Trauma Psicosocial PDF

(DRAFT)
TRAUMA &
PSYCHOSOCIAL ASSISTANCE

A HANDBOOK BASED ON THE EXPERIENCE OF
GEORGIAN NGO

CONTENTS

INTRODUCTION

CHAPTER 1 BASIC PRINCIPLES
1.1 Basic principles for a project on the psychosocial rehabilitation of
IDPs
1.2 Role of the Helper
1.3 The First Contact
1.4 Psychosocial Support for IDP Children and IDP Adolescents

CHAPTER 2 DISPLACEMENT AND TRAUMA
2.1 Evidence of Traumatic Stress
2.1.1 The Trauma of IDP Children
2.1.2 The Trauma of Adult IDPs
2.1.3 The Trauma of IDPs in Collective Centres
2.1.4 The Trauma of Privately Accommodated IDPs
2.2 Coping with Crisis

CHAPTER 3 PSYCHOSOCIAL REHABILITATION OF IDP CHILDREN:
INTERVENTION METHODOLOGY
3.1 Levels of intervention
3.2 Basic Intervention Techniques
3.2.1 Play
3.2.2 Drawing
3.2.3 Creative Imagination
3.2.4 Metaphors
3.2.5 Folk Diplomacy
3.3 Fields of Psychosocial Rehabilitation for School Age Children and
Adolescents
3.3.1 Group work with Children and Adolescents
3.3.1.1 Training on Communication Skills
3.3.1.2.Training on Conflict Management
3.3.1.3 Working on Overcoming the Enemy Image
3.3.1.4 Creative Thinking
3.3.1.5 Training on the Environment
3.3.1.6 Peculiarities of Group Work with Pre-School Age
Children
3.3.2 Community Work
3.3.2.1 Working with Parents
3.3.2.2 Working with Teachers
3.3.2.3 Working with the Host Population
3.3.3 Casework

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Psychosocial Rehabilitation of IDPs
CHAPTER 4 PSYCHOSOCIAL REHABILITATION OF ADULTS:
Intervention Methods:
4.1 Focus Groups
4.2 Problem-Solving Groups
4.3 Brainstorming
4.4 Simulation of Problem-Solving Situations
4.5 Self-Help and Mutual-Aid Groups
4.6 Targeting Skills Training: Job Creation
4.7 Psycho-Correctional Groups
4.8 Family Counselling
4.9 Individual Help

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The authors of this handbook are as follows: from the NGO Foundation for the
Development of Human Resources, Nodar Sarjveladze, Zurab Beberashvili, Darejan
Javakhishvili, Nino Makhashvili, and Natalie Sarjveladze. Credit must also be given to
Manisha Thomas, Manana Gabashvuli, and Naila Gusaienova, from the Norwegian
Refugee Council, who edited it. The book was initiated within the framework of the CIS
Conference
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Working Group on Humanitarian Assistance facilitated by Patrick Daru from
the Norwegian Refugee Council.

We thank the Norwegian Ministry of Foreign Affairs, which funded translation and printing
costs of the first edition. The book was not written for commercial purposes and selling
prices are to cover printing costs. The book may be copied or reproduced in part or in
whole for non-profit purposes, without prior authorisation from the organisations involved,
providing no changes are made to the text and that credit is duly acknowledged.

July 2000

1
Regional Conference to Address the Problems of Refugees, Displaced Persons, Other Forms of
Involuntarily Displacement and Returnees in the Countries of the Commonwealth of Independent
States and Relevant Neighbouring States by UNHCR, IOM, and OSCE.
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INTRODUCTION

This book is the result of the experiences of three Georgian non-governmental
organisations (NGOs) in their psychosocial work with internally displaced persons
(IDPs) from Abkhazia and South Ossetia. These NGOs have academics and
volunteers who have given their time and knowledge to the service of the
populations that have suffered from internal conflicts and which still have not found
a permanent solution to their plight.

In the south Caucasus, one can distinguish between two types of NGOs working in
the psychosocial area. One type of NGO is composed of psychologists and
psychiatric doctors who had to change their casework approach to a more
community-based one in situations where masses were affected by traumatic events.
The other type is NGOs composed of social helpers who had a specific emphasis in
their programmes on the psychological well-being of their beneficiaries.

Both categories of NGOs have designed projects to help IDPs regain social
functioning and to restore their psychological well-being: two intrinsically linked
aspects that are mutually beneficial to the rehabilitation
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process. This book is based
on these projects, which have been some of the most innovative and original in the
field of assistance to IDPs and which have had little Western financing.

This book will hopefully help to disseminate the lessons learned to NGOs assisting
IDPs and other categories of forcefully displaced persons around the world. The
authors hope that it will also contribute to the future establishment of standards in
this field of assistance, as it is a field that has not yet been investigated for standard-
setting.

Numerous books and academic articles have been written on traumatic stress. The
authors of this book, however, chose not to overload the text with such references.
Persons working with displaced populations are supposed to find in this book the
basic background knowledge and practical recommendations necessary to start a
psychosocial project and/or to improve already running social projects by taking into
account the specificity of traumatic stress and by actively supporting the
rehabilitation of the beneficiaries.

Words like symptom, syndrome, disorder, distortion, and illness do not
appear in this handbook. In the majority of cases, the persons assisted by
psychosocial workers are healthy and the authors consider traumatic stress to be a
normal reaction to abnormal events. When assisting traumatised individuals, social
helpers should avoid the idea of abnormality or of a subconscious disposition to
disease.

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Rehabilitation here should not be read in its medical sense: in both Georgian and Russian,
rehabilitation does not have this connotation.

The authors do not attribute the trauma only to social factors (Obviously, he is
depressed because he is lonely, has no job, and is starving.). Such an approach
hinders the helpers capacity to penetrate deeply the world of a traumatised
individual and might lead to professional helplessness and pessimism.

Psychosocial rehabilitation includes a wide variety of methods, techniques,
procedures, games, and exercises. However, they should be adapted in accordance
with the situation and the trauma the person is experiencing. Sometimes the changes
are so significant that almost an entirely new method is introduced. Psychosocial
work represents a permanent search for new solutions beyond stereotypes and
restrictions and the authors hope that the readers will look at the methods described
in this handbook as a possible basis, which can be elaborated for their own work.

The Environment Affecting Internally Displaced Persons (IDPs) in
Georgia

More than 280,000 persons were displaced within Georgia as a result of ethno-
political conflicts between 1991 and 1993. Most of the displaced now live in
overpopulated centres lacking basic urban facilities. Others are accommodated in the
private homes of friends and relatives. The dire economic situation in which they
live additionally has a negative impact upon the severe psychological trauma that
they experienced as a result of their displacement.

More than nine years have passed since the majority were forced to flee from their
homes, but many still cannot cope with both the material and human losses. The
amount of humanitarian assistance, provided by both governmental structures and
international organisations, has decreased sharply and the living conditions of the
displaced have worsened in recent years. In May 1998, more than 40,000 persons
were displaced for a second time, forcing them to experience again the loss of
relatives, violence, and humiliation.

Many have also experienced destruction and/or captivity and most suffer from high
levels of stress. The loss of relatives and friends, exile, and confrontation with a new
physical and socio-cultural environment, may provoke the fear of identity loss,
especially when the IDPs are scattered throughout an urban environment. Those who
live in community centres face the additional problem of being isolated from the
host community, which can lead to feelings of alienation and perceptions of the host
community as being hostile. The sympathy shown by the host population during the
first days of the IDPs arrival continues to decrease and social relationships become
tense. These factors combined hinder the integration of the displaced into the
community.

Defeated during the war and living with an acute feeling of injustice, IDPs often
express feelings of revenge and anger, not only towards opponents, but also towards
those who failed to prevent the disaster (the government and state security bodies).

Children, students, women, and the elderly form the majority of the IDP population
in Georgia. Some working age men died during armed conflicts; others left the
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country in search of employment mostly to Russia. The majority of families are
missing family members and this absence further complicates the social functioning
of the community.

The younger generation is in an especially difficult situation since it has inherited
victimisation, intolerance, alienation, and mistrust. Without timely intervention and
psychosocial support, there is a real threat of a trans-generational transmission of
trauma.

Protracted conflicts, political and economic instability, and the uncertain future of
IDPs provide the necessity for psychosocial rehabilitation and for the facilitation of
the reconciliation process.

NGOs psychosocial projects are primarily directed at persons living in collective
centres. Assistance to those living in private accommodations comes with a number
of problems, such as additional costs for setting up special rehabilitation centres, and
providing information to people scattered around town. As a result, the number of
projects targeting IDPs who are privately accommodated is relatively small and
reaches only a limited number of beneficiaries. This book is mainly based on the
NGOs experiences with IDPs in collective centres.

Further information on the situation of IDPs in Georgia the reader can be found in
the Norwegian Refugee Council country profile on the Global IDP Database:

http://www.db.idproject.org/Sites/idpSurvey.nsf/wCountries/Georgia
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Chapter 1
BASIC PRINCIPLES

Psychosocial rehabilitation is a relatively new field in Georgia. It emerged as a
response to various factors, including: the economic crisis; the failure of state public
services in providing adequate welfare; numerous ethnic confrontations; renewed
conflicts; and, above all, major population displacement in a country in transition.

This section discusses the general principles of psychosocial rehabilitation and
describes the skills needed to work in this field. We aim, first and foremost, at
supporting the development of these skills rather than offering ready-made
prescriptions or quick how-to advice (even if examples of possible activities are also
included as suggestions).

More importantly, psychosocial assistance, as explained in this book, stems from
some basic tried and true principles singled out during field experience. These
principles should never be considered as dogma. They are being constantly
redefined and supplemented thanks to accumulated experience. It is the hope of the
authors that practitioners will be able to enrich further the following list.

1.1 Basic Principles for a Project on the Psychosocial
Rehabilitation of IDPs

Orienting the personality towards growth and development

The critical state in which a displaced person finds him/herself after a traumatic
event should not be considered a disease, but a normal reaction to abnormal
circumstances. Crisis is a process of personality development: if overcome
positively, the person reaches a new stage of his/her personal psychological state.
Consequently, psychosocial rehabilitation should be considered as a support element
in the long-term development of the personality rather than as a form of treatment.

Listening and understanding before acting

While assisting others, psychosocial workers (hereinafter referred to as helpers)
should never follow pre-designed recipes. Professional assistance should only
complement and strengthen the resources and potential of a traumatised beneficiary.
Helpers, therefore, should have a good understanding of the persons psychological
problems and potential before applying any methodology. Helpers should, first and
foremost, empathise with the group with which they are working and should listen to
them. Knowledge of the language is key. Understanding the culture and traditions,
as well as the reasons and result of their flight, is important.
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Flexibility

Helping traumatised persons is similar to travelling through unknown territory.
Despite our experience, new paths for healing will be discovered each time. There
are several constructive approaches to assisting a person in overcoming
psychological crisis, but some ways end in deadlock. Therefore, helpers need to
have a plan that serves as a guiding thread, which can be adapted accordingly as new
elements about the displaced are learned during the process. This plan should be
instrumental for the helpers in understanding:

the structure of the crisis;
the why and how of traumatic experiences; and
the final stage of the crisis.

Knowledge of support networks

According to the rules of social psychology, any psychological intervention, even at
the level of a small group, has an impact on the whole community as an integrated
organism. Before providing concrete assistance, helpers should be acquainted with
the structure of the community network and at least be able to answer the following
questions:

Are the community members closely bound to each other?
Who is the leader?
Who are the members left out?
What are, if any, the mechanisms of support and assistance among
community members?
What social links need to be strengthened?
What links disappeared because of the traumatic event?
What links do not need intervention at all?

Adaptability to the environment

Field psychosocial interventions differ significantly from those that take place in
centres set up for this purpose. First and foremost, there is a lack elementary
conditions warmth, space, or chairs for group sessions. In most cases, helpers work
in the halls of dormitories or in the yards around buildings. Despite practical
inconveniences, such work has huge rewards. Helpers have direct access to the
displaced where they live, which allows the helpers to assess the IDPs real
difficulties and to witness family/community relationships, as well as the
relationships that IDPs have with the host population. Fieldwork requires flexibility
and the ability to improvise. Helpers should be able to do the following:

quickly assess the mood of the community and the general atmosphere;
encourage initiatives coming from IDPs;
turn any obstacles into positive resources;
use even the smallest opportunity for active rehabilitation;
Chapter 1
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work with problems as they arise, etc.

Improving ones skills

The helper should be very sensitive and attentive in his/her work in order not to miss
even the slightest details that eventually could turn out to be crucial for
rehabilitation. The ability to perceive quickly the signals coming from a person or
group makes it easier for the helper to understand and empathise and to penetrate
deeper into the problem. Training of this quality gives the helper the opportunity to
become a very efficient facilitator achieving good results.

As is well known, a person perceives the environment through ones senses vision,
listening, touch, scent, and taste. They could be divided into three main sensation
systems: visual, audio, and kinaesthetic (including touch, scent, and taste). Sensation
channels that are open to the environment make a person very sensitive and attentive
to any indignation. He/she starts noticing things that are not noticeable at first
glance. These qualities can de developed through appropriate training.

Helpers as catalysts

A good helper is not one who takes over all responsibilities and organises everything
by him/herself. There are moments when the IDP needs a guiding figure, but such
moments generally occur in emergency situations. The main task of the helper is to
support the displaced person in making the best use of his/her resources. The helper
is only a small part of the IDPs social environment and he/she can not usurp the
roles and functions of the IDPs family members and friends. Rather than making
the person dependent, helpless, and needy for assistance, the helper needs to
encourage him/her to use efficiently his/her inner resources and the resources of the
social environment. Ultimately, the helper should play the role of a catalyst by
promoting the development and preservation of dignity.

To find ones niche

Psychological intervention is only one link in a chain of possible and actual sources
of support. Helpers efforts only partly contribute to the total assistance. Formulas
such as, It is only us who are able to assist these displaced persons, reflect a
misunderstanding of community support mechanisms. It is important for the helper
to find a niche in existing social networks where he/she can be helpful and possibly
strengthen it, but without disturbing or destroying natural and already existing forms
of assistance. The given principle is similar to the medical principle of Do no
harm.

Empathy

Empathy is the ability to feel as the person does and to look at the world through
his/her eyes. Empathy differs from an objective, impartial knowledge of the IDP.
Chapter 1
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Formally we may know a lot about the person, but may still be unable to understand
him/her. The only way to develop empathy is to find similar experiences in ones
own life and put oneself in the persons shoes.

The feelings of the displaced in a deep psychological crisis are of a similar nature to
our feelings when we suffer from regular, daily stresses (although of greater
intensity). Once we have drawn parallels with our own experiences, we are able to
better understand the psychology of the beneficiaries, to better perceive the essence
of their feelings, and to be more effective in our support.

When we add sincere empathy to the genuine will to reinforce the trust that the
displaced have in their capacity to change their own destinies, powerful
transformations can take place.

Competence

Psychosocial intervention in crises implies that helpers have a good theoretical
knowledge of trauma psychology, as well as practical skills for assisting people. At
the same time it is very important that helpers remain open to any new information,
so as not to lose even a small chance of enriching their knowledge and skills.

Parity

The helpers attitude should be based on I-you relations. Such a relationship
implies an interaction between equal subjects where each sees and recognises the
personality, uniqueness, and dignity of the other. Helpers should not behave in a
manipulative manner, try to demonstrate their superiority, or expose inferiority. The
attitude towards a traumatised person should not differ from the attitude towards a
healthy person in full control of his/her own resources and with his/her own vision
of the world. I-you relationships empower both the helper and the traumatised IDP
to share knowledge and experiences.

Trust and voluntary engagement

Psychosocial support implies the voluntary presence and involvement of two
persons: helper and the IDP. Without trusting relationships between them,
psychological assistance can be rejected, especially if it is presented in a humiliating
form. IDPs may not want to receive psychological assistance if they feel it affects
their dignity, especially in cases where their self-esteem has already been lowered by
the crisis. They will strive to preserve a strong self-perception, as if they were fully
in control of their environment. They might eventually engage in psychosocial
rehabilitation activities, but only after overcoming feelings of mistrust towards the
helpers.

Chapter 1
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Reality (Expectations and biases)

Before providing any psychosocial assistance, one needs to assess what IDPs lack
and what they really need. Not all IDPs express wishes that coincide with what they
actually need. On the other hand, helpers tend, sometimes, to be biased because of
their speciality, and to impose their skills on those they are assisting without
properly identifying their needs. The helper may, for instance, decide that the IDP
needs only what he/she can provide him/herself. The assistance plan should be based
firstly on a fact-based assessment of the needs of the IDP.

Economy

Psychosocial support in crisis situations requires great strength and energy from
helpers. Their stocks of sympathy and humane compassion are sometimes
exhausted. They are then burnt-out. One of the ways to prevent burn-out is a
system of co-facilitation in psychosocial sessions. Two helpers take turns in the roles
of leader and co-facilitator. Helpers also need to be supported with sessions on
cohesion, capacity-building, skills development, and also with debriefings.

Continuity

No matter how qualified, a small team of helpers (12-15 persons) cannot embrace
the whole caseload of IDPs. The experience gained needs to be passed onto other
helpers in order to be able to rely on a network that will allow project co-ordinators
to reach out to more IDPs.

1.2 Role of the Helper

While working, the helper appears in different roles as a facilitator or co-facilitator
(working with the group), moderator (in focus groups), trainer (in training groups),
social worker (during mass actions or the mobilisation of a social help network), and
psychotherapist (during individual interventions). However, in most cases, the
helper turns out to be facilitator and it is for this reason that we give more precise
details of what exactly this role entails.

Facilitation

Facilitation (from the English to facilitate to help, make easier, promote) means
an action directed at easing the interaction of people, removing psychological
barriers, and increasing personal activity. The process of facilitation mostly depends
on the skills and abilities of the facilitator. In order to be efficient, it is necessary for
the helper to develop these skills.

Firstly, the facilitator has to be concentrated on the situation in which he/she is
present. He/she has to show sincere interest in everything that is happening.
His/her presence should inspire hope and confidence in all participants.
Chapter 1
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Secondly, the facilitator has to be able to be impartial and unprejudiced. He/she
should accept any position and not judge it.
Thirdly, the facilitator should be able to communicate, i.e. be able to speak and
listen. He/she should speak in such a way that the listener gets the necessary
information and listen in such a way that the speakers know they are being
understood.
Fourthly, he/she should be flexible and creative, show that he/she controls the
situation and knows what he/she is doing. He/she should be ready to face any
event and be able to direct the IDPs in the necessary direction.
Finally, the facilitator has to be open always to both verbal and non-verbal
information.

These outlined abilities do not cover the whole spectrum, but are certainly skills
without which no helper can work.

Facilitation is a process. The facilitator should always be oriented to the process, i.e.
the possible result, rather then the problem itself. The basic principle of facilitation
is:

If something happens do nothing; if nothing happens do something.

The main goal is to evoke a positive change. The main task is to facilitate the
process towards this change. If the facilitator sees that the group is spontaneously
moving towards the positive change, he/she should not interfere. But, if he/she sees
that the process is stuck, he/she should take action.

The most important step in facilitation is the establishment of mutual understanding
with the person or group. In psychological language it is called rapport or joining
the other persons reality. In order to lead the other person towards change, one has
to meet this person at the place and moment where he/she is. Thus, the process of
facilitation can be described in the following way first, it is necessary to determine
where the person (or group) is and then show him/her (or the group) the way to
alternative choices.

The role of the co-facilitator is also very important. Assistance to traumatised people
requires a lot of energy and one person, even a professional, cannot manage to
control everything. The co-facilitator should guarantee feedback to the leader both
during the session by acting as a mirror, reflecting an efficient process, and after
the session, by analysing the work. The co-facilitator also plays the role of a
buffer or of a sponge, smoothing the sharp edges or absorbing negative
moments of the group process. The facilitator and co-facilitator take turns and
complement each other, thus guaranteeing protection from possible professional
burn-out. The principle of co-facilitation provides a good opportunity for
interactive teaching and the exchange of experiences.

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Exercise: Dance of Palms

Goal: Elaborate the skills of rapport and interaction with the partner. The
given strategy, as well as others described below, can be used during group
training for the development of skills in efficient communication.

Materials: This exercise can be implemented in any available place
comfortable for the participants. No materials are required.

Composition of participants: Two persons carry out the exercise. The third
participant gives the commands and clarifies the analysis of self-reporting by
the participants. If the exercise is conducted in a group, the facilitator takes
on the responsibility of the third participant and the exercise is done in pairs.

Procedure: Two participants sit opposite each other with out-stretched
palms, touching the partners palms. After the command, one of the
participants begins to freely move his/her hands, still touching the partners
palms. In this phase he/she is a leader (leading the hands). The other
participant is, consequently, led. The participants are instructed to observe
their own feelings and sensations. The exercise gives more efficient results if
done with closed eyes participants can more easily concentrate on their
own sensations. The first phase lasts no less than 5 minutes. Then after the
command of stop the movement of hands is stopped and after a short
break, participants change roles the leader becomes led and vice versa.
The length of the second phase also lasts no less than 5 minutes and is
ended by the same command of the facilitator stop. In the third phase
participants share their own impressions with the group and the facilitator
highlights the most important nuances of the self-reports of the pair.

