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HHRI - GBV Manual presentation

Presentation for 12. August
by

Elisabeth Langdal

on 15 November 2016

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Transcript of HHRI - GBV Manual presentation

Dissemination as much as possible
A webpage has been developed to guide further use
Including a question & answer section
Additional information about practical implementation and adaptation
Comments and experiences based on use
Compilation of evaluations and future ideas
Implementation and follow up……..


GBV - Training manual
Trained more than 100 helpers in five different countries
GBV manual web site
More than 310 manuals sent to 29 different countries
150 Memory sticks sent to additional countries, downloaded 870 times
The manual referred to on websites and in IASC new GBV guidelines
Training in Khartoum, Sudan March 2015
Waiting for feedback and results from users
4 hours Introduction training for 20 helpers
Webinar introduction to UNFPA - MENA region with 15 different countries


What we have achieved so far

Pilot III: Adana, Turkey, with
Human Rights Foundation 2013

How was the manual developed?


Low intensity training
Focus on mental health, and psychological reactions to traumatic events
Practical interventions, exercises and skills training
Resource oriented – survivor as well as helpers
Builds on experience and local knowledge
Tool for training, supervision, groupwork and self-study
Lots of room for adaptation and adjustment for each context
Developed by clinicians but can be used without formal training
Aims at being self-explanatory
Supplements existing guidelines and manuals
Based on a clinically informed and human rights based approach

9.
What characterizes this manual?

Please contact us if:
you want more information
you want the manual sent
have questions regarding application of manual










THANK YOU

Pilot V, Amman, Jordan

with Arab Resource Collective (ARC) in March 2014



Making the
Butterfly woman
cultural applicable

Butterfly woman in Khmer

Pilot IV: Phnom Penh, Cambodia
with AFESIP, February 2014

Pilot II Oslo, October 2013

Pilot I: LIMPAL & HHRI,
Colombia, 2013

Would it travel…..
Could it be used across borders?
Was it as self-explanatory as we hoped?
Are the exercises ok?
The group works?
Does it give practical tools?
A sense of mastery to participants?
Does the human rights perspective come across?
Will it change or improve practice?
Will it strenghten support to victims?

To pilot the manual we co-operated with local organisations in 5 different countries, training 100 helpers.
We needed to pilot……try it out –


The Norwegian Ministry of Foreign Affairs
The Mental Health Project, Norway



The work was made possible through funding by



19.
The good helper

The Butterfly Woman

To better understand trauma, what it means in the life of the survivor, trauma reactions and dealing with these – we use a metaphor:


The BUTTERFLY WOMAN


8.
Why this manual?

Strong international efforts to combat gender based violence in conflict and war.

A large number of valuable initiatives including guidelines and reports exist

But how do we support the survivors?

How can we ensure that the survivor and her family are helped?

And how to support the helper?c

Introduction
- 15 «boxes» – with basic information,
main ideas, themes and content.

The actual training
with instructions to trainer, group exercises, grounding techniques, role play and discussions, introducing and following the
Butterfly Woman metaphor and working on skills and tool-box

Theory
and resources, further reading, brief presentations of theory, and links



13.
The Construction of the manual

The Helper in Arabic

Discussions, own experiences,
diplomas and pearls ….

A group of dedicated and experienced professionals
got together……

Doris Drews (psychiatrist), Katinka Salvesen (clinical psychologist)
Annika With (expressive art therapist), Solveig Dahl (psychiatrist) Helen Christie (clinical psychologist), Josefin Larson (masters in psychology), Nora Sveaass (psychologist), Elisabeth Ng Langdal (executive Director of Health and Human Rights Info)


Nora Sveaass.
Clinical psychologist and Associate Professor at the Department of Psychology, University of Oslo. Many years of clinical work with survivors of trauma and forced migration. Former member of UN Committee against Torture, now member of UN Subcommittee for the prevention of torture.


Elisabeth Ng Langdal
Executive Director of Health and Human Rights Info, masters degree in human geography and bachelor in media studies from Oslo University. Responsible for the Health and Human Rights Info resource data-base and developing the manual on gender based violence.

Health and Human Rights Info
makes information about mental health more accessible to personnel working with people exposed to human rights violations. We bring this material together through evaluation, analysis and editing.

HHRI provides relevant and comprehensive information that can be of practical use and support in situations where more specialized services within mental health care are not available and the need to provide care is of essence.

14.
How to read the manual
15.
There is a left side and a right side
What the trainer needs to know
What is said aloud
18.
The good helper

A brief introduction to ‘trauma’
To set the note for the training we would like you to spend a 5 minutes to watch this little film.
It is about the Good helpers in Congo who first inspired us to write this manual.
The qualities of a
good helper.
This image was
shared by
counsellors working
in the Democratic
Republic of the Congo.
The aim of this
manual is to let the helpers discover their own tools and maybe give them some new ones.

23. Taking care of yourself as a helper
When working with severely traumatised people, close attention should be paid to helpers’
reactions. Helpers too are at risk.

