2001 AWARD WINNERS - INTERNATIONAL HUMANITARIAN AWARD
Karen Hanscom
The International Humanitarian Award recognizes extraordinary humanitarian services and activism by psychologists, including professional and volunteer work conducted primarily in the field with underserved populations. Award recipients are psychologists who, by their extraordinary service at a difficult time, improve the lives and contribute to the well-being of people in a large or small geographic area anywhere in the world.
Citation
For her commitment to human rights, to the healing of torture victims, and to educating the world community about torture. Karen L. Hanscom has touched the lives of hundreds of women who survived the civil war in Guatemala through her work with the Puentes de Paz health project. In the words of one of the participants, 'We knew nothing about mental health before... Karen gave us a new vision... now I get upset but I know how to deal with it, and I know I'm not alone.' Hanscom has been a driving force in the development of torture treatment programs locally and nationally. Her training programs have contributed to increased understanding of the needs of torture victims by a wide variety of professionals and community groups. Her direct work with torture survivors has changed the lives of many who have suffered the worst experiences imaginable. The reach of her compassion spans the globe."
Biography
Karen L. Hanscom, recipient of the 2001 American Psychological Association International Humanitarian Award, received her bachelor's degree in 1973 from Lycoming College, a master's degree in teaching from Bloomsburg University, and a master's degree in psychology from Marywood College. She received her doctoral degree in psychology form the University of Maryland in 1989. Hanscom was on the staff of Union Memorial Hospital in Baltimore, from 1989 to 1999. Her interest in and commitment to human rights started 10 years ago when she began to volunteer with a small group of health care providers who were developing a program to provide comprehensive treatment to torture survivors. Hanscom is now the director of that program, Advocates for Survivors of Torture and Trauma, based in Baltimore.In 1998, she began work for the Guatemala Human Rights Commission training local healers to psychologically treat survivors of trauma and torture. Hanscom spends two weeks of every other month in Guatemala conducting training sessions. She has contributed to the development of the National Consortium of Torture Treatment Programs, which include centers across the United States. She is currently working on a book about torture and human rights.
TREATING SURVIVORS OF WAR TRAUMA AND TORTURE
Karen L. Hanscom
Advocates for Survivors of Torture and Trauma
Psychologists are in a unique position to assist individuals and groups in the world who have survived torture and war trauma. Symptoms of post traumatic stress disorder and other psychological diagnoses can be treated effectively by mental health professionals and trained lay counselors in the smallest of committees in the world. This article proposes a model for the treatment of survivors of torture and war trauma. This model has been designed to be useful to mental health professionals and to lay individuals in communities who constitute the front line in treatment: health providers, midwives, ministers, and teachers. The model is presented through examples of its use in the training of mental health counselors in the United States and in the training of promotores (health promoters) and comodrones (midwives) in Guatemala.
This article is an invitation to psychologists to become involved in the international issue of human rights. As part of the world community, psychologists cannot hear the news or read the newspaper without becoming aware of human rights abuses in the world, nor can they be unaware of the devastating effects on individuals of the loss of such rights. Psychologists are in a unique position to understand and treat individuals suffering from the horrific effects of torture and war trauma. Further, psychologists have a unique opportunity to become involved in this international issue on a personal and professional level. As a result of this presentation, I hope that you will join other psychologists in this commitmentto human rights.
In this article, I first briefly define torture and war trauma. Next, I present principles underlying the treatment of survivors of human rights abuse through the discussion of a developmental view of the effects of such abuse. Then a model for the treatment of survivors is presented. Finally, I describe a project in Guatemala that uses this model to train village women to treat survivors of war trauma and torture in their communities. Additionally, I describe one of the torture treatment centers in the United States as an example of training professionals in the treatment of survivors who have fled their countries and are seeking asylum in the United States.
