Trauma Awareness, Healing, And Group Counselling In .
51 56 Olij07-03-200511:29Pagina 51Judith OlijTrauma awareness, healing, andgroup counselling in secondaryschoolsJudith OlijTen years after war and genocide in Rwanda tookalmost a million lives; trauma still exists on a largescale. This is especially true amongst adolescentswhere it hampers the process of reconciliation. As aresult, crisis outbreaks frequently occur at secondaryschools. In this article, an intervention for secondaryschools is described that promotes trauma awarenessand healing within a school environment. This intervention appears to succeed in preventing trauma crisis:in the four schools covered by the project, no crisis tookplace. It also accelerated the process of reconciliationamongst the students from different ethnic groups: theywere able to commemorate and mourn together withdignity.Keywords: counselling, psycho education,reconciliation, sensitisation, training, trauma,and youth clubs.Trauma in RwandaA considerable proportion of the Rwandanpopulation has been traumatised to a greateror lesser extent, due to decades of intermittent inter-group violence. This culminated inwar, genocide, and the massacres of 1994. Inless than a hundred days, more than 800.000people were slaughtered. Hundreds of thousands of children lost either one, or both parents, or the family was separated. Almost allchildren witnessed brutal killings, sometimesof their own family, and sometimes by theirown parents.The Rwandan family-structure used to offeremotional support to members of the family.Women went to their mothers, aunts, orgrandmothers. Men would go to theirfathers, uncles, and grandfathers. In Rwanda,many children and adults not only lost theirimmediate family, but also a great deal oftheir extended family, and therefore theirsocial network. This has left few opportunities for emotional support.The African Centre for Rehabilitation ofTorture victims (ARCT-RUHUKA), a localassociation of trauma counsellors1, selectedadolescents as one of its priority targetgroups. If adolescents do not manage to copewith their personal traumas and to understand the traumas of others, this not onlyhampers their individual development, butalso the process of reconciliation as a whole.Therefore, in 1999 ARCT-RUHUKA initiated and implemented a pilot trauma projectat a secondary school in Kigali with theobjective of reducing the psychological consequences of trauma, and to prevent ethniccrisis in schools. Counsellors gave training tothe staff and provided psycho education andcounselling services to the students. Afterimpact was shown, ARCT-RUHUKA decided to develop a specific project: ‘Trauma51
51 56 Olij07-03-200511:29Pagina 52Trauma awareness, healing, and group counselling in secondary schoolsIntervention 2005, Volume 3, Number 1, Page 51 - 56Awareness, Healing and Group Counselling’for four severely affected schools2, whichwere proposed by the Provincial Directors forEducation due to severe problems manifesting in those schools.Before the projectIn the period before the implementation ofthe project, all schools faced daily basic challenges and disturbance of lessons by: screaming, crying, aggressive or apparently undisciplined behaviour by students. Often it wasnot possible to provide lessons as planned.Staff members were annoyed by the conductof the students, felt frustrated and powerless,and were often impatient towards students3,because they assumed it was simply undisciplined behaviour. Students, on the otherhand, did not find it easy to find guidanceand support when they felt desperate, ordepressed.Many students felt lonely and isolated, couldnot concentrate on their studies, were suffering from Post Traumatic Stress Disorder(PTSD), depression, fear and/or grief, whichoften manifested in symptoms such as nightmares and flashbacks. Some of the studentswere unable to speak. Sadly, these manifestations were not recognised as symptoms oftrauma. Staff and fellow students consideredthese students as ‘mad’ and ignored them asmuch as possible4.Each week, students were referred to hospitals, where they were admitted and usuallysedated through drugs. At one of the schools,the average number of students referred tohospitals because of ‘strange’ behaviour wasestimated at 20 per week. Another schoolreported a minimum of 10 referrals eachmonth5.After hospitalisation students returned toschool, were sent away, either for good or fora period of time, but in all options problemsstarted as soon as the students returned to52their respective schools. Students with‘deviant’ behaviour were punished by staff,often ignored, or teased by others. Outbreaksof rage and other crisis manifestationsinvolved large numbers of students whichcreated an environment where it was impossible to continue lessons.This not only negatively affected the generalatmosphere of the schools, but also hampered the performance