ICB Newsletter 0710 PDF

8/9/2019 ICB Newsletter 0710 PDF

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The Center for Victims of Torture

New Tactics July Online Dialogue: Staying Safe, SecurityResources for Human Rights Defenders

CRTS, BangladeshACET, BulgariaTPO, CambodiaCRAT, CameroonRCVTE, Ethiopia

ECAP, GuatemalaIMLU, Kenya

KRCT, KosovoSCRVTV, India

PEACE, NamibiaSACH, PakistanTRC, Palestine

CAPS, PeruICAR, Romania

CAPS, Sierra LeoneTCSVT, South Africa

ACTRVT, SudanACTV, Uganda

ICB ProjectPartner Centers

Join New Tactics for this important dialogue on Staying Safe: Se-curity Resources for Human Rights Defenders from July 21 -

27, 2010. Human rights defenders are often met with oppression,discrimination and violence. Human rights work is powerful and

necessary; it is important identify strategies and methods for protec-

tion of these defenders. This dialogue will bring together practitio-ners that work with human rights defenders developing security

strategies to share important resources and tools for the human

rights community.

For additional information, visit the New Tactics website.

Unfortunately, the solution previously described is

not as perfect as it may seem. While there may beno other immediate option in this scenario, there are

significant problems with using an ad hoc

(improvised or impromptu) interpreter, particularlyif the person is a family member or friend. This arti-

cle will outline the standards of practice for trained

interpreters and the problems that can arise if provid-

ers use ad hoc interpreters with torture survivors.

Accuracy and Complete Interpretation

The role of a trained interpreter is to provide clearcommunication between the client and the provider.

An interpreter should not add to or omit things fromthe information that is being shared in a session.

A friend or family member serving as interpreter

may have trouble in this role and find it difficult tofollow this guideline. Friends and family members

sometimes have their own ideas about what their

loved one needs or wants; they may feel compelled

to share their ideas about what the client needs ver-

sus allowing the client to articulate this for them-

(Continued on page 2)

A new client comes to your clinic in

search of help. He has a story to tell and

is desperate to communicate with some-

one who understands what he has experi-

enced. The problem? No one on staff

speaks a common language with him.Just then, a teenage boy walks in and

introduces himself, in your language, asthe son of the man before you. He offers

to interpret for you during the intake

process. How lucky! A problem has justbeen solved.

The Use of Trained Interpreters with Torture Survivors:A Worthwhile Challenge -Alison Beckman and Diane Long

http://

www.newtactics.org/en/

blog/new-tactics/

staying-safe-security-

resources-human-

rights-defenders

July 2010International Capacity Building

International Capacity Building

(ICB) Project NewsletterInside this issue

Pages 1-3: The Use ofTrained Interpreters: A

Worthwhile Challenge

Page 1: New Tactics JulyDialogue: Staying Safe,

Security Resources for Hu-man Rights Defenders

Page 2: Ways for Interpret-ers to Create Comfort &Safety

Page 3: Signs and Symp-

toms of Vicarious Trauma

Pages 4: Managing Stress& Anxiety: Helpful Things

for Interpreters to Do

Pages 5-8: SecondaryTrauma for Interpreters

Pages 9-10: Clinical Cor-ner: Personal Experiencewith Social Work (Peru)

*Spanish version Pages 11-12


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member of the opposition party.

Provision of a Consistent,Professional Role

A trained interpreter should main-tain a professional distance. All

parties should understand that theinterpreter has a very specificrole: to communicate information

between the client and the pro-vider. Interpreters are not there tobe the clients friend, confidante,

case-worker or parent.

With torture survivors, it is rec-

ommended to use the same inter-preter throughout treatment.

Through consistent professionalinteractions with an interpreter, a

client can come to trust the inter-

preter and provider and is better


selves. A family member may share informa-

tion about the client that the client does notwant to have transmitted, or, conversely, they

may omit information they do not want the pro-

vider to know. Untrained ad hoc interpreters

may censor clinically relevant information they

find embarrassing, offensive or frightening.

Confidentiality

A trained interpreter should maintain confi-dentiality. This means that any information

transmitted in the session should not beshared outside the treatment center, otherthan with specified staff/providers. Even the

simple fact that a client is coming to the treat-ment center is not to be shared with commu-nity members.

An ad hoc interpreter may not fully appreciate

the necessity of confidentiality when working

with a torture survivor. Many survivors fear

details of their torture leaking out into the

community and may be particularly sensitiveabout other community members learning

about their mental or physical health symp-

toms. They may worry an interpreter willshare intimate details from their experience

with others. This will inhibit the developmentof a trusting relationship. In a small commu-

nity where most people know each other, shar-

ing even small details about the content of asession would violate a clients right to pri-

vacy. What a client discloses may be more

limited as a result and negatively impact ther-apy. It is therefore vital that interpreters ad-

here to this guideline and clients know thattheir confidentiality will be respected.

Impartiality

An interpreter should be an impartial party- unbi-ased, neutral, and disinterested. This is not to sayan interpreter does not care about the client ordoes not want them to get help. Instead, it meansthe interpreter should not have a personal stake inwhat the client is transmitting. An interpreter

should not give advice or attempt to influence aclients decisions.

If using an ad hoc interpreter, an individuals

(Continued from page 1)

Ways for Interpreters to Create Safety and Comfort

for Themselves and their Clients

Be aware of personal needs and the needs of client. Attend to personal needs first (rest, nutrition, exercise, restroom break,

water, etc.).

Know your role.

Create a safe and comfortable physical environment.

Orient yourself to the places where you work and help clients orient to

the space as well.

Be open and friendly.

Explain your credentials and define your role for the client.

Maintain clear boundaries.

Do not give out personal information. Make sure clients have the phonenumbers and contact info they need.

Outside of the center, dont approach a client first.

Respect confidentiality. Have an attitude of non-judgment.

Be prepared. (Know the language, have the necessary tools.)

Pay attention to accuracy.

Take notes and explain the purpose/content of notes.

Let a client set their own pace.

Maintain professional behavior at all times.

Know where to go for support.

*List generated by CVT interpreters at August 2007 quarterly meeting.