Definition of Torture and War Trauma
Torture can best be described as "a total violation of human dignity"(Gonsalves, Torres, Fischman, Ross, & Vargas, 1993, p. 352). The following principles underlie the practice of torture: (a) Torture is systematic and deliberate, (b) torture is directed not only at the individual but also at a country's entire social and political fabric, (c) torture is an assault on the very core of a person and on a society's primary sociopolitical groups, and (d) torture's profound impact results in massive psychic trauma on the individual and on the culture (Gonsalves et al., 1993).Torture is defined in Part 1, Article 1 of the United Nations Convention Against Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment:
Torture means any act by which severe pain or suffering, whether physical or mental, is intentionally inflicted on a person for such purposes as obtaining from him or a third person information or confession, punishing him for an act he or a third person has committed or is suspected of having committed, or intimidating or coercing him or a third person, or for any reason based on discrimination of any kind, when such pain or suffering is inflicted by or at the instigation of or with the consent or acquiescence of a public official or person acting in an official capacity. (United Nations, Secretariat Centre for Human Rights, 1987)
War Trauma refers to an experience that meets the definition of trauma as described in the DSM4 under Post Traumatic Stress Disorder that results from exposure to war conditions. Thus, it is an experiencing of an event that involves actual or threatened death or serious injury, or a threat to the integrity of the individual. Second, it is an experience that causes a person to react with intense fear, helplessness, or horror.
Today in the United States there are thousands of refugees who are being sheltered following war trauma in such countries as Sierra Leone and Bosnia. Additionally, there are an estimated 400,000 individuals in the US who have fled from their countries of origin following torture. These individuals come from the more than 140 countries in which torture is occurring today. Many more individuals in the world have experienced war trauma and torture and remain in their countries. Guatemala is an example of a country in which most individuals remained during the more than 36 years of civil war, or fled to neighboring countries and have now returned to Guatemala.
Whereas the needs, intensity of consequences, and issues of these groups differ in many ways, there are similarities, which serve as the foundation for training professionals and paraprofessionals in the treatment of survivors. An examination of psychological assessment and diagnoses of survivors is beyond the scope of this presentation.
Principles Underlying a Treatment Model
As a framework for understanding the needs of traumatized individuals, it is helpful to take a developmental look at the basic needs of human beings and what happens to these needs in the face of trauma and torture.
Universally, the early development of human beings involves meeting the basic human needs of safety, trust, and a sense of one’s ability to impact the world. When a baby is born, the infant experiences total reliance on a parent figure to fulfill all needs. The parent, usually a mother, provides nourishment, protection, and physical care. When the child is hungry and cries, he or she is nourished. The child is protected from the cold and from danger. As a result of having these basic needs met, the infant begins to perceive the world as a safe place. Thus, a sense of both safety and trust is developed. Within this context of safety and trust the growing baby begins to experience an ability to impact the world. It is at this stage, for example, that the infant may demonstrate the rejection of undesired food by pushing away the spoon. Thus, the baby is beginning to learn that they are able to have an impact on the world. They find that they can act in a certain way and have the world respond. As babies grow they have a myriad of experiences of acting and receiving a response in an environment of safety and trust.
At any age, the experience of torture and trauma significantly disrupts the sense of safety, trust and the ability to impact the world that was established in infancy. When tortured, the individual experiences profound vulnerability and finds the world to be unsafe. The ability to trust other human beings is disrupted. Further, victims find that their own ability to take action to protect self, to escape, or to stop the abuse make absolutely no impact on what is occurring. Consequently, the critical and primary experiences of trust, safety, and the ability to impact the world are fractured.
It is my belief that an essential condition of healing of survivors of torture and trauma is the re-establishment of the experience of trust, safety, and the ability to impact the world. Compassionate interaction between the survivor and the "counselor" is the necessary condition for the relearning to take place. Thus, I believe that the essence of this relearning is wholly the human interaction and therapeutic alliance between the survivor and a wise and compassionate individual willing to listen and open him or herself to the survivor. Further, I believe that there are warm, caring, and intuitive people in every community in the world who are offer emotional support and guidance to others. It is my strong belief that such "wise" individuals can assist others in healing from the effects of trauma and torture. The effectiveness of these "wise" individuals in helping survivors of human rights abuses can be maximized with additional training about the specific effects of trauma and torture, coping strategies used by individuals, and counseling techniques. Certainly, the modes of treatment used in such communities may not always resemble our Western medicine’s concept of the therapeutic session. But working within the cultural mores of a community, we can greatly expand the available number of "counselors" available to survivors. Because the number of survivors requiring assistance far exceeds the available number of mental health professionals, it was said at the Seventh International Symposium in Cape Town, South Africa that we need to "expand the treatment model beyond the office" and "shift to community-oriented approaches".
