CVT Healer Roundtable Discussion

Wednesday, June 28, 2017

In honor of Torture Healing Awareness Month, three CVT healers were gracious enough to make room in their busy schedules to answer a few questions about their role in the organization. Leora Hudak, MSW, LICSW, is a psychotherapist at our St. Paul Healing Center (SPHC) and was joined by Amanda McDonald, MSW, LICSW, social worker and case manager at SPHC. Ilona Fricker, clinical advisor for physiotherapy, added to the conversation via email from Jordan where she is located. The three addressed their respective roles in helping survivors of torture along their healing journey, insights they have learned from clients and the nuanced work of torture healing.

Why did you choose this career?

Leora: I was working in China as a volunteer and I was in an area in the southwest of China, really close to a project called the Three Gorges Dam Project. Many of the families of the students I was teaching had been displaced off their original family land. I started to get to know the issue a little bit more intimately. I came back and went to grad school to become a social worker. I work as a psychotherapist now, but I'm a social worker by background. It was during graduate school that I found a torture treatment center in Chicago, a sister center to CVT and I absolutely fell in love with it. Joining CVT was one of those experiences where I came into the work wondering if I could handle the issue of torture, I wondered if it would affect me, I wondered if I would want to leave right away and get as far away from it as possible. It had exactly the opposite effect. I felt like once I bore witness to my client's stories there was nothing else I could do.

Amanda: I learned about CVT when I was working abroad. The more I learned about it and how reputable it is and what a well-run organization it is, the more I wanted to work for CVT. So that's how I ended up here. I chased this organization.

Ilona: As a young sports woman, I was always fascinated by the human body and I enjoyed the thought of helping people recover from injury so that they could continue to practice the sports that they loved. I worked in the field of physiotherapy international development for a number of years in different countries before finally arriving at CVT. In my job before CVT Jordan, I was in Lao People’s Democratic Republic working for an organization which provided rehabilitation to UXO (Unexploded Ordnance) survivors. This was the beginning of my path in to the field of trauma rehabilitation.

What advice would you give to therapists entering torture rehabilitation work?

Leora: I would say, especially as a psychotherapist, coming into this type of trauma work it is so common to think that it’s going to be all about the torture narrative, but people are so much bigger than that. That's not the whole person. And as providers here, we end up working on so many more things. I talk to my clients about their boyfriends and their girlfriends and about their school and text messages and Facebook and all sorts of things that are just as real to the human experience as the torture. And so although you do talk about the torture, it’s not like you'll sit all day listening to torture stories for forty hours a week. It’s so much more about the whole individual.

Amanda: I think there’s a misperception. People think you hear about torture all day long. I'm a social worker and we have different content. We're more focused on the present and the future than the past. I can go days and weeks without hearing explicitly about someone’s torture. Torture treatment is sometimes subtle, we don’t necessarily have to talk about it continuously to address social functioning.

Leora: And if you are doing the work well then and everybody is working hard toward the same thing, then I often tell my clients we want get you to point where this is part of your story but it is not what defines you.

Ilona: Physiotherapists working in mental health and specifically in torture rehabilitation are a minority. The aims of physiotherapy rehabilitation in this setting are not well understood by other health professionals working in the same field. Helping your colleagues understand the work that you do through advocacy and ongoing training is a big part of the work and can seem repetitive, but persevere and the end result is effective interdisciplinary working and subsequently better outcomes for the clients.

How do you stay positive about humanity?

Ilona: I think about my children.

Leora: I don't have a ton of trouble with this. I think that is because of the juncture where we are meeting our clients. When clients have managed to make it to us they have survived. They've gotten through torture and detention in their country. They have taken the journey from their country to the United States and everything that is involved in that. I sometimes stop and reflect on the fact that it is absolutely miraculous that they have even made it into my office. And that’s where we're starting from. From that place, there is so much hope. We know the treatment is good, we know it works when clients are engaged. It may be a little different than our colleagues who are in the refugee camps meeting with clients who are in very different junctures in their lives. But we're in a place where we can provide a lot of safety and support so I think that's what I rest on when I think about the healing process. We're on the upswing at the end of that. There's a lot of hope. People talk about vicarious trauma, but they don't talk enough about vicarious resilience and the things that what we really gain from our clients. We see them as they move through this process. We feel that too. Every accomplishment they have is really hopeful.

What is a person's typical reaction when you tell them where you work?