The most vital part of the exercises is that the pairs carry out the exercise in
silence without any verbalisation or comments about any inconveniences or
other sensations. The participants report on their experiences only in the
third phase. Usually, during this exercise the participants feel the whole
gamut of sensations from the sensations of domination and subordination
to a harmonic relationship with the partner. They experience that joining the
dance removes tension and resistance.
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Exercises for the Development of Sensory Sensitivity

Goal: The development and reinforcement of sensorial perceptions,
sensitivity, and attention, which are necessary skills for the facilitator.

Materials: If the exercise is done in a group, two rooms are necessary.

Composition of participants: The training is conducted usually in a group
of 12-15 persons, but in smaller groups, three persons are enough.

Procedure: The group is divided into small subgroups of three persons. One
person is the receiver of signals, the other two are transmitters.
Participants can then change roles.

The First Phase: Training of the visual system. One of the participants
the receiver within one minute remembers the posture of the transmitter
who is sitting or standing before him/her without any movement (frozen)
and then mimics it. Then when the minute expires, the receiver turns
around. The transmitter changes slightly his/her posture and again
becomes frozen. The receiver turns around and has to guess what has
changed. The third participant acts as an observer and jury. Gradually, the
play becomes very complicated the changing becoming so insignificant
that the receiver has to notice even the tension in different parts of the
body or changes in mood of the transmitter.

The Second Phase: Training of the audio system. The receiver turns
his/her back to the transmitter. The transmitter sends him/her some audio
signals (e.g. whistle). The transmitter will send his/her signals without any
sequence. The receiver has to concentrate on these signals he/she
becomes all ears and has to guess who is the sender of the signal.
Gradually the receiver learns the distinctive nuances of each transmitter.
The exercise becomes complicated and more difficult to distinguish the
audio signals presented even the breath might be used as a signal. (In this
case, one of the transmitters simply stands behind the receiver who has
only to guess who is standing behind him/her).

The Third Phase: Training of the kinaesthetic system (mainly senses of
touch). The receiver turns his/her back to the transmitters. They begin to
touch the receivers back or the shoulder with their palms. The receiver
has to guess who is touching him/her. Obviously, the transmitters try to
confuse the receiver by changing the way of touching and thus
complicating the exercise.

A very important moment of the whole exercise is the self-reports of the
participants at the end of each phase when they share their own strategies
of guessing and ways of reading the signals of each other or of the group.

Benefit: These exercises can be of great benefit for the future specialist, as
shown by the following examples.
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Example 1: Working on trauma-processing, the therapist asks the client to
recall a traumatising event. The client simply sits before him/her with closed
eyes. Then suddenly, the clients eyes behind the eyes begin to move, the
head is also moving, and the breath becomes more frequent. That means
that the client has recalled an incident. But most interesting is that it is a
subconscious recollection the client even has not realised it. The questions
What is this? or What do you see? assist the client to realise and give
accounts of the recollection. Otherwise he/she could simply miss the episode
and have it miss his/her consciousness.

Example 2: The client is not only moving his/her eyes, but also has bent
forward. That might mean that he/she is participating in the event. If he/she
bents backwards, he/she seems to see the event at the distance.

Certainly, based only on body movements it is impossible say what exactly
happens. However, having accumulated experience, the professional can
notice very important nuances: not only from the clients gestures, but also
by changes in his/her breath and face colour, by expressions in his/her eyes,
voice intonations, the tension of muscles, and even by changes in body
temperature.

.3 The First Contact
he first contact with a displaced community is very important. Further co-operation
t the same time, traumatised people miss warm, friendly, and sincere relationships.
Tips for helpers
Do not promise or offer more than you can do realistically. Displaced

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depends heavily on this very meeting. The loss, pain, and frustration of displaced
people are all aggravated by the empty promises they often get from the authorities.
They feel they have been deceived many times and perceive that their needs and
requirements are neglected. They react, therefore, to any attempt to intervene in their
lives or into the life of their community with caution, mistrust, or even aggression.
They no longer want to be deceived or manipulated. They believe that they have
learned to identify the people who, in fact, want only to satisfy their own ambitions
or gain something and do not really want to assist IDPs.

A
They need to talk about their problems frankly and openly and, thus, relieve their
pain. The dispositions of helpers play an important role in establishing trust.
Traumatised persons can easily distinguish any hint of insincerity or manipulative
attitudes.

persons easily catch helpers on this point.
Be friendly, benevolent, and sincere.
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Do not reveal any kind of superiority over people you are assisting neither
by wearing expensive clothes or jewellery nor by demonstrating your own
social status.

Helpers often discuss the issue of how to introduce themselves to the community
as psychologists, teachers, social workers, or someone else. Within the displaced
community, as well as within the society as a whole, there exists a kind of prejudice
towards psychological help. The majority perceives psychosocial assistance as
psychiatric care. The visit of psychologists might cause some suspicion or comments
like: We do not need any psychological help. Everything is OK with our minds.
What we need is food and a roof. However, eventually the community becomes
aware of what the helpers real goals are and the attitudes towards psychosocial
assistance change. Adults remain suspicious for some time. In the beginning, they
only enter into simple, spontaneous conversations. However, they are happy to see
their children engaged in activities. They are happy to see that the assistance takes
care of their children.

Thus, before trust is established, it is premature to plan any specific rehabilitation
activities other than with children. During the first visit, when the adult IDPs see the
helpers playing with their children, they immediately react positively they see
that these strangers, i.e. helpers, have genuinely kind goals.

The first contact with IDPs in their temporary shelters immediately following their
displacement is a special case. The trauma is new, levels of anxiety, aggression, and
mistrust are extremely high. Therefore, special techniques of psychological
intervention are required like active/empathetic listening and reduction of effect.

Example: Displaced persons stand in one front line facing strangers at a certain
distance and start to interrogate them: who they are, where they are from, why did
they come? These questions are all accompanied by anger and dissatisfaction.

Helpers must remain patient and listen attentively. It is important to give the
possibility to traumatised people to discharge their anger, which in fact is not
directed at the helpers at all. Active listening is the best way to deal with this
situation.

It is also important to change the spatial arrangement. When displaced people stand
as a wall at a certain distance, they non-verbally express their isolation and
confrontation. Helpers have to try to change the line into a circle; step by step,
helpers take places on both sides of the barricades.

Helpers can even use some psychological tricks:

Stand in a position at the corner almost next to the traumatised person
preserve a personal distance and at the same time be close and try to create
the optimal position a circle.
Mirror the posture and gestures of a speaker take a similar posture.

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These tricks, together with empathy, sincerity, and active listening contribute to
the effective reduction of anger and the establishment of an atmosphere of trust.

1.4 Psychosocial Support for IDP Children and IDP Adolescents

Unconditional positive attention

Mutual trust and mutual respect are the basic roots of good adult-child
communication. The child should be accepted as he/she is and not judged. During
rehabilitation sessions, a safe environment is secured that can encourage the child to
express him/herself and open him/herself to the world. If there is a need to correct
his/her destructive behaviour, the helper makes sure the child understands that
his/her behaviour is targeted not his/her personality.

Age differences

Work methodologies should differ with the age of the child and the main interests of
the child. We can distinguish three groups:

1. Pre-school: This group concentrates on learning through games, drawing,
singing, and story telling (fairy tales).
2. 7-12 year olds: More attention is paid to staging role-plays, art-therapy, and
elements of body and motion therapy (sport games).
3. Adolescents: The sharing of problems and discussion increases.

Orientation in the community

The helper needs to have a global approach to the child's development, including
his/her social environment: parents, grandparents, and teachers. He/she will work
towards bringing together generations separated by displacement trauma to
strengthen positive links in the community.

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Chapter 2
DISPLACEMENT AND TRAUMA

Psychosocial rehabilitation projects for the displaced should take into account the
specificity of the individuals and the communities trauma: they lived through war,
destruction, violence, captivity, humiliation, the loss of relatives, and the loss of
homes. Such events are, obviously, hard to experience and leave a deep mark on the
soul.

But, in fact, the nature of the traumatic experience has much in common with daily
life crises, such as the death of a loved one, divorce, severe illness, the loss of a job,
etc. The difference is that ordinary crises often trigger natural mechanisms of
support and do not require the intervention of a specialist. However, parallels
between ordinary crises and traumatic ones will help us to better understand the
structure of the trauma. Feelings we have experienced will also help us to get closer
to the person in deep psychological crisis. This is the key to an empathetic attitude,
which is crucial to the helpers work.

Some Situations of Daily Life Crises

The death of a spouse is one of the most severe forms of loss. The unexpected loss
of a spouse ruins usual, day-to-day life. The point is not only that the widow/er faces
solitude, but also numerous resulting problems. He/she must give up the mutual
tasks and plans the couple was intending to fulfil. This death may also have financial
consequences. Moreover, he/she perceived him/herself as his/her wife/husband.
Friends and neighbours also perceived him/her as half of the whole. The widow/er
has, in fact, lost an extended part of his/her ego.

In armed conflicts, many people lose family members, friends, and relatives with
which they had very close relationships. Many also lose their homes that they built,
decorated, and for which they cared. They invested their love and energy into their
homes and were proud of them. The house was a part of their ego. As in the case of
every loss, the more significant and valuable the thing is, and the more sudden and
unexpected the loss was, the more painful it can be.

If an event develops slowly, we have time to realise that it is inevitable and can do
something about it or prepare ourselves for the loss. If an event develops rapidly or
happens unexpectedly, we have little or no time to control the situation. An
unexpected loss is perceived as an event that is beyond our control.

An example of an event beyond our control is when one is fired from a job. Such an
event shakes our self-image of a competent, good employee. Being fired deprives
one of the resources that were used to support self-confidence. We find ourselves in
trouble and facing an uncertain future. Will I be able to find a new job? How will
19

my family react? Will they pity me or criticise me? Suddenly, we move from a
structured world to an undetermined one. Our everyday habits and agenda become
senseless. In this case, we face not only an event beyond our control, but also loss
and humiliation. We also face two more characteristic features of a crisis an
undetermined future and a sudden distortion of our regular lifestyle.

Most of Georgian society faces a similar crisis situation now. The 300,000 IDPs are
among the most vulnerable. They have not only lost their jobs, houses, property, and
relatives, but most of them have had to start living from scratch in a new
environment. Both the present and the future are undetermined for them. Above all,
the majority of IDPs has faced a real threat of physical harm or elimination.

We face a threat of death not only in cases of cataclysms, but in daily life too, e.g. in
the case of severe diseases or in traffic accidents. In these events, we have to face
the fact that our future is limited and that life is not endless.

We can already sum up the above-mentioned explanations on crisis characteristics.
We face crisis if an event:

provokes intense, prolonged stress;
includes spiritual and/or material loss;
includes a threat of physical harm and/or elimination;
provokes feelings of humiliation and helplessness;
distorts usual self-images;
is beyond our control;
is unexpected;
distorts one's usual lifestyle;
makes our future undetermined and uncertain.

Unexpected, violent, and threatening events, for the sake of simplicity, can be
defined as traumatic. Although the distinction between traumatic stress and non-
traumatic stress is quite relative, trauma implies a sudden, unexpected, massive,
threat to the security of human beings. Traumatic stress goes hand-in-hand with
catastrophes. The horror induced by such events increases with the number of
persons involved. Such events often involve whole communities. The helper who
assists victims of catastrophes also faces an acute emotional experience of his/her
own.

Human beings act on the basis of the perceptions they have of themselves and of the
world. These perceptions are elaborated throughout life and are reflected in their
experiences and are adapted from them. Every human being has his/her own unique
model of the world and of the self. His/her model emphasises his/her personality
and his/her similarity with other people. These basic perceptions or belief systems
are formed in early childhood and, from the very beginning, they serve as a defence
mechanism. Age and life experiences bring certain changes to these perceptions, but
even in adulthood these perceptions are quite strong. That is why they often are
called basic beliefs. These are as follows:

1. Belief in self-immortality.
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2. Belief in a simple structure of the world. (The world is well-organised,
understandable and just.)
3. Belief in self-innocence.

Traumatic stress ruins these basic perceptions. It changes, unexpectedly, the usual
models of the world and the self.

Basic Beliefs

1. Belief in immortality

Although almost everyday we hear about car accidents, murders, cancer, AIDS, etc.,
we believe that these things will never happen to us. This belief protects us from fear
and anxiety and reinforces our feeling of safety. It is difficult for us to imagine that
one day we will die. Once a traumatic event happens, we face a difficult reality. We
are faced with a real threat of physical destruction. Yet we do not want to accept
this reality. It is difficult for us to acknowledge this fact as it entirely changes our
perception of reality. The comfortable world suddenly appears chaotic and full of
threats. There is no guarantee of security.

2. Belief in a simple structure of the world

Human beings need to believe that the events happening are understandable,
structured, regulated, and fair. This belief helps human beings to achieve a certain
peace of mind. We believe that we get what we deserve. Traumatic events totally
destroy our world perception: Why did it happen to me? What did I do? How unfair
the world is!

3. Belief in self-innocence

Human beings usually assess themselves quite positively. They believe that they are
strong and are able to do a lot. But when they face a situation that is beyond their
control, they feel unhappy, weak, and helpless. Victims of crises experience
humiliation and shame for what has happened to them and what they could not
avoid.

Thus, trauma is related, as well as daily life crises, to the contradiction between the
reality and our perceptions of the world and the self. It destroys the beliefs that
help us to feel safe and secure. Basic beliefs help us to live without fear and despair.
However, these beliefs also make us more vulnerable to crises.

Traumatic events force human beings to change their usual models of the self and
of the world, which can no longer reflect the existing reality. Traumatic events push
a person into a severe and unmerciful reality, striking such a strong blow on the
self image that a radical re-understanding of the existing situation is needed. It is a
long-lasting and painful process.

Helpers have to identify the distorted part of the self image and the image of the
world. This is the best start for a profound understanding of the IDPs problem. It
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also helps to find ways to support the IDP in his/her quest for new and adequate
models of the self and the world that are consistent with reality.

2.1 Evidence of Traumatic Stress

What happens during a traumatic experience?

It is difficult for the human mind to process the information related to traumatic
experiences. The information is unacceptable and painful. It is not only an
information overload, but an emotional overload as well. Therefore, processing the
information, like in normal times, is not enough to memorise and digest it. Displaced
persons also need to make-up a new model of reality consistent with their traumatic
experience.

The life of any person is comprised of a long chain of events. He/she experiences
these events and learns lessons from them. Each event has its beginning,
continuation, and end. If the event goes through all these stages, no matter how
pleasant or unpleasant it may be, it exhausts itself. The experience we need has been
gathered out of it and the event is left behind. However, there are cases when people
face such a volume of information that they cannot cope with the processing task.

For instance, an overly condensed lecture cannot be digested in a short period.
However, after several days spent thinking about it, the student will manage to
understand it and freely master the information contained in it. A similar
phenomenon happens when there is an overload of information in crisis situations.
In the case of emotional overload, the information processing can also be delayed
and lessons learned later.

People cope with most of their life events and, as a result of processing these events,
they gain useful experiences that strengthens their capacity to deal with the future. In
the case of information and emotional overloads, the processing stage may not
happen at all. However, events are kept in the IDPs memory as a frozen copy of
rough experiences in order to be processed later. The person is reminded of the
existence of these frozen copies through unpleasant recollections and other
evidences of trauma that need to be resolved.

What is traumatic stress?

When traumatic experience remains unacceptable for the beneficiary, the
consciousness gives it out piece by piece, under various forms, but only in
amounts with which the person can cope. The person does not consider them to be
unprocessed parts of his/her past traumatic experience. He/she ascribes them to the
present reality. More precisely, he/she often considers it to be an over-reaction to a
present event for instance, unusual anxiety, panic, tears, sadness, anger, fury, or
rage and tries to establish an explanatory link between these reactions and the
present situation. In most cases, he/she does not succeed and these over-reactions
remain unexplained both for him/herself and others around him/her.
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Involuntary reactions related to the trauma can subside in time and may not attract
the constant attention of the beneficiary. But any accidental stimulus that reminds
the person of the traumatic experience is enough to provoke automatic reactions
related to it again. For instance, headaches start every time the person approaches a
bridge or he/she suddenly turns away and runs from a red car. In these cases,
unprocessed traumatic experiences try to attract the persons attention.

Flashbacks

Sudden, involuntary revivals of traumatic scenes or unwelcome recollections are
known as flashbacks. Flashback is a term used in cinematography to refer to the
insertion of a short retrospective shot in the current action. The traumatic event
comes back to the persons memory even without any external stimulus and he/she
then experiences a feeling similar to the trauma.

Avoidance

By trying to reconcile the traumatic experience with the new reality, IDPs may
actively avoid everything that is associated with their traumatic experience. They
avoid thinking or talking about it (We should not talk about trauma). They also
avoid thinking or talking about situations, moments, and places when or where
traumatic scenes can be remembered.

The IDP may also not recollect significant episodes of traumatic events because the
most painful fragments are left beyond consciousness. Some specialists argue that
this systematic avoidance of reality is a part of the self-defence strategy of the
human mind. This is the so-called prolonged avoidance, which frequently takes such
forms that the persons completely lose memory of the trauma, as if the traumatic
event never happened to them, but to the others.

In daily life it is usually manifested as a loss of interest towards what was valued for
them prior to the traumatic experience. Nothing attracts them any more and they
become alienated from, and indifferent towards, their families, friends, and
colleagues. Avoidance often blunts emotions so much that IDPs lose the ability to
experience strong feelings like love, joy, creative enthusiasm, and spontaneity.

Psychological Absorption

The source of the stress may also absorb all the capacities of the beneficiary. It is
mostly revealed in obsessive recollections and flashbacks. They provoke strong and
painful emotions that are accompanied by fear and feelings of helplessness. These
feelings are revealed both in dreams and nightmares. At the same time, the IDP
experiences sleeping difficulties as traumatised IDPs may involuntarily resist
sleeping in order to avoid difficult scenes in their dreams.

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Hyper-arousal

Another manifestation of traumatic stress is so-called hyper-arousal.
Psychologically, it may be explained by the same mechanisms as avoidance or
absorption.

1. It is as if the IDPs are watching themselves to avoid falling accidentally
under the source of past painful experiences. They do not want to find
themselves again in the hell out of which they managed to escape.
2. Beneficiaries had to be extremely vigilant during the traumatic events in
order to survive and they simply did not shift back to their prior behaviour.

Hyper-arousal requires great effort from IDPs and does not give them the
opportunity to relax or rest. They are constantly tense, as if always ready to confront
both inner and outer threats at any moment.

Risk-taking

Although IDPs consciously avoid clashes with traumatic scenes in their imagination,
the trauma has given a special meaning to their life. The point is that the experienced
feelings were so intense that the traumatic event ultimately equalled their entire life.
They perceive themselves as the ones who have experienced the hardships of life
and have become wiser with this experience. They think that they have already seen
everything in life and, consequently, their future existence does not make any sense.
Their lives are divided into two parts: before and after the traumatic experience.

They often lose the desire to build a new life for example, to think of a career,
marriage, or children. This phenomenon develops mostly in those combatants who
have participated in warfare and have experienced particularly acute and intense
trauma. They perceive regular peaceful life as dull and uninteresting. In order to
fill a deficit of impressions, they often take unjustified risks. For instance, they
recruit themselves as mercenaries in hot spots, work as bodyguards, and may be
reluctant to participate in demilitarisation programmes. They consider themselves
unfit for regular life, perceive themselves as being rejected by everyone and do
not feel needed. Such feelings often lead to the use of alcohol and/or drugs and they
are frequently inclined to violence or suicide. Traumatised IDPs addictions to
alcohol or drugs may also be explained by their desire to suppress tough and
unacceptable experiences.

Anxiety, Depression

As described above, memories of traumatised IDPs have not been processed and,
thus, not been completed. As a result, they perceive their futures as being blocked
and feel neither safe nor secure at present. Fundamental components of traumatic
stress are anxiety and depression. Anxiety is caused by an undetermined present and
an uncertain future while depression is caused by hopelessness.

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Permanent anxiety may arouse the feelings that were experienced during the past
trauma tension and threats and in regular daily situations, it may provoke
reactions of extreme fear and panic. Hopelessness and unpleasant feelings may drive
the person to despair. These forms of reaction to stress are more or less
understandable to us. But traumatic stress, above this, is characterised by the
phenomenon of anger and feelings of shame and guilt that destroy self-dignity.

Anger

Anger arises when we are hurt or perceive ourselves as being offended. In the
majority of cases this is a normal reaction to perceived humiliation and injustice. It
is very difficult to accept a different opinion when you are angry. You wish to hear
only a confirmation both of your thoughts and emotions.

