Dr. Kenneth Hardy on African American Experience and the Healing of Relationships

Black Man Grove Series
Black Man Grove Series (Photo credit: afsart)

 

African American experience and the healing of relationships

 

by Kenneth V. Hardy

 

The following interview appears in the book: ‘Family therapy: Exploring the field’s past, present and possible futures’ edited by David Denborough (Dulwich Centre Publications, 2001). Kenneth V Hardy lives in New York where he works at the Ackerman Institute for the Family.

 

DCP: Could we start perhaps with how it is that you came to be engaged with the field of family therapy?

 

I grew up in Pennsylvania in Philadelphia as the oldest of six siblings. Throughout my childhood there was significant emphasis placed on the importance of the family. My maternal great-grandmother lived with us until I was a junior in college. She was the granddaughter of a slave and I can’t think of another person who’s had a more profound influence on me. She taught me what can’t be learnt from books. She told me stories about humanity and human beings, about the potential for kindness and the potential for inhumanity. I heard so much from her about the ugliness of slavery and the impact it had on her parents’ life and my parents’ life.

 

I knew very early on what I wanted to do with my life. I had an insatiable yearning for some greater understanding of what we had become as a people and why. When I was exposed to the whole area of psychotherapy, I found that there was some attention being paid to issues of poverty, race and ethnicity but only in superficial ways. This was when I got excited about family therapy. I think my own family predisposed me to be interested in this area.

 

As an African-American working in a field that is dominated by white people and white values, I’ve had to get in there, step in the mud, make mistakes, have people laugh at me, feel ashamed and just continue. There certainly wasn’t a manual as to how to act and I had to endure the humiliation of not really knowing how to act in the white professional world.

 

One of the reasons why there are so few people of colour, so few African-Americans in the field of family therapy, is because family therapy has been a somewhat marginalised discipline in comparison to mainstream psychology or psychiatry. It’s very difficult for those of us who have membership in devalued and marginalised groups to invest heavily in a profession that’s in some ways marginalised and devalued. There’s something about getting educated and finding the right job as an African American that’s supposed to be freeing. There are meanings involved in employment and education for African-American people that are different than for white Americans.

 

For African-Americans to engage with family therapy it requires us to practise unrequited love. It requires people of colour to love family therapy more than it seems to love us! The curriculum in universities is not designed to look at marginalised experiences so I had a lot of discouragement along the way. I recall in Graduate School a Professor saying to me, ‘Maybe you should look at some other area because white families probably won’t think about going to see a black therapist, and a lot of black people don’t believe in therapy.’ I had my own ideas about this however, and if I had my life over again I would live it the same way. I’d be a family therapist.

 

DCP: Much of your work has involved trying to articulate the skills and steps required in healing relationships, especially those affected by differences in power. Can you speak a little about this?

 

In terms of healing any relationship, I believe there has to be some willingness to look at dynamics of power. Power is an integral part of our relationships and until that’s acknowledged it is often very difficult to move forward. Once there is an acknowledgement of the relevance of addressing issues of power, I am interested in drawing distinctions between those who are privileged and those who are subjugated. I think that while both have responsibilities in relation to healing relationships, the responsibilities are not equal. In situations where a relationship has broken down, I’ve attempted to define what some of the different tasks are for those in privileged positions and those in subjugated positions. Of course, I don’t think these categories of privilege and subjugation are absolute. The same person can occupy positions in different categories on different issues – eg. culture, gender, class, sexuality. And yet I have found it helpful to try to articulate what the different responsibilities might be for those in privileged positions and those in subjugated positions in order for relationships to be healed.

 

One of the first responsibilities for the privileged is to overcome mistaken notions about equality and inequality. I believe it’s customary for the privileged to just assume that everyone and everything is equal. One of the privileges of the privileged is to be able to be oblivious to the life experiences of the subjugated. I don’t believe healing can take place in a context where the privileged have not come to terms with the existence of inequality. Not only must the privileged acknowledge the existence of marginalisation, they must find some way to appreciate the inequality and the suffering of the subjugated.

 

There is also a critical distinction that has to be made between intentions and consequences. In my experience, the privileged almost always deal in the realm of intentions, while the subjugated almost always deal in the realm of consequences. Often this means that there can’t be a dialogue between the privileged and the subjugated because their reference points are so different. It’s important to realise that you can have pure intentions that render very damaging consequences. In order for healing to take place, the privileged must stop routinely using their position to clarify their intentions in ways that disregard the very real effects of their actions.

