The Power of Empathy – Working With Those Who Have Suffered the Worst

Thursday, March 24, 2016

Luca Modenesi is a psychotherapist/trainer in CVT Jordan.

Shown in the back row are Luca Modenesi and Jafar Udwan. In the front row are Lina Al-Haj Hasan, Insherah Musa, Malak Al-Sarisi and Noor Abuljoud.

“Thank you. You treat me as a human,” a torture survivor said to me in the early stages of his rehabilitative care in Amman. In my work with torture survivors and as a trainer of psychosocial counselors, I receive feedback and hear this kind of comment on a regular basis. When I heard these words from this man, I knew the depth of meaning behind them. Working with those who have endured torture requires empathy – at the core of our work, we are helping people regain their sense of humanity; we can say that the healing process starts from this point.

I started out working with the homeless and with prisoners, not political prisoners – criminals. Working with these groups gave me a base, and then I started to travel quite a bit in the Middle East, and during the conflict in Occupied Palestinian Territories (OPT). I decided this was my life. I’ve always been a psychologist in humanitarian contexts since the beginning of my career, working with NGOs in complex mental health emergencies. I spent many years in OPT and then in Sri Lanka after the tsunami, also Iraq and Lebanon. My focus is the Middle East.

I had a professor in college who asked the students to identify our client. “Who is your client?” she asked. This is an important question, she told us, because the basis of this job is curiosity. We could say that my client is the Arab people and the many cultures and communities represented in this region. I am very familiar with the Middle East and in differing contexts: trauma or without trauma. I believe I have a good understanding of the culture, probably because it is not so far from my Mediterranean one. Across my work, I have observed that there is a lot of pain and suffering across these communities, but I see so much resilience. Despite what’s happened to them, they are still fighting.

Photo of Amman by Luca Modenesi.

When I finished my degree, relatives asked me, what gift would I like? I asked for a famous book on torture treatment called Bourreaux et victimes: Psychologie de la torture by a French psychotherapist named Francoise Sironi. I read it and found it intersected with the work I was interested in. I learned of CVT in 2010 while I was working in Jordan with other humanitarian organizations. I applied a first time but I didn’t get the job; it was a very competitive position that required a strong set of skills. In 2014, I had the opportunity to apply again and finally I got it— probably because I had improved my English and competencies about the group therapy.

Working as a psychotherapist / trainer is a complex role. I have to pay attention to many very different aspects of the clinical work as well as management of therapists. The clinical and management tasks overlap. There is a lot of work on project indicators, requirements and all the non-negotiable aspects of the work: the follow-ups, the numbers, etc.

For therapists, the more exciting work is on the clinical side: observing groups, having the opportunity to participate as supervisor of the group counselors. There are precious moments in this work. You supervise the case management of the therapists, working on techniques, but you also have the opportunity to develop people, help them develop skills, help them become more reflective. It’s an important skill to be able to reflect more on themselves, see why they did what they did. The therapists are the front line. If they’re not aware of themselves, they can’t work as effectively. Supervision is a moment of mirroring. I help the counselors see themselves. They learn skills – they help clients. It helps them understand individuals and culture.

For instance, how counselors deal with grief themselves influences them. Being self-reflective helps them see, for example, what are the challenges of being a mother? The clients have this challenge. You watch the elements of therapy with supervision: how counselors face their grief and discuss it with clients. It’s a common space. Or how to recognize and manage anger. How they manage the projection of the clients, how to not react and how to integrate the projection into therapy. All are integrated and complex.

Overall, the most important element in this work is empathy. Building relationships and trust. My approach is based on these elements. For example, we worked recently with a number of severely traumatized clients, including a number of rape cases. These were women who hadn’t disclosed their rapes to anyone. And there were men who had been tortured very badly. Very badly. Physically, the torture touched their sense of gender – gender and identity were brutally disrupted.

We developed interventions for them, and worked through sessions. This is when, at the end of a session, one of the clients said “Thank you. You are human. You treat me as a human. You restore my dignity as a human.”

And this was at the beginning of his therapy – he already had begun to rebuild a sense of humanity, and we hadn’t started the more technical aspects of his treatment. This is why empathy is very important. Often, torture survivors have lost their sense of humanity.

Another element that is important to our work is listening. All therapists are aware of this. However, it’s so easy to search for and propose a solution that sometimes we need to remember to listen first. Then through empathy, offer the emotional support. The solution will come.

As an example, it can be difficult for trainers or counselors when clients ask for financial support. We wish to find a practical solution, so this is difficult. It’s important to use empathy instead to help the client find the emotion, the source of pain behind this request. If we listen, we might hear from a woman how she feels now that her husband cannot provide because they are refugees. We hear about the anxiety of a mother who cannot buy toys for her children. Here at CVT, they feel safe enough to speak about such things. With their families, they have to be strong. When a woman says “I need my husband to be strong,” we can look at what the problem is behind that. Why does she not allow herself to cry?

And “allow” is the key. Women clients tell us they cannot show their emotions and feel they must be strong for their families. Many never tell their families about their rape or trauma. “I cannot let them down,” they will say.

We had a client who was beating her child. She had been tortured and raped, but her family didn’t know anything about it. She didn’t know what to do about this anger she felt. We used the metaphor of a cooking pot with her, describing how the pressure inside the pot builds and builds if it has nowhere to go. For her, this made sense. She was able to sit with the counselor and find ways to release her problems. Then she understood. It was a fitting metaphor.

My work as a therapist is most rewarding when I see a client change, even a little. My work as a trainer of counselors is very rewarding when I see improvements. For example, I’ve asked myself, how can I teach intuition? I can’t teach someone to be intuitive. How can I? But I see it happen. I worked intensively for a few months with a talented counselor, and in the middle of a session, she came up with an intervention for this client. Now, she’s very intuitive. She entered that space in the right moment with the right metaphor.

When I see this kind of application, I see that our training methods work. All these things are very rewarding: When I see that a mother is not beating her child anymore. When I see the signs of mutual respect in the eyes of male clients. When I see their body language change and relax. Sunni, Shiite sit together and help each other. They rarely see each other as the enemy. We will have one client who was tortured by Sunni and one client who was tortured by Shiite. They work together. That is CVT groups.

In the past, I had a lot of problems with the idea of “hope.” It’s not technical. It’s nothing. What is hope? I thought it was a way to try to buy people. But I was wrong. Hope is the key. It doesn’t matter where individuals are in their practical life. Hope is something else.

Back when I was in the OPT in the middle of conflict, I asked some of the young people, activists, why do you go to something like these children’s rights workshops? You could easily be put in jail. A 16-year old girl, active in this work, from an educated family and very visible in her activism, said to me, “We know change happens slowly.” This teenager was able to keep from being full of anger. She understood that to change is a slow process.

Most clients have a similar capacity. Yes, I believe in hope but also in the tiny window that clients find through their work with us. We promote hope in people. We see it in the little changes: a child passing from silence and complete lack of facial expressions to the end of the counseling cycle when she is active and smiling, sleeping better. She has hope for herself and her family. That is hope.

 

Funding for CVT’s work in Jordan is provided by the United States Department of State’s Bureau of Population, Refugees and Migration and the United Nations Voluntary Fund for Victims of Torture.

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