At the same time, anger is a reaction to the threat directed at ones personal safety.
And, indeed, if we analyse the situations when we are annoyed, we realise that
before getting angry we have certainly experienced some threats. These threats
might be meaningless. However, at that particular moment the imaginary threat was
real to us. The nervous system of traumatised persons is very sensitive to
threatening stimuli even if they are irrelevant. This is why frequent outbursts of
anger and fury, which are characteristic of traumatised persons, occur. These
reactions are of great concern among ex-combatants. They complain that at such
moments, they cannot pull themselves together and they do not understand what
is happening to them, though later they do regret what happened.

Aggression

In some cases, anger turns into aggression. Aggression, like anger, may be
considered to be a defence against helplessness and frustration. It may also be
analysed as a projection (transfer) of the pain to the outer world and the discharge of
feelings (fear, humiliation, offence, mockery). Such outbursts give traumatised
persons temporary relief and may protect them from the extreme forms of loss of
control, such as psychotic splitting. Nevertheless, it is very important not to let
anger grow into physical aggression and to prevent IDPs from doing harm both to
themselves and to others.

It often happens that the helper becomes the target of the IDPs aggressive reactions.
Anger might not be directed at the person who appears to be the target of aggression.
Real targets of aggression are primarily those who caused the suffering. IDPs might
also experience anger towards themselves as they could not manage to take
revenge, and as they appeared to be helpless in this situation. They also blame
the authorities, the public security services, and all the others who could have
prevented the traumatic experiences.

Aggression is, therefore, frequently projected at the immediate social environment
of traumatised persons (family members, relatives, friends, colleagues, and even
God).

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Shame and Guilt

As mentioned above, anger may be viewed as a substitute for fear and helplessness.
These emotions have a negative impact on self-esteem. Shame is also caused by
humiliation of the persons dignity. He/she wants to run far away and hide. This
feeling comes with the perception that there is a judge somewhere observing him/her
with despise and disgust. The problem is that the judge is the person him/herself.

Since we consider that we live in a fair world, where human beings always get
what they deserve, part of us considers victims responsible for their suffering. The
feelings of shame that victims experience coincide with their own system of beliefs
in a fair world. Time is needed to change their perceptions and to regain their self-
dignity.

Guilt (the feeling of moral responsibility for the fate of other victims) is particularly
destructive. Displaced persons may experience it because, for instance, during the
evacuation, they could not manage to take care of a relative they left behind. When
feeling guilty, displaced persons desire punishment. The feeling of guilt is a basic
experience in traumatic stress. They start to engage in auto-destructive behaviour.
They are stuck in the past, they do not look forward to anything, and they even
consider that they do not deserve to be alive.

Guilt feelings may arise in the following cases:

1. Self-blame for imaginary faults: For instance, an IDP considers that he/she is
the one to blame for the death of his/her relative because he/she cursed
him/her before the disaster.

2. Self-blame for non-action: Undoubtedly, in any situation, the IDPs may
discover that they might have avoided the disaster if they had done
something else: If only I did not hurry..., If I had only paid proper
attention to it, If I had not allowed him/her to go out ...

3. Self-blame for being alive when the other is dead: i.e. survivors guilt or
the syndrome of concentration camp prisoners.

To sum-up, the trauma is caused by a sudden, unexpected, massive, and inevitable
threat to personal security, and provokes intense fear, feelings of helplessness, and
horror. Traumatic stress happens when traumatic experiences are not processed.
Evidences of traumatic stress include:

Repetitious, obsessive recollections and flashbacks;
Involuntary automatic reactions and reactions to accidental stimulus that
reminds one of traumatic events;
Recurrent nightmares related to the trauma;
Hyper-arousal;
Anger and aggressive behaviour;
Anxiety and depression;
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Feelings of shame and guilt;
Addiction to alcohol and/or drugs;
Active avoidance of thoughts, feelings, conversations on trauma, places, and
actions that are related to the trauma;
Active avoidance of stimuli that remind them of the trauma;
Forgetting important episodes of traumatic events;
Loss of interest towards everything that existed earlier;
Alienation and indifference to their human environment;
Loss of the ability to experience strong feelings;
Insomnia;
Loss of desire to build a future.

2.1.1 The Trauma of IDP Children

Two types of trauma can be distinguished:

1. The trauma based on direct and personal experience during bombing,
captivity, and loss of a family member, i.e. the trauma caused by the direct
witnessing of traumatic events.
2. The trauma they share with the whole population or societal trauma
inherited by the younger generation.

Children who left the conflict zone before the hostilities, as well as those who were
born in displaced families after the forced displacement, have avoided the first type
of traumatic experience. However, they suffer from societal trauma. Stories of
forced displacement, unprocessed grief, unspoken and unexpressed aggression,
feelings of shame all of this heritage lies as a heavy burden on their shoulders.

In collective centres for displaced persons, the stories of war and defeat, persecution
stories, and stories of forced migrations are constantly exchanged. IDPs are nostalgic
about the pre-displacement period, dissatisfied with the unsettled present, and
anxious about the future. A new folklore (songs and poems based on traumatic
events of the war) may appear. Children absorb this atmosphere with their mothers
milk from a very early age.

This is part of a song written by an IDP from Abkhazia:

We are refugees, let the whole world know about it,
We have come from Abkhasia, tortured,
Humiliated, we have found shelter here...

Children often adopt a victim attitude and develop an image. The image transforms
itself into intolerance to the outsider (other opinions, other persons).

If not addressed, victimisation and the enemy image may be later revealed in
two alternative ways of vicious development:

1. Identification with an aggressor; revengeful and aggressive tendencies,
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2. Identification with a victim: passive life position; running away from
responsibility; and searching for a rescuer.

Children, who have witnessed traumatic events, have similar psychological
problems, but they are more acute. Their psychological state is even more severe.
There are several indicators that can predict these developments in a child:

Feelings of insecurity and helplessness

The child feels that he/she is in no position to change his/her life or to control his/her
existence. If the helper talks to him/her about the future, the answer usually is:
What can we do, we have been expelled, we are chased. The child perceives the
world as a source of unpredictable, dangerous events.

During discussion on the topic of What depends on human beings and what does
not? children, as a rule, would defend the view that nothing depends on a human
being. You live, you do no harm to anybody and suddenly the war starts, or an
earthquake strikes, and everything is ruined... If asked: What would you like to
become and why, children would frequently express the desire to become an
invisible creature, a fly, or even a smaller creature. Their motivation is that in that
case you are left alone, you can go and stay where you want (even to your own
home) and nobody will notice you or hurt you.

Anxiety about the future, expectations of the worst, fear of change

The above-mentioned feelings of insecurity are closely associated with an anxious
and suspicious attitude towards the future and a systematic expectation that only the
worst will happen. For instance, being asked to draw on the topic The Earth after
five centuries children represented World Wars, Star Wars, injured and evil
civilisations, and death.

Particularly significant was the drawing of a 16-year old boy, The Earth in a
Garbage Can. The drawing shows the boys view of our future: life will worsen and
the planet will finally find itself in a garbage can.

Expectations for the worst will make the child reluctant to any change. When the
helper is suggesting any new activity, the childrens first reaction is often to refuse.
They do not accept new games and want to repeat a previous one to which they are
already accustomed.

Shame, low self-esteem, feelings of guilt

Along with the feelings of helplessness and distrust of the world, children develop
low self-esteem, and feelings of shame. These reactions are completely natural if I
am helpless, if nothing depends on me, then I am nobody. Childrens low self-
esteem is revealed in the fear of expressing themselves and in the difficulty of
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engaging themselves in an activity in which they express their individuality. Usually
the first opinion or the first drawing is repeated by the rest of the group.

Case study

In Georgia, the word IDP itself, which implies an exile from the homeland,
material dependency, and being differentiated from the rest of the society, is
traumatising. Children often speak about it at rehabilitation sessions. For
instance, at one of the sessions they were asked to name the characteristics
they value in themselves and those they do not like. Under negative
characteristics, they referred to themselves as refugee, expelled, or
chased. This negative image was actually perceived by them as an
integral part of their identity.

Another example: the hero of one story, invented by a group of children, is a
disabled man (without an arm) rejected by the rest of society. They strongly
identify themselves with him and with his vulnerability. Another analysis
would be that children only explain their lives through external factors and,
by doing so, avoid taking responsibility.

Very interesting discussions about guilt took place in one of the adolescents groups.
They suggested that nothing depended on them (or, more generally, on human
beings). Yet, at the same time, they considered displacement to be a punishment of
God. However, if it is a punishment, it should be as a result of misdeeds. In this
case, guilt feelings can be interpreted as a defence mechanism to decrease anxiety:
being guilty proves that something also depends on me, and therefore, I am not so
helpless and, in the future, I will behave in another way and will be able to avoid the
disaster.

Anger, aggressiveness

Basic needs of security, safety, and self-dignity are frustrated in traumatised
children. The frustration provokes a reactive anger and possibly some cases of direct
aggression. At the same time, children know that there is someone who is guilty for
their misfortunes. But this aggressor be it the confronting party or the government
is at an unreachable distance from them and not available for discharge or
aggression. This enemy image may be compared with an empty frame that floats
around and can fix itself on the first available object. The easiest target among
surrounding persons is the other, the different one. It is then not a surprise that
children reveal a negative attitude towards different opinions, activities, viewpoints,
and personality styles. During the first stages of rehabilitation sessions, for instance,
the rest of the group immediately ridicules any different behaviour. Acceptance of
the other is an important element of success for the rehabilitation process.

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Intolerant attitudes towards others are sometimes revealed in conflicts with the
host populations children. Our experience shows that these conflicts are frequent in
schools where displaced children and local children are isolated from one another
(by studying in several turns, for instance). The pretext for these conflicts is, usually,
insignificant. However the above-mentioned mechanism of replacement of the
enemy image could explain it.

Alienation from the social environment

The floating enemy image might fit, not only the person, but also the entire
social and even physical environment. Displaced children did not choose to live in
collective centres, which are usually not properly maintained. Children have careless
attitudes towards their living environments. In Georgia, for instance, the displaced
population is characterised by high standards of hygiene and clean habits. Private
rooms are clean but common premises (nobodys place) are presented as objects
for destruction and garbage, and, seemingly, for the discharge of aggression.

Case study

In Georgia, alienation from their physical environment is revealed also in the
fact that in spite of a long period of residing in Tbilisi (more than 6 years),
children do not know the city or its suburbs. Moreover, when excursions and
sightseeing tours were organised, children considered them dangerous,
showed obvious signs of anxiety, and were reluctant to join.

When living in collective centres not far from the local population, displaced
children often play separately and do not enter into relationships with the locals.
There are also certain para-autistic tendencies that can be identified in the childrens
drawings. Free topics represent nature, plants, birds, flowers, or houses, but no
humans. Thematic drawings, such as My Family, frequently show an empty
interior of the childs home. Some drawings reveal helplessness as the following:
Thoughts of the Leaves in Autumn: Look, one leaf told the other, people below
us are sweeping the ground and soon they will gather our friends and throw them
into the garbage. They might burn them. That is the way people are.

Unprocessed grief

Sadness is a characteristic of trauma. Any trauma, as previously mentioned, is
associated with the feeling of loss the loss of a beloved relative or friend, the loss
of self-perception, the loss of hope in the future, etc. But being able to express it
reduces the grief. However, most often the trauma prevents the IDP from expressing
his/her losses and difficult experiences. The child is even in a more difficult
position, as his/her thinking and speech abilities are not developed enough to
articulate experiences. Frequently, the only means of expression they rely on is
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crying. Adults may resent this habit and oppose it, for instance by saying: You are
already grown-up and you should not cry, You are a brave girl, etc. Then there
are only two ways left for children either to emotionally isolate themselves or
protest by anger or aggression.

Immediately after displacement, IDPs face severe material problems and have no
time to mourn their dead relatives or the material losses they have experienced.
Although IDPs folklore may include mourning elements, their intensity does not
correspond to the degree of trauma. The unprocessed grief of IDPs is especially
acute with children and adolescents.

Four stages of mourning can be distinguished:

1. Denial: The traumatised person does not accept the objective reality as it is.
2. Protest: He/she attempts to revert the new reality.
3. Despair: He/she expresses nostalgia for the pre-traumatic past, reviews
his/her experiences, points at the mistakes he/she or others have done.
4. Coping: He/she slowly accepts the new reality and decides to establish new
social links.

Case story

During four years of work with Georgian IDPs, the authors witnessed these
four stages. When the project started, each session was ended by the IDPs
farewell, probably, we will not meet again, as they strongly believed they
would return home in a months time. They denied reality and did not
confess, even to themselves, that return in this period of time was an
unattainable dream.

Last year, in the collective centres where second-time displaced IDPs lived,
the authors witnessed strong reactions of protest like the damaging of cars
of humanitarian organisations, burning the goods brought in by NGOs, etc.

Today it is already possible to meet families that have reached the coping
stage they are employed, have bought apartments, and are engaged in a
new social network. However, the majority of IDPs are still blocked in the
stage of despair (nostalgia for the past, strong desire to return, searching for
those who have caused their suffering).

Post-Traumatic Games

Traumatic games differ significantly from a regular imitation game in the following:

1. They are accompanied not by joy, but by fear;
2. They do not include improvisation or roles, but rituals;
3. They do not serve childrens development;
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4. They are repeated endlessly, with obsession; and
5. They may possibly alter into traumatic activity for new victims.

Traumatic games are contagious. The child brings his/her game into a group where
other children pick it up and absorb the traumatic experience contained in this game.

Case story

Kindergarten and elementary school teachers in Georgia reported that
displaced children played war games all the time. It is obvious that these war
games were not the usual imitations all children play at this age. They looked
like real events. Adults forced them to stop as it reminded them of the past,
which was not really a good solution. Prohibiting the games could not help
the situation. The games were a signal that the children had psychological
problems and needed special psychological assistance.

Another traumatic game they played repeatedly was the re-burial of dead
birds, rats, cats, and dogs. They would take them from one grave to another.
Two children playing this game had crossed the Svanetia Mountains when
they fled their native place. During the displacement some people died of
hunger and of cold. Relatives buried them wherever they could, in the
ditches along the road, hoping to re-bury them later in their native land.
Witnessing this episode by children provoked such games.

Repetitious Actions

Extreme reactions to the traumatic event will be repeated over and over. Anxiety and
panic reactions take place during the distribution of humanitarian aid among
displaced persons, for instance. They are afraid that they will not get the products
and want more, even if not necessary. They are afraid that they will not get enough,
as was the case during their displacement. Such a panic reaction can be explained by
the poverty these IDPs experienced during the first stage of their forced
displacement. These recurrent reactions can be witnessed among children, as well
during the distribution of newspapers and journals. As the trauma might be
experienced in the period when the child was not yet able to speak, behaviour is
often the only way children express it.
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Case story

In Georgia, pre-school displaced children in collective centres ran away to
find shelter and hide (under the staircase, in the corners, in the basements)
whenever they saw strangers. Their hyper-activity and the repetitions of
impulsive actions were also striking and it was rather difficult to introduce
some kind of order in the groups.

Deformation of the world picture

Trauma distorts the picture the person has of the world. Children, whose self-system
is not yet established, face the danger that their beliefs will be malformed under the
traumatic influence. The world is likely to be perceived as a source of hostile events
with children as victims. Such a misconception deprives them of real choice. If it is
not addressed, it will turn against the person him/herself and the society. Several
types of vicious behaviour may emerge from it:

1. destructive tendencies/revenge or
2. passive life position/avoidance of reality (neurosis, medication-dependence
etc.).

Problems of attention, memory, learning

Unprocessed traumatic experience tends to actualise itself constantly: that is to
reappear at each moment of daily life. The child would spend a lot of energy
resisting this tendency and mastering these painful emotions. It affects his/her
cognitive activity (memory, concentration capacity and, consequently, thinking).

Various types of fear

Fear is a common feeling as it plays an important defence role. In the process of
development the child or adolescent experiences various so-called normal fears.
For instance, fear of independence (which reveals itself in adolescents) helps the
IDP to join social networks, etc. Each of these fears, if overcome and digested,
serves as a basis for moving to a new stage of development.

Traumatic fears differ from the above-described ones, as they are more intense,
more long term, and destructive. Displaced children are characterised by fears that
they have inherited from their parents. A four-year old boy would run away
frightfully when he sees a stranger. He starts crying desperately every time he meets
a person he does not know. In his picture of the world, the image of a stranger and
the concept of threat are tightly associated due to the trauma he experienced.

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Sleeping Difficulties

Traumatic dreams are one of the signs of unprocessed traumatic experience. They
differ by the degree of precise reflection of the traumatic event. Dreams can show
exactly what happened or show the trauma under a veil. They provoke strong
emotions. The child might cry, shout, jump, or walk. Frequently, he/she is not able
to recollect in the morning what he/she was dreaming at night. Non-traumatised
children may also have nightmares. However, for traumatised children, nightmares
are recurrent and last longer.

Case story

With IDP children, we organised special sessions on dreams in a safe
atmosphere. Children had the opportunity to talk about the dreams that
bothered them. The majority of children between 7 and 12 years told horrible
dreams. One childs story was interrupted by his brother: It is not a dream, it
happened in reality. He is lying.

Psychosomatic Disorders

Rehabilitation should focus on the trauma rather than on the symptoms of
psychosomatic disorders. Children with these disorders need individual
psychotherapy, apart from group rehabilitation sessions. Family counselling can also
play an important role, as family members who understand the essence of
psychosomatic disorders will assist children to overcome them.

Therefore, the indicators that can predict the psychological state of a child are as
follows:

Feelings of insecurity and helplessness;
Anxiety about the future, expectations of the worst, fear of change;
Shame, low self-esteem, feelings of guilt;
Anger, aggressiveness;
Alienation from the social environment;
Unprocessed grief;
Post-traumatic games;
Repetitious actions;
Deformation of the world picture;
Problems of attention, memory, learning;
Various types of fear;
Sleeping difficulties; and
Psychosomatic disorders.
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2.1.2 The Trauma of Adult IDPs

Forced migration can be compared with a plant pulled out and transplanted
elsewhere. The plant may perish, but might instead grow roots. Forced migration
ruins the life of the person. He/she deeply suffers from the departure from his/her
usual climate and cultural and social environment and from everything that has
fed his/her existence and active life.

In psychology, this phenomenon is known as the fear of identity loss and it is one
of the characteristic features of crises. It happens when there is a threat to the
process of identification and belonging to ones immediate social environment. For
example, an IDP finds him/herself in another socio-cultural environment where the
language, traditions, values, and life norms are alien to him/her. Similar feelings
are felt by the IDPs even if they voluntarily emigrated to this new environment.

Helpers should understand to what degree the ordinary lifestyle of displaced persons
is ruined and what is his/her present social environment. In other words, the one we
assist is not an isolated beneficiary. He/she is part of a community and the social
micro- and macro-environment where he/she has to coexist with other IDPs. That is
why it is absolutely necessary to know the IDPs environment, what air he/she is
breathing in, what circumstances may help him/her to overcome a crisis, or what are
the obstacles.

There are two categories of internally displaced persons:

1. The majority of them are in so-called collective centres and live together, in
communities, and share a common fate;
2. The second category has found shelter at their relatives or friends places
and they are disseminated in large cities or city-type villages.

In spite of the fact that both categories of displaced people passed through similar
traumatised events and forced deportation, their social psychological portrait is
characterised by a number of peculiarities.

Victimisation

Another phenomenon that contributes to the formation of a traumatised society is the
feeling of victimisation. From the very beginning we should distinguish between
two types of victims. One type is an IDP who experienced trauma, but who is not
using it for his/her own benefit. The second type is the IDP who uses his/her
traumatic experience for some gain. In some cases, it is not necessary at all to
experience trauma to play the role of a victim. The second type of IDPs try to
represent the trauma. And they consider the environment obliged to sympathise,
assist, and pity them. Victimisation is accompanied by such negative features as
dependence, irresponsibility, and passiveness.

Hard social and material conditions force IDPs to take the position of a victim. In
the IDP population, the phenomenon of victimisation is very frequent. During one
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group session the leading psychologist shared with the group her anxiety about the
upcoming exam she had to pass. Group members (IDPs) gave her some friendly
advice: Tell them that you are an IDP and they will give you a good mark. As
another example, during one regular rehabilitation session we asked the group
members to give examples of effective communication from their experiences. The
majority of them brought up manipulation through their victimisation as examples of
their success.

Rescuer

Victimisation is also supported by the society that takes on the role of a rescuer.
Frequently, the victims themselves ascribe the role of rescuer to their social
environment and seek help from it. The role of rescuer is played by state
structures, the victims immediate environment, and humanitarian organisations that
were assisting the IDPs during the disaster. However, even here we should
distinguish sincere assistance from assistance that is carried out by a rescuer who
is trying to extract a definite profit or benefit from it. Such a rescuer is interested
not in actually helping, but in being recognised as being a responsive and kind-
hearted beneficiary, so that he/she can be proud of him/herself. He/She is providing
help even when nobody asks him/her to do so he/she will never teach other IDPs
how to fish and will never give them fishing rods. He/She prefers to get a fish
for the other in order that the latter remains dependent on him/her for as long as
possible.