 

Furthermore, it amazes me when people of privilege say, ‘I tried to reach out to this group of people but they were so hostile and angry that I just can’t do it anymore’. I think that such statements are an expression of privilege. They are a cop-out. I get frustrated because I think that sometimes privileged folks, whether it’s men, or white people or heterosexuals, seem to require a manual before they will take action. They want to know how to approach these issues in ‘the right way’, a way that involves the least amount of risk to them. Perhaps they are used to being guided through life, perhaps they are used to being able to follow guidelines that are set up to enable them to progress through life. This is not true for people in subjugated positions. We are familiar with the feeling of not knowing what to do. We are used to facing hostility and anger when we step into unfamiliar territory. If relationships across difference are to be healed then people of privilege cannot turn away at their first experience of rejection or hostility. If we, as members of marginalised groups, gave up when we experienced hostility we would get nowhere in life.

 

For the subjugated, there are different responsibilities. The most important of these is to find some way to regain one’s voice. One can not experience domination and subjugation and retain the whole strength of one’s voice, it quickly becomes compromised. I think that there has to be a concerted effort to regain that which has been taken away, that which has been lost. There have to be steps taken to reclaim one’s voice, one’s heritage, one’s history.

 

I think another major task for the subjugated is to find a way to have some willingness to allow the privileged to come to terms with their participation in injustice. It is very difficult for gay and lesbian people to sit there and watch a heterosexual get agitated or upset in relation to issues of heterosexual dominance, because most gay and lesbian people know that if heterosexual people get angry it can culminate in some form of violence. It is very difficult for African-Americans or people of colour to sit there and watch a white person get agitated and upset, because we know that horrible things often happen when white people get mad. It is very difficult for the poor person to sit there when a very wealthy person gets upset, because they know the person with wealth will have the resources to get them withdrawn from the situation if they decide they have had enough of the uncomfortableness.

 

I think that part of the socialisation process for subjugated peoples is to be trained into finding ways to take care of the privileged. That is just a part of our experience. You look at those who shine shoes in the airports, those who make the beds up in hotels, and those who drive cabs, they are all people from subjugated groups. One of the dominant stories of our lives involves taking care of the privileged, doing this well and doing it in self-compromising ways. When we are trying to address injustices in our relationships this is something the subjugated have to come to terms with. We have to deal with our tendency to instantly take care of people from privileged positions. We have to enable privileged people to engage with these issues and come up with their own responses. Members of subjugated groups must find ways through this without responding to privileged people’s uncomfortableness in self-compromising ways.

 

The other experience that the subjugated have to come to terms with is to find some channel for rage. For many people, experiences of subjugation and domination are accompanied by rage. Rage is not anger which an be an immediate response to a particular situation. Rage is historical and it’s tied to experiences of domination and subjugation. There is nothing episodic about rage; it’s long term. I believe that subjugated people’s experience of rage can contribute to the short life expectancy of our people. We need to try to understand our rage and to find ways to use it which are constructive both for individuals and our communities.

 

We have to find better ways to help those who are subjugated to channel their rage because the alternative scares me. In some ways I can relate to the stereotypic menace to society on the streets of New York who is mean and angry and waiting for his next victim. Sometimes I think that the difference between my life and his may not be as great as it seems. Maybe the difference is that I have found some way to channel my rage. This discussion is a chance to channel rage. I have speech, I have writing, I have my work with people. These are all ways in which I can engage with my rage that are not destructive of myself or others.

 

DCP: In Australia at the moment there is considerable discussion about the place of apologies in relation to addressing historical injustices. What is your view in relation to this?

 

There are three key steps the privileged can take in relation to past injustice. Firstly, there has to be a meaningful acknowledgement of the injustice. Secondly, there has to be an apology for the injustice done. And thirdly, there has to be a request for forgiveness. With anything short of this it’s very difficult to heal.

 

You have a large group of African-Americans in this country who remain very angry, in a way that white people can’t understand, because there’s been no formal acknowledgement and apology in relation to slavery. I think an apology would go a long way towards collective healing. And yet somehow we haven’t got to that point. There are examples of ways of relating to past horrors that we can learn from. You can go to Washington DC, for example, and hear about the horrors of the Holocaust but there are no similar museums dedicated to honouring the massacres and genocide that happened on this soil. To this day we have the most alarming rates of alcoholism and suicide on most First Nations’ reservations and the reaction from the mainstream is, ‘Why won’t those damn Indians stop drinking?’. People don’t say, well that’s because their whole lives, and their children’s lives and their parents’ lives and their grandparents’ lives have been assaulted by this country. You don’t hear those parts of the story. I think an apology to the indigenous people’s of this land, and a formal apology in relation to slavery would go a long way towards healing the psyche of this country. Clearly there would need to be powerful acts of acknowledgement around this apology, and a request for forgiveness. If this occurred I think it could be transformative for this nation.