The Use of Trained Interpreters (continued from page 1)

biases may influence what is being

interpreted. Neutrality is especially

difficult for family members. A clientwho is feeling anger that her parents

have abandoned her after she was

raped may not feel comfortable shar-

ing her story if the interpreter is a rela-

tive. When family members are used

as interpreters (especially children),

the details of the torture experience

can be very distressing. Clients may

choose not to share this information

for fear of alarming their families.

Interpreting may be also more challeng-

ing when the interpreters cultural val-ues or moral views differ from a client,

or if their life circumstances are in factvery similar. A client who is, say, de-

ciding to quit a political party for fear of

being tortured again will be less likelyto tell you if the interpreter is a fellow

Page 2

International Capacity Building (ICB) Project Newsletter


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piece of providing sensitive, competentcare. Connecting with other ICB Centers

to learn how they work with interpreterscan be a way to begin thinking about how

to create an interpreter program if you do

not currently have one. Please feel free to

consult with CVT in the remaining months

of the ICB project regarding ideas for cre-

ating an interpreter program. Since inter-preter programs add a significant expense

to budgets, you will need to seek funding

opportunities to start and maintain an inter-

preter program.

Self-Care and On-Going Support for

Interpreters and other ProvidersVicarious trauma is a real issue for all

service providers, including interpreters.

Conscious attention should be given toways to promote self-care before, during

and after interpreting traumatic material.Interpreters can benefit from sharing self-care strategies with each other directly to

find solutions as a group.

An interpreter may sometimes need to de-

brief about a session, especially if the inter-preter themselves has been victimized in a

similar way or has witnessed violence. Thisshould only be done with trained providers

who are a part of the treatment team and

who, like interpreters, are required to re-spect client confidentiality. When interpret-

ers are viewed as part the treatment team, it

makes their roles clearer. This, along withopportunities to share experiences, helps to

counter some of the stress and isolation theymay feel. It also improves the quality of

interpreting. Practices and protocols for

managing symptoms of vicarious trauma

can be discussed and shared among allmembers of the treatment team. Talk with

others in the ICB project about options forproviding additional support.

References

DeAngelis, Tori. 2010. Found in translation. Moni-

tor. 42 (2). http://www.apa.org/monitor/2010/02/translation.aspx

International Medical Interpreters Association.

Medical interpreting standards of practice.Retrieved from http://www.imiaweb.org/

uploads/pages/102.pdf

Requesting and working with interpreters.Community Relations Commission May,

2006. http://www.crc.nsw.gov.au/data/assets/pdf_file/0015/2283/interpreter_book.pdf

The Center for Victims of Torture (2005).Working with torture survivors: Corecompetencies. In Healing the hurt (pp.19-38). Retrieved from http://www.cvt.org/

files/pg100/Healing_the_Hurt_Ch3.pdf

able to share the story of traumatic ex-

periences. Because torture impacts asurvivors ability to trust, the use of dif-

ferent interpreters is not recommended.

You may have to start over building

relationship with clients each time there

is a new interpreter. For the reasons out-

lined earlier, the professional distancerequired for interpreting does not exist

when using family members.

Interpreter Training

Training should include not only thebasics of how to provide professional

interpretation but also specific guide-lines for interpreting traumatic material.

Where do you find a trained interpreter?The answer to this question will vary

from country to country. Training op-portunities in different countries range

from a full University program in inter-

preting to no formal training opportuni-ties at all. In many places in the world,

there are no rules or regulations regard-

ing who can call themselves a trainedinterpreter. For these reasons, torture

treatment centers may need to provideon-going interpreter training in-house. It

is often beneficial to use role-plays based

on real-life scenarios that accurately re-

flect the challenges interpreters face.

The use of trained interpreters comeswith significant expense, coordination

and staff resources. Many Centers

across the world may not have the cur-

rent resources to support such a pro-

gram. However, for the reasons out-lined above, using trained interpreters

with torture survivors is an integral


The Use of Trained Interpreters (continued from page 2)

Page 3


Symptoms of posttraumatic

stress disorder:

Nightmares

Sleeplessness

Avoidance behavior

Irritability

Denial of clients trauma

Overidentification with client

No time and energy for oneself

Feelings of great vulnerability

Insignificant daily events areexperienced as threatening

Feelings of alienation Social withdrawal

Disconnection from loved ones

Loss of confidence that good is

still possible in the world

Generalized despair and hope-

lessness

Loss of feeling secure

Increased sensitivity to violence

Cynicism

Feeling disillusioned by humanity

Disrupted frame of reference

Changes in identity, worldview, spirituality

Diminished self capacities

Impaired ego resources

Alterations in sensory experi-

ences (intrusive imagery, disso-

ciation, depersonalization)

*(Lansen, Pearlman and Saakvitne, Wilson and

Lindy, Hoppe).

Signs and Symptoms of

Vicarious Traumatization


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You may feel physical responses:

Hypersensitivity to noise or touch

Headaches/dizziness

Muscle tension/pain

Intrusive thoughts or images

Elevated blood pressure

Mind racing

Stomach/throat tightening

Difficulty breathing

Heart beating faster

Difficulty sleeping/nightmares

Temperature changes

Muscle tremors or weakness

Numbness

Things that may help:

Sit in a chair and feel the points of contact (back, butt, feet). Notice all the

places where you are supported by the chair. Press thighs with hands and feel contact between hands and thighs.

Feel the pressure into your legs and then down into your feet.

Become aware of breathing. Notice your breath moving in and out.

Sit on the floor. Feel your body on the floor, supported by the ground.

Look around. Find 6 objects and name their color or shape.

Tap the skin of your entire body slowly or squeeze muscles gently.

Contract muscles of arms and legs. Hold for a 5-count and release.

Notice sensations as they change.

Use positive self-talk to remind yourself of the here and now.

Page 4

You may feel emotional & social

responses:

Isolation

Boredom

Confusion

Sadness

Lack of purpose

Agitation/Irritability

Helpful things to do may include:

Foster connections with other people.

Do things you enjoy.

Create purposeful activities and

routines.

Use physical activity to calm yourselfor to improve concentration.

Go for a walk or spend time innature.

Focus on soothing images or

practice meditation.

Use your hands for gardening, wood-

working, arts and crafts, etc.

Renew spiritual practices.

Seek counseling and support.