Such a rescuer might be turned into a persecutor, especially when he/she is
attempting to assist the other regardless of any circumstances, even against the
other's will. In such a case they can also find themselves in the position of a
victim I am doing kind deeds but he/she does not see it. What ingratitude! It is
not rare that such a rescuer is an ex-victim him/herself when he/she is not
able to assist him/herself, he/she starts assisting the others. But it is only possible to
help after you have helped yourself. All three roles victim, rescuer, and
persecutor are tightly interwoven and if an IDP fits him/herself in one of them,
he/she can easily move to other positions, but only in the frame of this role triangle.
The exit of this vicious triangle, both for the victim and the helper, is one of the
basic tasks of psychosocial rehabilitation.

Isolation and the feeling of non-resemblance in IDPs also weakens the feeling of
their belonging to the society, in spite of the fact that a new social environment
(local population) is related to them both by language and basic spiritual values. In
this context, on the one hand, the position of a victim is presented as a symbol of a
new value, it might even be called the symbol of new identity and it becomes
utilised, i.e. secondary gain is sought. In this first case, destructive behaviour
stereotypes and passive life positions are formed. On the other hand, victimisation is
the symbol of opposition to new values that stem from the alien culture. In this
case an enemy image is formed, but at that moment the confronting party is a new
social environment, i.e. the local population. In this second case, spots of constant
tension and conflicts between the IDPs and the local population are formed which,
in turn, fuel tendencies of revenge and contribute to the spirit of intolerance. Both
mechanisms strengthen the process of victimisation of the society, form the enemy
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image in IDP consciousness, and, in a way, determine the formation of the
traumatised society.

Enemy Image

Enemy image, as well as victimisation, is a phenomenon characteristic of
traumatic stress. The feeling of victimisation is always accompanied by both the
search for a rescuer and the unmasking of an aggressive persecutor. The
unjustly repressed searches for the guilty one in his/her misfortune and
involuntarily is creating the enemy image. If during the traumatic incident
enemy features were ascribed only to real adversaries, then when the guilty is
far away, the phenomenon is generalised and is transferred to the immediate social
environment, i.e. to those who are to blame for their present worries.

We would like to clarify from the very beginning: enemy image is not a real
adversary or enemy with a human face. Enemy image is a created perception and
is an exaggerated and distorted image to which all evil is ascribed. The enemy
image is evil, faceless, ominous, alien, and dangerous. We will not discuss here in-
depth mechanisms that lie at the basis of the formation of this phenomenon.
However, we would like to emphasise that the process of enemy image formation
is always preceded by feelings of isolation and non-resemblance to others and with
the dehumanisation of the enemy, i.e. prescribing to him/her inhuman qualities.
Within isolated and densely populated communities where group values prevail, the
formation and strengthening of enemy image is particularly easy.

Loser in War

The phenomenon of a loser in war contributes to the formation of enemy image,
victimisation, and intolerance within the displaced population. This phenomenon
is particularly revealed among men. The feeling of infringed dignity and the feeling
of the inability to reflect the enemys actions and provide security for the family
arouse painful feelings of helplessness, self-humiliation, and unrealised aggression,
which lay the foundation for the formation of tendencies for revenge. Many of them
avoid useful activities. They consider that they should not waste time on details, but
should serve higher ideals for example, victory over the enemy and return to
the homeland. This disposition forms in them a passive life position and restricts
social activity, which, in turn, lowers even further their already low social status.

The phenomenon of the loser/defeated in war decreases the status of men not only
in their own eyes, but in the eyes of the social environment as well. For example, in
theatre sketches staged by children, the active role of head of the family is
prescribed to the mother while the father and is represented as a passive man,
spending all his/her time in wasted talks and toasts. In childrens drawings, the
figures of mothers are strong and big, while those of fathers are small and in dark
colours. This mixing of stereotypical roles is consistent with reality women are
more active socially. Many of them are engaged in small businesses and in
rehabilitation activities.

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2.1.3 The Trauma of IDPs in Collective Centres

IDPs residing in collective centres may not have their basic living needs fulfilled.
However, they live together, shoulder to shoulder, share lifes difficulties, and try to
preserve traditions and usual social norms, language, and culture. As a consequence,
they fear an identity loss to a lesser degree than those living in private
accommodations. Those IDPs living in private accommodations require strong
support from the helpers side as a basis for any community-oriented rehabilitation.

However, living in centres also has its negative side, which can be the basis for the
further development of traumatic stress. Displaced persons sharing a similar history
and a common fate develop the feeling of non-similarity with others. One can call it
pride, as they do not believe in the capacity of the outside world to understand their
plight. On the other hand, they feel isolated and alienated from society.

The point is that in society there exists the myth according to which a victim
arouses, first of all, sympathy. However, in fact the attitude towards the victim, as
was mentioned above, is frequently diluted with covert aggression. This attitude is
based on the basic belief in the just world, that we get what we deserve: if you
have lost your property, you should not have been a scatter-brain. People
involuntary run away from the victims, as if they are afraid to be infected with
their misfortune. There are examples when parents give their children instructions
not to play with traumatised children or to share a school-desk with them. Centres of
refugees or IDP settlements are perceived by the rest of the society as reservations,
which emphasises their isolation even more.

2.1.4 The Trauma of Privately Accommodated IDPs

This category of displaced persons is characterised by the same psychosocial
problems mentioned above. Some of these problems are manifested to a greater or
lesser degree. For instance, IDPs who live in urban areas and are supported by
relatives and friends are in better material conditions; they have better possibilities
for using the benefits of urban life; and they experience feelings of isolation from
the society to a lesser degree. But it is far more difficult for them to manage severe
trauma and overcome psychological crisis as they lack the support of brothers in
misfortune. Fears of solitude and identity loss are expressed more strongly among
them. This category of IDPs faces a difficult choice: either they should reject their
habits, traditions, and social norms and assimilate into an alien culture with alien
values or preserve their originality and find their own niches in order to gain new
self-confirmation in the society.

Being dispersed in cities, IDPs more acutely experience the problems of adaptation.
They must adapt to the social requirements of the alien culture. In this sense,
adaptation is especially difficult for those IDPs that have moved from rural areas to
urban ones. They experience the so-called stress of a big city, which further
aggravates their psychological crisis.

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The above mentioned psychosocial specificity, obviously, does not reflect all the
nuances of the factors that are functioning in the displaced population, but they give
a general impression of these essential phenomena, which need to be considered in
order to direct effectively our actions.

2.2 Coping with Crisis

There are numerous forms of coping with crisis. Each person has his/her own style
to overcome difficulties and to fight psychological pain. However, all these forms
can be reduced to the following three:

1. Denial;
2. Palliative (half-measures); and
3. Problem-focused.

To be aware of the forms of reaction to trauma is very important both for the
traumatised IDPs and helpers.

Denial

In trying to overcome severe psychological crises, human beings, in the majority of
cases, tend to use ineffective measures. One of them is the denial of problems.
Human beings are often very strict with themselves. When someone else a friend
or relative is experiencing crisis, the IDP easily puts him/herself in his/her shoes,
understands his/her state, and tries to explain that such a reaction is quite natural.
But when it comes to his/her own experiences, he/she tries to conceal the feelings
and tries to behave as if nothing happened. Behind such behaviour is the fear that the
surrounding IDPs will get tired and bored and change their opinions in a negative
direction if he/she is not strong enough. It is certainly wrong to draw conclusions on
the IDPs weakness by his/her reaction to crisis. That is why it is necessary from
time to time for helpers to remind victims that emotional reactions during
psychological crises are normal and obvious.

A more frequent form of coping is to take the desirable for reality. If only this did
not happen... or If it were... The person deepens in endless fantasies about what
could have happened if... Such half-measures can reduce, for a period of time, the
pain caused by reality, but they are not enough to cope or to eventually reduce the
ability to actively cope. Sooner or later, reality returns and the IDP becomes aware
that he/she has not advanced at all in understanding the genuine essence of the
events the future has already come and time that should have been spent finding
new ways of influencing the situation has been wasted.

Frequently, the person tries to forget the trauma he/she has experienced, to run away
from the problems, to hide them somewhere far away in the attic and to lock
them away there. He/she does not want, and is not able, to throw them away, as it is
his/her past and part of his/her life.

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Palliative

Avoidance is an involuntary reaction to the trauma and it is accompanied by
emotional non-involvement. In a definite period of psychological crisis, half-
measures, such as avoidance, play a positive role and help the person to feel as if in
safety. But if it becomes the only strategy for overcoming crisis, it causes new
problems because the avoidance of feelings and permanent control can block an
important and valuable source of information and can hinder coping.

Problem-Focused

Another ineffective means of coping with crisis is the use of alcohol, medications,
and drugs. Many in crisis tend to use alcohol, strong-affecting medication, drink
coffee in enormous amounts, or to smoke. All these substances strongly affect the
biochemistry of emotions and create problems. For example, the frequent use of
caffeine increases anxiety. Alcohol in large quantities is accompanied by a loss of
control. Even more dangerous, a passion for these substances can form dependency
and abuse, which negatively affects the severe psychological state. Medication can
play a positive role for only a short period of time it can, for example, help
sleeping disorders for a while but their long-term use, instead of applying effective
means of coping, is inadmissible.

Effective ways of coping with crisis are based on active, problem-focused efforts.
These means are rather diverse as the range of difficulties requiring resolution is
very wide. It is important for a person to set the frame within which it is possible to
change events. There are no guarantees here: the only thing that can be said is that a
human being never achieves anything if he/she does not take definitive steps in
setting the frame. When a person does not believe in his/her own effectiveness, it is
the biggest obstacle for resolving problems, as he/she does not try to change the
situation. Many in deep crisis search for ways of growing and try to enrich their
experiences with new skills and knowledge.
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Chapter 3
PSYCHOSOCIAL REHABILITATION OF IDP
CHILDREN: INTERVENTION METHODOLOGY

The psychosocial rehabilitation of IDP children aims at overcoming their traumatic
experiences, victimisation, and enemy image, as well as contributing to their
personal development and growth by mobilising their inner coping resources and
those of their environment (parents, family, school/teachers, kindergarten, entire
community).

The following negative factors should also be taken into account when planning the
assistance:

chronic emotional blockage;
conflict in the family or immediate surroundings;
the absence of a parental role model;
a non-supportive environment; and
the absence of opportunities to practice his/her skills.

However, a comprehensive approach focusing on resources within and around the
child can help him/her to digest traumatic experiences, develop skills, clarify vitally
important values, beliefs, and objectives, and can contribute to freeing his/her
personality from aggressive impulses.

3.1 Levels of intervention

Intervention should target all levels of the childs functioning:

Behaviour and skills

Activities at this level aim at eliminating of non-constructive behavioural
stereotypes (e.g. victim-aggressor), the enrichment of behaviour through co-
operative patterns, and the formation of skills required for consistent action. The
latter objective can be achieved through the involvement of children in structured
team activities. It is also important to foster the development of skills for effective
communication, conflict management, creativity, and self-expression.

Emotions

The most important tasks in this area are to help children to act out their traumatic
experiences, to sob out their grief, to free themselves from aggression through its
41

expression, and to overcome inner constraints to better recognise, understand, and
express emotions.

Cognitive functions

At this level, the work should be carried out in two directions:

1. The development of the cognitive functions blocked by traumatic
experiences: after appropriate action, the child should be able to concentrate,
to use actively his/her memory, and to think creatively. The latter is
especially important as it gives children the ability to view situations from
different angles.

2. The correction of the perception of the world and of the self: the child should
be able to view the environment as containing the potential for personal
growth, rather than as something hostile. The child should also be aware of
his/her freedom of choice and have a responsible view of his/her life within
the community.

Attitudes and the belief system

It is very important for children to be aware of universal human values such as those
enshrined in international human rights instruments, but also of love, friendship,
forgiveness, and tolerance, and to have a caring attitude towards their own family
and social environment.

Self and personal identity

The helper should create a safe atmosphere in order to foster childrens expression,
self-awareness, and self-esteem. It is very important for children to be aware and to
accept their personalities, and to understand that they are unique individuals with
free will and potential.

3.2 Basic Intervention Techniques

This section contains several basic tools (drawing, games, creative thinking, etc.) for
the psychosocial rehabilitation of children. Each exercise will be connected to the
framework described above.

3.2.1 Play

Play represents one of the major components of psychosocial rehabilitation for
children. As a basic form of human behaviour, playing is able to create a positive
impact, especially through games since they structure childrens activity and develop
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their self-management skills and their understanding of their own limitations. Games
foster responsibility, leadership, and, most importantly, promote spontaneous
happiness, and mutual trust. They aim at encouraging the spontaneous interaction of
participants through structured activities.

Games can be played in pairs, in small groups (3-4 children), and in large groups.
Apart from verbal explanation, the helper should also demonstrate to children part of
the game. Even though he/she can get involved in the game whenever he/she finds it
necessary, he/she basically acts as an observer.

Below is a quick typology of games:

Information gap

A possesses some information unknown to B. B has to guess what
this information is. The games can be one-sided or two-sided or played in
a large group. Participants possess a certain part of information and must
compare it with the partner's information to solve a common problem.

For instance, the facilitator puts his/her hand into a bag with different
items and describes the thing that he/she chose. Participants have to
identify his/her choice. This exercise is good for team building purposes.

Another example: A man with a parachute walks in a field and dies
Participants ask questions to guess what has happened. The leader
answers the questions only by saying Yes or No. Such a game helps to
stimulate non-standard thinking.

Another example: Each participant of the group has a piece of
information he/she has to share with others in order to get the full
picture of an event.

Guiding

The group helps one of the participants to solve a difficult task. This
fosters a team feeling and mutual help. For instance, a participant draws
on the blackboard or a piece of paper with closed eyes. The group tells
him/her what and how to draw the picture (be it a landscape or a
geometrical figure).

Exchange

The game is based on the barter principle. All participants have something
to exchange with others (ideas, pictures, articles, drawings, etc.). The
aim is to satisfy both sides.

Example: Each participant writes his/her name on four pieces of paper in
4 different ways, like Nati, Itan, Tani, Anit (Tina). These pieces of paper
are put in a common bag and mixed together. Then each participant takes
4 pieces out of the bag. When introducing themselves to each other,
participants have to exchange their pieces of paper. The goal is to find
the 4 pieces containing the parts of one's own name.
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Puzzles

Participants exchange and compare different segments to make a full
picture. The games of this type are crosswords, charades, etc. It is useful
to develop the ability to concentrate and think creatively.

Role playing (simulation)

In these games participants identify scenarios, select roles, and play
them. According to widely accepted psychological theories, roles do not
develop from a persons self, but the self emerges from the roles.
The essence of psychodrama is the staging of an improvised scene that
gives participants an opportunity to play new, alternative roles in a staged
situation, without taking any risk, and to freely express emotions, wishes,
and thoughts in a psychologically safe environment.

Self-expression helps them to release themselves from strict self-control
or tension, and makes them more flexible and sociable. It actually offers
a wider range of behavioural opportunities and enables them to reach an
optimal pattern of reactions within their community.

For instance, children can practice different types of reactions
aggressive, indecisive, or self-assertive. Shy or aggressive children can
actually try the opposite behaviour: aggressive or shy. It is also a good
way to explore the participants dreams, fears, and imagination, to
introduce positive changes to their emotional state, and to help them to
change a rigid, ineffective behavioural model into a more functional one.
Roles should be selected in correspondence with participants age and
needs and the staged scenes should not amplify their weaknesses
(laziness, aggression, etc.). Each staged situation is later subject to
discussions: how did he/she perform? What did we learn from it? etc.

In some games, one child is appointed as stage director for a play that can
be inspired from his/her dreams, a written scenario, or real life
situations. He/She assigns roles to other children, explains to them what
they have to perform and how, tells them what they should say, and what
postures they should take.

Children can also be asked to react to situations in different ways:
aggressive, indecisive, or self-assertive. At the end of each exercise it is
necessary to discuss the characteristics of each reaction (typical facial
expressions, voice, postures).

Complex themes can also be staged. For instance, the Robinson Crusoe
game: you are a member of a crew whose ship has sunk and you find
yourself on a desert island where you must build a new state.

The range of possible games is very wide and the facilitator can also use
improvisation for rehabilitative purposes.

Energisers

Energisers are used to create a relaxed and trust-based atmosphere at the
beginning of a session, a positive dynamic throughout it, and an optimistic
ending. Sessions lasting more than two hours should be interrupted 2 or 3
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times to mobilise participants and bring in a new flow of energy. Children,
for instance, cannot concentrate for a long time and may get easily tired
when fully participating in a session. Energisers increase children's
working potential and enable them to relax. Energisers should not require
intense intellectual activity and should be entertaining and dynamic.
However, it should be noted that if used more than needed, energisers
might undermine the working atmosphere, which makes it difficult to
bring participants back to the planned activity.

Example: Which direction is the wind blowing? Participants sit in a
circle. The facilitator, who stands on his/her feet answers the
participants question ("Which direction is the wind blowing?") in this way:
It is blowing in the direction of children who are dressed in red (/ who
are laughing, / are tired, / have dark hair, etc...). The children with the
relevant characteristics jump on their feet and exchange their seats. One
is not allowed to go back to one's own seat. The facilitator takes a free
seat. The child, who has been left without a seat becomes facilitator and
continues the game.

Energisers can also be used for team building purposes.

Example: Breaking through the circle. Participants stand in circle,
holding hands. One of the participants tries to break into the circle using
any available means (jump over the circle, break through it using force,
etc). When he/she succeeds, he/she joins the group, and the game
continues with the participant that let in him/her trying to break into the
circle.

Many different games can be used as energisers. They can introduce
diversity into the sessions activity and support team building. Numerous
books have provide catalogues of energisers and this one will not attempt
to duplicate these publications.

Skill and Ability Development

Games can also be aimed at the development of different faculties, skills,
and abilities (attention, memory, speech, imagination, etc.).

Example: Paths. The purpose of the game is to develop co-ordination.
The game is used with pre-school aged children. Using 10 metres of
thread of different colours the facilitator makes paths that interlace with
each other. Each participant has to choose his/her own path and follow
the selected thread up to the end. It is desirable to place paths in a
small space, so that the children can practice more subtle body
movements.

3.2.2 Drawing

Drawing is both an easily accessible and useful method. Drawing satisfies the child's
need for the creative expression of his/her emotions, thoughts, dreams, fears,
conflicts, and trauma, at a symbolic level. It helps children who have problems to
understand their own thoughts and emotions at several levels:

Children can show their emotions in a non-verbal way;
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They can release the inner tension linked to their emotions (to ventilate
emotions);
The drawing can raise his/her self-esteem as a result of the creation and other
childrens approval;
It allows the helper to get a good understanding of the functioning of the
childrens group (tensions, competition, solidarity, roles, etc.);
It strengthens the childrens team. No importance should be paid to the
artistic qualities of the drawing. What is encouraged here is spontaneous
creativity, i.e. the process more than the result. Children have to learn not to
laugh at each other in the case of unsuccessful performance. They have to
learn to see unique qualities in any drawing, no matter how simple it is;
It allows the helper to understand the child's vision of his/her environment,
the childs inner world, attitudes, ideas, desires, and problems. The child is
asked to speak on behalf of one or several items of the drawing (If the
thunder you draw could speak, what would it say?). Spontaneous responses
to this question can convey blocked emotions, later clarified by the helper.
It allows for the correction of the childrens attitudes towards the world. It is
important not to leave the expressed trauma unanswered and to propose
another direction for the attitude of the child, either through another drawing
or through explanation.

Before starting the activity, the facilitator supplies children with all the necessary
material, such as paper, pencils, chalk, etc. Children can draw on a blackboard,
fabric, etc. A drawing can be free or related to some theme. It can be individual,
created in pairs, or by groups of children. The facilitator arranges a space and later
tries to be as inconspicuous as possible. However, he/she observes the process and is
ready to render any necessary assistance. A drawing session can be accompanied by
suitable music.

In general, drawing sessions in groups can either encourage childrens interaction
through the exchange of drawings (Visiting cards, Who I am, What I like/don't
like about myself, How people see me/what I really am, my own emotions,
my own dreams, my feelings expressed by symbols, etc.) or their cooperation on
a joint drawing.

Several types of interaction between children can be fostered:

Assistance/Solidarity: Drawing in pairs with the duty of assisting each other
with complementary roles (one with a blue pen, the other with the red).

Negotiations: Interfering with each other when there is only one pencil
available, for instance.

Contribution to a common project: Drawing in a circle each child
makes a drawing on his/her own piece of paper. On a signal from the
facilitator (bell ring, a clap), he/she passes it on to his/her neighbour. Each
child needs to contribute to the drawing before it comes back to the one who
initiated it. "Group drawing children draw on a large piece of paper in
turns or together. One child starts the activity, which is followed by another
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child, etc, until the whole group participates in the creation of a common
picture or all children have to co-ordinate to draw a joint picture.

Team building can easily be reinforced when children are geared towards a common
goal (to create an emblem for their club, etc.). Live exhibitions and interviews are
often followed by drawing sessions with the artists. Videotaping of these events and
their subsequent viewing can be very stimulating for children. Drawing can also be
linked to other methods like wish-making, poetry, or any piece of literature.
Drawing helps children to express their self and to pay attention to their emotions.
It stimulates creativity and promotes personal growth.

