Training to Help

Traumatized Po p u l a t i o n s

B r i e f l y . . .

• Mi l l io ns of people aro u nd the world have ex p e r ie nced psycho l o g ical distress caused

by ex p o s u re to armed conflict. Po s t - t ra u ma t ic stress disorder (PTSD), as it is of t e n

c a l l e d, involves a ra nge of no r mal re s p o nses to events outside the realm of no r ma l

hu man ex p e r ie nc e.

• Tra u ma caused by ethnic and other conflict—as disting u i s hed from tra u ma stemm i ng from na t u ral disasters—can pro duce profo u nd changes in social and politic a l

p rocesses that affect not only the ge ne ra t ion that directly ex p e r ie nced the tra u ma

but also subsequent ge ne ra t io ns. Socie t ies riven by ethnic conflict often ex p e c t

y o u nger ge ne ra t io ns to ma i ntain certain me ntal re p re s e nt a t io ns of tra u ma t ic hist o r ical events and to clearly establish ethnic bounda r ies that distinguish one tra umatized ethnic group from ano t he r.

• T he needs of tra u matized people take ma ny fo r ms and can be successfully addressed in

d i f f e re nt ways by a variety of prof e s s io na l s — ra ng i ng from psychia t r i s t s, psycho l o g i s t s,

a nd social workers to educ a t o r s, re l ig ious clerg y, and de v e l o p me nt pra c t i t io ne r s.

• Tra u ma tra i n i ng pro g ra ms are mo re likely to be successful if they are based on a

deep unde r s t a nd i ng of the complex political, econo m ic, and social fo rces and

e v e nts that contributed to the cont ext in which the tra u ma occurre d. Such tra i ni ng pro g ra ms should be learner cent e re d, highly partic i p a t o r y, and case based, and

s hould inc o r p o rate peda go g ical techniques that build a team approach to pro b l e m

s o l v i ng. Ide a l l y, tra u ma tra i n i ng pro g ra ms should also permit advanced ex p e r ie nt ia l

l e a r n i ng through closely supervised int e r ns h i p s.

• Trau ma recovery is a long-term process re q u i r i ng perio d ic assessme nt of the needs of

i nd i v idua l s, their care g i v e r s, and the community of which they are a part. Pe r io d ic

a d j u s t me nt of appro a c hes and techniques to re s p o nd to evolving needs is ne c e s s a r y.

P ra c t i t io ners pro v id i ng services to tra u matized people also need to be pre p a red to ma ke

l o ng-term commitme nts to them and to the commu n i t ies they are seeking to assist.

Defining Tra u m a

While the appro a c hes used by tra u ma specialists vary, workshop partic i p a nts employed

similar lang ua ge to describe the pro b l e ms they addre s s. Ac c o rd i ng to Dr. Syed Arshad

w w w. u s i p . o rg

S P E C I A L R E P O R T

1200 17th Street NW • Washington, DC 20036 • 202.457.1700 • fax 202.429.6063

December 17, 2001

AB O U T T H E RE P O R T

A diverse group of United States Institute of Pe a c e

g ra ntees specia l i z i ng in tra u ma tra i n i ng in zones of

c o n f l ict met at Airlie House in Wa r re nton, Va., in

August 2001. Jo i n i ng them for the two-day works hop were add i t io nal tra u ma tra i n i ng ex p e r t s, othe r

p rof e s s io nals (inc l ud i ng a number of military 

c h a p l a i ns) who have worked with tra u ma 

v ic t i ms, and Institute staff. 

T he primary purpose of the workshop was to share

t ra i n i ng appro a c hes and perspectives on tra u ma

rel ief, as well as to establish better commu n ic a t io n

a mo ng experts working in the fie l d. Several Ins t itute gra ntees ma de pre s e nt a t io ns de s c r i b i ng the i r

work in the Balka ns, the Cauc u s e s, and Africa, 

while ano t her gra ntee outlined a tra i n i ng 

c u r r iculum in tra u ma re l ie f .

This report was written by Judy Barsalou, dire c t o r

of the Institute’s Gra nt Pro g ra m .