What factors create the most stress for you in your role as an interpreter ?**The following responses were given by interpreters at CVT, August 10, 2007.

Time constraints, rushing, jobs going overtime.

Listening to some of the stories.

Other peoples stress has caused panic attacks.

Stress related to parenting.

Hard not to relate client experiences to personal experiences.

Intrusive thoughts, nightmares.

Clients becoming very dependent when they have little support.

Difficulty setting boundaries with clients and friends.

Rushing and running around between appointments.

Too much repetition. Having to ask clients to repeat the

same subject matter over and over is stressful for clientsand for interpreters.

Lack of supportive systems for clients when they leave the

center, imagining what is happening for the client.

Frustration dealing with administration and paperwork. Its difficult to say things in the first person, because it

becomes a part of you.

Seeing the things that get left out, being tempted to add additional

material.

When you know things that would benefit the client but its against

the rules to do anything.

When we interpret the questions and clients do not respond, the

interpreter is called into question.

Feeling helpless, not being able to fix things from the past.

When there isnt an equal level of communication between client and

provider, i.e. attorneys use legalese and other providers use language

that is too difficult and alienating.

Clients talk directly to the interpreter and it is difficult to direct atten-

tion back to provider.

Recognizing clients needs and not being in a position to make adifference.

Noticing where systems and structures are not meeting client needs. Feelings of helplessness - It is not our job to help solve the

problems.

The Center for Victims of Torture

Managing Stress & Anxiety: Helpful Things for Interpreters to Do -From Diane Long, CVT


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Page 5


The Institute for Study of Psychoso-cial Trauma (ISPT) is a non-profit

organization based in California,

providing psychological treatmentto refugees affected by war trauma

and the aftermath of torture sincethe early 1980s. ISPT has trained

clinicians and other health personnelthroughout the U.S., South and Cen-tral America, staff in an Interna-

tional Court, and international hu-man rights lawyers and field work-

ers. They work with human-induced trauma caused by experi-encing or witnessing acts of war,

genocide, religious, political or eth-nic persecution, domestic abuse,

incest, rape, genital mutilation, andhuman trafficking. Their main em-

phasis, however, has been servingsurvivors of war and physical, psy-chological and sexual torture.

While their initial work with secon-dary trauma was focused exclusively

on primary responders and clinicians,it has expanded in the last eight yearsto include interpreters and membersof the legal profession.

It is now well established that inter-preters are among those vulnerableto experiencing secondary trauma,

just as associates of trauma survi-vors, primary responders, disasterworkers, victim assistance special-

ists, nurses, physicians, psycho-therapists, and others.

Psychological trauma

Psychological trauma refers to anexperience that is emotionally pain-

ful, distressful, or shocking. It cre-ates a psychological wound that

may lead to substantial negative

impact to a persons physiological,psychosocial and family systems.

The consequences of trauma vary widely accordingto diverse variables, such as the victims age, the

pretrauma psychosocial context, the nature and se-

verity of the trauma, and the support received fol-lowing the trauma. Some common symptoms of

trauma (and PTSD) include fear, helplessness, hor-ror, anger, rage, sleep disturbances, alterations in

memory, irritability, difficulty concentrating, re-experiencing traumatic events, avoidance or numb-ing to avoid thoughts and feelings connected with

the traumatic events, detachment, and estrangementfrom others.

Psychological trauma creates an emotional woundthat may harm a persons physiological and psy-

chological systems. Severe traumatic events in-volve extreme stress that overwhelms the ability to

cope, and shatters habitual categories of perceptionand understanding. Trauma may entail different

losses, such as those of sense of self, meaning andhope. This experience of loss often varies accordingto ethnic, cultural and religious differences and the

national or sociopolitical context in which it occurs.These losses usually lead to feelings of depression.If interviewed superficially, a traumatized person

may be diagnosed with a major depressive disorder,and the trauma symptoms may be overlooked.

Secondary trauma

Many of the experiences and symptoms describedabove are also commonly reported by caregiversand other providers that interact with traumatized

patients or clients. Therefore, Figley and othersintroduced the concept of secondary trauma, alsoknown as vicarious traumatization, event counter-

transference, and compassion fatigue. Secondarytrauma refers to the psychological signs and symp-

toms that result from ongoing involvement withtraumatized clients. Professionals that engage withempathy and care with people that have enduredsevere trauma may experience psychological diffi-culties produced by the survivors account of their

traumatic experience and the professionals reac-tions to such accounts. By becoming a witness to

these atrocities, these may become part of the pro-

viders consciousness, leading to a potential incor-poration of their clients traumatic experiences.Therefore, professionals may experience, to a lesser

degree,some of

the same

symptoms as those impacted byprimary trauma. As previously

stated, these may include fear,helplessness, horror, anger, rage,

sleep disturbances, alterations inmemory, irritability, difficulty con-centrating, avoidance or numbing

to avoid thoughts and feelings con-nected with traumatic events, de-

tachment, and estrangement fromothers. In addition, they may un-dergo intense emotional reactions,

ranging from denial to over-identification. Experience with

particularly severely traumatizedclients, combined with frequent

confrontations may influencetherapists in-session reactions. Forexample, a significant part of the

clinical literature shows thatwounded healers are less effec-tive in helping traumatized clients.

At the same time, they may showparticular strengths in workingwith survivors.

A wounded healer may attain adeeper understanding of the dy-namics of a specific trauma as adirect result of having endured a

comparable traumatic experience.Clinicians dealing with human-induced trauma have long under-

stood the usefulness of psychother-apy with victims of primary

trauma. More recently, they haverecognized their own vulnerabilityto secondary trauma while workingwith traumatized individuals, in-cluding victims and witnesses at

war crimes tribunals. However, thesecondary trauma of the interpreter

has hardly been addressed, despite

them being clearly vulnerable tosecondary trauma. Being exposed


Clinical Perspective: Secondary Trauma for Caregivers/Interpreters*From Secondary Trauma in the Legal Professions, A Clinical Perspective

by Yael Fischman, PhD; Director, Institute for Study of Psychosocial Trauma, California

(TORTURE Volume 18, Number 2, 2008)


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Page 6


Clinical Perspective:Secondary Trauma for Interpreters (continued from page 5)

daily to detailed traumatic narratives is ex-tremely demanding and adds an important

emotional dimension to their work.