3.2.3 Creative Imagination

Creative imagination is an important element of personality development. Children
with well-developed imaginations are more successful in coping with trauma and in
restructuring trauma in a creative way. They are also better adjusted to their
environment. Imagination can be the subject of training and can be developed.
Exercises in active imagination also enable the helper to study the child's world and
to detect threatening and painful areas. Above all it helps the child to release
him/herself from the grasp of traumatic experiences through the increase of self-
esteem and transformation of given situations.

Exercises of imagination need to be linked with other exercises (drawing, role play,
meditation, etc.). It is preferable to practice the exercises with closed eyes, even
though some children often object to it at the start. They can be allowed to do it with
open eyes. After some time and practice, the group gradually gets used to the
situation and selects the most suitable mode.

Helpers should also take into account that every person has his/her own natural
rhythm. Therefore, the pace of the facilitator can be optimal for some children and
too fast or too slow for others. For this reason, children should be encouraged to
follow their own working pace.

Exercises should be followed by discussions through which children can express
their feelings and thoughts, share their impressions with the facilitator and other
participants, and describe their difficulties during the exercises. A thorough
discussion (reflection) diminishes the risk of leaving children with their painful and
frightening images, which could spontaneously arise in the course of exercises.
When planning a session, the facilitator should take the above into consideration and
allocate enough time for debriefing/reflection. Visualisation should start with
relatively simple, easy exercises, so that children do not lose interest in the tasks.
Exercises can also have an impact on the development of the senses.

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Visual images

Children are asked to close their eyes and imagine the following:

a hand is slowly writing their names on a piece of paper;
a hand is slowly writing a one digit number, followed by a two digit number,
three digit number, etc., until the last distinguishable number. Keep the
figure before your inner vision for 1 or 2 minutes;
a hand is slowly drawing a golden triangle, a blue circle, a rainbow;
a hand is slowly drawing a white rose, which gradually turns red.

The list of objects described can become more complex and include landscapes,
people, and even abstract concepts and events involving the children (I am standing
in a field, I am standing on the top of a mountain, etc.). Situations that are
potentially traumatic for children should be avoided.

Tactile images

Children are asked to imagine that they pat a cat or a dog, that they feel their skin, or
that they touch newly baked bread, a stream of water, a tree, or some sand. To
simplify the exercise, images may first be combined with visual ones, but later the
helper should help children to concentrate on tactile ones only.

Olfactory images

Children are asked to imagine they smell freshly baked bread, wheat-flour, grass,
fire, smoke, and perfume.

Gustatory images

Children are asked to imagine the taste, temperature and consistency of a banana,
walnuts, hot chocolate, or a cake.

Auditory images

Children are asked to close their eyes and to listen to a voice, to his/her name being
said, to the rain, to a creaking door, or to a bell fading away.

Images of body sensations

Children are asked to imagine that they are walking then running along the beach,
they feel the movement of their muscles, they are climbing a tree, chopping wood.
When performing these exercises, children should avoid excessive tension. If there
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is something they cannot manage to do, they should not be too persistent, and should
shift to the next exercise or give up their efforts for a while.

The Mandala can serve as an example of a non-structured exercise that fosters free
imagination. Children lie on the carpet, so that their heads are at the centre of a
circle and their legs on the outer line of the circle (or vice versa). The facilitator
instructs them to close their eyes and to breathe slowly. Children can let themselves
imagine what they wish and then discuss it in a group discussion.

Exercises in active imagination enable us to improve children's emotional state here
and now and has many positive effects that extend beyond the session.

3.2.4 Metaphors

Metaphors (fables, parables, sayings) can be successfully used in psychosocial
rehabilitation for illustrative purposes. Metaphors help children to realise basic
values (friendship, love, and faithfulness), to generalise personal experiences, and to
develop forgiveness and tolerance. They offer models, which can be internalised
during the process of personality development and develops the childrens ability to
conceptualise an empathetic understanding, a caring attitude towards others, and
some strong ethical principles.

When telling metaphorical stories, the facilitator should be aware of the strong
impact that they may have on children. Negative values of old tales (about womens
roles, for instance) and global themes should be repeatedly discussed from different
perspectives in group sessions. The function of the metaphors is to trigger the child's
mental activity. Later, the facilitator should stand by the child and support him/her in
overcoming the painful memories of his/her trauma that he/she might express
through the discussion.

Below is a Chinese tale the helper can use in the sessions.
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Who Knows

Once upon a time there was a peasant who had a pure bred horse. The ruler
of the country, who had a collection of horses, learned about the peasant's
horse and sent someone to buy it. The peasant refused to sell his horse.
Then the ruler approached the peasant with his people, loaded with silver
and gold, but the peasant did not accept the deal. The ruler was quite
amazed and decided to visit the peasant himself. When seeing the horse, he
offered the peasant half of his kingdom in exchange, but the peasant was
firm in his decision. This horse is my friend. How can I sell it? he said.
Other peasants said to him: What a fool you are! How could you give up half
of the kingdom? It will serve you right if you die in misery and poverty. Who
knows, quietly answered the peasant.

One stormy night the horse broke away from the stable and disappeared.
The neighbours told the peasant: What a misfortune! You have nothing
now, no horse, no kingdom. Who knows, was the peasant's answer.

After some time the horse returned and brought a horse-herd with it. The
peasant sold part of the horses and gained quite a lot of money. How clever
you were not to get desperate when you lost the horse! It brought you luck
said the neighbours. Who knows, was the answer.

Once, the peasants only son fell off the horse and broke his leg. The
neighbours approached the peasant again and said - What a misfortune!
Your son became a cripple because of this horse! Who knows what it is,
misfortune or what, was the answer.

Soon a war started and all the young men from the village were taken to the
army, but the peasant's son stayed at home. Mothers of the young people
said to the peasant: Lucky you! Your son is a cripple, but he is, at least,
alive. Who knows, was the peasant's answer

The facilitator may then direct group discussion in different ways:

by emphasising the phenomenon of friendship (between the peasant and his
horse);
by discussing the difference in reality perception (reality viewed by the
peasant and neighbours);
by stressing the phenomenon of two sides of the coin (each event has its
positive and negative aspects);
by showing children that we do not live in a black and white world, but that
there are ups and downs, good and bad;
by showing how difficult it is for people faced with crisis to perceive the
consequences and meaning of this event.
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It is also possible to analyse the image of the wise man and his characteristics, the
themes of life and death, and even ask the participants to write a continuation of the
story. The most important point is to enable children to see their traumatic past
through other people's eyes and to view it from a different perspective, which is a
precondition for the formation of a new attitude towards the past and the
development of a more pro-active position.

3.2.5 Folk Diplomacy

Apart from serving immediate objectives (building peace bridges, establishing
relations with the opposing party, fostering official negotiations), folk diplomacy
meetings are also very important for the purpose of psychosocial rehabilitation.
Every conversation with displaced populations reveals their desire to return to the
homeland. Their involvement in folk diplomacy meetings helps them to feel part of
the process taking place and reinforces their sense of self-esteem and responsibility.

These meetings also help to eliminate the enemy image, the stereotypes of the
opposing side, and over-generalisations that become weaker after establishing direct
human relationships. Their reduction is a necessary step for involving the other side
in peace building, and for ensuring future peaceful coexistence.

In folk diplomacy meetings, people of any age can participate, but in this case, the
focus is on working with the younger generation only.

The first problem is the selection of participants among the children and adolescents.
Since we deal with restricted resources, we should focus on participants with
positive leading characteristics in order for the benefits of the meeting to spread
beyond its limits. They should also be of the same age.

Meetings can take the form of joint workshops in conflict management or
entertaining activities, such as concerts, excursions, or exhibitions. However,
programmes combining these two aspects are the most effective. Children should be
adequately prepared with training on efficient communication and on subjects listed
under 3.3.1. After the meetings, it is important to sustain the links established
between the participants and to conclude the meeting a plan for more exchanges.

3.3 Fields of Psychosocial Rehabilitation for School Age
Children and Adolescents

There are several forms of childrens and adolescents' psychosocial rehabilitation.
They include:

Group work with children and adolescents;
Community work with parents, teachers;
Casework;
Group work with parents & family consulting;
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Teacher training; and
Arrangement of meetings of conflicting parties.

3.3.1 Group work with Children and Adolescents

In areas with many IDPs, sessions are held once per week, for two and a half or
three hours, with 15 to 25 children/adolescents and at least two facilitators (see
facilitators role in previous chapter). The following five programmes have been
elaborated for group sessions:

1. Communication skills;
2. Conflict management;
3. Overcoming the enemy image;
4. Creativity and non-standard thinking; and
5. Environment.

The above programmes comply with a global strategy to overcome victimisation and
increase tolerance. The first three programmes should be implemented in succession.
The programmes for ecological education and creative thinking are implemented
along with the communication skills and conflict management programmes. The
programme for overcoming enemy image can be a very emotional experience for
participants, as it touches deeper layers of their personality. The sessions of the five
programmes are almost identical in the case of 7-12 year old children and
adolescents. However, their complexity differs according to their ages.

At the beginning of the work, participants should be introduced to each other in a
safe atmosphere, based upon mutual trust. For this purpose, it is desirable to include
special exercises, during which participants introduce themselves to others in an
amusing way.

To create a safe atmosphere, the facilitator should ask participants to decide on
ground rules for the sessions. They can include, for instance:

When one person talks, others should listen to him;
Respect for the opinions of others; and
If a group member does not want to participate, he/she has the right to
abstain from participation.

The joint elaboration of ground rules enables children to consider themselves co-
creators of the group processes and responsible for the group activity within a
tolerant atmosphere, at the exclusion of any judgmental attitudes. Participants who
are afraid to express themselves and do not normally take part in group activities
will feel more at ease. The facilitator should make the outsider feel that he/she is
not criticised for passivity, is not an object of special attention, and that the group
will always give him/her the time and space to be included in discussions if he/she
wishes.

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Each session includes three stages: introduction, main part, and conclusion.
Involvement of children in the introduction is aimed at warming them up, through
games and energisers, so that they fully participate in the next phase and become
more involved in the group dynamics.

Through an interactive process (brainstorming, small group work, etc.), the main
part is composed of elements from one or more of the five programmes listed above.
Following the interactive process, the facilitator provides the participants with brief
theoretical information (for 10-15 minutes) connected with the major theme
(persuasive communication, non-verbal language, conflict escalation stages, etc.). If
the audience becomes too passive during the session, the facilitator should try to
effectively put in energisers. The conclusion stage includes feedback from the
participants on possible improvements for the sessions. Additionally, the feedback
identifies energisers that stimulated participation in the next session.

3.3.1.1 Training on Communication Skills

The process of psychosocial rehabilitation often follows a scheme from periphery
to the centre, with the traumatic experience as the centre and the knowledge, the
experience, and the skills acquired through the development process as the
periphery. This model implies supplying children with the necessary resources
and skills for the periphery, in order to support a creative adjustment and a better
ability to cope with their traumatic experience, as it will become part of a broader
context.

Training for children and adolescents should be structured, while allowing flexibility
to focus on problems as they arise in the childrens expressions.

Our experience shows that apart from traumatic stress, IDP children also experience
psychological problems, including difficulties in relationships with peers, parents,
teachers, and neighbours. Excessive control, rage, anxiety, and insufficient
emotional development also may have a profound impact on their communication
skills. They may also be lacking in positive role models.

IDP children often lack the skills needed to express their emotions in the appropriate
manner. A discrepancy between their feelings and their body language (facial
expression, hand movements, etc.) may occur for which they have insufficient
control. However, some children will remain in a shy, expressionless position.

Interpersonal communication represents the main area of training in communication
skills, even though it implies the reinforcement of the inner link between the self
and explicit behaviour. It is also intended to promote emotional development
(expression of emotions, revealing one's own self), the ability of having a sense of
responsibility, and the ability to be socially active. During the sessions, children
learn to use harmonious and persuasive communication, to control emotions, to
listen in an empathetic way, to respect their own experiences, as well as the
experiences of other people, and to accept others subjective realities.

Communicating in an harmonious way
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Harmony implies consistency between the inner experience and its expression. It
forms the basis for clear and reliable communication that does not resort to defence
mechanisms. Harmony is a precondition for positive and effective interrelationships.

To provide children with a picture of harmonious communication, the facilitator can
stage the following scene: the children are instructed to say I want to help you, or
I love you with gloomy faces and clenched fists to show the lack of congruence
between the verbal message and the body language. The facilitator then
distinguishes between conscious and unconscious incongruent body language by
giving some examples.

A guest who felt quite bored during his/her visit tells the hostess: I had such a nice
evening. The guest knows quite well him/her own feelings and experience, but does
not reveal them at the verbal level, but with conscious body language. Similarly, a
person may not realise that his/her gestures express aggression or rage.

Children learn that their facial expression, gestures, and posture involuntarily
express their inner state. Children also learn that non-verbal manifestation is one of
the most important components of the communication process. Realising the
possible effect of their physical self helps them to better understand themselves and
their emotions and more easily express, through actions, their emotions and
conflicts.

For this purpose the facilitator may use the following exercises:

Box of emotions

Objective: Increasing childrens awareness of inner feelings and
experiences.

Children sit in a circle or semicircle. The facilitator writes down the feelings
recalled by children (rage, etc.) on small pieces of paper and puts them into
a bag, which then goes from child to child for distribution. Each child should
then express the feeling indicated on the piece of paper he/she picked up in
a non-verbal way, while others have to guess which one he/she os
conveying. If the child does not manage to convey his/her feelings, he/she is
assisted by the facilitator or by a volunteer member of the group. The
exercise is followed by discussion, during which the children identify and
review different non-verbal signals of the human body.

Pantomime of mental states is a more complex version of the previous
exercise. In this case, the facilitator writes on paper possible situations and
dynamic states, like Before going to sleep, Waiting for punishment, etc.,
which should be expressed and identified by children.

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Only eyes

Objective: Experimenting with non-verbal communication.

Children are split into pairs and asked to establish non-verbal eye contact
with their partners. After several minutes, they can share verbally their
impressions (Was your partner, sad, angry, happy, quiet?). Then the
children may choose a new partner and repeat the exercise.

A smile

Objective: Using non-verbal communication to generate positive feelings in
the partner.

The exercise can be conducted in pairs, or with the participation of the whole
group. If played in pairs, one of the participants is asked to look indifferent,
not to express his/her emotions, and to think about something unrelated to
the subject. The other participant is asked to make the partner smile
without using words or touching the partner. Once he/she smiles, roles are
exchanged. After practising the exercise, participants are asked to analyse
the game, and share their impressions regarding their roles (which role was
more difficult and for what reason, what they liked about the game, what they
learned from it, etc.).

A mirror

Objective: Training in distancing one's own self and in looking at oneself in
the mirror.

The group splits into pairs. One of the partners becomes an animated mirror,
which reflects the other participants facial expression and movements. After
a few moments, the partners exchange their roles. During the discussion
they tell each other what was easy or difficult to do, what they saw in the
mirror, what was pleasant/unpleasant, etc.

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Staging

Children stage a play of their own invention and allocate their roles. They
break into two groups. One group has to guess the content of the scene
staged by the other group. They learn how to deduce meanings from
individual details of the play (intonation, gesture, face moves, etc.). The
same text may also be said with different speeds (quickly, slowly) and
intensity (loudly, clearly, warmly, coldly, etc.).

Power of language

Objective: Awareness of the structure of one's speech through its alteration
and the increase of the sense of responsibility towards ones speech.

The following words are written on the blackboard:

I have to - I would prefer to
I cannot - I do not want
I need - I want
I am afraid that - I would like to.

The group splits into pairs. Each participant writes down 3 sentences,
starting with I must that he/she says to his/her partner (without getting
answers). Then, I must is replaced with I prefer, without changes to the
rest of the sentence. The revised sentences are also told to the partner. The
same applies for the other sentences written on the backboard. Children
then share their impressions. During the closing discussion it is emphasised
that the first phrases deny the child any responsibility for actions, emotions,
and thoughts. The replacement of words brings the feeling of freedom and
competence. Children are finally encouraged to search for examples, in
which the alteration of the structure of speech and the replacement of words
entails positive results.

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My credo

Objective: Training in the components of active listening.

Material: A small ball or some small item.

Participants sit in a circle. The facilitator tells them to express their credo and
to throw the ball to another child. The child that catches the ball will
summarise what the previous child said in an empathetic way and then gives
his/her life credo. The ball goes around the circle and comes back to the
facilitator. Participants that experience difficulties in summarising the
statements in an empathetic manner are helped by volunteer members of
the group.

Management and communication of emotions

Children have to learn to be aware of their own feelings, to know how to manage
them, and to be responsible for their expressions. Conveying clear messages about
one's inner state implies having a responsible attitude towards one's expressed
emotions. IDP children, as said above, have problems expressing their feelings in a
coherent way. One girls indifferent expressions were interpreted by her peers as
arrogance. Actully, she was only trying to express fear and tension.

Training children in properly communicating their feelings helps them to convey
their message in an understandable manner. Using I, my, pronouns, direct
definitions, and metaphors all help them to distinguish ideas from facts and
emotions. Non-judgmental communication makes their partners less defensive,
releases the tension, and forms a ground for more effective communication.

Exercises involving comparisons of day-to-day speeches can be used for training
purposes. For instance, the difference has to be stressed between the sentence
Helen, you are an untidy and a lazy person, which implies an insult, with the
sentence, Helen, you spilled soup and did not clean the table, which describes the
action. (see also the exercises related to I message" under 3.3.1.2).

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Recognising types of communicators

Triad

Objective: Identification of behavioural types through their portrayal in order
to reveal their qualities.

Children are given the descriptions of behaviour types that they are asked to
portray in an inflated way. These types are:

The obsequious pacemaker
The accuser
The calculating computer"
The isolated insane.

Their opposites are:

The harmonious
The flexible
The well-balanced.

Each of the three members of the triad selects for him/herself the type
he/she wants to portray. In the course of the dialogue the two other
participants have to guess what role he/she chose.

The family

Adolescents are asked to review the roles Adult-Parent-Child and their
interaction. A dialogue is staged, for instance between a mother and a child,
where the child asks mother to buy him/her a bicycle. The participants follow
the dialogue and then discuss which attitude is more effective in individual
situations. Children are also asked to review the different modalities through
which messages are transmitted (visual, auditory, etc.). Socially competent
and incompetent types (for instance, too aggressive and too shy) are also
reviewed in this context.

Training in persuasive communication

Children are trained in flexible, congruent, sincere, and convincing communication.
In the course of the training they employ already acquired skills. Children play roles,
stage different situations, and later discuss which components were omitted and
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which were effective for the achievement of the set objectives. Themes can range
from Persuade your boss to give you a two week leave, to Make the stingy
neighbour lend you money, or Presentation and advertising of a selected idea or
product, or Justifying a decision, etc. Adolescents are also trained in saying
No. For this purpose the facilitator can use a number of exercises with discussions,
exchanges of ideas, and justification of one's statements.

Magicians

Objective: In addition to the above, consideration of life goals and priorities.

1. Participants receive a card with a list of magicians and split the list into 3
groups, with 5 experts in each.

a) the five most desirable magicians
b) five less interesting magicians
c) the five least desirable magicians.

2. Children in the group or sub-groups compare their cards and try to
identify the basis of grouping (which values prevailed in the selection of
certain experts).

3. Children explain to others why a magician was included in the selected
category.

4. At the end of a group discussion, in which children express justifications
for their choices, several participants can take a role of the most
desirable expert-magician and involve themselves in an enjoyable
discussion regarding their usefulness for mankind.

A card sample:

A group of 15 experts-magicians offers you its services. Success is
guaranteed!

1. Doctor Clairvoyant. To help you to learn everything about the future and
teach you how to become clairvoyant yourself.

2. Mister Moneymaker. He will teach you how to make money.

3. Doctor Designer. He is an expert in plastic surgery and fancy clothes.
He will help you to have the appearance of which you dream.

4. Robinson Crusoe. Expert in adventures: your life will never be dull.

5. Professor Clever. He will help you to become very intelligent.

6. Mister Rose Glasses. He will teach you how to become optimistic.
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7. Doctor Wisdom. He will teach you to accept your age.

8. Saint Valentine. With his help you will find true love.

9. Lady Luck. She will help you to find the activity you want.

10. Mister Personality Growth. He tells you about your real Self.

11. Miss Popularity. She will make you popular.

12. Mister Prominent. He will help you to become important in your job.

13. Family Idyll. They will make your family life very happy and interesting.

14. Doctor Creative. He will develop your artistic abilities and will help you to
become a good artist, sculptor, or writer.

15. Miss Idea. This expert will help you to generate ideas in any situation.

Acceptance and realisation of subjective realities
hen someone tries to understand others opinions and takes them into
The Elephant in the Dark

W
consideration, he/she avoids categorical statements and evaluations. He/She does not
use rigid statements or black and white typologies. For illustrative purposes the
facilitator can use pictures with double meanings, parables, and fables.