The views ex p ressed in this report do not necessarily reflect those of the United States Institute of

Pea c e, which does not advocate specific policies.

UNITED STATES INSTITUTE OF PEAC E

CO N T E N T S

D e f i n i ng Tra u ma 1

Tra u ma Caused by Ethnic Conflic t 2

Goals for Tra u ma Tra i n i ng 3

Tra i n i ng for Tra u ma Relie f 4

D e s ig n i ng Tra u ma Curric u l a 5

Tra i n i ng Pro g ra ms in Ac t io n 6

L e s s o ns Learne d 7
Husain of the University of Missouri, post-tra u ma t ic stress disorder (PTSD), as this

form of psycho l o g ical distress is commonly known, involves the de v e l o p me nt of chara c t e r i s t ic symptoms fo l l o w i ng a psycho l o g ically distre s s i ng event that is outside the

ra nge of no r mal hu man ex p e r ie nc e. Such events may involve a threat to one’s life,

harm to one’s self or family me m b e r s, the sudden death of family members or de s t r uct ion of one’s ho me, or the witne s s i ng of vio l e nt injury or death. Tra u ma t ic event s

b e c o me int e r nalized in the minds of vic t i ms and are relived by them long after the

e v e nts are over.

P TSD symptoms, accord i ng to Dr. Husain, are ge ne rally divided into three gro u p s.

“ R e - ex p e r ie nc i ng symptoms” inc l ude disturbing re c o l l e c t io ns, distre s s i ng dre a ms,

f l a s h b a c k s, and int e nse distre s s. “Av o ida nt symptoms” involve an effort to avoid

t ho u g hts or feelings about the tra u ma t ic event, avoida nce of activities related to the

e v e nt, inability to recall the event, diminished int e rest in sig n i f ic a nt activitie s,

det a c h me nt or estra nge me nt from othe r s, and a fo re s ho r t e ned sense of the future.

“ Hy p e r - a rousal symptoms” inc l ude difficulty in fa l l i ng or staying asleep, irritability,

d i f f iculty conc e nt ra t i ng, hy p e r - v ig i l a nc e, exa g ge rated startle re s p o ns e, and psychol o g ical re a c t io ns to events that symbolize or resemble the tra u ma t ic event. Tra u ma t ic

ex p e r ie nce may also be tra nslated into phy s ical disorde r s, such as nausea, he a da c he s,

a nd backa c he s, as well as cause severe learning diffic u l t ie s.

D r. Vamik Vo l kan, director of the Center for the Study of Mind and Hu man Int e ra ct ion at the University of Virg i n ia, ma kes a distinc t ion between ind i v idual tra u mas and

t hose shared by large numbers of vic t i ms. The latter inc l ude na t u ral tra u mas (such as

e a r t h q ua kes), hu ma n - i nduced tra u mas (such as the me l t down of a nuclear power

p l a nt), symbolic losses (such as the death of a re v e red leader), re v o l u t io ns that profou ndly change the established orde r, and de l i b e rate injuries inflicted by an ene my

g roup (often du r i ng armed conflict). These differe nt types of tra u mas may be diffic u l t

to disent a ng l e. The injurious effects of a na t u ral tra u ma, such as an earthqua ke, fo r

exa m p l e, may be compounded by further tra u mas linked to hu man erro r s, such as the

des t r uc t ion of buildings that do not comply with earthqua ke building code s, or ina de q uate re s p o nse to earthqua ke vic t i ms from go v e r n me nt of f ic ials and hu ma n i t a r ia n

re l ief worke r s.

Massive tra u mas may create changes on three differe nt levels, accord i ng to Dr.

Vol kan. They may result in various fo r ms of PTSD in ind i v idual vic t i ms, may cause ne w

s o c ial and political processes on a bro a der social level, and may result in altere d

b e h a v ior tra nsmitted from one ge ne ra t ion to ano t he r.