A model of treatment
I would like to propose a model of treatment that addresses the needs of two different survivor groups in two different settings. The first group, Guatemalan women, consists of people who have remained in their country of origin, which was the place of the trauma. The second group consists of individuals who have fled to the United States to seek asylum and are being treated at Advocates for Survivors of Torture and Trauma (ASTT), one of the country’s 16 torture treatment programs. Thus, the model is constructed to be basic enough to effectively train lay individuals in a community or to train professionals in the United States or other countries who are beginning to work with survivors.
The use of this model in the training of lay counselors will be demonstrated through a description of an ongoing project in Guatemala. This model is referred to in Spanish as "ESPERA" or "hope." The program provides training for indigenous women to broaden their intuitive skills in providing both individual and group counseling to survivors of war trauma and torture in their communities in Guatemala. Interwoven will be examples of this same model, referred to as "HEARTS", as it is used in the training of psychologists and other mental health professionals in the United States who are working with survivors of torture and trauma.
The project in Guatemala is called "Puentes de Paz, or "Bridges of Peace". For the last three years this project has been operating in Guatemala as a project of the Guatemala Human Rights Commission – USA. The project is currently running in three different sites in Guatemala where most of the indigenous Mayan people have witnessed or suffered one or more traumas, including state terrorism, massacres, torture, and other grave human rights violations. The organization of the Puentes Project itself matches the community’s need for safety and trust through the use of an existing network of "Promotores" (health promoters) or "comodrones" (midwives). This is a community-based model that has been used in Central America for decades. Briefly, individuals in a community who are considered "wise" and "leaders" are selected to receive training in such things as general health (first aid, nutrition) or midwifery. Following training, these individuals provide direct service to their own rural communities. For example, in Site One of the project, there already existed a small medical clinic consisting of one doctor, one nurse, and one assistant who were involved in the training of a group of 14 women, referred to as communicadores (communicators) in this region. Each of these communicadores conducted meetings about nutrition and health to their own village groups of 20-40 women who met 2-4 times each month. As stated by Fischman and Ross, such group treatment of survivors "fosters individual healing by generating a sense of community and membership". The Puentes Project began with using this already established and trusted structure to implement mental health training and treatment. In Site Two, there existed a loosely knit group of women who had yet to commence communicador training. In Site Three, women who were already trained as midwives were gathered because of their wish to learn about mental health and form community groups of their own. Women have been the focus of the Puentes project because Guatemala women hold a very low status in society which has grave effects upon their physical health and their mental health.
Based on the writings Paulo Freire, the project has as its main goal the enhancement of the participants’ recognition of their inherent ability to provide effective counseling while also providing them with additional training in individual and group counseling concepts and skills. Because this is a project "owned" by the communities, dependence of the participants on the leaders is minimized by careful scheduling and constant monitoring of how well the needs of the women are being met by the topics and issues addressed in the workshops. For one year, the women receive intensive training for two weeks every other month. The women maintain the project during the intervening periods. In subsequent years we return 2-3 times each year to offer continued support through supervision or to provide organizational strategies and additional skills and concepts training that might be requested by the women. The training makes use of a variety of learning approaches. Art, music, movement, and acting are used in combination with didactic training. We maintain cultural sensitivity by having the participants choose the types of activities and discussion topics used in the training groups. By the end of the first year the women have requested training in such topics as anger control, the psychological effects of war, assertiveness, domestic violence, reproductive rights, and poor treatment they receive as indigenous women. During trainings, the women spontaneously discuss and work through their own history of past human rights abuses. Through modeling and training, the women learn and practice the concepts and skills necessary to provide counseling to others using the approaches, rituals, and manners specific to their culture. The ESPERA model is used as a framework for teaching the concept of psychological trauma and torture and as a basis of treatment for survivors in their communities.
