Trauma therapy in East Congo

Democratic Republic Congo

For more than 15 years now violent conflicts have taken place in the northern region of Kivu in the east of DR Congo which also effect the civil population. A dynamic constellation of different (para-) military groups control vast parts of the region. In the spite of international efforts civilians cannot be sufficiently protected. In many places the population is at the mercy of a system of violence and corruption. Our national media often cover only the most cruel of violent acts that take place.

Sexual and gender-based violence

The degree of sexual violence in this conflict is unconceivable. Extremely aggressive and extremely violating rapes occur on a daily basis (e.g. carried out with objects and in groups). Often members of armed groups are held responsible for such assaults but even within civil communities abuse and rape are condoned without any negative consequences for the rapists and thus normalised. The survivors on the other hand are left alone with the physical and psychological as well as social consequences. Shame and fear of being stigmatised and/or cast out by family and society and the resulting hush too often result in the victims' silent agony.

Peace mission MONUSCO

MONUSCO, the peace mission of the United Nations, is stationed in the Democratic Republic of the Congo since 2010. With more than 20000 soldiers and a yearly budget of 1,4 billion US dollars the mission tries to "neutralise" paramilitary groups und maintain security in the country. Besides the military presence, the mission focuses on a demobilisation programme to offer rebels a chance to back out. Apart from former rwandan fighters that settled in the northern regions of the Kivu after the rwandan genocide, between 3000 and 5000 congolese soldiers per year take part in the MONUSCO-DRRR formal demobilisation programme. Nevertheless, a dynamic back and forth between life as either civilian or soldier takes place in regions that are sometimes hard to access. The so-called Mai-Mai groups are an example for such a development: originating from civil rights movements that tried to defend their communities against rebel groups, they are taken nowadays to be part of the continuation of the conflicts.

The fighters in this war have themselves experienced a certain history of traumatisation and violence. Most of them have been recruited as children, before their eighteenth birthday. They witnessed death, violation or illness of family members and friends. They themselves were in constant mortal danger; looting, cruelty and violence became their daily life. After their demobilisation former fighters often lead a life in poverty and constant danger. They have to face new challenges: stigmatisation, unemployment, weak public structures - but most of all they have to cope with the omnipresence of their memories regarding their past as armed fighters. In many cases they do not succeed to overcome a general feeling of uncertainty which requires a constant disposition to defend themselves and often pave the way back into the rebel groups, and thus crime, cruelty and drug abuse.

voki: Voices of the Kivus

With our project we try to lend the - usually unuttered - traumatic elements of memory a voice: Voices of the Kivus (voki). We analyse the consequences of different experiences of violence on mental health through detailed diagnostic interviews and thus try to find treatment approaches. We focus especially on symptoms that influence the spiral of violence. In addition to the attitudes and behavioural patterns reported by the participants we also analyse epigenetic markers which interact with specific environmental parameters.

Narrative Exposure Therapy for survivors of sexual violence

In cooperation with vivo international (vivo.org) we research the efficiency of 'Narrative Exposure Therapy' (NET; Schauer, Neuner, Elbert, 2011) in a clinical study with a sample of survivors of sexual violence. We focus especially on penetrating the long lasting silence through therapeutic conversations and recognition of the suffering.

Narrative Exposure Therapy for former fighters

Another clinical study researches the efficiency of an adapted version of the NET for traumatised ex-combatants. It is crucial for former combatants to process the past and to deglorify violence at the beginning of a successful demobilisation. On the so-called 'Lifeline' sticks symolise the violent acts performed by oneself, in addition to flowers and stones for positive and negative life events. Group interventions which take place parallelly shall even the path to a non-violent intercourse with each other.

Handling of violence an traumatisation in society

Apart from individual therapies we develop an approach to process collective tramatic memories on the basis of narrations that were compiled during single sessions of NET. The aim is to facilitate the development of a commemorative culture, an awareness for the reciprocity of violence and to acknowledge the suffering of all survivors in order to break through the barriers between perpetrator and victim. This is the only path to achieve a peaceful intercourse in the long run.

Principle of training

In the beginning the NET counsellors are being trained in a three-step dissemination model. Subsequently they execute therapies under close supervision and consequently gain precious experiences and expertise. Then the NET counsellors learn how to conduct NET workshops on their own and thus to ensure the quality of ensuing therapies. NET master counsellors accompany their trainees and offer positive criticism and empathy during trainings.

Finally, the NET master counsellor shall learn how to secure the quality of the trainings. So-called NET supervisor counsellors are thus in a position to regulate the treatment offer for trauma patients in their region.

Working with the „Lifeline“

The patient gets to reconstruct a detailed chronological sequence of his biography by means of NET. Following thorough diagnostics and psychoeducation the patient starts working in his first session on the so-called "Lifeline", symbolised by a rope: the beginning stands for birth, the other, still furled end for the future. Against the background of this picture therapist and patient talk about the central life events of the patient who places stones and flowers on the rope. Stones symbolise negative and traumatic events, such as experiences of abuse or militant attacks, the flowers represent important positive events, such as school enrolment or the first positively experienced kiss.

Narrative Exposure

In the following exposure sessions the most important events , above all the 'big stones', are being experienced again in all their qualities - sensory, cognitive, emotional, introceptive - in order to form the usually fragmented history of the trauma into a coherent narrative. Thereby it becomes apparent when fear and despair may emerge from memory and to which context those feelings belong. The therapist inscribes the narrations, the report is being read out loud in the next session. Missing pieces or faults can thus be added or corrected until the narration of the patient is correct. In the last NET session the narration will once more be read out loud, signed in a symbolic act by both therapist and patient and handed out to the patient.