In events whe re the tra u ma is shared broadly within a socie t y, but the backbone of

that society is not bro ken, “psycho s o c ial re ge ne ra t ion” may result. As an example of

t h i s, Dr. Vol kan described a village in Wales that ex p e r ie nced an ex t ra o rd i narily hig h

b i r t h rate in the wake of the loss of a number of village children from a land s l ide. In

s uch cases, psycho s o c ial re ge ne ra t ion is ma r ked by the ability of vic t i ms to event ua lly perform two tasks. They regain basic trust in the order of thing s, and, du r i ng a period that often lasts one-to-two years, they unde rgo a psycho p hy s io l o g ical mo u r n i ng

p rocess that must be ex p e r ie nced befo re fo rg i v e ness is possible.

Trauma Caused by Ethnic Conflict

Tra u mas re s u l t i ng from na t u ral disasters may some t i mes be disting u i s hed from tho s e

caused by ethnic conflict (a form of hu ma n - ge ne rated tra u ma) by an important differe nce: The da ma g i ng effects of the latter can pro duce profo u nd changes in social and

p o l i t ical processes that affect not only the ge ne ra t ion that directly ex p e r ie nced the tra uma but also subsequent ge ne ra t io ns. Dr. Vo l kan described such changes as “psycho b iol o g ical de ge ne ra t io n . ”

A mo ng the symptoms of psycho b io l o g ical de ge ne ra t ion in deeply tra u matized soci2

AB O U T T H E IN S T I T U T E

T he United States Institute of Peace is an indep e nde nt, nonpartisan fede ral ins t i t u t ion cre a t e d

by Cong ress to pro mote the pre v e nt ion, ma na geme nt, and peaceful re s o l u t ion of int e r na t io na l

c o n f l ic t s. Established in 1984, the Institute me e t s

its cong re s s io nal ma ndate through an array of

p ro g ra ms, inc l ud i ng re s e a rch gra nt s, fellowships,

p rof e s s io nal tra i n i ng pro g ra ms, confere nces and

w o r k s ho p s, library servic e s, public a t io ns, and

o t her educ a t io nal activitie s. The Institute’s Board

of Directors is appointed by the Pre s ide nt of the

United States and confirmed by the Sena t e.

BOA R D O F DI R E C TO R S

Chester A. Cro c ker ( C h a i r man), Ja mes R. Schlesinge r

P rofessor of Stra t e g ic Stud ie s, School of Fore ign Servic e,

G e o rgetown University • S eymour Martin Lipset ( V ic e

C h a i r man), Hazel Professor of Public Po l ic y, George

Mason University • Betty F. Bumpers, F o u nder and 

fo r mer Pre s ide nt, Peace Links, Wa s h i ngton, D.C. 

• Holly J. Burkhalter, Advocacy Dire c t o r, Phy s ic ia ns fo r

Hu man Rig ht s, Wa s h i ngton, D.C. • M a rc E. Leland, E s q . ,

P re s ide nt, Ma rc E. Leland & As s o c ia t e s, Arlington, Va. 

• M o ra L. McLean, Esq., Pre s ide nt, Afric a - A me r ica Ins t it u t e, New York, N.Y. • María Otero , P re s ide nt, AC C IO N

I nt e r na t io nal, Some r v i l l e, Ma s s. • B a r b a ra W. Snelling,

State Senator and fo r mer Lie u t e na nt Governo r, She l b u r ne,

Vt. • S h i b l ey Te l h a m i , A nwar Sadat Chair for Peace and

D e v e l o p me nt, University of Ma r y l a nd • Harriet Zimmerman,

V ice Pre s ide nt, Ame r ican Is rael Public Affairs 

C o m m i t t e e, Was h i ngton, D.C.