However, interpreters are not traditionally

trained to address work-related emotions oracknowledge the potentially traumatic im-pact that their work may have on them and,by extension, on their clients. In some in-

stances, they may feel overwhelmed by uni-dentified emotions. Interpreters may experi-ence symptoms such as those described

above, and may also undergo intense emo-

tional reactions, ranging from denial to over-identification. These feelings are particularlyconflicting when they are neither labeled nor

voiced and may lead them, for example, tounknowingly detach. In such cases they dis-tance themselves from their clients, with-

drawing empathy and a supportive stance.

Secondary trauma: examples

The following examples included in this section

might be helpful to readers unfamiliar with theactual experience of secondary trauma.

Literal statements from interpreters in groupprocesses which I developed and co-led in-

clude: How do I get out of the feeling that Ididnt help the client?; How can I cope

when I feel overwhelmed by the narrative thatI have to translate?; Can you give me tools todeal with my sadness? When interpreters

have themselves been victims of primarytrauma, their risk of retraumatization is very

high. Interpreters still affected by primarytrauma have reported stomach aches,

heartache, feeling exhausted after a session

translating for a human rights attorney, inabil-ity to stop thinking about the reported trauma

several hours or even days after interpreting,increased intake of alcohol or junk foodfollowing a work session. Statements recordedinclude:

I feel flooded by memories of what went on inmy country; I get scared of what information

(Continued from page 5) will come up next and what I will have to deal

with in the following session.

A psycho-educational model to address

secondary trauma

Williams & Sommer, Pearlman and othershave used specific approaches to addresssecondary trauma. Most share some basicprinciples such as the importance of self

care, the need to develop awareness ofsigns of excessive stress, and the need toidentify personal triggers for secondary

trauma. Some clinicians also propose de-

briefing following particularly painfultrauma-related interviews, to facilitate theproviders release of thoughts and feelings

that might not otherwise be expressed.Understanding that education and accurateinformation are important elements in the

prevention of secondary trauma, I devel-oped a psycho-educational model for pre-

vention and early intervention for legal

professionals, primary responders, psycho-therapists, and others that may be vulner-

able to secondary trauma.

When workingwith providers wholive and work in

societies wherewar, terrorism or

human rights vio-lations are occur-ring, we need to be

aware that theycommonly share an experience of primary

trauma with their clients. It is important tounderstand that this creates unique difficul-

ties in the provision of services. For exam-

ple, in situations such as those of primaryresponders, human rights lawyers or psy-

chotherapists, they might be facing theirown primary trauma, while also incorporat-ing their clients traumatic experiences.This creates problems such as blurring of

boundaries, potential exacerbation of emo-tional responses and issues of personalsafety. Such problems may hinder the inter-

preter or clinicians ability to set limits in

their work, take care of their ownphysical and emotional health, and

even allow themselves to be mindfulof their personal reactions to trauma.It is therefore crucial to focus on the

physical and mental wellbeing of pro-viders, explore creative means for

self-care and the release of emotionsand personal feelings, and provide

supervision to help minimize the blur-ring of boundaries. Group training orsupervision may also function as a

support system.

Here is a step-by-step description of

the topics ad-dressed in lec-

tures, discussionsor process ses-sions and smallgroups that can beused to address

secondary trauma. These are intro-duced below in the order in whichthey take place.

1. The training starts with lecturesand interactive sessions to teach theconcepts of trauma, retraumatiza-

tion and secondary trauma; this is

followed by a discussion of individ-ual, family, and community effects

of traumatic events and how theseinteract with the work of providers.

2. The next step is a lecture and

open discussion of the processthrough which caretakers developsymptoms that parallel those of their

clients and of the way in which theirbehavior is impacted by such symp-

toms; consideration of emotional

changes and their impact on theiroutlook on life; attention to behav-

ioral changes following secondarytraumatization, including disruption

in relations with spouses or partners,children, co-workers, supervisors,and friends.

3. The previous topics are followed

by a discussion of common secon-



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Page 7


Clinical Perspective:Secondary Trauma for Interpreters (continued from page 6)

dary trauma symptoms such as irritability, hy-pervigilance and numbing as well as of the po-

tential for dangerous behaviors such as recklessdriving, alcohol or drug abuse. All the informa-tion discussed is based on an understanding of

the cultural meaning of trauma and healingwithin the group with which we work, andawareness of culturally appropriate ways to de-velop and foster resilience whenever that is pos-

sible. Although our team is not completely mul-ticultural, we actively try to educate ourselveswithin possibilities on the meaning ascribed to

trauma in different cultures.

4. Following the examination of the impact ofsecondary traumatization on the individual

caregiver, lead a discussion about the ethicalresponsibility of traumatized professionals toaddress personal healing needs. Awareness of

potential counterproductive responses rangingall the way from excessive distancing to over-

identifying with their clients contribute to a

better understanding of how secondary traumamay affect a providers decision-making proc-

ess, lead to inhibited listening, ameliorate theability to maintain appropriate boundaries and

to render effective services.

5. Subsequent to such analysis, offer educa-

tion to facilitate early identification of symp-toms of secondary traumatization, and ap-

proaches to prevent further traumatization.Examples that lead to a mentality of preven-tion include suggestions such as: Learn to

identify changes in your mood. Are you feel-ing angry very frequently? Do you often feel

that you are about to cry? Given the workyou are currently doing, these may be signs

of secondary trauma; do not ignore them. Try

to make some time for activities that distractyou from your everyday routine, such as

spending time outdoors, playing with friends,children or pets, engaging in some artisticpursuit, etc. Also, practice observing yourmood changes. The more you observe these

changes, the more control you will eventu-ally acquire over your moods.

Learn to identify changes in your behavior.

(Continued from page 6) Do you get frustrated very frequently? Are

you becoming impatient with your family,friends, co-workers? Have you increased

your alcohol intake? Are you fighting a lotwith your spouse or significant other? Doyou have a desire to attack them physically

or feel that you cannot control your temperwhen you are around them? In your presentcircumstances, these also might be signs ofsecondary trauma. They may indicate that

you need to take time out, get support fromfriends, or talk to a psychotherapist.