 

DCP: How do these sorts of considerations translate into your work as a therapist with families?

 

Part of my frustration with our field is that we seem so determined to locate human suffering narrowly while ignoring broader ecological perspectives. In family therapy we pride ourselves on having a systemic understanding of problems, that we need to look not just at the individual but at the whole family. But in some ways this is still very narrow, because the family exists in a broader socio-cultural context. Because I am interested in the effect of this socio-cultural context on those with whom I meet, I’ve had colleagues seriously say to me, you’re not a therapist you’re a sociologist, or you’re an anthropologist. This is not an insult to me. I’m pleased to hear such remarks. What they mean to me is that in therapy, I’m always looking for connections between what’s happening in this micro-systemic relationship and how it’s tied to one’s experiences in macro systems of culture.

 

Just a couple of days ago we had a Russian couple come in, who had recently emigrated to the USA. They have a very volatile relationship and are in the process of destroying each other. Small things trigger huge arguments, such as when she says to him, ‘Can you take your shoes off when you’re walking on the carpet?’ How are we as therapists to approach such a circumstance? We could focus on their communication and their need for anger management, but I’d prefer to explore what it means to be a Russian who lives in the United States. I don’t know what it’s like to be a Russian who lives in this country but I do know what it’s like to have membership in a group which relentlessly receives very powerful messages about being less than. My understanding of this couple dynamic is that some piece of what we’re dealing with is within their relationship, some piece has to do with some critical, domineering parenting pattern, but another part of it has to do with the way they feel very profoundly disrespected in this society as Russians. There is a way in which they have been so profoundly devalued that it has altered their understandings about how to act in order to achieve the respect of each other.

 

Most of the ways that people approach therapy don’t even begin to consider matters of ethnicity and culture of origin. Most therapies don’t even begin to wonder about the impact of the minute everyday cultural practices on the experiences of individuals and families. I want to expand the dialogue so that therapy is not seen as being restricted to conversations about a particular problem that someone may be experiencing. In society, race, class, gender, sexual orientation, and other dimensions of diversity are always a part of our interactions. There should be some opportunity to talk about these issues in the therapy room because otherwise the conversations may not be acknowledging significant realms of experience.

 

I couldn’t trust a therapist I was seeing who didn’t talk about my experiences as an African-American. If I couldn’t do that it wouldn’t be therapy worth believing in. Being African-American is such a core piece of my identity. And yet I wouldn’t expect my therapist to raise the issue for the sake of raising it. Instead, I’d expect him or her to be a good seamstress in the ways they assisted me to see how the issues of my life are stitched together, how my experiences of life are linked to broader histories and the wider ecology.

 

DCP: Can you expand on the metaphors of ecology and how such a metaphor influences your thinking and your work?

 

One of the struggles in my life is to resist the temptation and seduction of simplicity. There are lots of opportunities in a technologically advanced society to make our lives simpler. Yet what feels more meaningful for me is to keep struggling to understand my life and the lives of others in all their wonderful complexity. My own life, in hundreds of ways each day, is shaped by relations of gender, race and religion. How I understand a particular situation is influenced by so many histories, it’s just that we are not trained to see this. We are not encouraged to make the links between how we understand our lives and the broader relationships of culture, gender, class and sexuality. In fact, this is often actively discouraged to the point that we cease to look for or to realise what significant factors these broader relations of power have in our daily lives. Segregated thinking is such a cancer in our society.

 

Let me give you an example from my own life. If I was to measure myself against a psychological scale in relation to paranoia, I think I would rate so highly that I would be off the scale! Yet I think it would be a mistake to interpret such a result as simply an indication of my craziness. When I get stopped by a policeman because of my membership of a group that’s systematically targeted, paranoia is a logical response. What is seen through one lens as psychological paranoia, in another can be seen as a logical result of discrimination and racism.

 

In this context, ahistorical, non-ecological approaches miss so much. If I was to understand my experience by thinking, if only I could trust more, if only I could take a pill to get rid of this paranoia that is inside of me, then I would miss the opportunity to take meaningful action to challenge the relations of power that are discriminating against me. I think therapy, that is to say therapy built on ecological understandings, therapy that makes the links between people’s experiences of life and the power relations of the society in which they live, goes hand in hand with activism.

 

There are those therapists who believe family therapy has gone too far in terms of its involvement in human rights issues. They say we can’t be an ‘Amnesty International’ for families, that we should just help couples navigate the stresses of their lives. But from my point of view, we have an obligation to change the world. Our job is to serve families, indeed to serve all families, not just the wealthy and those who speak a common language, but those who aren’t even sure what language they speak. It’s our responsibility to make the links between the issues families are facing and broader relations of power. And it’s our responsibility to take some action in relation to redressing injustices in the culture in which we live.