While many of the actual training techniques differ, as you will see, the same model, referred to as HEARTS in English, has also been used in the training of professionals in the United States through activities of Advocates for Survivors of Trauma and Torture, (ASTT). ASTT is a comprehensive center for the treatment of survivors of trauma and torture who have fled from their countries to seek asylum and safety in the Maryland, Delaware, and Washington, DC area. ASTT provides psychological treatment, psychiatric care, medical referral, legal referral and expert court reports and testimony to asylum seekers and other survivors. Along with direct treatment, the training of such groups as social workers, refugee workers, hospital staff, psychologists, religious, and others is a concurrent mission of the center. The particular issues, psychological diagnoses, and problems of survivors constitute the core of these trainings in which the HEARTS model is often used as a framework for the treatment of survivors. Following such trainings, ASTT makes itself available as a referral source, or as a source of consultation, to these professionals and agencies.
The HEARTS Model
This HEARTS/ESPERA model will be described as a stage model for ease of explanation of the complete process. However, it is not a linear model. Rather the model describes the elements of treatment which may occur in various order within or throughout treatment. For example, it is very common for survivors to initiate treatment with someone due to somatic complaints. Thus, the element "Asking about Symptoms" will constitute the beginning of treatment. Or, as is often the case, the survivors may come to the counselor with questions about how to handle newly developed anger control problems, in which case "Teaching Relaxation and Coping Skills" would begin the process.
Healing the HEARTS of Survivors
H - Listening to the HISTORY
Providing a gentle environment
Listening with the body
Attending to the flow of speech
Hearing the voice and tone of the speaker
Observing the speaker’s body
Looking at the facial expressions
Remaining quietly patient
Listening compassionately
E - Focusing on EMOTIONS and Reactions
Using reflective listening
Asking gentle questions
Naming the emotions
A- ASKING about Symptoms
Using your own style to investigate:
Current physical symptoms
Current psychological symptoms
Suicidality
R - Explaining the REASON for Symptoms
Showing how the symptoms fit together
Describing how the body reacts to stress and trauma
Explaining the interaction between the body and mind
Emphasizing that these are the "normal" symptoms that "normal"
people have to an "abnormal" event
T - TEACHING Relaxation and Coping Skills
Instructing the individual in relaxation skills: abdominal breathing,
meditation, prayer, imagery, visualization and more
Discussing coping strategies: how they have coped in the past, reinforcing
old and healthy strategies, teaching new coping strategies
S Helping with SELF-CHANGE
Discussing the person’s world view: the original view, any changes,
adaptations or similarities; and recognizing the positive
changes in the self
Note: The Spanish version of this model is called ESPERA: E – ESCUCHAR el cuento;
S – SENTIMIENTOS y reacctiones; P – PREGUNTAR acerca de los sintomas; E – EDUCAR acerca de los sintomas; R – RELAJACION y formas de como manejar el asunto; A – AYUDA con integraction (trauma in su vida).
H - Listening to the HISTORY
"Silence" is a basic tool of repressive governments. During the war in Guatemala, and to this day, it was imperative for individuals to maintain extreme caution in speaking to or associating with others. One’s survival depended upon keeping political views and associations private and confidential. The constant presence of both the guerrillas and the army maintained an ever-present fear. No one ever knew when he or she would be identified as supporting the guerrillas and then persecuted. Thus, women stopped talking to women. Mothers stopped discussing all but daily living issues with their sons. Men only met with other men to confer after accepting the great risk this involved and doing all that was possible to get together in secret. Thus, a dominant social survival strategy developed. In order to survive, one needed to withdraw and isolate oneself from other individuals. Together with this decrease in communication, in concern for one another, and in social interaction, came ever-increasing withdrawal and isolation.
For this reason, confidentially communicating with another individual and telling one’s story is important both to the survivor and to his or her society since it is a means of "helping to undo the silence created by society’s denial of torture as an instrument of political repression". Further, "testimony facilitates cathartic release" and assists individuals in "integrating fragmented experience."
As with all psychological interventions, one’s story must be told in an environment of safety, honesty, trust and strict confidentiality. The survivor requires a safe and gentle environment in which he or she can relate the details of the story, the history, the trauma and human rights abuses. The psychologist or clinician is both a compassionate listener and a professional observing and formulating diagnostic hypotheses.