6. This section is followed by a lecture ondiverse approaches to self-care which con-

tribute to both prevent secondary traumati-zation and attempt to reverse its effects as

needed. Some of these approaches empha-size the importance of incorporating bal-anced nutrition, physical exercise and a

short, interesting, inspiring, or relaxingactivity into everyday life. Also, highlight

the importance of obtaining supervisionfrom someone that understands the dynam-

ics of work with traumatized clients, as

well as ongoing discussion groups withpeers whenever possible. The support of

professional peers provides nonjudgmentallistening, objective feedback, and addi-tional professional perspectives.A central aspect of the presentation on the

topic of self-care involves organizingsmall process groups to recapitulate thereasons that lead each professional to

trauma work. This is followed by question-

ing whether such reasons are stillvalid, in order to evaluate potentialoccupations in a related field that

does not necessarily involvetrauma. For those who decide tocontinue their employment in the

field of trauma, its highly recom-mended to limit direct involvementwith survivors of trauma and toattempt to combine it with other

lines of work. If the original moti-vation to choose this line of profes-sional work remains in place, par-

ticipants are invited to reflect onthe two sides of trauma work. On

the one hand, it deals with the

dark side of life. On the other, itgrants us the privilege to bringlight into darkness, challenge thosein power who adhere to a world-

view that creates horror and de-spair, fight injustice, or to try tofulfill an inner commitment of

healing the world. It also allows usto appreciate the courage and resil-

ience of those who have enduredharrowing experiences.

7. At this stage the amount of expo-sure to the subject usually allows

participants to safely move intosmall process groups to consider

individual variables that may in-crease the vulnerability to secondarytrauma. These include personal

trauma history, degree of integrationof traumatic experiences, and lack

of necessary support from the socialand family milieu.

When there is acknowledgement oflack of social or family support, try

to decrease feelings of frustrationand loneliness by clarifying that it

is not realistic to expect immediatesupport or understanding from

family and friends. It may take

them some time to acknowledgethe pain involved in trauma work,

and people who are not familiarwith trauma need help to graduallyunderstand and develop the ability

to process the information that isshared with them. (Confidentiality



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Page 8


Clinical Perspective: Secondary Trauma for Interpreters(continued from page 7)

regarding identification and specific circum-stances of clients is always emphasized).

In addition, attempt to normalize expectedreactions such as anger, outrage and hope-

lessness that result from continued exposureto the helplessness of traumatized victims.When these emotions emerge, put forward

the option of joining local organizations thatfocus on preventing the specific crimes that

cause major negative impact in each pro-

vider. This offers a positive channel to ex-press anger and helps counteract feelings of

hopelessness.

Conclusions

Even though secondary trauma is not a uni-

versal phenomenon that impacts all profes-sionals interacting with trauma, the problem

is frequent enough to merit serious attention.Secondary trauma may affect a providersdecision-making process, lead to inhibited

listening, decrease the ability to maintainappropriate boundaries and to render effec-

tive services. Also, many professionals bur-dened by secondary trauma abandon their

work with trauma survivors in order to avoid

serious emotional distress. It is important tokeep in mind that particularly vulnerable

individuals, such as those with a history ofunresolved primary trauma, may need indi-vidual or group psychotherapy in addition toeducation and self care.

Prevention and education appear as a verycost-effective approach to avoid the negative

(Continued from page 7) consequences of secondary trauma affecting

providers, and by extension, ser vice users.Education is also a simple way to remind

interpreters and clinical professionals aboutthe risks of retraumatization, and to bringinto focus the dangers involved in retrauma-

tizing clients through inadequate, untimelyor insensitive questions.

An emphasis on group work provides a

safe forum to discuss important practicalissues as well as existential dilemmas thatmay intensify symptoms of secondary

trauma. The psycho-educational model

described above has proved to be a valu-able method to identify, prevent or dimin-ish the effects of secondary trauma. A cen-

tral focus of this model is the clarificationof personal motivations leading profes-sionals to trauma work and its connection

to purpose, meaning, worldview and thespiritual dimensions of trauma. It also al-

lows us to remind providers that while we

cannot undo what happened to those weserve, we can attempt to heal and restore.

ReferencesDiagnostic and Statistical Manual of Mental Disor-ders. 4th ed. Washington: American Psychiatric

Association, 1996.

Figley CR. Psychosocial adjustment among Viet-

nam veterans: an overview of the research. In:Figley CR, ed. Stress disorders among Vietnam

veterans. Theory, research and treatment. NewYork: Brunner/Mazel, 1978.

Figley CR. Catastrophe: an overview of familyreactions. In: Figley CR, McCubbin HI, eds. Stress

in the family. Coping with catastrophe (v. 2). NewYork: Brunner/Mazel, 1983.

McCann L, Pearlman LA. Vicarious trau-matization: a framework for understandingthe psychological effects of working with

victims. J Trauma Stress 1990;3:134-49.

Danieli Y. Countertransference, traumaand training. In: Wilson JP, Lindy JD, eds.

Countertransference treatment of post-traumatic stress disorder. New York: Guil-ford Press, 1994:368-88.

Figley CR. Compassion fatigue. Toward a

new understanding of the costs of caring.In: Stamm BH, ed. Secondary traumatic

stress. Self-care issues for clinicians, re-searchers and educators. Maryland: SidranPress, 1995.

Smith A et al. How therapists cope withclients traumatic experiences. Torture2007;17:203-15.

Holmgren H, Sondergaard H, Elkit A.Stress and coping in traumatised interpret-ers. A pilot study of refugee interpretersworking for a humanitarian organization.Intervention. 2003;1(3):22-7.

Levin AP, Greisberg S. Vicarious trauma

in attorneys. Pace Law Review2003;24:245.

Parker LM. Increasing law students effec-

tiveness when presenting traumatizedclients. A case study of the Katherine &George Alexander Community Law Cen-

ter. Georgetown Immigration Law J2007;21:2.

Williams MB, Sommer JF. Self care and

the vulnerable therapist. In: Stamm BH,ed. Secondary traumatic stress. Self-careissues for clinicians, researchers & educa-

tors. Maryland: Sidran Press, 1995:230-46.

Pearlman LA. Self care for trauma thera-pists. Ameliorating vicarious traumatiza-

tion. In: Stamm BH, ed. Secondary trau-

matic stress. Self-care issues for clinicians,researchers & educators. Maryland: SidranPress, 1995:51-64.