 

DCP: One of the realms of injustice that I know you are constantly speaking about involves the effects of the criminal justice system on families and communities of colour. Can you say a little about this?

 

Even if you go to places in the USA that don’t have a high African-American population, when you look inside the prisons there you find disproportionate numbers of African-Americans because they’re shipped in from other states. The current over-policing and imprisonment of African-American people is a form of ongoing colonisation. In my more melodramatic moments I say it’s the new slavery. We’ve replaced chains and plantations with bars and razor wire. In some ways the phenomena is exactly the same.

 

The great sadness is that the general population assumes that it’s just, that ‘they wouldn’t be there if they didn’t deserve to be’. But the laws in this country aren’t equally applied. If you look at those who receive the death penalty in this country it’s mostly the poor, mostly people of colour. The injustices involved in policing and imprisonment in this country at present are overwhelming and they are devastating families and communities of colour.

 

This issue even spreads beyond the issue of incarceration. I think our society in the United States is becoming increasingly punitive in many arenas of life. What’s more we are becoming more comfortable with the fact that those who are receiving punishments are disproportionately children and disproportionately marginalised people. As therapists I believe we have to initiate a dialogue about punishment and about prisons. We have to put these issues on our agenda. I don’t even think they are on the agenda of most therapists at the moment.

 

DCP: I know that in the past you have said that one way of looking at family therapy is to see it as a response to human suffering, can you say more about this?

 

Even if I believe my job was limited to helping families deal with their distress, there’s something about poverty and racism that’s very distressing and that infiltrates every aspect of life. I can’t see the world in a fragmented way. I’m not just saying that, I honestly can’t, for the life of me. I keep saying to the students that I’m training that what I’m attempting to do is to help trainees become relationship experts. What I believe we should be concerning ourselves with is trying to address human suffering in whatever manifestation it takes place. So whether it’s dealing with heterosexual married couples who love each other but can’t find a way to be with each other, or whether it’s dealing with the First Nations people and their efforts to convince white European Americans of the ways in which they have been oppressed, I believe we need to be learning how to heal strained relationships. We need to be determined in our efforts to find ways to help people come together. I know this may sound grandiose but that’s what I believe. We cannot afford to turn our eyes away from any form of suffering whether it affects us directly or not. We must find ways to play our part in responding. This, to me, is the role of the therapist.

 

Copyright © 2001 by Dulwich Centre Publications Pty Ltd

 

 

 

Therapy and Racial Trauma | My Life Uncensored

Black Blanc Beur
Black Blanc Beur (Photo credit: looking4poetry)

Therapy and Racial Trauma   A friend forwarded me a link yesterday from Psychology Today yesterday regarding minorities and mental health treatment. The article discusses the mistreatment of minority patients in the treatment of race based traumas. I know all too well about this kind of thing as the most difficult step in getting help for mental illness can be findinga therapist who understands the kind of trauma that you are dealing with . In the last seven years I have been through at least four of them and I am still on the hunt here in DC to find someone that can understand the issues that I am dealing with and how to help. I am constantly working in therapy to help with my self esteem issues and I remember going to a therapist in 2008 and when we began to discuss my childhood, I remember the therapist asking me, why would I feel discriminated against by other African Americans when they were indeed African Americans. She clearly had not heard of colorism, so that was my second and last visit to her because I need a therapist that at least has an inkling of what I am talking about. As a community, we are not known for getting help for mental illness, and I am afraid that therapist that do not take race based traumas seriously, will further deter people from getting the help that they need.   via Therapy and Racial Trauma | My Life Uncensored.

VIDEO + AUDIO: India.Arie’s Return Is As Smooth As ‘Cocoa Butter’ » SOULBOUNCE-COM – NEO•GRIOT

Last night, a collective cry of joy erupted from the internet when India.Arie took to Twitter to confirm that she indeed had new music ready and that the first track to be released would be “Cocoa Butter.” For India.Arie fans, her return has been a long time coming, and after making that announcement she didn’t make them endure much more waiting before giving them their first listen. Barely able to contain her excitement about the song and her forthcoming album, SongVersation, India.Arie tweeted, “its been a LONG! LONG! road here #COCOABUTTER by @_SHANNONSANDERS and ME!” Singing, “your love is like cocoa butter on my heart,” she praises the healing and protective benefits of a love that has smoothed over her emotional scars. If you’re overexposed and in need of a little restoration, India.Arie’s got the musical salve for your soul.

via VIDEO + AUDIO: India.Arie’s Return Is As Smooth As ‘Cocoa Butter’ » SOULBOUNCE-COM – NEO•GRIOT.