The circus arrived in a village where people had never seen an elephant
before. Being very curious, they sent several people to the cage with the
elephant to come back with a description of it for the to other villagers. It was
dark in the cage and the only thing the people could do, was to touch the
elephant to learn something about it. When back in the village they did could
not agree on the description. He looks like a fan, said the man who touched
the animal's ears. No. He is like a huge pillar, said the person who touched
his/her leg, etc. They had contradictory impressions that reflected their
various experiences, but each of them was right in his/her own way. But they
were uncompromising in their judgement and for this reason, they did not
succeed at picturing the elephant, that consisted of the sum (and even more
than the sum) of subjective realities.

he facilitator reads a list of words. For each of these words, children write
down which other word they first associate with the one they heard. When

T
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summing up the exercise, the facilitator emphasise that any of our
associations expresses a subjective reality, which is unique and personal.

3.3.1.2. Training on Conflict Management
sons life. Not only have they
ften been displaced because of a war, but daily arguments within the community,
e childs belief in his/her own
bilities and to give him/her practical analytical tools with which to cope with
Training objectives
nd adolescents formulate a concept of conflict from
different angles and to identify a potential for development from it. Although

2. t the conflict stages, especially regarding the formation of
the enemy image that can manifest itself in distrust towards everybody or

3. nce of other subjective realities and to
make them understand how the denial of the right to have your own,

4. ement of
this objective is extremely important since internally displaced children tend
to avoid conflict situations. In one of the role-plays, children were told that it

Conflict is unfortunately inherent to the displaced per
o
misunderstandings between adolescents, latent or expressed negative attitudes from
and towards the representatives of the hosting population, conflicts between
different generations (especially during the puberty period), happen very often as a
consequence of the trauma, but also due to the poor living conditions (overcrowding,
lack of privacy, not enough material resources, etc.).

The primary objective of the training is to develop th
a
conflicts. Studying alternative ways of conflict resolution helps to develop creative,
non-standard thinking for an effective resolution of disagreements. The childs inner
resources, if properly utilised, should suffice in dealing with the conflicts he/she
encounters.

1. To help children a
children constantly hear from parents that the conflict is the reason for
their misfortune, they do not have a clear understanding of the concept. They
look at it as something irreversible, fatal, and ominous. This attitude prevents
them from viewing conflict situations in terms of a potential resource for
their development.
To teach them abou
might limit itself to different or weak people in the immediate
surroundings. The opposition between internally displaced and local children
can be partially explained this way.
To make them aware of the existe
different opinion contributes to the creation of a conflict. Children are also
helped to develop communication skills, enabling them to express their ideas
to the conflicting party without insulting it and to accept different ideas and
feelings from the opponent (active listening, I message). A useful tool for
the development of a tolerant attitude, is the Convention on the Rights of the
Child, in its articles 12 and 13, concerning freedom of expression.
To train them on win-win conflict settlement strategies. The achiev
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was possible to avoid a catastrophe if they could negotiate the acquisition of
a certain substance. They solved the problem in a simple way: through the
evacuation of the population (seemingly following their own experience).
During discussions on the Ozone layer, local children suggested to
strengthen the Green movement while IDP children proposed to work
towards moving the entire Earths population to another planet. Systematic
avoidance of threat can become dangerous and harmful when viewed as the
only possible means of conflict resolution as it prevents the person to find
other alternatives.
To encourage teamwork and mutual support through the development of co-
operation skills. Ps

5.
ychosocial rehabilitation is based on group work and it is
important to support the involvement of all children, even those that are at

The Essence of Conflict
first unwilling to participate. Exercises successfully completed also serve as
proof of the usefulness of teamwork and mutual support. Conflict resolution
is also part of the other activities of psychosocial rehabilitation, as the helper
will assist children in finding a mutually beneficial solution for each of their
conflicts, as they arise. Even when their positions are incompatible (for
instance, two children want the same pencil), their interests can be quite
compatible (one wants to draw, the other one wants the eraser attached to the
end of the pencil in order to erase a bad drawing).

Objectives: Understanding the essence of conflict; greater awareness of
one's own attitudes to g ones vision of the wards conflict, and widenin
conflicts positive and negative effects.

Materials: Paper and colour pencils.

Group members sit in a circle and recall in what circumstances they have
heard the word conflict. They talk about its aspects, possibly in a symbolic
way (what colour, what form, what voice, etc.) and jointly try to reach a
definition. Afterwards, they draw this concept and hold an exhibition of the
drawings. Each artist describes his/her picture. Other children listen to it and
then question the artists motives. At the end of the exercise, the facilitator
summarises the session and gets feedback (what children learned, what was
new for them, etc.).

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Associations with Conflicts

Materials: Paper and colour pencils or blackboard and chalk

Exercise 1: The facilitator asks the following questions: What is associated
for you with conflict? He/she divides a sheet of paper into two parts and
splits the listed associations into two parts: the associations positively related
to conflict and those having a negative relationship. The facilitator
encourages the discussion about the positive and negative sides of conflict.
Group participants can bring examples from their own experience.

Exercise 2: The facilitator presents a story depicting a conflict situation and
points to the resources contained in conflict. The story is discussed in the
group. Children define conflict (conflicts) and the conflicting sides, talk about
positive and negative aspects of the conflict, and the transformation of
conflict in a positive direction.

Exercises on conflict escalation

The objectives of the following exercises are to familiarise children with conflict
escalation stages and with the aggravating factors of the conflicts.

Conflict Escalation Stages

Exercise 1: Small groups of five children each are requested to imagine a
conflict situation for which they will have to identify the conflicting parties, the
issues at stake, and then role play the situation. They should not try to solve
the problem, but rather show the conflict escalation. Based on their
performance, the facilitator can explain the conflict dynamics.

Exercise 2: Small groups of five children are requested to recall a conflict
they experienced and the aggravating factors they can now identify within
them.

Exercise 3: Group discussions on how to avoid aggravating factors from
taking place. The facilitator should emphasise the distortions typical of
conflict situations, like You always, You never, (labelling, judgmental
statements, etc.)

Exercise 4: The facilitator selects a story showing the intensification of
conflict. The group works on the identification of escalation stages and the
factors that have caused the conflict.

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Conflict settlement strategies

Objective: To be aware of the importance of communication in transforming
a competitive relationship into a co-operative one.

Materials: Paper and pencil

The facilitator splits the group into pairs. Each pair is asked to share a pencil
to make one drawing on one sheet of paper. Partners are forbidden to talk to
each other. After reviewing the pictures, the exercise is discussed in the
group. The facilitator then organises a brainstorming session during which
he/she underlines that such competitive relationships often result in two
losers. This exercise is also suitable for the acquisition of different conflict
resolution strategies, like compromise, consensus, etc. Each group member
shares with the others his/her impressions and together with the facilitator
and the group, he/she tries to identify the conflict resolution strategy applied
in his/her case.

This exercise represents a logical continuation of the previous one in which
children are also instructed to draw in pairs, but with discussions between
each other. After carrying out the assignment, children display their pictures
and compare them with those created in the previous exercise, where they
did not communicate with each other. The facilitator conducts the discussion
process by emphasising the fact that communication helps to reach a
successful solution of the task.

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64

Exercise Oranges

Objective: Development of active listening skills; differentiation between
position and interest; and experience of conflict settlement according to the
win-win model.

Material: A role description for each participant based on the fact that each
person needs a different part of the orange (seeds, peel, juice, pulp, etc. ).

Children quarrel because of oranges. For example, one needs them for the
health benefits, the other one for making biscuits. Since the participants are
not allowed to read each other's roles, they can only rely on active listening,
and thus try to differentiate between interest and position. This enables them
to understand that the child who needs the oranges for his/her health has to
get only their flesh and the other person, who wants to make biscuits,
actually needs their skin as clearly stated in their roles.

Upon the completion of the exercise, participants exchange views on how
they manage to go beyond the conflict using different strategies:

avoidance;
competition;
distinction between position and interest; and
compromise.

The facilitator asks participants to recall similar situations where a win-win
model was applied.

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Island

Objective: The development of effective solutions to conflicts in the case of
limited resources.

The facilitator draws an island on the floor on which less than the number of
participants can stand.

Group members act like frogs and the facilitator as a crocodile, which, at
every clap, swallows part of the island (crossed out each time on the
drawing). They should not stop jumping around the island. When hearing a
clap, they have to manage to get back to the island. The game is played in
several rounds until only three winners are left.

The facilitator emphasises in the debriefing that children who stood on one
foot and held each other were more likely to win than those who are
competitive and pushed others into the water.

Exercises in the development of active listening skills

Rumours

Objectives: Awareness of the effects of one-sided communication on the
distortion of information and preparing the ground for the acquisition of active
listening skills.

All participants leave the room except one who is told a story by the
facilitator. Then one by one, the children come back into the room, re-telling
the story to the one entering the room after them. The last to enter tells the
story in front of the whole group. The facilitator then reads the original
version of the story. The facilitator then asks the group what could have
been done to avoid the distortion of information. He/She also explains that
this one-sided communication has a disastrous effect on the accuracy of the
information: one should allow the listener to be an active participant.

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66

Retelling Stories

Objective: Acquiring restatement skills and the ability to carry out non-
evaluative judgements.

The group is split into pairs. The children in pairs have to tell each other, in
turns, any story (real or invented) for 4-5 minutes. The children instructed
that they will restate their partners story using their own words to ensure
correct comprehension. During the debriefing, the facilitator asks the children
to identify the qualities of good listeners.

It is emphasised that in the case of active listening, the listener recognises
the subjective reality of the person to whom he/she listens. The ability to
differentiate between recognition and agreement is important. Recognition
means one accepts the fact that the other person has his/her subjective
world and that he has the right to experience the feelings and emotions
absolutely different from his/her own. Agreement means you consider the
other person's subjective world as fair, correct, and appropriate.

I message

Objective: Development of effective communication skills; acquisition of I
message related skills.

Children are requested to find ways in which the person who feels victimised
can explain to his/her friend his/her feelings without causing conflict
escalation, in the context of a day to day conflict. The facilitator tries to make
the group feel the destructive nature of the messages like You + blame, and
he draws the group's attention to the so-called I-concept.: I + my feeling +
behaviour causes this feeling. The facilitator then helps the group to
formulate I messages.

3.3.1.3 Working on Overcoming the Enemy Image

The biggest problem of internally displaced children is that someone has chased
them out of their homes. The enemy image that came out of this frequently
manifests itself in an intolerant attitude towards conflict, but also towards anything
perceived as different. Basic tasks related to the elimination of enemy image are as
follows:
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Integration of the fragmented sections of traumatic memories

As mentioned above, an important stage in overcoming traumatic experience is
sobbing out one's grief to finish with previous pain. Memories revive previous pain
through a difficult process. For this reason, people are reluctant to engage
themselves in a mourning process. Consciously or unconsciously, they avoid going
back to their wounds and, by doing so, they hinder the process of overcoming their
traumatic experiences. At the same time, the trauma that has not been completed has
a strong impact on the IDPs life and manifests itself in fragmented memories and
destructive symptoms.

Sessions of story telling are very effective in helping the displaced person in
releasing his/her painful emotions and integrating fragmented memories related to
trauma. Since it is difficult for children to verbalise their experiences, when working
with children's groups it is advisable to use methods involving other kinds of
expressions (drawing, etc.).

Acceptance of traumatic experience

To sob out one's grief, the person has to face his/her pain and accept it as part of
his/her life experience. To perceive negative events from the perspective of
personality development is key to the mechanism of acceptance. Tactful questions
should be asked, orienting him/her towards personality development.

When working with children, it is very important to develop the ability of perceiving
non-verbal expression and of using metaphors and symbols to emphasise the
positive impact of their trauma on the development of their personality.

Enlargement of the perception of the world and correction of
destructive beliefs

As already mentioned, trauma has a negative impact on the perception of the world
by the IDP and on his/her belief system, because of generalisations. Generalising
may have an adaptive function and may be important for survival, but over-
generalisation hinders the adequate perception of the reality. Over-generalisation is
one characteristic of traumatic experiences, especially for those traumas that took
place in early childhood. By providing opposite examples, the helper should clearly
identify and tackle non-constructive generalisations, which are at the heart of the
victimisation and the enemy image processes.

Overcoming the victim-aggressor model through an I-You
relationship

Since the formation of the enemy image is based on a negative attitude to the other
one, children should be encouraged to see a positive meaning in differences and to
perceive the other one not systematically as an opponent but as one enriching life
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68

experiences. This will enable them to embrace a different reaction towards different
thoughts, feelings, and opinions. Intolerant attitudes towards the other one often
form the basis of the victim-aggressor type of behaviour that is so apparent in the
role play of IDP children. The facilitators behaviour, encouraging group co-
operation and parity, will have a strong impact on the process.

Forgiveness

Children should understand that forgiveness is linked with freedom, as a direct
means of releasing his/her negative emotions and of avoiding these emotions taking
control of his/her life or absorbing all of his/her energy without leaving any inner
resources for constructive actions. Discussions on this theme, with practical
examples, should be organised with the children, who should be supported in
drawing their own conclusions from it. Their personal responsibility on this issue
(forgive / not to forgive) should be stressed.

Storytelling

Objectives: Integration of traumatic experiences and freeing oneself from
related emotions.

Participants and the facilitator sit in a circle. The facilitator suggests a
discussion on the topic of How I arrived here (i.e. involuntary
displacement). Participants tell the others about their experience. In the
course of storytelling they express negative emotions and free themselves
from such emotions, empathise with each other, etc. The facilitator has to
assist the process in a tactful and subtle way, ensure a trust-based, safe,
empathetic atmosphere, and actively listen to each member. By doing this,
he/she encourages self-expression on the one hand, and on the other hand
helps to integrate the fragmented knowledge of traumatic experience. To
promote such integration, upon the completion of storytelling by a
participant, the facilitator has to return to the storyteller the same content.
The stories might reveal the victimisation feeling and enemy image. In this
relation, after releasing painful emotions, it is desirable for the facilitator to
direct discussion at recalling the positive points in the interaction with the
opposing side, which helps to correct the over-generalisations forming the
basis of enemy image.
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Drawing on the theme What I am afraid of

Objective: Releasing painful trauma-related emotions.

The facilitator suggests the theme What I am afraid of for drawing a picture.
At the end of the session the group analyses the drawings that are triggered
by traumatic recollections. The facilitator should create an atmosphere that
helps the expression of emotions and the sharing of traumatic experiences
with group members. The exercise should be organised in such a way that
group support will appear as a positive element in tackling trauma.

Picture of the Abkhaz or "the Ossetian"

Objectives: Awareness and expression of war-related experiences;
correction of over-generalisations underlying enemy image.

The facilitator asks the group to draw a picture of the Abkhaz or the Ossetian
(or the one perceived as THE enemy). Trauma-related themes appear in
the course of the discussion as the participants experiences associated with
the opposing party are actualised. The facilitator first assists the group in
releasing painful emotions and later in recalling the positive experiences
related to the interaction with the opposing party (before the conflict).

Drawing Forgiveness

Objective: Awareness and activation of ones potential for forgiveness.

Participants are asked to draw a picture of forgiveness and to recall their
own experiences related to forgiveness (when he/she was able to forgive, or
when someone else forgave him/her), and to analyse how forgiving changed
the situation and what effect it had on the other one.

Group discussion Joseph and his brothers (from the Bible)

The following points should be emphasised during discussion: Joseph
forgave brothers for having betrayed him and if they had not, he would not
have become the Pharaohs minister.

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70

Drawing on the theme 10 years later

Objectives: Awareness of the future and development of personal
responsibility for the future.

Instruction: You are invited to a conference with participants from other
planets. They know very little about the Earth. Your task is to familiarise
them with some events and characteristics of life on Earth through drawings.
During the discussion, the participants and the facilitator make comments on
the drawings and talk about their perceptions of the world.

Social Radius

Objectives: Awareness of one's own model of the world and future
perspective.

Each participant is given ten colours of paper and told to write on nine of
them the life factors that he/she considers important (position, people in your
environment, feelings, achievements, etc.). He/She should then write I on
the 10
th
paper and place the nine papers around it, in a manner that reflects
his/her relationship to the life factors he/she chose. Participants are then
asked to do the same to reflect their situation in ten years time. The final
instruction is to replace the papers to show what will happen if the participant
does not work towards achieving his/her goal.

My Favourite Hero

Objectives: Realisation of one's desires and ambitions.

Children are asked to draw a picture of their favourite hero/heroine from a
fairy tale. During the discussions, they speak about what they like/dislike
about the hero/heroine and how they would continue the plot of the tale.
During the debriefing, the facilitator underlines that the qualities of the
hero/heroine are actually those that the child wants to have.
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Composition and staging of a joint fairy tale

Objective: Overcoming the stereotypes of victim-aggressor.

The facilitator suggests that the group compose a joint fairy tale. Each
participant has to add his/her own sentence to the previous participants.
Children decide when the tale is completed. Children then choose their
roles. The helper can see with which role the child identifies him/herself,
what is his/her favourite communication style, and what are his/her
problems. The play is staged once. The second time, roles are exchanged.
During the debriefing, participants express how they felt in each role, what
the exchange of roles resulted in, and what experiences they gained.

Discussion: Friendship between different people

Objective: Developing tolerance to differences.

A metaphor offered by the facilitator stresses friendships between different
people. The ensuing discussion touches up the usefulness and uselessness
of differences in order for participants to realise that the wealth of diversity is
conditioned by the existence of differences.

3.3.1.4 Creative Thinking

This method aims to develop creative potential; to overcome rigid thinking; to foster
non-standard alternatives; and to increase self-trust in one's own capacities.The
result is a more constructive adjustment to traumatic experiences.

The work is carried out in the following directions:

1. Stimulation of non-standard thinking using puzzles, exercises, problems,
etc.;
2. Creative work manufacturing of souvenirs and toys from cheap materials
like stones, paper, etc.; and
3. Doll-making and the creation of a puppet show.

The structure of the sessions differs according to the age of the participants. The
sessions for the pre-school age include very easy tasks (for instance, making a dog
by folding paper several times and then painting it) as well as jigsaw puzzles. The
prevailing type of activity with children aged between seven and twelve is
craftsmanship, etc. Adolescents activities include making garlands and more
discussions.
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Lessons in creative work are aimed, not so much at the development of practical
working skills, as at the rehabilitation of the child. The items produced by children
serve diagnostic and correctional purposes (for instance, children can be asked to
speak on behalf of the mask they just made, puppets will be used for a puppet play,
etc.).

Brainstorming

Objectives: Generation of ideas and group decision-making.

Stage one: The group is split into sub-groups of 4-7 children each. Each
sub-group is given the same task (for instance, to think of possible ways to
arrange cheap holidays). The groups generate as many ideas as possible to
solve the problem, without any critical comment.

Stage two: Each sub-group presents a list of ideas in the plenary session.

Stage three: Out of the full list, the group selects 5 ideas according to pre-
established criteria (originality, practicality, reliability, etc.), through group
discussion.

Stage four: Group analysis and discussion during which the facilitator
highlights the stages in the generation of ideas: ideas that are more creative
generally emerge in response to the unfeasibility of more rational ones
("Then, why don't we do ...").

+/- Rating

The facilitator reads a list of events to the group (e.g. scientists have
discovered a new, cheap way of obtaining gold). Each participant has to
think of the positive, negative, and interesting aspects of each event. After
writing down their ideas, participants work in pairs to discuss and compare
their ideas. The session ends with group discussion.

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73

Results

Objective: Reflection upon the cause and effect relationship.

Stage one: The group is split into sub-groups of 3-6 people that are given
cards on which situations are described (for instance the pollution of the
oceans) and are asked to think of the short term and the long term impacts
of the situation.

Stage two: Sub-groups exchange their cards and start the discussion
again.

Stage three: Ideas related to each situation are discussed in a plenary
session. The facilitator should emphasise that a single action can have long-
term repercussions and should support an increased sense of responsibility
on the part of the participants for their own acts.

Discoveries

Objective: Realisation of one's own resources.

Stage one: Each participant identifies five resources that help him to live
and five weaknesses that hinder his/her development, and writes them down
on a piece of paper.

Stage two: The facilitator reads the papers in a plenary session, without
identifying the authors. The aim is to transform negative qualities into
resources, which can be done in two ways:

1. Finding a context in which a weakness can become a comparative
benefit (for instance controlled anger may become an asset in a situation
where a person has grounds to be angry, as in the case of human rights
violations, etc.);
2. Renaming a weakness to discover a new, positive meaning in it, which
will transform it into a resource (e.g. cowardly can be renamed
cautious).

Stage three: Group discussion in which the facilitator emphasises that the
elements perceived as weaknesses can actually serve the person if
apropriately controlled and renamed.

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74

Masks

Objective: This exercise helps to differentiate between positive and
negative thinking.

Group members sit in a circle. The facilitator reads sentences, like The sun
is shining, Tomorrow is the first day of winter, etc. Group members have to
react to these sentences by making either negative statements
(accompanied by putting on the mask expressing joy) or positive statements
(accompanied by putting on the mask expressing sorrow). The exercise is
followed by a group discussion about the positive and negative effects of
these two patterns of thinking.