Fischman Y. Interacting with trauma.Clinicians responses to the psychologicalaftereffects of political repression. Am JOrthopsychiatry 1991;61:179-85.

Fischman Y. Meta-clinical issues in thetreatment of psychopolitical trauma. Am JOrthopsychiatry 1998; 68:27-38.


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Clinical Corner: Personal Experience with Social Work (PERU)*Interview with Ericka Jimenez, The Center for Psychosocial Treatment (CAPS)

Where do you work?I work in the Center for Psychosocial

Care (CAPS).

What is your position?Social Worker

Who are your primary clients?

Victims of political violence and their family members

What do you work on from day to day? The work is varied:consultations, orientations, referrals, family orientations and in-terventions, home visits, community work, workshops with

youth and children of those affected.

What skills do you use in your job that you find are most important?To perform this work, I believe that one must take on an absolute

compromise with human dignity, with everything that the disadvan-taged encounter (this population is victimized each day, whether it be

by society or by their own selves); they should be approached with anattitude of respect toward their culture and their values, even when

they are different than ones own. One should be capable of creatingand developing models of prevention and intervention in the socialproblems in which they find themselves.

I consider it to be essential that one should have a spirit of soli-darity that is reflected in their disposition while listening eachday, making the person feel important and unique, with individ-ual abilities and skills, with a respect for human rights. Theskills for the latter include a capacity for adapting to diversesituations because each case that I deal with is different. Anothernecessity is to have the capacity to understand personal andgroup problems objectively, without bias of the diverse problemseach patient has. It is also important to work with a good amount

of creativity, imagination and initiative to come up with alterna-tive solutions. We cannot overlook the responsibility, the group

and community leadership that is required, social solidarity, ini-tiative to maintain acceptance and promotion of interdisciplinary

work with tolerance and an openness to change.

What do you most enjoy about your job? Facilitating people in apath of discovering and developing their potential and abilities.

It is a success to help a person realize that he is able to emergefrom a problematic situation through his own means and re-sources, that is helping him discover for himself and to know thatwe only went down those paths so we can arrive at this conclu-

sion. This assures us that the change is sustainable at this time,and is not just a momentary or temporary solution.

What do you find most challenging in your job? Per-

haps dealing with the mindset of the people, the work ofre-education, sensitization and consciousness-raising is

not easy. The process for a person to change his/hermanner of thinking requires time and an attitude to not

throw in the towel and to continue betting on success.I am convinced that if a person achieves this, it willchange his/her way of living, and he will have influencein his family and therefore in his community. A person

is a family, and this is the focus: the family, startingfrom the individual.

Are there particular methods you use in your work thatyou find most helpful/successful for your clients? Yes,

we work in coordination with other institutions or inter-institutional networks through referrals that are made forspecific cases that the institution cannot cover. Exam-ples include the areas of physical, educational and occu-

pational health. Contacts have been made with particu-lar institutions or government agencies in order to pro-

vide the support necessary to cover a specific need.

From the area of SocialCare, we work withmethods of individualcases, families, groups

and communities. Foreach group a methodol-ogy, instruments, spe-cific tools are employed. For example, in family inter-ventions specific objectives are: complete a diagnosis ofthe function of the familial relationships of the client,complete an analysis of the relationship patterns of thefamilial system, to sensitize the family to the effects oftorture and strategically intervening in the system, giv-

ing recommendations and models to make it better.

Additionally, informative material is distributed and if itis necessary a referral is made to other institutions de-

pending on the defined needs of the patient. Techniquesof observation, home visits, interviews are employed and

in general the methodology is dynamic and participatoryfor each member. During the intervention, the family is

able to play, paint, jump and be dynamic in the way theyachieve their established goals. It is very gratifying toobserve families that have never played or paainted to-gether and initially had no interest in it, who finally begin

to interact and realize that there are other things to dis-cover and other spaces to explore and to see their faces


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Clinical Corner: Personal Experience with Social Work (continued from page 5)

full of happiness really is something

indescribable. .

Are there people in your organiza-

tion that you collaborate with inyour work, and what do you workon together? Yes, we work hand inhand with the different areas within

the institution with an interdiscipli-nary team that allows us to address

different themes from different per-spectives.

Do you collaborate with profession-

als from other organizations in yourwork? Yes, we work in networkswith different institutions commit-ted to the development and well-being of the clients. The connectionwith other human rights institutionsallows us to intervene and later give

treatment in that institution. In gen-eral, in the first contact we try to

educate about the need to bring inmental health care.

Are there particular factors that you

find to be limiting in the work thatyou do? In certain areas the gov-

ernment doesnt provide the facili-ties in the areas of rehabilitation forthis population.

Can you please provide an exampleof a time when you were particu-larly proud of the work you do/did?

(Continued from page 9) Various cases came to mind, but one thatwill stay with me is that of a young girl who,

for this occasion we will call Maria. Mariais a young girl from Ayachucho who sawher father tortured in the Plaza of Arms in

her community. She found him hours afterhe had been mutilated by the terrorist move-ment Sendero Luminoso (Bright Path).

She came with her family to Lima, fleeingfrom all of the tragedy in their homeland.

She never talks about the subject, and muchless receives any type of treatment to miti-gate this pain. After 10 years of life, Mariahad already experienced 20 and was show-

ing bodily ailments. She couldnt count onsupport from her family and for this sheturned to CAPS. Maria arrived one after-

noon and I noticed that she was in delicatehealth; anxious, with an accelerated heart

rate and the beginnings of baldness, in ad-dition to having swollen legs for which she

requested some medication (I asked forsupport, as the Health insurance would notcover the treatment for the illness).

Upon seeing the alarming state of herhealth, I opted to take her to the nearest

medical center, where the doctor who sawher became alarmed at the critical state ofhealth of the patient. The doctor asked me,Are you a relative? Will you bar the re-sponsibility if something should happen tothe young girl? Immediately I assumedthis responsibility, until we were able to

contact the girls family with whom I spokewith about the facilities and the care. The

doctor mentioned that Maria could have acardiac arrest at any moment, and that itwas a miracle that the girl was walking andconscious. Immediately I took her to a

capital hospital for emergencies, wherethey admitted her. She had high blood

pressure and had a soaring fever.