In Guatemala, as in US training workshops, the development of "compassionate listening" is essential. Mayan women engage, for example, in a discussion on what it means to use their full body and heart while listening. After such a discussion of good eye contact, concentration, calmness of body, and culturally and clinically appropriate physical proximity to the individual, the women form counseling dyads, as they will throughout the training, to practice the skills learned. The group is divided in two – one group receiving instruction that they will speak about a certain planned topic (such as: "I get so annoyed when…."). The other group is instructed to act as counselors. They are to remain completely silent and use only their bodies. They are prompted, however, to NOT listen well with their bodies, but rather demonstrate all of the opposite conditions – restlessness, boredom, inattention etc. When the groups form their dyads and counseling begins, the fun-loving spirit of the women is demonstrated by the antics of the non-listening counselor. Following the resultant laughter and discussion, women often state that it made it very clear to them both how it feels when one is not listened to effectively as well as what body language is effective to use as a good counselor. I learned from this exercise how Mayan women avoid looking directly into the eyes of a person speaking of sadness, believing that to do so would transfer the emotional pain into their own souls. Following a discussion of this practice with the women, I now note that they have spontaneously begun to use improved eye contact during most of the session, deflecting their gaze, as is the cultural norm, only at times when the discussion is emotionally intense and they feel this need to "protect" themselves. Counseling dyads are used for practice throughout the program as the women expand their confidence as counselors and develop therapeutic skills.
In ASTT trainings, because of the professional background of the participants, a review of good listening skills is given. This review uses elements of Eastern medicine’s manners of diagnosis using all of the body in intense observation – using hearing, seeing, asking, and observing one’s own reaction as you compassionately connect with the survivor. Critical to this review of listening skills is the recognition that an honor is truly bestowed on a counselor whenever a survivor trusts this counselor enough to expose their history of horror.
It is exactly this compassionate connection with the survivor that both the lay counselor in Guatemala and the professionally trained counselor or minister in the U.S. uses as the essential condition of healing through the re-learning and re-experiencing of safety and trust. The sense of one’s ability to impact the world is relearned by the counselor allowing the survivor to work at their own speed in their disclosure of their tragic experiences and reactions.
E – Focusing on EMOTIONS and Reactions
The goal at this stage is to work within the factual history that was presented and begin to discuss the myriad of emotions experienced by the survivor. In this way, the individual begins to put "words" to his or her strong emotions. Identifying and using such words as anger, terror, confidence, bravery etc. that match the emotions is helpful to individuals as they attempt to "master" or get control of their terrible experience.
In Guatemala, training in this element of treatment begins with increasing the "feeling vocabulary" of the women. The use of the words "happy" and "sad" are expanded to include such words as frustration, annoyance, and fear. Drama has been an effective way of assisting the women in identifying this culture-specific vocabulary. For example, groups of 3-4 women may be instructed to act out a scene where the husband comes home to the family and dinner has not yet been prepared. One woman, acting as the husband, may act out the powerful feelings of machismo and become extremely angry and possibly violent.Another woman, acting the part of the wife or child, may dramatize feelings of fear, outrage, or helplessness. A discussion of these emotions follows. In addition to the expansion of feeling-words, there is spontaneous discussion and insight regarding domestic violence, machismo, and the rights of women.The women in the Guatemala project have also enjoyed a form of "charades" where they act out an emotion and the others provide words to describe what is being expressed.
A- ASKING Questions about Symptoms
The goal of the third part of treatment is to assess the individual’s current feelings and behaviors. While a full discussion of the various symptoms seen in post-trauma and torture are beyond the scope of this presentation, trainees in Guatemala and in the United States are in fact trained in the identification of clusters of symptoms commonly found in survivors. In trainings in Guatemala, cultural differences in symptom presentation and in vocabulary are carefully considered as symptom clusters are discussed. Symptoms that are indicative of a diagnosis such as Major Depression, Anxiety, or Post Traumatic Stress Disorder – but may not be referred to as such in Guatemalan culture and vocabulary – are taught through spontaneous case-presentations provided by the women. Within the framework of the promotores model, the women are familiar with asking questions and describing cases of individuals with whom they are working. Symptom groups (classifications) are discussed. Local remedies such as rituals and the use of local medicinal herbs are collected by the women as they assist each other by sharing their personal knowledge and expertise. Site three, for example, is actively engaged in preparing a booklet of drawings and samples of herbs used in their communities which they can then use for symptoms which they refer to as "fear," "hysteria," and "deep sadness."