Group Therapy Model for Refugee and Torture Survivors

108

CLINICAL EXPERIENCE

Group therapy model for refugee

and torture survivors

Ibrahim A. Kira PhD*, Asha Ahmed PhD*, Vanessa Mahmoud, Msw* & Fatima Wassim, MA*

Abstract

The paper discusses the Center for Torture and Trauma Survivors’ therapy group model for tor­ture survivors and describes two of its variants: The Bashal group for African and Somali women and the Bhutanese multi-family therapy group. Group therapies in this model extend to com­munity healing. Groups develop their cohesion to graduate to a social community club or initi­ate a community organization. New graduates from the group join the club and become part of the social advocacy process and of group and individual support and community healing. The BASHAL Somali women’s group that developed spontaneously into a socio-political club for Af­rican women, and the Bhutanese family group that consciously developed into a Bhutanese com­munity organization are discussed as two variants of this new model of group therapy with torture survivors.

Key words: group therapy, refugees, wraparound approach for torture treatment, community healing

Introduction

There is an increased concern about the relevance and effectiveness of current mental health programs and existing interventions

*) Center for Torture and Trauma Survivors CTTS, Georgia, USA. iakira@dhr.state.ga.us

that are derived from individualistic western cultures and based mostly on addressing single personal identity trauma, for example sexual abuse, with clients from different cultures and with refugees and minority populations who are cumulatively trauma­tized with personal and collective identity traumas.1-3

In general, treatment of refugees who have survived violence and torture is com­plicated and not manuals-bound. Most evidence-based traditional group therapies have been developed to address specific single personal identity trauma, e.g., sexual abuse, or post such single trauma symptoms using different cognitive behavioural, psycho-dynamic or other theoretical and technical approaches. However, refugees and torture survivors went through, and are possibly still going through, a host of different trauma types that include personal and collective identity traumas and which have cumulative effects. Cumulative trauma dynamics are dif­ferent from the dynamics of single trauma.4 Additionally, refugees and torture survivors usually belong to different cultures which are more collective than individualistic and may belong to different religious heritages other than those form which such group therapies were developed.5 It is important to adapt current evidence-based group therapies, regardless of their theoretical and

CLINICAL EXPERIENCE

109

technical approaches, to address cumulative trauma and collective identity traumas that clients endured, or are enduring, in order to be acceptable and effective with refugees and torture survivors. Most refugee populations and torture survivors come from collective cultures and the core (or index) traumas for most of them are collective identity traumas. In the case of ethnic persecution, which is a collective identity trauma, the group char­acter is even more evident. The traumatized refugees have become victims of persecution and or torture because of their belonging to a certain group. In collectivistic culture, heal­ing usually take place within the group context. When people get persecuted because of their group characteristics, a group therapy seems logical and has more therapeutic potential. In collectivistic cultures, it is common for families and community elders or religious or political leaders to be the first source of support for personal problems or health con­cerns. Family group therapy and community work can be especially effective. Using modi­fied or newly designed group interventions can be a potentially effective component in a wraparound multi-component, multi-model process for treating victims of political vio­lence.6-8

Torture consists of different traumas that target an individual or group. Col­lective identity is an important factor in this complex trauma. The multi-systemic, multi-component, wraparound psychosocial rehabilitation approach for torture treat­ment addresses the three systems affected by torture: The individual, family members and the group.6-8 Group therapy for torture survivors is an important component of this model. Group therapies in this model extend to community healing. Groups de­velop their cohesion in order to graduate to a social community club or initiate a com­munity organization. New graduates from

the group join the club and become part of the social advocacy process and of group and community support and healing. Fol­lowing this model, the Centre for Torture and Trauma Survivors (CTTS) currently conducts family and women’s groups for Iraqis, a Burmese men’s group, a Bhutanese family group, and an African women’s group of members who survived both torture and HIV (caused by rape during torture). In the following, we describe two of these groups as two variants of the model where each ends up establishing a sustainable community or­ganization, the Bashaal women’s group and the Bhutanese multi-family group, albeit in different ways.

Bashaal: a comforting shoulder In August 2006, CTTS began a thera peutic group for Somali, Ethiopian and other Sub-Saharan women who had suffered war trauma and torture. The group was led by a Somali case manager/community liaison and a consulting therapist. They were able to combine the case manager knowledge of Somali culture and language with the therapist’s experience with trauma and dis­sociation. They began the group by focusing on the common thread of female genital circumcision.

In the following months the group fo­cused on the women’s support of each other, the importance of their faith and culture in their survival, and their need for help in interfacing with systems. In the process of addressing day-to-day concerns and health problems, the women began to talk about the trauma they had experienced.