The Wise Maiden

The facilitator tells the group a story in which a young woman had to make
the right choice to avoid marriage with a wicked rich man. Out of two hidden
black and white stones in his purse, she had to pick out the white one to
save herself.

The facilitator asks the group what the woman did to save herself. Group
members can put forward any ideas. The facilitator encourages a non-
standard approach to the problem. The group may come up with a solution,
such as the following: she noticed that the man put two black stones into the
purse. She took out one of them and, without showing it to anyone, threw it
into the sea. So, when seeing the black stone in the purse, people would
think that she threw the white one into the sea.

Even though there are many answers to the problem the principle is always
the same a standard approach to a problem limits possibilities, whereas a
creative, non-standard approach increases the number of possibilities and
ultimately facilitates the solution.

Joining dots

In this exercise participants have to join dots in a frame with a single
uncrossed line. The only way to do so is to go outside the frame. At the end
of the session, participants sum up the lessons learned.

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75

3.3.1.5 Training on the Environment

The main objectives of the training on the environment are the development of
ecological awareness, overcoming the estrangement of the children from their
physical and social environment, the development of tolerance and a caring attitude,
and, ultimately, overcoming the traumatic experience.

Activities can involve, for instance, excursions to familiarise children with historical
monuments or the implementation of ecological actions, such as cleaning the
adjacent woods and fields, planting trees, etc.

Activities mainly aim at:

1. The familiarisation of children with their new dwelling place; the facilitation
of children's adjustment to their physical and social environment; and the
development of the feeling of belonging and of a caring attitude towards the
environment.

2. Bringing children closer to nature in order to realise its wealth, and to
develop a caring attitude towards it, which will increase their level of
tolerance.

3. The acquisition of useful skills (e.g. getting drinking water, the provision of
medical first aid using phyto-therapeutic means, etc.), which also leads to
self-reliance.

4. Familiarising children and adolescents with culture and history, reinforcing
their sense of national identity, and providing access to universal human
values through human rights instruments.

3.3.1.6 Peculiarities of Group Work with Pre-School Age Children

When planning work with this age group, the following should be taken into
consideration:

Children, born after displacement are not directly affected by the trauma, but
they inherit it in an indirect way. They absorb it from their environment
through parents discussions, atmosphere in their families and in the
community of displaced people, etc. Indirect trauma can be stronger than
direct trauma, given the vivid character of a child's imagination and his/her
blurred distinction between the real and imagined world.

Trauma-related psychological problems are clearly manifested at the
behavioural level (hyperactivity, traumatic repetitive actions, aggression, etc.).

Games are the leading form of behaviour at this age. Due to this, rehabilitating
activities should be carried out through games.
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The functional tendency towards the repetition of acquired knowledge allows
the child to internalise it and transform it into experience. For this reason, it is
advisable that the games allow for the repetition of lessons learned.

The main task in the rehabilitation of pre-school age children is to foster their
healthy development in order to eliminate the impact of the trauma experienced by
the older generation. The objectives should be as follows: the correction of
behavioural, cognitive, and emotional problems; the satisfaction of the need for
safety; the reinforcement of self-respect; and the development of a tolerant attitude.

Special importance should be attached to the development of children's cognitive,
motor, and creative skills.

Joint pictures

This exercise is intended for older children, but it can also be used with pre-
school age children in a simplified form.

Objectives: Development of the imagination, creative thinking, teamwork,
and the ability to differentiate between left and right. The exercise includes
some components of situation management.

The children sit in a circle. Each child continues the drawing (line, figure,
etc.) received from his/her right hand neighbour and passes it to the next
neighbour to continue. Upon the completion of the exercise, the children
display their drawings. The facilitator emphasises that pictures become more
interesting and diverse when every child contributes to their creation.

Story Session

Telling stories is one of the most important rehabilitation activities suitable for
children of this age, since it meets their natural interest in stories, which also
contain constructive metaphors.

The facilitator tells the group a story, selected at his/her own discretion. The
children are then told to ask questions (what they liked about the story and
why, whether they liked its end, etc.). After the discussion, the facilitator can
ask the children to draw the hero or the event from the story, which they
remember best. Children can be also asked to draw the characters in the
picture. Such a game will make the session more vivid and dynamic.

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Figures

Objectives: Development of spatial perception and motor skills; recognition
of geometrical figures; experience of teamwork.

The facilitator and the participants forms a circle by joining hands. The
facilitator asks the children which geometrical figures they know, draws
different figures on the black board, and suggests that the children create
them. Depending on the figure being created, some of the children act as
the sides and the others as the angles. To make the activity more
enjoyable, it can be accompanied with singing and applauding.

Fishing

Objectives: Revealing children's attitudes and needs; development of
imagination and motor skills; and acquisition of skills for creative work.

The facilitator shows the children how to make paper fish and to fish them
out of an imaginary river. If they catch one, the fish will grant three wishes.
The facilitator helps the children to understand their wishes and involves
other children in trying to make the wish come true.

Animal Steps

Objective: Learning about the animal world; development of body language;
co-ordination of movement; self-control; and the release of emotional
tension.

The children name the animals they know. The facilitator asks them what
they look like and what sounds they make. Children imitate the sounds
loudly and then quietly. The children are then asked to demonstrate the
animal's steps (jumping like a rabbit, crawling like an ant, etc.).
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A Knot

This exercise is used as an energiser.

Objectives: Warming up; increasing group cohesion; acquisition of some
components of problem solving; release of tension; and team-building.

The children hold hands to form a circle. The facilitator tangles the circle
while the children still hold each others hands. A child is then asked to give
the circle its original form. If he/she succeeds, the others applaud.

Colours

Objectives: Differentiation of colours and development of observation skills.

The facilitator names the colours of items in the room. The children then
have to recognise the colours of their clothes. The group corrects any
mistakes made by the participants.

Resonating

This exercise is used as an energiser when the group becomes restless.

Objectives: Emotional release and reinforcement of team spirit.

Children have to emit a long sound and, following the facilitator's instruction,
change its intensity. The sounds can be accompanied with different
movements.

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Acquisition of Components of Non-Verbal Communication

Objectives: Expression of emotions; development of sensitivity to the signs
of non-verbal communication; and realisation of your body movements
through mirror reflection.

Each participant first demonstrates the movements he/she does not like and
then the movements he/she likes while the group mirrors his/her
movements. Afterwards, they discuss these movements. Some participants
might like to explain their reasons for choosing their movements.

3.3.2 Community Work

This form of the psychosocial rehabilitation of children and adolescents includes
mainly work with parents and teachers.

3.3.2.1 Working with Parents

The objective is to make parents more aware of the issues involved in child
development and child psychology. It comprises the preparation and the
dissemination of leaflets and newspapers, highlighting issues such as:

how to help a child in a crisis situation;
how to improve mutual understanding in communication with other children;
how to overcome a child's stubbornness; and
what problems arise in adolescence, etc.

The helper should aim at improving parent-child relationships and increasing the
reliability of the child's closest resources. The involvement of parents is key in the
process of child rehabilitation. Experience shows that having a family focus and
supporting the childrens support network greatly benefits their rehabilitation.

The training for parents includes the following components:

awareness of the psychological problems of the children;
communication skills for an effective parent-child dialogue;
discussion of their relationship to the children;
providing group support;
release of emotional tension;
regulation of family relations; and
assistance in overcoming personal traumatic experiences.

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Awareness of childrens psychological problems

To better understand the child's inner world and his/her traumatic experience, we use
exercises in which adults recall traumatic experiences of their childhood as well as
the behaviour accompanying such experiences. This technique helps them to realise
that the reason for any problem behaviour (aggressiveness, shyness, etc.) lies in
traumatic experience, frustration, unsatisfied needs, fear, and anxiety. The training
uses models of rea-life problematic parent-child relationships, role-playing, group
discussion on similar situations, and the search for alternatives to make relationships
more effective.

In the development of effective communication it is important for parents not to
attach labels (e.g. lazy, hooligan, etc.) and to abstain from categorising their
children. For this purpose, the group works on active listening, restating, and the I
message. Analytical tools should gradually replace easy categorisation and
punishment, as parents learn the why and how of their children's problems.

During discussions, the helper should not make any judgmental assertions, but
should assist parents in reaching an independent understanding of different aspects
of their relationship with their children and in becoming more efficient in such a
relationship.

A single effective question from the helper is sometimes more helpful than a long
explanation. A young mother was complaining about the stubbornness of her four
year-old son and the difficulties she had because of it: Once I rebuked him for
something he did not do and all day long he reminded me of it. The helper asked
whether she apologised to her son. She did not answer. The question helped her to
realise the necessity for parity in her relationship with her son: she enforced a rule
that she did not respect herself, so that the double standard had a confusing effect on
the child.

Working with parents is an experiential process, rather than an educational one,
during which parents are free to bring up examples from their own experience.
Experiences of positive solutions can be replicated in other families. It often
becomes necessary to work with the parents emotional problems in addition to the
problems of their children. The trust-based atmosphere in a group enables its
members to talk freely about their traumatic experience. Mutual support,
compassion, and empathy expressed by group members helps them to positively
transform their traumatic experience. The development of meditation skills also
helps group members to reduce tension in their families.

Family consulting enables the helper to follow the child's psychological
development in the context of his/her family. A diagnosis should be made on the
style of the family relations, the ground rules for coexistence, the conflict-related
themes (dominance-subordination, responsibility-irresponsibility, closeness-
distance, etc.), latent and manifested conflicts, the family's history and its value
system.

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If an insincere atmosphere and latent conflicts prevail in the family, the rules of
coexistence restrict the development of the family members. The family is split into
opposing groups, based on major unresolved problems. In such cases, family therapy
must be undertaken by helpers specially trained for this purpose. Others must refrain
from entering this sphere of activity without due qualification.

One of the helper's tasks is to foster the children's co-operation with their parents
and to observe the dynamics of children's inner development. The helper should:

establish contact with parents;
explain to them the objectives of the rehabilitation activities;
offer co-operation in providing assistance to children; and
find out whether the parents have any problems in relation to their children or
any specific requirements.

Such an approach will enable the helper to get feedback regarding the efficiency of
the work conducted with children.

Restoring proper communication

Very often, the reason for family conflicts is a distorted communication system. For
instance, one family member assumes that another member feels this and that,
thinks this and that, etc., and believes his/her subjective perception to be the true
situation. Such a belief restricts his/her perceptions to such an extent that he/ she
overlooks the elements that do not confirm his/her own expectations. The helper can
facilitate family communication by assisting the members in expressing their
feelings, listening to each other, achieving agreement, and making joint decisions
with all interests taken into consideration.

Overcoming victimisation and enemy image

Family members should share the same visions and interpretations of past events, as
well as the same expectations for the future. The helper's work aims at the
elimination of over-generalisations underlying enemy images and victimisation. In
this connection, the facilitator stimulates positive memories associated with
communicating with the other side of the conflict. He/She also focuses on the
future of the family, its immediate and long-term goals, and their analysis. The
facilitator helps the family to realise what depends (and what does not depend) on
the family, and what they can be responsible for in the building up of the future of
the family. Such work creates a healthy atmosphere in the family, which has a direct
impact on the children.

Consulting parents in the case of the death of a family member

Parents should get advice regarding issues like what and how to tell children that
someone from their close circle has died:
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children should be told about the event in a safe atmosphere;
parents should be sincere when answering their questions (otherwise, the
children might have painful images, due to their rich imaginations);
children should attend ceremonies like funerals and other grieving rituals;
children should be given the opportunity to sob out their grief and parents
should not forbid them to cry. They should explain that it is a natural
human reaction and that even grown up people cry when they feel
unhappy;
parents should make them feel that they are not alone, that their pain is
understood and that they are in safety.

Consulting families with disabled children

Disabled children should be encouraged to take part in the psychosocial
rehabilitation process, not only because of their rights but also because of their
capacity for personal development. Parents should be convinced of this necessity
through the constant work of the helper. However, the helper should be careful about
not taking on the parents role through the manifestation of excessive love or
through top down advice that would discredit the parents in front of their children.

3.3.2.2 Working with Teachers

Teachers are in the child's direct environment and it is important to work with them
as they can greatly influence the child's development. This work should be carried
out in several directions:

development of teachers' awareness of trauma;
development of skills for an effective teacher-pupil dialogue;
acquisition of the necessary skills to improve students cognitive and
emotional competence;
acquisition of the skills necessary for regulating childrens relationships to
reduce tension and conflicts;
awareness of the peculiarities of the relationship between teachers and parents.

Great importance is also attached to professional exchanges between teachers, group
discussions of problems, and the release of emotions. When working with teachers,
the helper will use almost all of the above-mentioned methods that are employed
with parents, but with certain modifications and additions.

In order for teachers to have a better awareness of the special psychological and
other needs of traumatised children, empathetic understanding of the childrens
traumatic situation should be supplemented with theoretical knowledge on the
psycho-emotional state of children in crisis situations (see chapters 1 and 2).
Teachers should also be able to identify those cases for which they are not
competent and that should be referred to a specialist.

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When developing communication skills, special emphasis is placed on the teachers
perception of a student as a full-fledged person that should not be labelled (as
irresponsible, etc.) or categorised (as a difficult child, etc.). A teacher should be
open and sincere in his/her relationships with children and his/her possible previous
role of quasi-judge should be replaced with the one of a spontaneous facilitator,
within an atmosphere of trust and safety. At the same time he/she should confine
him/herself to his/her relevant functions and clearly differentiate between the
parents and his/her responsibilities. Along with childrens academic achievements,
the teacher should take care of the improvement of childrens emotional and social
competence, referred to in the table below.

Levels of a childs social competence

High level Adequate level Low level
Excessive control Adequate control Insufficient control
Lack of ability to defend
his/her own rights
Defends his/her own rights
and respects other peoples
rights
Cares for his/her own
rights and does not respect
other peoples rights
Rarely achieves his/her
objective, is not able to
establish emotional
relations
Is able to empathise;
achieves his/her objectives
without doing harm to
others
Achieves his/her
objectives, even at the
expense of other peoples
interests; poorly developed
empathy
Frustrated, vulnerable,
feels unhappy
Satisfied Frustrated, resentful,
defensive
Passive, constrained Socially and emotionally
expressive
Aggressive, resentful,
explosive
Prefers that others make
decisions
Makes decisions and
always takes the groups
interests into consideration
Dominating; criticises
others decisions
Verbal manifestation
Sorry, let it be like this
since others think so
(difficulty saying no)
I think, I assume, what do
you think? We can
I, mine, how can you think
like this? It is ridiculous
Non-verbal manifestation
Avoids conflicts, tense
posture, speaks in low
voice, tense muscles, lack
of eye contact
Posture reflects safety and
self-reliance, relaxed
muscles
Dominant style,
threatening posture, speaks
loudly, tense body,
persistent

The teachers should also advocate to close down the IDPs only schools and to
integrate the children within local classes.

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3.3.2.3 Working with the Host Population

The helper should organise several activities for both local and IDP children in order
to foster their integration, such as:

concerts, exhibitions, quizzes;
staging of puppet plays created by the children;
dissemination of newspapers containing children's works like poems, pictures,
stories, etc.; and
promoting letter exchanges between children.

In schools where local and displaced children are in the same group, there is often
tension. Joint education and being in the same group are very important for
overcoming isolation and estrangement. This fosters mutual acceptance and helps a
person to perceive him/herself as a fully functioning member of society. It should be
taken into consideration within the policy of education, as suggested in the Guiding
Principles on Internal Displacement.

3.3.3 Casework

This kind of work implies the provision of professional psychotherapeutic assistance
to children suffering from traumatic and psychosomatic disorders by psychologists
and psychiatrists. Helpers should refrain from entering this sphere beyond their
particular competence without adequate support. However, personal contact with a
child who has specific problems interacting with others is often needed. In this case,
the helper will treat the child in a benevolent, non-judgmental way that will help the
child to feel safe in his/her relationships. Sometimes only one meeting is enough for
a child to take a crucial step and engage him/herself in group activities.

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Chapter 4
PSYCHOSOCIAL REHABILITATION OF ADULTS:

Traumatised adults are often reluctant to receive psychological assistance because
their society is not accustomed to it. Psychosocial assistance is generally equated
with psychiatric treatment and such help is considered a luxury when basic
commodities are often lacking.

As a consequence, the helper is advised to introduce psychosocial activities through
training on useful skills. The activities should still serve the objectives of processing
traumatic experience, relieving the person from the consequences of the trauma, and
supporting the rehabilitation of his/her social functions.

The helper should also remember that because of their temporary vulnerability, the
persons he/she wants to assist are first concentrated on the material benefit they can
gain from the situations in which they find themselves. However, they also lack
normal human contacts and sincere friendly support. As stated earlier, reality should
be at the root of the helper's actions.

Intervention Methods

4.1 Focus Groups

Focus groups are an ideal starting point for working with adults as it fosters an I-
you relationship and focuses on their practical problems. Such groups are aimed at
giving the helper a chance to identify the material problems with which the
displaced are confronted, as well as their psychological problems and their
resources. Participants learn to discuss their problems, to generate ideas to resolve
them, and to plan for the future. The groups also gain psycho-corrective meaning
from the problem-focused atmosphere, time limits, and the meetings structure,
which bring order into the chaotic world of traumatised persons. It gives them hope
that the problems to which there seem to be no solution can at least be addressed.
They become more confident, coherent, and acquire skills of joint decision-making.

A comfortable environment (space and chairs for the participants) is necessary, as
well as recording equipment (dictaphone, videocamera), and a board for writing
conclusions during discussions.

Six to eight participants are chosen based on some common criteria. A homogeneous
group guarantees, on the one hand, a deeper focus on problems discussed and, on the
86

other hand, creates conditions for openness and gives participants the possibility of
feeling that they are among their people.

Topics of discussion can vary from problems in daily life to successful life
achievements. Information is gathered not only on the subject under discussion, but
also on the way participants tackle the problem (how they come to a consensus, how
the group interacts, etc.).

The moderator should have a good understanding of the groups dynamics. He/She
should support spontaneity, but keep the meeting within the time limits by not
allowing deviations from the subject. Excellent listening skills and the ability to
clearly express his/her thoughts and to create a trusting and relaxed atmosphere are
key qualities the moderator must possess.

The scenario for the meeting, including the sequence of the questions should be
prepared beforehand.

The meeting begins with the introduction of the ground rules. It is better to start
group discussions with open questions. This allows all participants to feel free in
sharing their ideas and helps to break the ice. Gradually, questions become more
structured and intensify the focus of the discussion on concrete problems.

In the process of the discussion, the moderator can use pauses as a technique to
provoke additional points of view. He/She also requests the clarification of answers
to define inexact or vague statements. After the meeting, collected material should
be processed (using audio or video records, records on the board, etc.) and analysed,
and actions decided upon during the meeting should be implemented. The analysis
of results by the moderator and his/her assistants is of special importance. It is also
advisable to invite an independent expert to discuss the collected material.

4.2 Problem-Solving Groups

This group strategy differs slightly from the focused discussion as it is more
spontaneous and uses a greater number of tools, i.e. more concrete methods,
psycho-technical games, and exercises. The main aim of such groups is the
development of problem-solving skills. The method also carries a psycho-
correctional element overcoming an emotional crisis and its consequences by the
reinforcement of joint stress control mechanisms.

The method is aimed at developing skills for coping with various problems and
making decisions in difficult situations. Another very important goal is the
development of teamwork. A minimum accessory kit (paper and pencil) should
always be available for the helper, as similar group sessions can be conducted
spontaneously after a problem arises.

Groups can be of either three to four participants or eight to 12. However, if needed,
the number of participants can be increased. The group can be either homogeneous
or heterogeneous. Only the positive will to participate is needed on the part of each
participant. The group is led by a facilitator and a co-facilitator. The facilitator
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should structure the space for the session, introduce the idea, and explain the
purposes and the aims of the session. Then the whole group formulates ground rules
for the discussions. The participation of all group members in the making of the
ground rules will guarantee their respect.

Ice-breaking energisers are used before starting to work. Two main techniques are
used: brainstorming and simulation of the situations. The helper not only has to have
a rich store of psychological tools and be able to adjust them to concrete problems,
but also has to be able to use his/her creativity for designing and simulating during
the whole process.

The helper should always remember that a psycho rehabilitation activity is aimed at
the transformation and the processing of the traumatic experience. While he/she
facilitates the solving of practical problems, he/she should first and foremost help
the participant to relieve emotional crises. At the end of the session, participants
jointly analyse the work and discuss the achievements.

4.3 Brainstorming

Brainstorming can also be used for rehabilitation purposes. Firstly, special attention
should be paid to the creation of a safe and confidential atmosphere in the group so
that each member has the possibility to freely express any ideas without the threat of
being laughed at. This can be reached through careful joint agreements on
procedural rules that will allow participants to relax.

Confidence and feelings of safety liberate thoughts and imaginations that have been
numbed by emotional trauma. Non-standard thinking should be encouraged and
attempts to evaluate, criticise, or condemn the ideas or the author should not be
permitted.

On the other hand, brainstorming should occur at a very quick pace. Humans are
fast-learners and it is necessary to use this ability completely. A quick pace also
avoids the potential barriers of self-criticism and self-awareness, which inhibit the
human psyche under stressful situations. The facilitators skill to record quickly is of
vital importance here.