Trainees in the United States are instructed using DSM4 classifications. Discussions are encouraged regarding such classifications as Post Traumatic Stress Disorder which, while coming close to describing the symptoms seen in survivors of torture and trauma, does not fully define the problem. In the U.S., as in Guatemala, the elements of the three categories that comprise the diagnosis of Post Traumatic Stress Disorder (PTSD) are stressed: persistent re-experiencing, persistent avoidance, and persistent arousal and treatment options discussed. Trainees at ASTT are encouraged to use their personal therapy style to discover the survivor’s current symptoms and use available resources (hospitals, psychiatry, etc). The importance of psychological symptoms is stressed. While it appears inherent to the Guatemalan women to understand the use of physical symptoms to express distress, trainees in the U.S. often need further explanation about the way in which individuals of many cultures will speak freely of physical symptoms when beginning work with a clinician. In many cultures, diffuse somatic complaints are the primary concern of survivors. Survivors will report both clear, physical symptoms that have resulted from specific forms of torture (for example, burns on the wrists from electric shock), or broad non-specific symptoms ("my whole body hurts") that represent the emotional wounds of trauma and torture. Body memory symptoms are also discussed and included such symptoms as the symptom of dizziness experienced by one woman which was found to be a body memory of her repeated experience of being forced to drink large amounts of alcohol and then being raped and tortured. In either case, admitting to such physical problems may be a more culturally "acceptable" means of getting both medical and psychological assistance and must be recognized by the professional.
R- Explaining the REASONS for Symptoms
This element of treatment refers to the counselor’s need to assist survivors in understanding and "making sense" of their symptoms. A survivor often states that he or she is "loosing my mind" or states that "my spirit has left me". With this comes feelings of powerlessness, helplessness, vulnerability and doom. Thus, this element of treatment involves assisting the survivor in understanding that there are physical and psychological reasons why specific symptoms are occurring. They learn that these symptoms are the result of their trauma and torture and that these symptoms constitute a"normal" reaction that "normal" people have to an "abnormal" event such as war trauma and torture. This educational component is essential and produces a sense of self-control.
In both Guatemala and the U.S. a discussion of "stress" is important to this element of treatment. Stress is, of course, not part of the regular vocabulary of Mayan village women. At one site, I was speaking about stress while spontaneously demonstrating emotions that I feel while stressed. I was met with nodding heads and agreement as women expressed to me that "a las tres" (3:00 in the morning) happens to them as well! The spoke of waking up in the night tense and anxious with worry and unable to resume sleep. They acknowledged that they often get this feeling at other times of the day as well. "A las tres" continues to be the term used to mean "stress" at that project site.
While the term "stress" is not used in Guatemala, the concept is part of the past history and current condition of the Guatemalan women. In a recent discussion at site three the women participated in an active discussion of the stressors in their lives. One woman spoke of her conditioned response to the sound of rain which results in the stress of re-experiencing the day she hid while her fellow villagers were all massacred. Another woman spoke of the stress she feels being a midwife and leaving her home in the darkness to assist with delivering a baby. The stress of the darkness is compounded by the presence of a jaguar which she has seen several times along side of her home. Another woman spoke of the stress she experiences when there are rainstorms and she recalls the day that the hill behind her home slid into her house where she stood with her baby. She recalls the cow and pig that had slid down the hill and were, like her, trying to survive in the three feet of mud.
Both in the U.S. and Guatemala, post traumatic stress and other symptoms are explained as a way in which a person’s body and mind are genuinely attempting to protect them in the present moment. First, the stress-response is explained. Then, symptoms such as hypervigilance are explained as the way in which the body and mind remember the initial trauma and remain in constant alert to prevent the individual from ever being hurt again. Though the symptoms are distressing, counselors are taught to encourage survivors to accept and gently "thank" their bodies for trying to keep them safe. Survivors are assured that in time these symptoms will quiet as they use this approach and other strategies to calm the body and mind.
T- TEACHING Relaxation and Coping Strategies.