Three group changes have marked the growing empowerment of the women. In November 2006, the group members took “ownership” of the group by naming it Bashaal, which refers, in Somalia, to a late afternoon women’s gathering in the pres‑

110

C L I N I C A L EXPERIENCE

ence of wise elders, a time to share their stories of troubles and triumphs. They share ginger tea and dates, while relaxing after the day’s chores. The second significant change was to move the group from the offices of CTTS to a community room in the heart of the Somali and Ethiopian community, near the main Masjid mosque. The organization and use of the center was negotiated by the physician, with the support of the Somali community. The room is furnished in a trad­itional Sub-Saharan manner and is cared for by the women. In the summer of 2008, a new therapist started a second women’s group with the Somali case manager/com­munity liaison, while the first group con­tinued as a self-sufficient group, sometimes mentoring the new group!

The group has interpreters and various interns who assist and visit and who help members reach the goals they have set for the group. The goals of the group are:

a)  To give members a safe place to gather and to talk about their concerns, includ­ing their recovery from torture;

b)  To assist in the acculturation and immi­gration process by discussing cultural and religious differences they encounter;

c)  To increase members’ feelings of personal empowerment and mastery in various aspects of their lives through trad itional women’s handicrafts and basic living skills;

d)  To diminish symptoms of PTSD, anxiety and depression through psychotherapy and support;

e)  To form a social organization that brings women out of isolation and that can eventually be maintained by members with a steady core membership.

After an initial assessment of the potential group members’ experiences with torture and trauma, using the instruments devel‑

oped for the Center for Torture and Trauma, approximately 20 members were selected by the case manager for membership in the group. Meetings are held once a week, on Fridays, prior to Jumah (Friday) prayers. Participants are transported to meetings or arrive via public transportation. Refresh­ments are often served, particularly tea and sweets. Members greet each other tradition­ally and get to know the rules of the group. Confidentiality, privacy and safety are em­phasized in the group.

The therapist facilitates a therapeutic group process, incorporating relaxation breathing and guided imagery for stress relief, pain management, and relief from intrusion phenomena. The group is organ­ized around a theme or activity each week, pre-selected by the members and the thera­pist the week before. Themes include: im­migration experiences, parenting, marriage, communicating with doctors, tribal conflict, difficulties in protecting and raising sons, finding husbands for daughters, maintaining authority with children, memories, night­mares and dreams, financial difficulties, cultural differences, divorce, losses, grief, rage and loneliness. Activities can include crocheting, knitting, quilting, drawing, sew­ing, simple automobile maintenance, driving tests, scrapbooking, jewelry making, etc. These activities are all activities they can continue outside of the group. They are nor­malizing, calming and soothing to the mem­bers. While they are working on a project they hold their discussions, just as one might on a visit to a friend. Within this context, the shame and guilt that they might otherwise feel when thinking or talking about many issues is diminished. Members look forward to these meetings every week. They report using their crafts as ways to calm and soothe themselves at home when times are difficult. They are supportive and respectful of one

CLINICAL EXPERIENCE

111

another. They cry and laugh together and celebrate each person’s small triumphs or significant losses. In this way, the group is truly a comforting shoulder for each woman.

Bhutanese Multi-family Therapy Group for Torture Survivors’ Families

The group started in November, 2008, con­sisted of between five and eight families. The group was led by a bilingual mental health counsellor, and a Bhutanese case manager/ community liaison co-facilitator who has a masters degree in Political science from Nepal. The goals of the group are:

a)  To give members a safe place to gather and to talk about their concerns and their stories, including their recovery from tor­ture;

b)  To assist in the socio-cultural adjustment;

c)  To increase members’ feelings of personal empowerment and mastery in various as­pects of their lives;

d)  To diminish symptoms of PTSD, anxiety and depression;

e)  To form a social organization for Bhu­tanese torture survivors who continue to support each other after the group and advocate against torture and oppression, which helps with the continuation of per­sonal and community healing, advocacy and social support.

However, the focus in the first stage switched to survival issues, because of the new added traumatic stress, arising from the dire economic situation in US at the time. The therapy focused, at this stage, in devel­oping assertiveness training, problem solv­ing skills, using humour, laughter and other skills, for example, journaling and making to do lists.

Clients are encouraged to share their story but they are not pushed to. Most of

the members are interested in discussing religious topics. They are also interested in discussing the politics of Nepal and Bhutan. The experience one time of a member who was very quiet in all sessions, but who spoke up for the first time about politics and gave his opinion, shows the relevance of this topic to group participants.

General Principles for torture groups:

1)  Helping clients regain control of their life. Also, providing a safe space to practice control during group time. For example, letting them have cell phones and giving them the choice to answer it (it could be from their job agency, sick relative, etc.)