ME M B E R S E XO F F I C I O

Lorne W. Cra n e r, As s i s t a nt Secretary of State for Demo cra c y, Hu man Rig ht s, and Labor • Douglas J. Fe i t h , Unde r

S e c retary of Defense for Po l icy • Paul G. Gaffney II, V ic e

Adm i ral, U.S. Navy; Pre s ide nt, Na t io nal Defense Un i v e r -

s i t y • R i c h a rd H. Solomon, P re s ide nt, United States

I nstitute of Peace (no n v o t i ng)
3

e t ies are the loss of basic trust in the order of thing s, difficulty in mo u r n i ng, and difficulty in re v e r s i ng a sense of he l p l e s s ness and hu m i l ia t ion. Te r r i f y i ng new social patterns,

s uch as aggre s s ion, do me s t ic vio l e nc e, pro s t i t u t ion, ra p e, kid na p p i ng, youth gang s, and

o rganized criminality tend to inc re a s e. Mo rality becomes mo re “flexible” in such sett i ng s, and some ind i v iduals inc re a s i ngly rely on “ma g ical thinking,” such as belief in

spells against illne s s. The bre a kdown of socie t ies involved in serious ethnic conflict is

also often accompanied by hu man de s t r uc t ion of the na t u ral enviro n me nt .

S h a red tra u mas caused by a common ene my, accord i ng to Dr. Vo l kan, inc rease the

s e nse of large - g roup ide ntity or “we-ne s s,” and the perc e p t ion of larger distanc e

between “us and them.” The greater the stress ex p e r ie nced by the group, the harde r

g roup members cling to their group ide nt i t y, to the point whe re the tho u g ht of losing

that ide ntity may become mo re horrible than fa c i ng death. Un l i ke tra u ma caused by na tu ral disasters, tra u ma caused by the activities of an ene my also creates a sense of shame,

hu m i l ia t ion, and he l p l e s s ness amo ng the vic t i ms for whom the tra u ma t ic event in quest ion may be so de v a s t a t i ng that pre v ious personal stre ng t hs cannot withs t a nd the stre s s.

V ic t i ms may also become pre o c c u p ied with borders and bounda r ies of all sorts that

s e p a rate them from their real and ima g i ned ene m ie s, and they may adopt minor differe nces in their behavior or dress to subtly but clearly mark their separa t e ness from the

e ne my. As an example of the latter, Dr. Vo l kan cited Turkish and Greek fa r mers in Cyprus

w ho can be disting u i s hed by the differe ntly colored belt sashes that they wear (red fo r

Turks and blue for Greeks) and by their differe nt cho ice of cig a rette bra nds (re s p e c t i v ely characterized by their distinctive red and blue boxes). In add i t ion, purific a t ion rituals of various types may become obligatory in tra u matized socie t ie s. After ex p e r ie nc i ng

t ra u ma, vic t i ms may ask the ms e l v e s, “Who am I now?” and shed the ide nt i t ies that the y

s h a red with the perpetrators of the tra u ma. Examples of purific a t ion processes inc l ude

re moval of bodies in ceme t e r ies belong i ng to the “othe r,” and changes in lang ua ge to

p ro duce greater differe nc e s, for exa m p l e, between Cro a t ian and Serbian. Ethnic cleansi ng of territory is the most ma l ig na nt form of purific a t io n .

Tra u matized socie t ies some t i mes eng a ge in historical ima ges and fa nt a s ies that ma y

bear little re l a t ion to re a l i t y. These shared ima ges become what Dr. Vo l kan described as

“chosen tra u ma s.” By he l p i ng to mark group ide nt i t ie s, and through leade r - fo l l o w e r

i nt e ra c t ion, chosen tra u mas can be reactivated over time to pro v ide the fuel for war.

P re s ide nt Slobodan Milosevic of Yu go s l a v ia, for exa m p l e, reactivated a chosen tra u ma

w hen he disint e r red the body of Prince Lazar, killed in the Battle of Kosovo in 1389, and

c e re mo n iously buried the body in one Serbian village after ano t he r, re v i t a l i z i ng the

mou r n i ng process as though Prince Lazar’s death had occurred yesterda y. The re ne w e d

s e nse of threat and ent i t l e me nt to seek re v e nge helps to magnify large group conflic t s

a nd mobilize large - g roup activitie s, some t i mes leading to the inflic t ion of new tra u ma s. 