of the students, andthe work-satisfaction of staff6.The projectThe project started in February 2001 at twoschools and lasted until October 2004. It wasimplemented by four fully qualified traumacounsellors, two at each school. In the secondyear of the project, two other schools wereselected and two more counsellors wereemployed, and two counsellors were movedfrom the first two schools to the new schools.One trainer/supervisor was appointed as aProject leader. This official was responsible forthe organisation and implementation of theproject. She supervised the counsellors, kept intouch with the directors and staff of theschools, and was responsible for monitoringand reporting. Three of the schools were located in, or near towns, one was deep in a ruralarea. Total students for all schools was 2809.Many of them were orphans, some, but notall, were survivors of the genocide. Some students were separated from their parents, dueto disappearance or imprisonment if they weresuspected of participating in the genocide.Training the staff. In all cases, ARCTRUHUKA’s trainer/counsellors started withproviding training of ‘Helpful ActiveListening’ to all staff of schools, includingmanagement and supporting staff (210 participants). This is a six day training with aone day follow-up, with the objectives: to develop trauma awareness, to learn torecognise symptoms of trauma,
51 56 Olij07-03-200511:29Pagina 53Judith Olij to develop basic counselling skills, to prevent crisis by referring clients to professional trauma counsellors before crisisoccurs.Later, the counsellors also trained all newlyreported staff at the schools in ‘Helpful ActiveListening’.Sensitisation. Training of the staff was followedby psycho education (sensitisation) sessionsfor students. All classes were sensitised on theexistence, causes, and symptoms of trauma.In a later phase, the project also dealt withother themes, such as rape, HIV/AIDS andgeneral problems in respect to adolescents.Several schools in the neighbourhood, as welllocal authorities, were also sensitised on trauma through specific workshops. These workshops aimed to sensitise responsible authorities on trauma and its consequences, and todiscuss the need for future interventions.The counsellors continued to sensitise staffand students on trauma and related issues,during the duration of the project. In total530 sensitisation sessions were offered, whichreached an estimated 4000 people.Counselling. The counsellors, who were located at the respective schools, offered almostdaily consultation hours for students, staff,parents/guardians, and others, who were inneed of advise for problems related to trauma. The consultation hours were frequentlyused, and functioned often as the beginningof a working relationship between counsellorand client, especially those that requiredmore intensive therapy.Individual as well as group counselling wasoffered to students, who requested it themselves, or were referred to counsellors by others. Several members of staff also benefitedfrom individual counselling services,Counselling services included: advice to clients, visiting once or more (1770clients), individual counselling (900 clients), group counselling (700 clients).A limited number of counselling groups werealso formed for neighbouring schools.Often children started with individual counselling sessions, but when the counsellorthought they were ready, they were encouraged to participate in group counselling. Atall schools, the counselling groups weremixed, with children suffering from differenttraumatic events. Sometimes children whohad lost their family during the genocidewere in the same group as children whoseparents were in prison accused of participating in the genocide. Children discussed that itwas not their fault, what their parents did,but that they were responsible to ensure suchthings do not happen again.Youth clubs. After a mid-term evaluation,ARCT-RUHUKA added extra activities notplanned in the original project. With the aimof sustaining the impact of the project, thecounsellors proposed to set up so-called antitrauma-clubs (Club’s RUHUKA) at the fourschools. In the clubs, which have at presentbetween 50 and 100 student members, a limited number of staff members participateand/or advise the students. Counsellorstrained the members in Helpful ActiveListening. The clubs sensitise other studentson symptoms of trauma through: psychodrama, poems, dancing, counselling and supportof fellow students. The cultural events,including the drama, as well as sport-activities, are all meant as therapy. Club membersalso received training in Helpful ActiveListening. Large parts of the membership inthe clubs were traumatised and therefore usetheir own experiences in the activities.The present situationIn our evaluations,7 we observed that all(interviewed) directors, staff, and students areaware of trauma, its symptoms, and its con53