Secondary traumatisation.
Vicarious traumatisation.
Compassion fatigue.
The techniques used to help victims (such as stabilisation exercises, sleeping advice, etc.) can often be helpful to the helpers themselves.

Helpers need to understand that it is important to recognise their own needs and reactions, and understand what triggers and modifies them.
25.
A trauma is “a personal encounter
with death and violence”.
A ‘traumatizing event’ is one that has the capacity to cause mental or physical damage
Faced with such an event, the immediate response of the body and the mind is to struggle for survival (‘fight, flight or freeze’ responses, submission or ‘playing dead’)

To understand better how the
brain works, we have added a
short film by Dr Siegel.
Judith Herman
Please visit our manual web page for more information
http://www.hhri-gbv-manual.org/
postmaster@hhri.org
www.hhri.org

Stabilization
Grounding exercises
When the worst has happened

Experiences triggers and flashbacks
some time after the trauma.
Gradually healing
The Butterfly Woman metaphor describe how helpers can stabilize a survivor – by bringing her into the here and now, within her window of tolerance. They energize her when she is under-active and lower her agitation when she is over-energized by bad feelings, thoughts and memories.
To discover the effects of these techniques, we can ask these guiding questions:
• What happens in your body?
• What happens to your feelings?
• What happens to your breathing?
• What happens to your thoughts?
• What happens in your heart?
GBV
is a distinctive form of trauma
because the violation involved is
extremely invasive and gives
rise to feelings of shame, self-blame
and guilt. When combined with fear
of being injured or killed,
it is traumatising in almost all cases.
Grounding is a stabilization method for
handling strong emotions of fear or flashbacks, when a memory ‘takes over’ and is experienced in the present.
is an approach that helps to handle trauma-related reactions
Grounding exercises can help a survivor to reconnect:
• With the present moment in time
• With the here and now
• With her body, and reassert personal control
• To the safe context of the room in which she is
The aim is to keep the survivor within the window which indicates that she is in the ideal state of emotional response. In this state she can absorb and respond to information effectively. Above the window she experience hyper arousal (often associated with the body’s ‘fight and flight’ response). Below the window, she experience hypo arousal (associated with freeze, ‘playing dead’, submission and dissociation
responses).
Window of tolerance
We want you to teach the survivor how to stabilize herself
The Butterfly woman and stabilization techniques
I will now tell you a story about the Butterfly Woman. Listen – and notice what happens to the Butterfly Woman’s
thoughts
,
feelings
,
breathing
,
heart
and
body
.
Once upon a time, a Butterfly Woman lived in a small village surrounded by green hills. The Woman had a good heart and a strong body. The days went on. In her
right wing
were all the good memories of her life – like the green hillside, the sound of the river she loved, and the fragrance of her favourite flowers. Thinking of the trees and animals made her feel calm. Looking at the house made her feel safe.
In the
left wing
, she kept her dreams about the future and some worries too, though they
weren’t too big to handle. Sometimes she dreamed of a new dress, and some good shoes to
keep the rain out. But her strongest dream was for her children’s education..............
The Butterfly Woman Metaphor
Triggers and trauma reminders
Trauma-reminders are events or situations that remind survivors of their painful experiences, and awaken memories
Such reminders may elicit trauma reactions over and over again
We call them ‘triggers’


Reporting
Sometimes it will be important to report violent incidents to relevant bodies. Always do so with the consent of the survivor, and in collaboration with her. What are best practice rules when a survivor decides to describe her experience formally?
How to consider the possible risks involved in reporting?



Making a good ending

When ending the story:

Explore the notion of ‘success’ and allow the group to construct a suitably realistic ending.

To clarify the many challenges that may arise for a survivor when she returns to her community, and what kinds of assistance can make her return easier or more successful.

Be aware that some women may be marginalised and rejected by their families or community.
And that some women will not wish to return to their old life.
We have added different exercises, role plays, discussions and grounding exercises. It is good learning in doing the different exercises.


16.
Active participation
Role play
- you should act out your part as either a helper or a survivor. Make use of your skills and your knowledge. The situation may evolve in directions you did not foresee; if it does, continue to play your part. It is a good exercise for learning how to communicate and how to react to a survivor’s responses and body language.
Grounding exercise
is an important therapeutic approach for handling dissociation or flashbacks, and reducing the symptoms of anxiety and panic. It is important to practice the exercises again and again until the skill becomes automatic and can be called on even during moments of distress. Learn the exercises by heart, it will then be easier for you to apply the right exercise for the specific reaction.
7.
Mama Congo
by Arild Kumar - Join Good Forces
The Butterfly Woman Metaphor

Implement the manual in a way that works in your
everyday experience and context
Use it as it seems fit in your cultural context and
within your time frame
Use the whole training or just bits and pieces
For training in groups, individual studies, supervision,
discussion groups etc….
Always prepare well, including translators, venue etc

17.
Make the manual useful
20.
What are the qualities
for a good helper in
your community?
Metaphors provide a useful tool that helpers can use with survivors. Using metaphor, both you and the survivor can assess where she is, what she wants from the training, and the distance she can travel in her therapeutic journey. In the manual we use a single metaphorical narrative to describe the experience and consequences of GBV (choose a different metaphor if it does not fit your cultural setting). We explain the course that trauma takes in generic terms through the story of the Butterfly Woman; it remains a story but at the same time it is clinically accurate.
Metaphor as a tool
10.
Added value
For the trainer -
Learning new skills for helping survivors

For the survivor -
Empowerment by knowing and understanding and finding ways to deal with traumatic memories when they appear (grounding exercise).