In socie t ies tra u matized by ethnic conflict, younger ge ne ra t io ns are often aske d, cons c iously or unc o ns c io u s l y, to perpetuate a certain me ntal re p re s e nt a t ion of the historical event and to ma i ntain large - g roup ethnic ma r ke r s. In these ways, through the i r

c hosen tra u ma s, ene m ies become bound toge t her through hate. In order to be effective,

t hose who seek to help the tra u matized must be fa m i l iar with the complete historic a l ,

s o c ial, and psycho l o g ical cont exts in which the tra u mas occurre d.

Goals for Trauma Tra i n i n g

D r. Paula Gutlove of the Institute for Resource and Security Stud ies in Cambridge, Ma s s., outl i ned principles and goals for tra u ma recovery tra i n i ng based on the lessons learned in the

work that she has been do i ng with psychiatrists and psychologists in the fo r mer Yu go s l a v ia .

S he hig h l ig hted four ge ne ral principles for tra u ma assistance int e r v e nt io ns, as fo l l o w s :

• Those working with tra u matized populatio ns must unde r s t a nd that most post-tra uma t ic re a c t io ns are n o r m a l re a c t io ns to abno r mal event s.

In societies traumatized by 

ethnic conflict, yo u n g e r

g e n e rations are often asked,

consciously or unconsciously, 

to perpetuate a certain mental 

re p re s e n tation of the histo r i c a l

event and to maintain larg e -

g roup ethnic markers. 

S h a red traumas caused by a

common enemy . . . increase the

sense of larg e - g roup identity or

“ we - n e s s,” and the perc e p t i o n

of larger distance between 

“us and them.”
4

• The hea l i ng of tra u matized ind i v iduals cannot take place within a social vacuum, and

it is often part of an ongo i ng social pro c e s s. By he l p i ng othe r s, tra u matized ind i v iduals can help the ms e l v e s. 

• Whe re int e r na t io nal prof e s s io nals are active in zones of conflict, they should seek to

establish coopera t i v e, mu t ual partnerships with local prof e s s io na l s, whe re they come

t o ge t her to both teach and learn from each othe r. They should be pre p a red to ma ke

a long-term commitme nt to those re l a t io nships and to their work in the conflict are a .

• Trau ma recovery is a long-term, evolving pro c e s s, re q u i r i ng perio d ic assessme nt of

t he needs of the community and the care g i v e r s, and the adjustme nt of appro a c he s

a nd techniques accord i ng l y.

D r. Gutlove cont i nued with an overview of the he a l i ng goals of psycho s o c ial assist a nce work. At the ind i v idual level, these goals reflect the need to help tra u ma t i z e d

i nd i v iduals move through the fo l l o w i ng stages (as articulated by Judith He r man in Tr a uma and Recovery, New York: Basic Books, 1997):

• S a f e t y— e v o l v i ng from a state of feeling vulne rable to unpre d ictable da nger to a

state of feeling re l iably secure. This process is aided by pro v id i ng a safe space fo r

people to start re b u i l d i ng their lives.

• Ac k n o w l e d g m e n t— mo v i ng from a sense of disassociated tra u ma to ackno w l e dge d

memory of the tra u ma t ic event(s). Recount i ng ex p e r ie nces enables vic t i ms to seek

a c k no w l e dg me nt of wro ngs committed and to mourn their losses, and also ena b l e s

p e r p e t rators to apologize for tra ns g re s s io ns.

• R e c o n n e c t i o n— o v e rc o m i ng feelings of isolation and stig matism by re c o ns t r uc t i ng

mea n i ngful social conne c t io ns.

Based on her work in the fo r mer Yu go s l a v ia, in which tra u ma recovery is embedde d

in a process of both ind i v idual and community he a l i ng, Dr. Gutlove pointed out thre e

a dd i t io nal goals that involve he a l i ng at the community level: 

• Social reconstruction— re b u i l d i ng the social infra s t r uc t u re, inc l ud i ng re i nt e g ra t io n ,

re s e t t l e me nt, re t ra i n i ng, and phy s ical and psycho l o g ical care.

• Volunteer action— e m p o w e r i ng ind i v iduals and groups to help each other thro u g h

u n p a id, volunteer public service and social re c o ns t r uc t ion activitie s.

