Hana Mustafa is a senior physiotherapist, CVT Jordan.
When I started working with survivors of torture at CVT, I wasn’t aware of some of the complexities of working with children, as well as adults, who have experienced trauma. I was also unfamiliar with an interdisciplinary model of care. As part of this model, we take into consideration the social, physical and psychological needs of our clients, which means that we don’t deal with children alone – we also work with their parents. Similarly, we work very closely with counselors to ensure we are setting expectations for clients and educating them about trauma.
I learned early on that as an interdisciplinary team, the work for children is even more intense than when working with adults. We always pair a physiotherapist with a psychosocial counselor for children’s sessions. It requires very good preparation and a lot of effort to make sure our work is coordinated.
We always consider how every child has unique needs. For example, a hypoactive child is difficult to draw out, to engage. A hyperactive child, however, has different needs – they have short attention spans and need to be engaged in energetic, high-tempo activities like aerobics, and also to take the lead in some activities so they won’t be distracted. In addition, we conduct caregiver education sessions with parents so we can help them understand the symptoms of trauma they may be seeing in their children. We normalize the behavior they see – whether children are acting out, isolating themselves, or regressing with developmental milestones in ways such as bedwetting, being over-reactive and easily irritated by simple triggers which cause them to break objects, shout, cry, hit others or hurt themselves. These unusual changes may be symptoms of trauma that the parent did not understand. We say, “If you find children doing this, this is normal behavior following an experience of trauma.”
As clinicians, we feel responsible for improving the relationship between child and caregiver. When they first come to CVT, some parents are not satisfied with their children. They use non-therapeutic methods and punishment, which have the opposite effect of making their symptoms worse.
CVT’s interdisciplinary approach is very effective. In the past year, 100% of child physiotherapy clients had increased body awareness and self-regulation, and 95 percent of child psychology clients had lower psychological symptoms. Beyond the numbers, I see the results when our sessions with the children finish and we do a closing session with their parents. The parents tell us they feel proud of themselves and their children. The parents sometimes share things with us about how they feel sad for all the hard times they have been through with their children. One mother said to me, “I started to understand that my child is dealing with difficult things. Now I will be more supportive and close.” When I hear this, I can see they’re committed for this change. In addition, when we do three-month and six-month follow-up interviews, I continue to hear good things about their relationships with their children.
I began my career in physiotherapy after completing my Bachelor’s degree, working with clients who had cerebral palsy, disabilities or delayed milestones development. I also worked in an orthopedic center with people with musculoskeletal or neurological injuries. CVT was the first non-governmental organization (NGO) and first international place for me. Coming to CVT was an opportunity for me to gain experience in the neuroscience on rehabilitation for trauma survivors.
Some of the science was very new to me. I began to understand the CVT model and see that there is more responsibility on the role here. We approach clients holistically. We integrate the physical with the psychological; for example, we educate clients about how when your body is tense, you feel it both physically in your body but also psychologically. I tell clients, “You can’t be sad without it being in your body.” It can be hard for people who have experienced trauma to understand what’s happening, why they have pain. My role is to educate people about trauma and give them the keys to ownership and understanding their body.
We help clients feel, “I have sense of control over my body – I understand what’s going on.” This helps clients feel responsible in their lives. They have already lost their sense of control – in situations of torture and war, everything was out of their hands. We’re here as an interdisciplinary team to help them regain that control over their mind and body.
And for our work with children, we use a wide variety of tactics and different approaches based on their ages and also to keep them interested. Children like to move; they like to play, so we use therapeutic exercises like fitness high-tempo aerobic exercises, balance poses and yoga sequences. We always aim to teach children the body/mind connection and the power of regulating their bodies and body/mind connection. They like to brainstorm but also to think by themselves. We use activities like letting them prepare handicrafts or focus on a particular psychological element. For example, if they are having nightmares, we have them draw the thing that frightens them in the nightmare. They have the opportunity to turn it into something they like.
And we do a Loss & Grief session where we let the children count their losses. We give them a bead for each loss along with thread so they can make a bracelet. Having these losses part of a bracelet on their arms can send them a reminder of good memories even though the beads represent losses the war took. It can help children keep the good memories in their hearts and minds. We discuss with the children how these memories empower them, how the memories can help the child push forward. The children are excited about this activity – it’s a good session.
It is impressive to me how strong they are. These children are deep thinkers.
My responsibility to my clients is very important to me. To me, it is a real achievement when I hear they’re getting better – getting sleep, improving function, becoming able to move in the ways they did before torture, before the war.
I hear words of hope in the last session that we do with clients. We close out the therapy and prepare for the future in those sessions, and I hear clients say they have become so much more aware of their bodies and themselves. They know how to be more comfortable in the world; they know how to act in every day of their lives.
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.