2)  Giving them choices and teaching them to choose for themselves. Letting them make the rules for the group and then adding more important ones if neces­sary.

3)  Abstaining from re-traumatizing by recalling memories of torture. Encour­age, not force them to share about their torture. Most of them are afraid, guilty, embarrassed, feel responsible for what happened to them.

4)  Most importantly, establishing and gaining their trust. Making them feel very comfortable in any way possible. Talking about their history, where they came from, history behind their coun­try, learning about their culture and its practices. Letting them educate the therapist and case managers about the conditions they came from. Talk about politics and religion, their favorite mov­ies, songs they like.

5)  Using laughter and humour: Laugh­ing is the shortest route to the heart. Strat egies of telling jokes and laughing in the moment helps them forget about their pain for now. Talking about the

112

CLINICAL EXPERIENCE

new host culture, inviting them to share any funny events relating to the host culture that they experienced are help­ful interventions.

6)    Using art and other creative activities. Collage was liked by all members. Tell­ing stories by looking at some emo­tion cards, writing letters of gratitude, accultur ation activities, educating about the new culture and its practices, hav­ing them draw their interests, hobbies, strengths, accomplishments, successes, and positive focused therapeutic activi­ties were all utilized.

7)    Balancing power dynamics in the group was important. Getting down to their level and accessing them, reflection of power in dress, seating in the group, not practicing too much control, or making strict rules were important.

8)    Letting them vent and complain be­cause they have no place else to do that. Listen to them closely without any judgements, supporting them, but not letting them obsess about complaining and intervening when they are com­plaining too much.

9)    Help problem-solve. Brain storm with them to solve the current problems in their life (ranging from filling forms to accessing transportation, getting jobs, learning English, etc.).

10) Help create a cohesive bond between them, so they have access to support outside the group setting. They can help each other which will help them feel good about themselves if they can help others.

11) Teach basic coping techniques with stress, adaptation to a new culture, find out how well they cope currently and find strengths in them. Learn their ways of coping and help reinforce those if they haven’t been coping well.

12)      Psycho-education about their symp­toms and how it relates to their overall traumatic experiences, about PTSD, how it is affecting their life and how they can minimize the symptoms, cope with them, take care of themselves.

13)      Teach them the importance of self-care. Most of them are very modest, gener­ous, put others first and leave them­selves out.

14)      Getting them involved with community events. Invite them to attend events related to the celebration of torture survivors, cultural celebrations, and potlucks.

15)      Teach them assertiveness, conflict resolution, parenting skills. Help them practice/role model newly learned tech­niques in the group and get feedback.

16)      Letting them tell their story without forcing them, but a little probing may be necessary. Make sure they feel safety and trust.

17)      Find out about their religion and spir­itual strengths and practices. For most of them that is the first resource or coping strategy to turn to their religion.

18)      Involve their family and community.

The Bhutanese group provided another model for achieving the community organ­ization goal. While community organization in the Bashaal group happened spontan­eously, in the Bhutanese group it happened intentionally. The case manager, the co-fa­cilitator of the group, who is a Bhutanese community leader and previous political science professor in Nepal, initiated the call for group organization after the sixth session, and started to help them apply for non-profit status. In this model the case manager, a Bhutanese leader himself, who has a master’s degree in political science, initiated establishing the non-profit organiza‑

CLINICAL EXPERIENCE

113

tion for the Bhutanese community of torture and non-torture survivors. The organization celebrated cultural events and organized art and craft expositions and participated in the Georgia coalition of refugee stakeholders.

Summary and conclusions

Torture consists of different traumas that target an individual or group. Collective iden­tity is an important factor in this complex trauma. The multi-systemic, multi-compo­nent, wraparound psychosocial rehabilitation approach for torture treatment addresses the three systems affected by torture: The indi­vidual, family members and the group. Group therapy for torture survivors is an important component of this model. Group therapies extend to community healing. Groups de­velop their cohesion to graduate to a social community club. New graduates from the group join the club and become part of the social advocacy process and of group and community healing. The Bashal Somali women group and the Bhutanese multifamily groups are variants of this model. The wom­en’s therapy group has developed to be a social club for Somali torture survivor women that convenes and arranges social activities and work on arts and crafts. They hold their events to celebrate and sell their products and to lobby against torture in the community at large. The Bhutanese group provided another variant of the model for achieving in com­munity organization goal. While community organization in the Bashaal group happened spontaneously, in the Bhutanese group it hap­pened intentionally. The case manager, the co-facilitator of the group who is a Bhutanese community leader, initiated the call for group organization. While the CTTS group therapy model with its variants have a theoretical face and validity, future studies are needed to provide empirical evidence of its effectiveness in achieving and sustaining its goals.