Before starting the evaluation of results, it is necessary to explain to the group that
the ideas chosen as the best ones are products of the whole group that integrate those
from which they were inspired. Such explanations raise mutual trust and confidence
and also foster the process of generating ideas.

4.4 Simulation of Problem-Solving Situations

This method requires creativity and improvisation skills from the helper. All kinds
of psycho-technical games, drawings, and exercises could be used for this
procedure. In possessing a store of these instruments, the helper can simply adapt
them to actual problems by slightly altering them.
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4.5 Self-Help and Mutual Aid Groups

These groups focus on the acquisition of psychological skills and/or first aid skills.

The groups are organised in the collective centres in order to train IDPs for basic
psychosocial assistance and/or medical first aid or on other subjects they request.
This method saves on the resources of professional helpers and has a sustainable
effect in strengthening the independence, confidence, and dignity of the traumatised
individuals. It also prevents them from spreading the consequences of their own
trauma among community members as they develop a more responsible attitude
towards their community. Self-help groups also have far-reaching effects as they
help to build up solidarity in the community and strengthen feelings of self-
confidence and independence.

It is worth mentioning that in these self-help groups, the most active person who can
create an atmosphere for community mobilisation and development can be
identified. These persons often become volunteer helpers and are of great support in
future rehabilitation activities.

Case study

During problem solving discussions, IDPs expressed their willingness to
acquire self-help skills, to learn how to care for an ill person, and to get
acquainted with medical and hygienic massage. They also requested to be
taught effective communication and business skills, and conflict
management and negotiation techniques.

For the group meetings, it is necessary to have space, chairs for the participants,
paper, pencils, and visual aids for the demonstration of medical manipulations.
Groups are formed on a voluntary basis with up to 20 participants in each.

Group training is conducted in the form of interactive education. The trainer, a
professional in the requested field, facilitates the session in a participatory manner:
the training modules will be based on the previous experiences of the participants in
the field discussed. The trainer asks participants to identify which skills actually
guaranteed their success in the situation they described and on which skills the
training should focus. After the first training session, participants are given tasks to
test the newly acquired skills in real situations. They present the results for
discussion at the next group meeting.

The organisation of self-help groups in collective/communal centres provides an
excellent opportunity to solve day-to-day problems and to mobilise the community
through mutual aid and support.

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4.6 Targeting Skills Training: Job Creation

Unemployment is one of the main problems of post-conflict situations. Skills
training will strengthen self-confidence and the hope of trainees. However, they
should be based on a close community-based evaluation of both the capacities of the
future trainees and the job market potentials. The training should only aim at
adapting the existing skills of the trainees to the job market opportunities. More
ambitious projects should be conditional upon the existence of sustainable
conditions identified for the IDPs. Management training and business games are also
very necessary.

4.7 Psycho-Correctional Groups

These therapeutic groups aim at processing and correcting the traumatic experiences
of the most psychologically vulnerable persons. This method may have an important
impact just after the trauma takes place. More precisely, these groups aim at:

Enhancing mechanisms for coping with stress;
Reducing stress disorders (fear, intrusive memories, insomnia, nightmares,
depression, etc.);
Correcting psychosomatic disorders; and
Skills development in order to overcome a psychological crisis.

The average number of participants in these groups varies from 8 to 15 persons. The
group is led by a facilitator and a co-facilitator. Initial sessions aim at building trust
and confidence, through energisers, in the group in order to guarantee a positive and
open attitude of the participants towards each other and towards the new experience.

The retelling of traumatic experiences is spontaneous and should not be pushed: a
person should be ready to share his/her feelings and sufferings with the group on the
basis of mutual confidence and acceptance. In most cases, participants
spontaneously start speaking of their traumatic experiences, but sometimes the
trainer can suggest a simple game of Stressful Words in order to engage the
process. The essence of the game is that each participant should say the word that
reminds him/her of unpleasant memories. The participants then choose the most
stressful words from the list and start an open discussion on the reasons why these
words are stressful.

After this warming up, a participant is usually willing to speak about his/her
traumatic experiences. The trainer not only has to encourage the initiative of the
narrator, but also should allow other participants to ask questions, which can help to
clarify events. The picture of traumatic incidents is always scattered and the
sequence of events is often wrong. Participants help the teller to restore a more
accurate sequence of traumatic episodes. They build a common picture of the event,
giving the sensation of cognitive organisation, which helps in the conversion of the
trauma.

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In the following stage, the trainer asks questions in order for the narrator to speak on
his/her feelings during the traumatic incident. For instance, questions like What did
you feel when this happened? or Why did you behave so? promote emotional
reactions. Sometimes such provoking questions can cause an extensive emotional
reaction of the narrator, especially when the trauma is still fresh.

This is why new helpers should be supported by professionals who can give them
the proper back-up. During the narration, other participants may feel similar
sensations. They want to share their own painful memories when they see
understanding and empathy. If strong emotional reactions are revealed, the trainer
should use them for the mobilisation of group support. A comforting touch and
words to the neighbour is absolutely acceptable here, as are tears.

In the last phase, the trainer retells the story to the narrator adding nothing and
omitting nothing. This is a very important phase and the helper should have not only
a good memory but also an ability to match the facts, form up a scenario, and
skilfully retell the events. Now the purpose of the last phase becomes clear: it
promotes cognitive organisation, reaction, and transformation of the traumatic
experience. At the end of the procedure, the group can be offered some relaxation or
meditation exercises for the release of emotions.

All of the above is basic procedure for the transformation of traumatic experiences.
It can be elaborated upon as the helper gains more experience and knowledge.

The psycho-corrective groups help people with emotional and psychosomatic
problems to take a new look at their own sufferings. It enables them to experience
the power of mutual support. However, what is most important is that people begin
to realise that their suffering is an absolutely natural reaction to abnormal
circumstances. As they acknowledge this fact, they begin to get rid of the problems.

As stated above, this is the method that works most efficiently in the initial stages.
With the acquisition of coping skills and the formation of self-help and mutual aid
groups, the need for psycho-correctional rehabilitation decreases and the displaced
prefer skill training rather than therapy.

4.8 Family Counselling

The life experiences gained through generations within families are at the root of the
psychological climate of the family, but also of the entire community. This
experience is processed through play and songs, through family legends, (Our
grandpa used to...), family habits, vocabulary, recollections of ancestors, interests,
collections, belongings (inheritance), vocabulary, parental blessings, parental
instructions, wishes, and bans.

Trauma leaves a deep trace on the family and its members, influencing and re-
shaping its experience (habits, traditions, social rating, and interests are changed).
Traditional family legends become covered by traumatic histories, full of
impatience, aggression, and despair.

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The structure of a family plays an important role in shaping its psychological
climate. Usually the family is organised according to two core principles power
and support. The first refers to how the family takes important decisions (who is the
authority who takes more decisions? are these decisions based on a consensus? do
children participate in these decisions as they should?). Support refers to the level of
affection, emotional satisfaction, physical contacts, approval, and care between the
members of the family.

While consulting a family in crisis, the helper should pay special attention to the
negative factors that influence the shaping of the family experience. Taking note of
the negative factors is of key importance to preventing the family, as well as the
community, from destructive tendencies and relationships. Family consultation is a
very powerful instrument for preventing an involuntary transgenerational
transmission of traumatic experience and the creation of a traumatised community.

The main aim of family counselling is the recovery of a positive socio-psychological
climate in the family and the creation of a positive attitude towards each other. The
ultimate aim of this correction is the creation of a healthy daily atmosphere in the
community, the preservation of its socio-cultural individuality, and the strengthening
of its foundations. It will enable the person experiencing a crisis to strengthen
his/her feeling of being a part of the community, as well as his/her sense of
usefulness. The person will be able to calm his/her wounded pride, restore his/her
self-dignity, and regain his/her lost identity.

Family counselling is mostly conducted in the family residence. A single facilitator
can conduct such sessions, but if resources allow, a co-facilitator should help.
His/her duty is to observe non-verbal communication and to relieve the work of the
facilitator by supporting him/her with feedback.

Usually, the session starts with a conversation with one or several members of the
family on vital daily problems. As trust increases, the session turns into an interview
through which the helper gets important information on the social functioning and
corrects negative factors that feed into the trauma (isolation, alienation from the
society, aggression, and intolerance to the other, victimisation, enemy image,
etc.).

The session consists of three phases: the collection of information, clarification, and
correction. Family members should be encouraged to express their points of view,
but the helper should not interfere even disputes between family members. It allows
the helper to gain a better understanding of the rules and styles of relationships that
prevail in the family and allows him/her to read all the positive and negative
aspects of the familys functioning. It is very important not to give advice, as family
members will come to certain conclusions themselves on the basis of information
provided by the helper.

In the correction phase it is possible to use stories and metaphors that reveal a
possible solution for the problem. Some questions, particularly questions concerning
the indirect trauma of children in the family, should be clarified separately, without
the presence of the concerned family members. At the end of the procedure, together
with family members, the helper establish a plan for further action and agree on
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when next to meet next. Certainly it can be limited to one session, but if time and
resources allow, a second meeting is really necessary.

At the following meeting, members of the family usually are more prepared and
excited by the results already obtained. Important nuances that were overlooked can
be clarified. A real partner's alliance of common efforts is created to overcome the
consequences of the trauma.

Family consultation is not an easy procedure. If conducted at a professional level,
one can achieve a significant effect in preventing the traumatisation of the younger
generation, in reshaping a positive psychological climate in the families, and in
reducing the psychological, and even the psychosomatic, consequences of trauma.

Family members participating in other forms of rehabilitation certainly bring a
positive element to the family that may be counterbalanced by the experiences of the
other members. However, other members of the family not participating in similar
actions quickly remove it. So when working only with one family member, the
process of overcoming the crisis at the family level is delayed. Family consultations
have the advantage of taking into account all members and all relationships in the
family.

4.9 Individual Help

Although this form of rehabilitation has a modest place in the variety of
psychosocial support, it remains an extremely important and efficient means of
psychological interference. The unpopularity of this form of psychological
assistance is linked to its cost that cannot be met in a situation where large numbers
of persons have been traumatised.

The individual approach is also necessary when working with persons traumatised as
a result of direct violence (sexual abuse, etc.). They demand special attention. In
fact, they tend to mistrust other people to the point where they reject any assistance,
even if offered by a professional. The helper should be always on the alert to
identify a possible victim of violence and, step by step, he/she should try to gain
his/her trust and prepare the ground for further individual work. Sometimes relatives
strongly recommend the helper focus on one person.

There are several methods of individual interference issued from psychotherapeutic
practices, trauma leaves such deep wounds in the human soul that only a high level
of professionalism, excellent skills, and delicate interference are able to heal them.
Helpers should not enter such a field without proper qualifications or support from
an experienced professional.

Below we will discuss one of the most efficient methods of individual assistance
that has undergone some significant changes during its practice in Georgia
3
.

3
This theory was first established by Dr. Shapiro.
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This method comes from the assumption that the human brain has a natural
mechanism of information processing, which allow humans to adapt to their
environment. For example, when something unpleasant comes to our mind, we start
to worry about it. We continually think and speak about it and we may even see it in
our dreams. Some time later, anxiety decreases and our experience can be used as
information directed to the future. We begin to better understand the situation and to
gain the capacity to cope with similar situations more effectively. Psychological
trauma experienced by a person reveals itself as breaking a balance of the nervous
system its ability of optimal functioning gets lost but the information on
traumatising events is saved in the brain in a distorted condition.

The hypothesis consists of the following: any actual irritator, such as eye
movements, triggers the activation of the information processing system. During the
series of eyes movements (see description of the procedure below), when a client
is asked to recall a traumatic event, an association is established between the
consciousness and the brain area in which the information on the trauma is kept. Eye
movements (external stimuli) force the person to focus his/her attention
simultaneously both on the actual irritant (fingers of the therapist) and on the past
trauma (double focusing). The associative mechanisms in the brain are, thus,
triggered and two kinds of information traumatic and adaptive are connected
with each other. This connection is necessary for getting a positive solution. That is
the initial point given by the author.

As for us, we consider that the alternative activation of the left and right
hemispheres of the brain occurs during the procedure of movement of the eyes.
Traumatic images kept in the right part of the brain, are activated when the eyes
are moved in a corresponding direction. Then, when the glance is transferred to the
opposite direction, the left hemisphere joins the function, which is responsible for
the processing of graphic information. Thus, occurs a measured processing of
traumatic experience, which, because of its severity and unacceptability in its time
was displaced from the conscious memory.

There are some other explanations of the effect. Some authors consider that quick
eye movements cause hypnotic trances, which, in turn, relieve a processing of the
traumatic experience through the mobilisation of psychological resources of the
person.

Anyway, the strategy works and it is worth trying, though the author does not
recommend conducting it without special preparation and a corresponding certificate
from a specialist. This prohibition stems from the fact of overly tempestuous
reactions during the procedure. However, such tempestuous emotional reactions
could be observed in other cases of psychological interference as well. And, if the
helper is able to cope with them, why should he refuse to practise this method,
especially since the technical side of it is not difficult.

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Procedure

The First Stage

In the first stage, the clients are selected for a session and their emotional and
physical conditions are evaluated and recollection is gathered. Usually the procedure
is conducted with the client, whose emotional condition allows such interference. If
the trauma is still fresh and emotional reactions and sufferings are intense, it is better
to postpone the session and use other forms to reduce the stress level.

The Second Stage

At this stage the client is being prepared for the session the contact (rapport) is
established and a confident and safe environment is created. The essence of
procedure is explained to the client and he/she is warned of possible emotional
reactions both during the sessions and after them. Remember to remind a client that
these reactions are absolutely natural and one should not be afraid or, moreover,
ashamed of them. At this stage it is possible to conduct the rehearsal of eye
movements with the client. It is done not for the transformation of trauma but only
for the determination of the optimum velocity and number of movements.

The Third Stage

At this stage the therapist chooses the subject for influence. He/She identifies the
traumatic episode with which to begin work. Usually, experienced specialists start
transforming the most anxiety-arousing fragments. After processing the main
traumatic moment, other episodes associated with it are transformed automatically
without additional intervention and the effect is reached faster. The beginner helper
who fears to witness the clients tempestuous reactions can choose less emotional
episodes with which to work.

During the same stage, the clients negative self-perception is identified. Negative
self-perception is formed by the clients negative statements about him/herself,
which have been caused by trauma. This is important, as the client should be capable
of distinguishing the low self-esteem in the past from self-perception in the present.
For example, statements like: I am weak... I am in danger... I dont deserve respect
can refer to his/her past and have no relations to his/her present state. In fact, this is
an irrational opinion because the traumatic event itself occurred long ago. The
method in question works successfully with exactly these irrational self-perceptions.

Along with the identification of the clients negative self-perception, at this stage the
positive self-perception should also be created. Positive self-perception represents
the verbalisation of the clients desired states. Usually it is a diametrically opposite
statement to the negative-perception. Positive presentation should be expressed in a
positive form. For example, expressions like I will not be a loser or I will not be
incompetent express the positive self-evaluation to a lesser extent than expressions
like I can be winner or I am competent.

For the creation of a desired positive image the so-called NLP technology can be
used. The essence of this technology is that the client is asked to recall the most
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pleasant episodes from his/her past, the episodes when he/she reached certain
personal successes, was satisfied with him/herself, and positively evaluated
him/herself. Going back to this episode facilitates the process of preserving a
positive self-perception by the client.

The Fourth Stage Desensitisation

This is the basic part of the procedure and it is sometimes called accelerated
processing. The client recalls the traumatic event and retains a picture of it in his/her
imagination. He/she identifies the location of unpleasant sensations in the body
sensations that are caused by these recollections.

Simultaneously, the client watches (without moving his/her head) the therapists
fingers. The therapist keeps two fingers vertically, with the palm turned to the client
approximately at the distance of 30-35cm from the clients face. Then the therapist
starts to move fingers horizontally from the right edge of the visual field of the client
to the left edge (or vice versa). The velocity of moving the fingers has to correspond
to the rate determined beforehand as the most comfortable for the client. Usually a
series of eye movements does not exceed 24 two-way movements, where the shift
from the right to the left and then back represents one movement. Some clients need
36 or even more to process the material. During one session several such courses can
be conducted. During the series of eye movements the therapist does not interfere,
but attentively observes the process. During the session some clients focus their
attention on a changing of images, others upon new insight or changing of
perspective on changes in body sensations. That is why the question should not
sound like: What do you see? What do you feel? The client reports on these
changes after the session.

Immediately after the series of eye movements, the therapist says: Have a rest,
forget all this, take a deep breath. Only after a certain pause may the client
verbalise his/her experiences during the processing. The therapist needs this verbal
account only for defining the level of processing and not for the analysis or
interpretation. The therapist should not reveal such skills. Neither should he/she
impose his/her own assumptions or hallucinations to the client. It is much better to
let the client express his/her own cognitive interpretations. If during the session new
painful recollections emerge, the therapist can simply use them for the following
series of eye movements. The therapists task is to identify the processing level and
if the level is insufficient, the series are repeated until the processing is completed.
This is the whole technology of this method. Certainly, it has many other nuances
too, but we have no possibility to go into more details.

We would like to share some considerations on this technology. Firstly, we
completely agree with Dr. Shapiro that it is not necessary to analyse the clients
accounts of his/her experiences during the session. Moreover, when we deal with
severe psychological trauma and when we know that usually the trauma is not
discussed, it is impossible to express it verbally. That is why it is inadmissible
to force the client to analyse his/her painful experiences the client him/herself
will perfectly cope with his/her own problems if we help him/her to get access to
his/her own positive resources. Stemming from this, the therapist should focus
his/her attention more on the process and its course, than on its contents.
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Secondly, the therapist should consider through which channel (mainly visual,
audio, or kinaesthetic) the client searches for access to recollections. It is possible to
define it beforehand, e.g. at the second stage. If the eyes are directed upwards, the
access to the past is achieved through the visual system. Consequently, if eyes move
in the horizontal direction, the audio system is used, and if downwards, the
kinaesthetic system.

It is possible to conduct an experiment during the session. Let the clients eyes move
not strictly horizontally but, for example 45 degrees upwards or downwards
(depending on what channel is used) by moving the fingers, correspondingly, a bit
above or below the clients head. During the session it might appear that the access
to some episodes of trauma is achieved through one channel and to others through
another. Sometimes when the therapist changes the movement of fingers along the
vertical axis, the client mimics or changes breathing to indicate the condition of
insight in spite of the fact that the access channel was determined beforehand as the
kinaesthetic sphere. There is an explanation for this: people usually use one
sensation system for recollection of the past and stick to it. Perhaps that is the
reason that causes the fragmentation of traumatic memory. When changing the axis
of eye movements the therapist transfers the client into another access channel,
where he/she can suddenly recall (see, hear or feel) hidden fragments of trauma,
restore a holistic picture of the traumatic event, and cope with it. That might cause
further insight.

The Fifth Stage

The installation starts when desensitisation is completed, i.e. the anxiety level is
already significantly reduced. Usually by this phase the clients negative self-
perception disappears. Even more, at the stage of desensitisation some spontaneous
positive self-perceptions may appear, e.g.: I can already control myself or I could
do this... The installation is aimed at the integration of positive self-perception with
chosen traumatic experiences. For this purpose, the clients positive self-perceptions
that spontaneously emerge during the session can be used. If there are none, positive
perceptions which were worked out beforehand during the third stage can be used.
The installation is used for the reinforcement of positive self-perception in
connection with the past trauma (i.e. in case of trauma). The client is given
instructions to think about the traumatic event and, retaining this image, repeat
positive self-perception statements. This instruction is general as far as the initial
image of the traumatic event could already be lost or converted into another that is
more acceptable and with another perspective. If no image already exists, the
therapist offers simply to think about it.

It may happen that the positive image worked out beforehand and as desirable for
the client at the third stage of procedure becomes insufficiently attractive. In this
case, additional work on image is necessary.

After defining all these nuances, the client is taken through the new series of eye
movements. These series are repeated until the clients positive perceptions in
connection with trauma do not become valid.

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The Sixth Stage

Since positive self-perceptions are completely obtained, the client is asked to retain
in the consciousness both a chosen traumatic event and positive self-perception and
at the same time scan his/her body from top to bottom. He/She is asked to identify
any remaining tension, revealing itself in the body sensations. Such sensations are
selected for further sessions. In many cases after the sessions, tension simply
disappears. Sometimes during the body scanning some remaining images of still
unprocessed trauma can appear, such as the sudden recollection of hidden episodes
of a traumatic event. This phase ends when the client finds no tension while
imaginary scanning.

The Seventh Stage

This is the last phase and it comprises two important moments. First, the client
should leave the session feeling emotional comfort. And secondly, the client is
informed that after the sessions some disturbing images may appear. These
reactions are signs of the further automatic processing of trauma. He/She is asked to
make a momentary shot of these images and to process them at the following
session. Usually it does not go so far and the client him/herself copes with the
remaining images. Or they might not appear at all, but still it is better to warn the
client in any case.
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