For the community -
Strong survivors participating actively in local community, taking part in decision making processes with their knowledge and experience.

Human Rights perspective -
Awareness of human rights, may assist both in understanding the suffering and in finding ways to respond to it in a respectful and helpful way.



The manual can be down loaded here or from our web site
Questions for further discussions
1) Discuss your own experiences of working with survivors of GBV.
Share a “good lesson learned” in your work that you want to bring with you.

2) Discuss situations that seemed difficult to handle in your work with survivors.

3) From the topics of the manual what in particular will be useful in your work with survivors?

Health and Human Rights Info
presents the
Gender based Violence training manual

Doris Drews

Specialist in psychiatry, who for many years has treated severely traumatised clients. In addition to working as a therapist and teaching, she is currently head of the emergency unit at Lillestrøm DPS.
21. Tools in work with survivors

Listening, respecting and acknowledging painful reactions
Communicate that you «see» her
Create safe place
Stabilizing by being here and now oriented
Grounding exercises
Relaxation and energising exercises
Psycho-educational approaches

The situation is overwhelming, inescapable and very frightening
Loss of control and beyond what we are prepared to deal with
Threaten life and integrity
Most people will struggle with serious reactions such as intrusive memories, re-experiences, flashbacks and sleeping problems afterwards

26.
What characterizes a traumatizing event?
An approach that helps to handle trauma-related reactions
We want you to teach the survivor how to stabilize herself
Grounding is a stabilization method for handling strong emotions of fear or flashbacks, when a memory ‘takes over’ and is experienced as if it happens here and now

Stabilization
22. Exercise: The good helper in your community
Have in mind.....

• Fight
• Flight
• Freeze
• ‘Playing dead’/submission
• The five focus areas

Trauma-symptoms“ - exercise
• Go into “freeze mode”. Tighten all your muscles. Stand still and feel the tension in your body.
• Go into “fight mode”. Make your body ready to fight. Tighten your muscles and activate your aggression. Feel the differences in these two states.

Story continues....

Grounding exercise 8 – straightening the back



Role Play and discussion
Calming triggered survivors, energising under-active survivors.
(Form pairs to practice a role play that can calm or restore energy to a survivor)
Discussion in the group

Pros and cons of reporting.
Using the best practice rules, ask the participants to discuss the advantages and risks of
reporting, which almost always requires survivors to describe their trauma, sometimes in detail.
Ask them to consider what helpers can do:
• To assist a survivor to decide wisely on whether to report.
• To reduce the risk that a survivor will be re-traumatised.
• To make it more likely that the outcome will be satisfactory or bring the survivor some benefit.
• To prevent the survivor from being put in danger or at risk because she reports.

Troubled sleep and nightmares
Before reporting
What reporting means and implies, including risks.
Explore the outcome, hopes and her fears.
Never put pressure to report if she is not ready or willing.
When ready ensure all implications,
Make sure she realises that the outcome may not bring a result that benefits her.
Prepare her for the possibility that retelling her story may re-traumatise her
During reporting
Ensure that a confidence is with the survivor.
Encourage her to use grounding techniques for staying in the present moment.
Make sure the environment is as safe as possible, and that support are available.
If a helper can be present to support the survivor when she makes her report, she should:
Agree a stop signal with the survivor, because this will help the survivor to hold her boundaries
Lett her tell her story in general terms (headlines) to avoid triggers.
After reporting
Find a good process of closure for the survivor.
If possible ensure that people are available to talk through the event.
Help her to ask for information about the continuation of the case.
Plan and make arrangements for the following days, shelter and safety etc.
To Take Home

Basic principles

• Say that you want to give support.
• Show respect.
• Ask for permission to sit down together.
• Balance distance and closeness.
• Give the survivor time to take you in.
• Do not ask a lot of questions.
• Let the survivor understand that she can talk or she can be silent.
• Remind her that she is in command of her own story.

Every case and every survivor is unique
A helper must think for herself and always use her own imagination and judgement
when she decides what stories to tell, what advice to give, and what grounding exercises to use.

Important to ask certain questions:
• What resources can the survivor draw on, in herself and in others?
• Will I (or other helpers) see her regularly or just a few times, or only very occasionally?
• As a helper, how much do I know about her situation? Do I know enough?
• If I ask her to trust me, am I in a position to sustain that trust?
• Am I in a sound position to advise her?
• As a helper, am I promising too much? Can I sustain the help that I am offering?
• Can I sustain the help that I am offering?

Role play: meeting between helper and survivor

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The story continues.....
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Full transcript