Learning from our Data: Why Survivors Come to CVT
Alyce Eaton is a research coordinator at CVT.
“I am suffering and sad.” This is one of hundreds of comments made by torture survivors as they complete CVT’s intake process; comments that open a window to the fears and symptoms they suffer, but also to the determination they have to begin recovery.
In each of CVT’s International Services projects, one of the first activities in which a survivor participates is a thorough intake interview. A CVT counselor asks the survivor about his or her family, living situation, trauma history, current problems and symptom levels, among other topics. In this conversation, the survivor might talk about relentless nightmares, losing family members or thoughts of suicide as the reason for seeking help.
These intake assessments are important to building the therapeutic relationship and providing us with a better understanding of our clients. Once the survivor completes the intake process, he or she becomes a client of CVT. After receiving services, clients take part in scheduled follow-up assessments to record any changes in their symptoms and circumstances.
We report regularly to our funders on quantitative questions—such as the demographics of our clients or their symptom improvements—but we in the Research Department less often have the time and resources to analyze the rich qualitative data obtained in intake interviews.
For example, in our international projects, we ask, “What is the main reason the client chose to come to CVT?” Some clients’ answers are long and detailed; others are terse. Some are hopeful, others despairing. Some clients come with a good understanding of CVT’s services, while others are desperate for any assistance.
With the help of a dedicated summer intern, Clare McCarthy (now a junior at Tulane University in New Orleans), we were able to delve into these responses more deeply. Clare analyzed 821 new clients’ statements from CVT’s project in Nairobi, Kenya, looking inductively for emergent themes and then coding each statement using those themes.
Clare worked with the research team to combine and refine these themes into eight categories. Merging the themes into more general categories led to more statements being included in each, which allows for stronger statistical analyses.
The eight primary reasons Nairobi clients reported they came to CVT were:
- Needing help, whether specifically—such as for counseling or physiotherapy—or more generally, such as to be with others or to regain happiness.
Example: “So frightened so I've come to seek help from CVT to reduce my worries.”
- Post-traumatic stress symptoms, such as hopelessness or flashbacks.
Example: “Client feels she has no peace; intrusive thoughts; fearful of having her traumatic past recurring.”
- Social problems, such as loneliness or family conflict.
Example: “Client is going through emotional pain of not knowing if his wife and children are still alive or not.”
- General trauma or problems.
Example: “Memories of traumatic experience bring thoughts of suicide. No peace because of daily life challenges.”
- A specific traumatic life event, such as torture, rape or abuse.
Example: “To get some help with his pain in the body due to torture and also his thoughts.”
- Feeling sad or depressed; for example, reports crying or suicidal thoughts.
Example: “I want to be advised because I feel desperate. I am suffering and sad.”
- Feelings of uncertainty or anxiety about their current circumstances.
Example: “Counseling will help me find advice on how to organize my life.”
- Low levels of self-esteem or self-worth.
Example: “Marital distress; client constantly feels insecure.”
Note that a statement may fit in multiple categories.
Using Clare’s work, this chart shows the percent of statements that fell into each category or theme of survivors’ reasons for coming to CVT, based on the intake form for new clients at our Nairobi project. In general, survivors are most frequently reaching out to CVT for help—whether general or specific—or to address post-traumatic symptoms such as flashbacks or nightmares.
Analyzing these responses helps us learn about how clients present themselves for services and what this may suggest about their symptoms or for their treatment needs.
For example, these statistically significant findings—among others—might guide staff as they conduct intake interviews:
- Men were more likely to report social problems and post-traumatic stress, while women more often requested some form of help.
- Clients who explicitly asked for help had higher symptom levels across all categories: depression, anxiety, post-traumatic stress, physical symptoms and behavioral functioning difficulties.
- Clients who mentioned traumatic life events had greater improvement in depression and physical symptoms than others three months after completing treatment.
Volunteers are now engaging in similar work with data from CVT’s other international projects. Further analyses of these statements and other qualitative data can shed more light onto our clients’ needs and how we can serve them better.