Counselors learn to teach survivors relaxation and coping strategies aimed at increasing a sense of mastery and reducing symptoms. Counselors in Guatemala and the U.S. are instructed in the use of many forms of relaxation training that can be used during sessions. Relaxation exercises at the end of sessions are helpful for session closure to insure that the individual is leaving the session in an emotionally stable state. Survivors are encouraged to practice the relaxation techniques at home. Such concepts as "mindfulness" and skills such as imagery and focused breathing are discussed. In Guatemala, Buddhist mindfulness, "Mayan-style" is taught.The women are taught to become mindful of their surroundings through the focused use of their senses. When mastered, the women pair these two techniques with "water". Throughout the day of a Mayan woman, water is essential. The woman hears the sound of water as she pours it into a pot and places it to sizzle on the wood fire to make coffee; she knows the slapping sound of wet clothing as it strikes the stones on the riverbank and the smell of these wet clothes as she stretches them out on the fragrant tall reeds; she knows the feel of dry corn kernels as she washes them in a tin bucket of cold water before cooking. The women are taught to use water as their "signal" throughout the day to take a deep abdominal breath and use all of their senses to focus mindfully in the present moment.
Along with teaching such strategies, a discussion of individual and culture-specific spontaneous and personal coping skills is important. Counselors learn to assist survivors in recognizing that they ARE survivors, and that they have survived because of certain personality characteristics and coping strategies that they possess.
Those trained in the United States are encouraged to discuss their own personal strategies for coping and to learn from reading the testimonies of survivors other means of coping. Counselors may read, for example, of how survivors mentally solve mathematics problems during captivity as a focus of concentration, how they used physical exercise in their cells, or the way in which they use imagery to recollect positive past events in their lives. Guatemalan women speak of how they have used, and continue to use, such things as prayer, ritual, or singing spiritual hymns "in their heads" as a way of coping. Counselors learn to help survivors to identify the coping skills they used during trauma and torture. They are encouraged to continue using healthy coping strategies in the present as a means of "quieting" their minds when such experiences as flashbacks or anxiety occur. In this way survivors gain a sense of control, mastery, and power by being aware of or learning new strategies of relaxation and coping.
S- Helping with Self-Change
Given the disruption in the experience of safety, trust and ability to impact the world caused by torture and trauma, most individuals will be significantly changed by the experience. The eventual goal of treatment is for survivors to identify the ways in which they are the same and different from the way they were in the past. Positive changes are identified and may include such things as increased assertiveness or a new understanding of the preciousness of life.
In Guatemala this element is best described using the local image of a river as representative of one’s life. The river water springs from a source and winds its way through gentle, calm, slow-moving areas as well as areas of turbulence and whirlpools. What the river water passes it may never pass again, though there may be similarities in the contours of riverbanks or vegetation. Trauma is imagined as an area of steep canyon through which the river cuts, or swirling whirlpools at the base of waterfalls. Guatemalan women have learned to help survivors to process and conceptualize the flow of their lives – what has occurred and where they presently flow – through painting and verbalization.
While the Guatemalan women often share similar beliefs in the "source" of the river or the answers to "why" rivers flow as they do, they come to see variations and differences amongst each other and respect these differences. Counselors being trained through ASTT are likewise guided first to identify their own beliefs. Significant diversity is displayed in U.S. discussions groups as trainees share their beliefs and feelings about such statements as: "Why do bad things happen to good people". Within such a discussion group, participants quickly find that their views may differ from the world-views of others. This experience acts as a catalyst for counselors to expand their reading about the beliefs of other cultures throughout the world.
Summary
The field of human rights work and the treatment of those in the world who have suffered are limited only by the creativity of those who join this movement. It is at this point, therefore, that I wish to extend my invitation to all psychologists to become involved in this movement for human rights. The expertise of psychologists in diagnosis, treatment, research and training is invaluable and critically needed in this field. Likewise, psychologists have consistently shown themselves to be innovative and creative in ways which would be amazingly beneficial in the treatment of those who have suffered and in the ultimate prevention of torture and war trauma. Psychologists may choose to learn about national or international careers in the field of human rights. Or perhaps one might wish to seek ways to volunteer at any of the national treatment centers that form the National Consortium of Torture Treatment Programs. This may consist of volunteer work as a Board member, clinician, researcher, or financial supporter of one of the centers. Simply telling just one other person about the international issue of torture and human rights abuse may have a wide-reaching impact. In summary, there are a wide variety of ways in which psychologists can contribute their immeasurable knowledge and skills to the cause of human rights.