet the needs and schedules of our patients and the south-side community. The variety of ways in which Capacitar can be adapted allows more people to utilize these wellness techniques. The participants have enjoyed the courses and have used them as a forum to share their own healing knowledge. It is fascinating to hear practices from places such as Mexico, Peru, Costa Rica, and Puerto Rico. The biggest barrier to fully sharing the Capacitar program is my own trust and comfort level with expressing the dynamic of energy. As I continue my own practices I feel that my confidence will grow. Thus the sharing of these techniques can expand and become more profound.

Comments of the Participants:

"Cuando primer llegamos a este pais pasamos encerradas. No conocemos el idioma, no tenernos familia, no sabemos como funciona la vida diaria, y todo anda muy rapido aqui. Y empecemos a estar deprimida. Tener la oportunidad participar en un curso asi ayuda quitar la depresion y uno no se siente tan aislada."

"When we first arrive in this country we close ourselves in our homes. We do not know the language, we do not have family here, we do not know how daily life functions here and everything in the US runs at such a fast pace. We begin to get depressed. Having the opportunity to participate in a course like this allows us to get rid of some of the depression and to feel less isolated."

"Cuando vine este noche y me sentía descaida no quisiera participar. No séntia que me pasú pero ahora, despues de los ejercicios, me siento muy muy bien increible."

"I came tonight feeling down, I didn't want to participate. I don't know what happened but now, after the exercises (Tai Chi and Massage), I feel very very good. Incredible!"