51 56 Olij07-03-200511:29Pagina 54Trauma awareness, healing, and group counselling in secondary schoolsIntervention 2005, Volume 3, Number 1, Page 51 - 56sequences. They recognise symptoms of trauma and are aware of the need to listen, to support and counsel the victims of trauma. Theywere also convinced of the need to cope withthe pain of the past in order to create anappropriate educational and social environment, where students can develop themselvesand support others. They recognised and feltthe importance of dealing with trauma, as acondition for individual and national rehabilitation, and reconciliation.Since the beginning of the project, a numberof crisis outbreaks occurred, but all on a limited scale, and all handled within the school.No students have been referred to hospitalsor had to be sent away. Most of the crisisappeared under stimulus such as the eruptionof the volcano, followed by earthquakes,increased insecurity, and periods of mourning.Students who showed symptoms of traumawere counselled by staff or fellow studentsand/or were referred to the trauma counsellor. In this way, a crisis could be preventedand the negative impact on groups or classeswas limited. Even during the period ofmourning between April and July 2004 nocrisis outbreaks were observed. This is amajor achievement, especially because atmany other schools in the country, this hasBox 1 Students’ comments on the project‘Before counselling I suffered. I was lonely and angry. Sometimes I was aggressive and I did not have anyfriends. Now I understand what caused this sadness in my heart. If I feel sadness now, I talk to my friendor I try to do the exercises, the counsellor has taught us’.‘Before the project started I was afraid to talk to other people, I did not want to see their faces. I did notwant to sleep, because then I could have nightmares, which made me very frightened. I felt isolated andhad no one. No one liked me. Now I have my friends here. Sometimes I still feel frightened, but now Iunderstand why, and so do my friends and they comfort me’.‘Before ARCT came I could not talk, not even whisper. I still remember it, but now I can talk! Also, Iwas always angry and I beat other students, and even teachers. Now that is over and people are startingto like me.’‘I could not cry and yet I always felt like crying. My heart felt so heavy and I always suffered from painin my stomach. Now I can cry and people do not laugh’.‘I did not like to study, because I always felt sick and I wanted (whispering) to kill myself. Now I caneven help others, because I understand. I want to study to become a good counsellor’.‘Before the project I pretended that I was an orphan and that my father was dead. That is what I toldothers. Now I tell them my father is in prison and yet I feel relieved’.‘We are both very sad what happened (a survivor of the genocide, pointing at the one whose father is inprison). So, we comfort and counsel each other and want to sensitise others on trauma and in the club, sothat these things cannot happen again’.54
51 56 Olij07-03-200511:29Pagina 55Judith Olijbeen a dramatic period with huge outbreaksof crisis, often followed by referrals to hospitals, students sent away, or schools closedcompletely.The general atmosphere at the schools hasdramatically improved, as has the performance of students.8Although there is a difference between individuals, and between the respective schools,most staff members are motivated and capable of recognising the difference betweenundisciplined behaviour and symptoms oftrauma in students. They feel less impatientand invite students to tell them about theirproblems. They provide basic counselling,and when problems are too complicated,they advise the students to see a counsellor.However, working schedules do not allowthem to spend the required time to give fullemotional support to the students9.At all schools visited the children were veryclear on the impact of the project for theschool and for them as individuals. They saidthat teachers were much nicer and that theylisten to their problems. However, they sometimes hesitate to approach staff, because theyseem too busy. They talk often with fellowstudents about their problems and feelings,and do not feel as isolated and neglected asbefore. They now feel accepted by others,and understand their own feelings andbehaviour better. The words; ‘being accepted’, ‘not isolated’ and ‘understanding’ allcame up in each group interviews with students.The students do not blame each other, but doaccept and respect the different causes ofpain. This is a very important contribution toreconciliation.ConclusionsThe project contributed not only to thereduction of trauma symptoms amongst students and to the prevention of crisis out-breaks at the schools. It also resulted in a general improvement of the educational environment and the performance of students. Theproject