The Use of Drumming as Cure for Children with PTSD

Djembe

The Use of Drumming as Cure for Children with Post-Traumatic Stress Disorder (PTSD)

Copyright © 2003 by David Otieno Akombo, Ph.D

Post-Traumatic Stress Disorder (PTSD) can be an extremely debilitating condition that can occur after exposure to a terrifying event in which grave physical harm occurred or was merely threatened. Traumatic events that can trigger PTSD include violent armed conflict like that of Somalia, Rwanda and Burundi, and Sudan. Others may include personal assaults such as rape or mugging, natural or human-caused disasters, accidents, or military combat such as the veterans who are serving in Iraq or those who served in Vietnam and the Gulf Wars; rescue workers involved in the aftermath of disasters of the World Trade Center, survivors of accidents, rape, physical and sexual abuse, and other crimes; immigrants fleeing violence in their countries; survivors of the 1998 Nairobi US Embassy Bombing among others.

Effective treatments have now been developed to help people with PTSD. Research is also helping more scientists to better understand the condition and how it affects both the brain and body. Different forms of music such as drumming are becoming an important therapeutic tool. Drumming exercises greatly reduce stress among Vietnam veterans and other victims of trauma, apparently by altering their brain-wave patterns.

The effect of drum in the treatment of diseases should not be disputed. Since our ancestors first struck sticks and rocks against the ground, drumming has been a sacred ritual in many societies.(1) This belief emanates from the fact that throughout the world, the drum has been used for healing purposes. The traditional peo

ples of Africa, the Aboriginals of Australia, the Balinese of Southeast Asia, the Native American Indians, the ancient Celts among others all used drumming to bring the rain, the sun, a bountiful harvest, successful hunting and good health.(2) The drum has also been used in tribal societies with shamanistic traditions while communicating with the gods. In West-African wisdom teachings, Cottel (2001) noted that emotional disturbance manifests as an irregular rhythm that blocks the vital physical energy flow. Cottel also refers to current medical research which has shown that stress is a cause of ninety eight percent of all diseases such as heart attacks, strokes, immune system breakdowns, among others. Recent biofeedback studies (for example, Spintge 1992; Harner 1990; McIntosh 1996) show that drumming along with our own heartbeats alters brainwave patterns (increasing alpha) and dramatically reduces stress. Unlike the western cultures which rely on material evidence such as infection from bacteria or viruses, cell production such as cancer, or genetic defective chromosomes, the non-western cultures, relate to the diseases from a cultural perspective connecting the etiology to the metaphysical world. Their understanding of the disease etiology is embedded in their cosmology. For example the Luo tribesmen of Kenya believe that HIV/AIDS is caused by a curse. In this perspective, a curse is viewed as evil pronounced or invoked by another living person or the spirit of the dead. Among the Luo tribe, drum ensembles are performed with the object of exorcising the bad spirit from the patients.

Among the many African tribes, regular and balanced meter are regarded as a sign of good health. Even in improvisations, the performers are expected to render an exact replica of a standardized musical practice. These mythologies that relay regular and replicated rhythms to heal the person in an immediate and powerful way by removing blockages and releasing tension can be seen in the performance of a Kenyan tribal ritual dance, ngoma of the Taita as well. During this performance, a glissando is played by the lead drummer by gliding his left hand from the middle of the drum to the edge (kusira ngoma). By doing this, the drummer not only provides an expressively emotional pattern at the climax of the healing ritual but also provides a functional significance to the healing process because it is during this moment that the drummer sedates the pepo spirit to descend and exorcise the evil spirits from the patients. Kusira ngoma, which literally translates into “going beyond with music,” is the climax of the healing ritual and its ultimate extreme. This is the stage at which the patients shiver, fall to the ground and ultimately go into trance. During this healing ceremony, the master drummer controls the emotions of the patient while the patient unlocks his or her inner subconscious mind. In the middle of the performance when the interlocking parts become intense, the patient is induced to a state where they start to dance pathogenically as they respond to the mwazindika drum, letting their souls soar into the supernatural world to meet the deity. In a similar supernatural mediation, Cornelius (1990: 127) found that the Afro-Cuban bata drums were believed to be capable of talking and communicating directly with the Orishas, Yoruba gods. But this power of the drum to be able to speak is also possibly seen as a catalyst to helping people to talk. Ms. Ruth Noonan, a practicing music therapist in Longmont United Hospital in Colorado has observed that in her recent practice, she has witnessed the drumming helping a patient to regain speech:

via The Use of Drumming as Cure for Children with PTSD.