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(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

Psychosocial Rehabilitation of IDPs CHAPTER 4 PSYCHOSOCIAL REHABILITATION OF ADULTS: INTERVENTION METHODOLOGY 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

Psychosocial Rehabilitation of IDPs

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 Conference1 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

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.

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 rehabilitation2 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 standardsetting. 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.

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

Psychosocial Rehabilitation of IDPs 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 ethnopolitical 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

Psychosocial Rehabilitation of IDPs 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

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. 8

Psychosocial Rehabilitation of IDPs 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; 9
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Psychosocial Rehabilitation of IDPs

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. 10
Chapter 1

Psychosocial Rehabilitation of IDPs 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.

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Chapter 1

Psychosocial Rehabilitation of IDPs 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.

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Psychosocial Rehabilitation of IDPs

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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Psychosocial Rehabilitation of IDPs

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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Psychosocial Rehabilitation of IDPs

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. 15
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Psychosocial Rehabilitation of IDPs

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.

1.3

The First Contact

The first contact with a displaced community is very important. Further co-operation 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. At the same time, traumatised people miss warm, friendly, and sincere relationships. 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. Tips for helpers Do not promise or offer more than you can do realistically. Displaced persons easily catch helpers on this point. Be friendly, benevolent, and sincere.

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Psychosocial Rehabilitation of IDPs

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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Psychosocial Rehabilitation of IDPs 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

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Psychosocial Rehabilitation of IDPs 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 nontraumatic 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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Psychosocial Rehabilitation of IDPs 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 21
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Psychosocial Rehabilitation of IDPs 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. 22
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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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Psychosocial Rehabilitation of IDPs 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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Psychosocial Rehabilitation of IDPs 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 selfdignity. 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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Psychosocial Rehabilitation of IDPs 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 selfesteem is revealed in the fear of expressing themselves and in the difficulty of

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Psychosocial Rehabilitation of IDPs 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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Psychosocial Rehabilitation of IDPs 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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Psychosocial Rehabilitation of IDPs 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; 31
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Psychosocial Rehabilitation of IDPs 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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Psychosocial Rehabilitation of IDPs 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 35
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Psychosocial Rehabilitation of IDPs 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 kindhearted 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 36
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Psychosocial Rehabilitation of IDPs 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 indepth 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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Psychosocial Rehabilitation of IDPs 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, halfmeasures, 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 cooperative 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

Psychosocial Rehabilitation of IDPs 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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Psychosocial Rehabilitation of IDPs 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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Psychosocial Rehabilitation of IDPs 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 selfesteem 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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Psychosocial Rehabilitation of IDPs 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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Psychosocial Rehabilitation of IDPs 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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Psychosocial Rehabilitation of IDPs 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. 2. 3. 4. 5. Communication skills; Conflict management; Overcoming the enemy image; Creativity and non-standard thinking; and 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 cocreators 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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Psychosocial Rehabilitation of IDPs 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 53
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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 experiences. childrens awareness of inner feelings and

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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Psychosocial Rehabilitation of IDPs 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. 59
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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 When someone tries to understand others opinions and takes them into 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 Elephant in the Dark


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.

The 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 60
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Psychosocial Rehabilitation of IDPs 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


Conflict is unfortunately inherent to the displaced persons life. Not only have they often been displaced because of a war, but daily arguments within the community, 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 the childs belief in his/her own abilities and to give him/her practical analytical tools with which to cope with 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. Training objectives 1. To help children and adolescents formulate a concept of conflict from different angles and to identify a potential for development from it. Although 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. 2. To teach them about the conflict stages, especially regarding the formation of the enemy image that can manifest itself in distrust towards everybody or 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. 3. To make them aware of the existence of other subjective realities and to make them understand how the denial of the right to have your own, 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. 4. To train them on win-win conflict settlement strategies. The achievement 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 61
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Psychosocial Rehabilitation of IDPs 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. 5. To encourage teamwork and mutual support through the development of cooperation skills. Psychosocial rehabilitation is based on group work and it is important to support the involvement of all children, even those that are at 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).

The Essence of Conflict


Objectives: Understanding the essence of conflict; greater awareness of one's own attitudes towards conflict, and widening ones vision of the 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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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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Retelling Stories
Objective: Acquiring restatement skills and the ability to carry out nonevaluative 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 overgeneralisation 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 68
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Psychosocial Rehabilitation of IDPs 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 cooperation 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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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 10th 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 preestablished 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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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 longterm 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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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 nonstandard 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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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 preschool 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, closenessdistance, etc.), latent and manifested conflicts, the family's history and its value system.

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


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 Iyou 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

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Psychosocial Rehabilitation of IDPs 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 psychocorrectional 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 87
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Psychosocial Rehabilitation of IDPs 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 selfconfidence 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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Psychosocial Rehabilitation of IDPs 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 reshaping 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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Psychosocial Rehabilitation of IDPs 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 92
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Psychosocial Rehabilitation of IDPs 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 Georgia3.

This theory was first established by Dr. Shapiro.

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Psychosocial Rehabilitation of IDPs 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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Psychosocial Rehabilitation of IDPs 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 95
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Psychosocial Rehabilitation of IDPs 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. 96
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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 selfperception 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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Psychosocial Rehabilitation of IDPs 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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