Ilona: Most people are surprised and fascinated. I don’t think it occurs to many people that organizations like CVT exist.

Amanda: 'Oh, that sounds so sad!' That's a pretty common one.

Leora: It's varied, right? I think there are people who really get it and they're engaged with it. When I tell people I go into it with the expectation that people are going to feel uncomfortable about this, but more often than not I think people surprise me. They'll say ‘Oh my gosh, is that in Minnesota? Tell me more about what you do. Who do you see?’ There's a lot of curiosity around it, but you know there are also some folks that feel uncomfortable about the topic. I would say that might be changing right now just because of our current political environment, people are just really aware of the refugee situation and so I will often lead with: ‘I work with refugees and asylum-seekers at CVT.’ And people are pretty curious about what the situation is right now for refugees and how they are being affected.

What questions do survivors have at the beginning of their healing journey?

Amanda: They want to know if they're going to get better. They ask that in various ways. Clients also want to regain a sense of safety so their most pressing needs are usually raised early on in treatment. For many, to regain safety means getting legal assistance to win asylum and to reunify with their family members.

Ilona: ‘What is physiotherapy? How will you help me? Will my pain get better?’   

Leora: For me, therapy is a pretty abstract concept. And it’s a western construct. So I would say I get a lot of questions in the beginning that are really practical. ‘What are we going to be talking about? Are we going to talk about my torture every time I see you?’ So a lot of it is co-constructing what the meaning of therapy is going to be like. So I get a lot of those questions and I think — just like Amanda mentioned — more existential questions. ‘Is it possible to heal? Will this be with me forever? How do I forget? How do I move on?’ Those questions are answered along the journey. 

Does torture counseling differ from other forms of trauma counseling? How so?

Leora: In some regards, it’s different. I think torture impacts the entire individual in so many different ways. There are physical scars usually from torture. There are mental and emotional scars. It affects faith and spirituality. It impacts the community and the family. The goal of torture by the perpetrator is to disempower, to control and silence. So the goal of treatment is to empower, to bring the voice back. So when we're treating an individual, we're taking a completely holistic approach. If we silo-ed out just the counseling and just the psychotherapy I don't think that it would work in the same way; which is why we have such a multi-disciplinary approach here. The interpersonal component is really important. Torture in and of itself is very intimate. It is inflicted from one human being to another, so the relationship between two people is absolutely essential to recovery. You are rebuilding their capacity to trust.

Ilona: Trauma-focused physiotherapy is a unique approach in that the trauma experience informs every stage of the client’s rehabilitation journey. For example, the treatment space looks different to a normal physiotherapy room because in understanding how items such as wall bars, metal pulleys and electrotherapy equipment may remind the client of their torture experience; the room is designed without these typical items. During the assessment, the level of physical contact differs greatly between clients and it may take a number of sessions before a client feels comfortable enough to allow the therapist to complete a full assessment. Treatment interventions commonly include concepts of Cognitive Behavior Therapy (CBT) allowing treatment goals to be shared across the physiotherapy and counseling disciplines. In order to provide an approach which reflects the mind/body connection, close interdisciplinary working is integral in trauma focused physiotherapy.

What does success look like when you are treating trauma like this?

Amanda: I think one of the main things coming out of the process is independence. A client’s independence encompasses a sense of empowerment and self-advocacy. We work towards someone’s ability to manage daily life on their own in conjunction with depression and PTSD symptoms decreasing. We work in partnership with a client so they are better able to manage what they need to, without the assistance of others. So I feel best about closure when I know that that this person is going to be able to move forward and things won't fall through the cracks.

Leora: Yeah. Success is definitely varied in psychotherapy, as much as possible. I feel successful when clients become authors of their own healing. As I mentioned before, we are co-constructing the process and moving through it together. In general, I would say success in psychotherapy is when somebody has been able to form the capacity to try to trust another person again; to form relationships with new people. I think that starts with providers at the center and we start to see those relationships develop outside of CVT then we know that the progress is starting to happen. Trauma is something that fragments the individual. After trauma, your emotions, your memories, the feelings in your body - all of that feels out of control because of the ways that trauma effects your brain and system. It sends things into a chaotic environment. When we're seeing success in psychotherapy is when we start to integrate those things back together. True success comes more from the individual sense that ‘I am somebody beyond this experience of torture. I am somebody who can live in the world and have relationships that are healthy and supportive of me.’ 

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