• Helping the helpers— a s s i s t i ng the prof e s s io nals and laypersons who are he l p i ng people and commu n i t ies to address the secondary tra u ma or stress they ex p e r ie nce as a

result of their the ra p e u t ic int e r v e nt io ns with tra u ma vic t i ms and perpetra t o r s.

As the above goals imply, no single approach to tra u matized populatio ns will suffic e.

Tra u matized commu n i t ies are best served by int e rd i s c i p l i nary teams that can address the

need to rebuild ide nt i t ies and re l a t io nships on the personal level, re c o ns t r uct commun i t ies at the phy s ical and social levels, and ma na ge complex re l a t io ns amo ng differe nt

e t h n ic gro u p s. In other word s, teams of prof e s s io nals working in conflict zones need to

possess skills in tra u ma int e r v e nt ion, social re c o ns t r uc t ion, a n d c o n f l ict re s o l u t ion. A

major challenge fa c i ng the conflict re s o l u t ion field is the tra i n i ng of workers who can

a ddress these mu l t i v a r iate ne e d s.

Training for Trauma Relief

A n ne Anderson, Leila Dan, and Ta m ra Pearson D’Estree described “A Tra i n i ng Curric u l u m

in Tra u ma Relief ” p re p a red by an int e rd i s c i p l i nary team of which they were members and

o rganized jointly by the Ame r ican and Cana d ian Psycho l o g ical As s o c ia t io ns and by 

P s y c hologists for Social Respons i b i l i t y. The curriculum is de s ig ned for gra dua t e - l e v e l

The healing of tra u m a t i z e d

individuals cannot take place

within a social vacuum, and it

is often part of an ongoing

social pro c e s s. By helping

o t h e r s, traumatized individuals

can help themselve s. 

Traumatized communities are

best served by interd i s c i p l i n a r y

teams that can address the

need to rebuild identities and

relationships on the personal

l evel, reconstruct communities

at the physical and social leve l s,

and manage complex re l a t i o n s

among different ethnic gro u p s.
5

t ra i n i ng of psychologists and related prof e s s io nals involved in tra u ma int e r v e nt ion and

c o n f l ict re s o l u t ion activities in zones of conflict, and is available free of charge at two

websites: ht t p : / / w w w. p s y s r.com and ht t p : / / c p a . c a / e p w / e p w.

T he three speakers noted that tra i n i ng pro g ra ms for tra u ma prof e s s io nals mu s t

a c k no w l e dge a number of challenge s :

• C u l t u r a l , i nc l ud i ng sensitivity to cultural and lang ua ge differe nc e s, and unde r s t a ndi ng of local power struc t u re s. 

• E t h i c a l / s t r a t e g i c, i nc l ud i ng an appre c ia t ion of the purposes served by, and the possible negative effects of, int e r v e nt ion. Wo r kers need to take care not to “me d ic a l i z e ”

p o l i t ical pro b l e ms (such as hu man rig hts vio l a t io ns), or to create a victim me nt a l i t y

a mo ng those whose needs are being addre s s e d. Pro g ra ms should also be planned and

i m p l e me nted with full local partic i p a t ion, and with the goals of building local capacity and ownership and long-term sustaina b i l i t y. 

• M e t h o d o l o g i c a l , i nc l ud i ng pro g ra ms de s ig ned to reflect local needs and customs and

to be capable of ada p t i ng to chang i ng circ u ms t a nc e s. Prof e s s io nals working with

t ra u matized populatio ns should perceive their roles as change age nt s, and not me rely as service pro v ide r s.

• S y s t e m i c, i nc l ud i ng the importance of unde r s t a nd i ng the bro a der social and politic a l

c o nt ext in which their work is carried out. Pro b l e ms often need to be addressed at

multiple levels if lasting change is to be achie v e d.

• Personal/operational, i nc l ud i ng an unde r s t a nd i ng of their own values, abilitie s, and

goa l s. Tra u ma prof e s s io nals must be aware of the personal stresses and seconda r y

t ra u ma that may result from working in conflict zone s, and the importance of ma i nt a i n i ng their own impartiality when int e r v e n i ng in conflic t s.