Around 11 oclock at night, we were given theresults. She had severe hyperthyroidism, andshe was experiencing edema and a loss of equi-librium (she had gone a year without medica-tion due to lack of financial resources).

I remember that the next day I needed to

talk with the chief doctor to enforce thegirls right to receive care free of

charge from her insurance, becausethey did not want to provide her medi-cation. It really became a battle with

the insurance so they would providethe girl with the medication sheneeded. Those two months were vital,Maria got better, she gained weight and

it was an achievement. In reality,Maria was saved from death.

Are there any other specific examples ofwork you have done that you would liketo share? A case comes to mind about

a boy, from the community Ashaninka(central jungle). He was deaf, mute,infected with parasites, anemic, and had

not yet developed speech and neverwent to rehabilitation therapy. His par-

ents mentioned that when he was only afew months old, they had to flee the

forest to avoid being found by the ter-rorist groups, they all had to be silentand when the boy was crying, themother pressed him to her chest so the

crying wouldnt be heard and theywouldnt be discovered in their hiding

place. Since that time, they never againheard him cry, much less talk.

It had to be determined whether theillness was natural, or was a result fromtrauma. Relevant psychological testswere done at CAPS and biological tests

done at a specialized center.

As we imagined, the parents were ex-tremely poor and illiterate and did nothave money to support the care. CAPSwas also unable to cover the costs of the

physical health care, so we looked forsupport from other institutions. They

were able to perform the tests, and laterprovided rehabilitation care and hearingaids which he received totally free.Now the boy has been welcomed in by afamily, is going to high school, has de-veloped his speech and abilities thatwere not thought to be possible.

Page 10



11/12


tener la capacidad de comprender los problemas

personales y grupales considerando las variableshumanas y sociales y contar con una percepcin

objetiva sin parcialidades de las diversas proble-

mticas que tiene cada usuario, contar con mu-

cha creatividad, imaginacin e iniciativa para

proponer alternativas de solucin, no podemos

dejar de lado la responsabilidad, el liderazgo

para la conduccin de grupos y comunidadesque lo requieran, solidaridad social, iniciativa

para mantenerse actualizado, aceptacin y pro-

mocin del trabajo interdisciplinario con apertu-

ra al cambio y tolerancia.

Qu disfruta ms usted sobre su trabajo? Faci-litar a las personas el camino para descubrir y

desarrollar sus potencialidades y capacidades. Es

un logro hacer que la persona se de cuenta que

puede lograr salir de su situacin problemtica

con sus propios medios y recursos, es decir ayu-

darla a descubrirse por si misma y saber que

nosotros solo fuimos los canales para que llegue

a esa conclusin. Esto nos asegura que el cambio

es sostenible en el tiempo y no solo una solucinmomentnea o meditica.

Qu le parece ms difcil en su trabajo? Tal vezlidiar con el pensamiento de las personas, el trabajo

de reeducacin, sensibilizacin y concientizacinno es fcil, como mencion antes, el proceso para

que la persona logre cambiar su manera de pensar

requiere tiempo y disposicin a no tirar la toallay seguir apostando a que lo lograr.

Estoy convencida que si la persona lo logra,cambiar su manera de vivir y ser de influencia

en su familia y por ende en su comunidad. Unapersona es una familia y ese es el enfoque, la

familia, partiendo desde el individuo

Existen mtodos especficos que usa usted en

su trabajo que encuentra lo ms ayudantes / exi-

tosos por sus clientes? Si, el trabajo en coordi-nacin con otras instituciones o redes interinsti-

tucionales que son las derivaciones que se reali-zan para casos especficos que la institucin no

logra cubrir, como por ejemplo el

rea de salud fsica, educativa y labo-ral.

Para este fin se hacen los contactos

respectivos con instituciones particu-

lares o estatales para que brinden el

apoyo necesario para cubrir la necesi-

dad especfica.

Desde el rea de Atencin Social traba-

jamos con el mtodo de casos, familia,

grupo y comunidad. Para cada grupo

se emplean metodologa, instrumentos

y herramientas especficas, por ejem-plo en las intervenciones de familia

cuyos objetivos especficos son: realizar

un diagnstico del funcionamiento de

las relaciones familiares del afectado, el

analizar los patrones de relacin del

sistema familiar, sensibilizar a la fami-

lia sobre los efectos de la tortura e inter-

venir estratgicamente en el sistema

dando recomendaciones y pautas parasu mejoramiento

Adems se entrega materiales infor-mativos y si es necesario se hace la

derivacin a diversas institucionesdependiendo de las necesidades de-

tectadas. Se emplear la tcnica de la

observacin, la visita domiciliaria, laentrevista y siempre por lo general la

metodologa es dinmica y participa-

tiva con cada miembro, durante laintervencin la familia puede jugar,

pintar, saltar, hacer dinmicas con elfin de lograr los objetivos propuestos,

es muy gratificante observar a fami-

lias que nunca han jugado o pintadocomo conjunto y que lo hacen en un

principio sin inters pero que al final

inician a interactuar y a darse cuentaque hay otras cosas que descubrir u

otros espacios por explorar y el ver


This Newsletter was made possible by the generous support of the American people through the Office of Private and Volun-tary Cooperation, Bureau for Humanitarian Response, US Agency for International Development, under the terms of Match-ing Grant Agreement No. FAO-G-00-00-00043-00. The opinions expressed herein are those of the author(s) and do notnecessarily reflect the views of the US Agency for International Development or the United States Government.

Dnde trabaja usted?

Trabajo en el Centro de AtencinPsicosocial CAPS.

Cul es su positin?

Trabajadora Social

Quines son sus clientes

principales?

Victimas de Violencia Poltica y

sus familiares

Qu trabajo hace da a da? Eltrabajo es variado, Consejerias,

orientaciones, derivaciones, orien-taciones e intervenciones familia-

res, visitas domiciliarias, trabajo

comunitario, talleres con jveneshijos de afectados.