stimulated a climate of mutual acceptance, where experiences and pain could beshared, and where emotional supportamongst different groups and individuals isoffered. In this way, the project provides acrucial condition for reconciliation.No crisis outbreaks occurred since the start ofthe project and no children had to be referredto hospitals, due to trauma related behaviour.Students feel more comfortable with eachother, and with the staff. Staff members feelless powerless in dealing with the problems ofstudents, because they understand the causesof their behaviour. They are also able torecognise the symptoms of trauma and arecapable of offering emotional support.However, it is a general complaint that staffhas not enough time to offer these serviceswithin their tight work schedule.Professional trauma counsellors, therefore,remain needed, to provide individual orgroup counselling to the most affected students. The Club’s RUHUKA will contributeto further increase trauma awareness and willguarantee that trauma issues remain on theagenda of the schools. They also offer emotional support to fellow students, but needencouragement and support to avoidburnout amongst the members.1ARCT-RUHUKA is a national non-governmental organisation and has a trainingand counselling program. Since its establishment in 1996, more than 120 nurses andsocial workers have been trained byARCT/RUHUKA to become professionaltrauma counsellors. This training takes oneyear: 12 weeks of theory and 250 hours practice with supervision, and is recognized bythe Ministry of Education. Graduated counsellors become a member of the association55
51 56 Olij07-03-200511:29Pagina 56Trauma awareness, healing, and group counselling in secondary schoolsIntervention 2005, Volume 3, Number 1, Page 51 - 56after graduation and some of them are alsoemployed by ARCT-RUHUKA. Seniorcounsellors have been trained astrainer/supervisors for the Counsellors (professional counselling), as trainer/supervisorsfor Helpful Active Listening Training (basiccounselling) or as trainer/supervisors forHIV/AIDS counsellors.2In addition, a project called Helpful ActiveListening was implemented. This project targeted all other secondary schools in Rwanda,but was more limited and focussed mainly ontraining for Directors and staffs in recognizing symptoms of trauma, basic counsellingskills and referring students to a traumacounsellor, before crisis occurs.3Information gleaned through staff interviews, confirmed by students.4Information gleaned through interviewswith client-students and staff.5Information acquired through Directors.6Information acquired through students,Directors and staff of the schools.7The following methods were used to assesthe project: reading relevant project documents and reports; interviews with management and counsellors of ARCT-RUHUKA;interviews with Directors and staff membersof the schools involved; interviews with representatives of provinces, in charge of youthand education; interviews with students, whowere individually counselled and/or participated in counselling groups (clients); meetings with members of the anti-trauma clubs(Club RUHUKA); observing inaugurationsand drama presentations by Club’s RUHUKA. Three of the four schools involved werevisited by the author.8Information offered by Directors and staff.9Information offered by staff, confirmed bystudents who feel that staff members wereoften too busy to be bothered by their problems.56Judith Olij has been working since 1998 as aTechnical Adviser, in the war-torn Great LakeRegion in Central Africa: Rwanda, theDemocratic Republic of Congo and Uganda forlocal and international NGO’s; with victims ofgenocide, war or natural disasters. She is currently working with the African Centre for Treatmentand Rehabilitation of Torture Victims inKampala, Uganda. Email: masolij@africaonline.co.ug
group counselling (700 clients). A limited number of counselling groups were also formed for neighbouring schools. Often children started with individual coun-selling sessions, but when the counsellor thought they were ready, they were encour-aged to participate in group counselling. At
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The assessed content included prima - ry survey, secondary survey, airway and ventilation, circulation, shock, thoracic trauma, head/spinal trauma, abdomen/pelvis trauma, musculoskeletal trauma, paediatric trauma, geriatric trauma, obstetric trauma, trans - fer of care, and other course specific inclusions.
as healing companions may face heightened emotional and interpersonal risks as a result of their role, the trauma‑healing training includes self‑care skills to avoid and diminish the risks of secondary trauma. The trauma‑healing approach is meant to reduce the likelihood of conflict as it offers an outlet other than future violence for those
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