Designing Training Curricula

E duc a t io nal pro g ra ms that train prof e s s io nals working with tra u matized populatio ns mu s t

be carefully struc t u red if they are to build skills to master the challenges and meet the

goals described above. First of all they need to be l e a r n e r - c e n t e r e d , w he re the learner has

a stro ng sense of his or her own capacities and competenc ies and develops a sensitivity to

t he cultures of othe r s. Such pro g ra ms should also be highly p a r t i c i p a t o r y, i n v o l v i ng activel e a r n i ng techniques and pro b l e m - s o l v i ng exe rc i s e s. Educ a t ion pro g ra ms also need to inc o rp o rate case-based approaches to learning in which the views of opposing prof e s s io nals are

s o u g ht on specific topics to enable the learner to cont e nd with diverse perspectives.

Because no ind i v idual alone will be capable of addre s s i ng the mu l t i v a r iate needs of tra umatized commu n i t ie s, peda go g ical appro a c hes should also emphasize t e a m - b a s e d s t ra t eg ies in which the ind i v idual learns to work closely with others possessing diverse skills.

E duc a t io nal pro g ra ms that are ex p e r i e n t i a l by advanc i ng tra i n i ng through int e r ns h i p

p l a c e me nts are highly de s i ra b l e. Ac c o rd i ng to Ta m ra Pearson D’Estree of George Ma s o n

Un i v e r s i t y, tra i nees may benefit most if organized in groups of two and given re s p o ns ib i l i t ies de s ig ned not to stretch them beyond their capacitie s. They must also be carefully supervised by advanced prof e s s io na l s. 

Training Pro g rams in Ac t i o n

Wor k s hop partic i p a nts shared info r ma t ion about pro g ra ms they have impleme nt e d

a ro u nd the world:

John Hubbard of the Center for Victims of To r t u re (CVT) in Minneapolis de s c r i b e d

Because no individual alone 

will be capable of addressing 

the multivariate needs of

t raumatized communities, pedagogical approaches should also

emphasize t e a m - b a s e d s t ra t e g i e s

in which the individual learns 

to work closely with others 

possessing diverse skills.
6

a CVT peer couns e l i ng tra i n i ng pro g ram based on ex p e r ie nt ial learning involving

ref u gees in camps in Guinea. Tra i nees selected from the ranks of re f u ge e s — t h ro u g h

tests assessing their conflict solving and other abilities—completed an int e nsive twoweek overview course. The re a f t e r, the tra i nees participated in a series of ten-week gro u p

c o u ns e l i ng sessio ns for tra u matized re f u gees in the camps. Initia l l y, the tra i nees me rely served as int e r p reters and observed the advanced prof e s s io nals running the sessio ns.

At the end of each day’s session, the tra i nees and tra i ners analyzed the session and

p l a n ned future sessio ns. With time, tra i nees co-facilitated group sessio ns and event ua lly assumed full re s p o nsibility for leading them. Their tra i n i ng was enric hed by int e ns i v e

t w o - day workshops on specific skills, such as active listening .

While it ma kes sense to target tra u ma tra i n i ng at health care, de v e l o p me nt, and conf l ict res o l u t ion prof e s s io nals from the zone of conflict in question, the reality is that

t he re may be few such tra i ned prof e s s io na l s. As an alterna t i v e, tra i n i ng pro g ra ms org anized by D r. Syed Arshad Husain and his colleagues at the University of Missouri h a v e

t ra i ned local school teachers as the ra p i s t s. In pro g ra ms ra ng i ng from Kosovo to

I ng u s he t ia and beyond, Dr. Husain and his int e rd i s c i p l i nary team have fo u nd teache r s

to be highly receptive learners of the the ra p e u t ic techniques they of f e r.

Bobbie Houser and Phillippe Dupont of Training Workshops International (TWI)

for the Children in Springfield, Va . , have also pro v ided tra u ma tra i n i ng for ind i v idua l s

with little or no prior prof e s s io nal ex p e r ie nce in related fie l d s. They started by mo u nti ng educ a t io nal pro g ra ms for tra u matized children in Bosnian orphana ge s. With time,

t hey re focused their efforts to pro v ide tra i n i ng for the children’s care pro v ide r s, and,

e v e nt ua l l y, the childre ns’ teache r s. When it became clear that the caregivers and teachers the mselves ne e ded help to deal directly with their own tra u mas befo re they could be

fully effective in he l p i ng the children, TWI for the Children re d i rected some of their fo c u s

f rom the needs of the children to the needs of the adults working with them. 