Cuales habilidades que se utilizanen su trabajo son lo ms importan-

tes? Para ejercer esta labor, creo

que se debe asumir un compromi-so absoluto con la dignidad huma-

na, sobre todo con los que se en-

cuentran en desventaja (esta pobla-cin es vctima y es victimizada

cada da ya sea por la sociedad opor ellos mismos), se les debe tratar

con una actitud de respeto hacia sucultura y sus valores an cuando

resulten diferentes a los suyos, se

debe ser capaz de crear y desarro-llar modelos de prevencin e inter-

vencin en la problemtica social

en la que se encuentran.

Considero elemental que se debe

contar con un espritu solidario quese refleje en la disposicin cada

da de escuchar, de hacer sentir a la

persona como importante y nica

con capacidades y habilidades, con

el respeto a los derechos humanos.

Las habilidades para este fin son la

capacidad de adaptacin a situa-

ciones diversas ya que cada caso

que se trata es diferente, otra es

Clnica Rincn: La experiencia personal con el Trabajo Social (Per)*Entrevista con Ericka Jimenez, Centro de Atencin Psicosocial (CAPS)

Page 11

Spanish VersionSpanish VersionSpanish VersionSpanish Version


12/12

La experiencia personal con el Trabajo Social (continued from page 7)


Vino junto con su familia a Lima, huyen-do de toda la tragedia vivida en su tierra

natal, nunca hablo del tema ni muchomenos llevo algn tipo de tratamiento

para mitigar ese dolor. Al cabo de 10 aos

Mara ya tenia 20 y presentaba dolenciascorporales, no contaba con el apoyo de su

familia y es all donde recurre al CAPS.

Llega la paciente Mara, una tarde y notque se encontraba delicada de salud, bas-

tante ansiosa, con ritmo cardiaco acelera-do, notable baja de peso, ojos saltones e

inicio de calvicie adems de tener las pier-

nas hinchadas para lo cual me pidi algu-na medicacin (pide apoyo puesto que el

Seguro de salud no le cubre tratamientode la enfermedad)

Al ver el estado alarmante de salud, seopt por llevarla al centro mdico ms

cercano, donde el mdico que la revis, se

alarm por el estado crtico de salud en elque se encontraba la paciente. De inme-

diato recuerdo que el mdico pregunto

usted es el familiar? se har cargo si le

pasa algo a la joven?, inmediatamente se

asumi la responsabilidad, hasta lograr

contactar a los familiares de la joven con

quienes se dialog para que brinden lasfacilidades y el cuidado respectivo. El

mdico mencion que Mara poda hacer

un paro cardiaco en cualquier momento y

que era un milagro que la joven este aun

caminando y lcida, de inmediato la llev

por emergencia a un hospital capitalino en

donde la internaron, tenia la presin alta y

volaba en fiebre

Alrededor de las 11 de la noche dieron los

resultados y era un hipertiroidismo severo,

estaba haciendo un edema y se haba des-

compensado, ya que hacia un ao que le

detectaron la enfermedad y no estaba medi-

cndose por falta de recursos econmicos.

Recuerdo que al da siguiente se tuvo que

hablar con el mdico jefe y hacer valer el

derecho de la joven a ser atendida de formagratuita por su seguro, ya que no le queran

suministrar la medicacin correspondiente,realmente fue una batalla con el seguro para

que se le brinde la medicacin quenecesitaba. Esos 2 meses fueron vita-

les, Mara mejoro, subi de peso y sevio un logro.. Realmente se salv a

Mara de la muerte.

Hay otros ejemplos especficos del

trabajo que Usted ha hecho que

quiere compartir? A mi mente elcaso de un nio, de la comunidad

Ashaninka (selva central) sordo mu-do, infectado con parsitos, anmi-

co, que no haba desarrollado el len-

guaje pues nunca fue a una terapia

de rehabilitacin, comentan sus pa-dres, que cuando tena meses de

nacido, tuvieron que huir al monte

(espesura de la selva) para no ser

encontrados por los grupos terroris-

tas, todos haban de hacer silencio y

cuando el nio lloraba, lo que hacia

la madre era apretarlo junto a supecho para que no sea escuchado el

llanto y no sean descubiertos en el

lugar de escondite. Desde ese tiem-

po no volvieron a escucharlo llorar,

ni mucho menos hablar.

Lo que se quera era descartar si el

mal era orgnico o si era producto

del trauma. Se hicieron los exme-

nes respectivos en el CAPS por la

parte psicolgica y en un centro es-

pecializado para lo orgnico.

Como nos imaginaremos, los padres

eran pobres extremos e iletrados por lotanto no contaban con dinero para la

atencin, el CAPS tampoco podra

cubrir los gastos en salud fsica, asque se busc el apoyo de otras institu-

ciones, se logr que le hicieran los

exmenes de descarte y posteriormen-

te que se le brinde la atencin de reha-

bilitacin hasta las prtesis auditivasque requera totalmente gratuito. Aho-

ra el nio ha sido acogido por una

familia, va al colegio, ha desarrolladoel habla y habilidades que no se crean

posible desarrollar.

sus caras de alegra realmente es algo indes-

criptible.

Hay personas en su organizacin con quie-nes colabora en su trabajo, y en que trabajan

juntos? Si, trabajamos de la mano con las

diferentes reas dentro de la institucin conun equipo multidisciplinario que permite

abordar los diferentes temas desde diferen-

tes perspectivas.

Colabora usted con profesionales de otras

organizaciones en su trabajo? Si, el trabajo en

redes o con diferentes instituciones compro-

metidas con el desarrollo y bienestar de losafectados es constante y reciproco. De las otras

instituciones de DDHH nos derivan casos para

poder intervenir y posteriormente dar trata-

miento en la institucin, por lo general el pri-

mer contacto es para sensibilizar sobre la nece-

sidad de llevar una atencin en salud mental.

Existen factores especficos que limitan eltrabajo que hace usted? Bueno por parte del

Estado que no brinda las facilidades en los

temas de reparacin para esta poblacin.

Usted por favor da un ejemplo de un tiem-po cuando se siento especialmente orgulloso

del trabajo que hace / hizo? Se vienen va-

rios casos a mi mente pero uno que quedaragrabado es el de una joven al que vamos a

llamar en esta ocasin Mara. Mara esuna joven de Ayacucho que vio como a su

padre lo torturaron en la Plaza de Armas de

su comunidad y se enter horas despus quefue cercenado por el movimiento terrorista

Sendero Luminoso.


Page 12

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