Lakshmi Ramarajan of Opportunities Industrialization Centers (OIC) International in Philadelphia described a workshop organized by OIC in Sie r ra Leone for local

t e a c he r s, hea l t h c a re pro v ide r s, workers for no n - go v e r n me ntal org a n i z a t io ns (NGOs), go ve r n me nt of f ic ia l s, and community leade r s. The workshop focused largely on he l p i ng part ic i p a nts recognize the sig ns of tra u ma and unde r s t a nd its impact on behavio r. It also

p ro v ided them with pre l i m i nary tools to address the needs of their clie nt s, but the OIC

o rganizers recognized that mo re ex t e nded tra i n i ng and follow-up are ne e ded to ena b l e

t he workshop partic i p a nts to gain all the necessary skills.

A l o ng with his colleagues at the Center for the Study of Mind and Human Intera ction at the University of Virginian, Dr. Vamik Vo l k a n has re t u r ned a number of time s

over the years to work with he a l t h c a re prof e s s io nals in Georg ia and the bre a kaway territory of South Ossetia. The center’s fo u r - p ro nged approach has inc l uded: (1) working

i nt e nsively with a small group of ind ige nous helpers from both sides to deal with the i r

own tra u ma and pro v ide services to others; (2) org a n i z i ng workshops and lectures fo r

Ministry of Health Offic ia l s, NGO leade r s, postgra duate stude nt s, and others about the

causes and effects of tra u ma; (3) pro v id i ng prof e s s io nal guida nce by observing and

s u p e r v i s i ng the work of the he a l t h c a re prof e s s io nals gra p p l i ng with tra u matized clie nt s ;

a nd (4) pre p a r i ng ma t e r ials about tra u ma for the Georg ian mass me d ia. In working with

hea l t h c a re pro v ide r s, Dr. Vo l kan and his colleagues have addressed the psycho l o g ic a l

obstacles they have enc o u nt e red both personally and prof e s s io nally amo ng their clie nt s,

a nd have ex p l o red these pro v iders’ mo t i v a t io ns fo r, and fears about, working in this diff icult fie l d. In an effort to establish lasting prof e s s io nal re l a t io nships between two

g roups of health workers across ene my line s, the pro g ram has helped partic i p a nts unde rs t a nd a basic opera t i ng principle: Their int e ra c t io ns must respect the needs of the two

o p p o s i ng groups to ma i ntain their separate ide nt i t ie s, as well as an “una m b ig uous psyc ho l o g ical border” between the m .

Paula Gutlove of the Institute for Resource and Security Studies in Cambridge,

M a s s., described building a network of mo re than 200 phy s ic ia ns, psycho l o g i s t s, 

While it makes sense to

ta rget trauma training at

health care, development, and

conflict resolution prof e s s i o n a l s

f rom the zone of conflict in

question, the reality is that

t h e re may be few such tra i n e d

p rof e s s i o n a l s.

The pro g ram has helped 

participants understand a basic

o p e rating principle: Their interactions must respect the needs

of the two opposing groups 

to maintain their separate 

i d e n t i t i e s, as well as an 

“unambiguous psyc h o l o g i c a l

b o rder” between them.
7

nur s e s, and teachers from thro u g hout the fo r mer Yu go s l a v ia to ide ntify and apply he a li ng principles and stra t e g ies for psycho - s o c ial assistance to tra u ma vic t i ms. She the n

focused on a set of pro g ra ms in Gra c a n ica, Bosnia, which is one of twelve “no des” in the

fo r mer Yu go s l a v ia connected to this network of prof e s s io na l s. Ac t i v i t ies in Gra c a n ic a

started mo destly with the tra i n i ng of an ethnically mixed group of twelve towns p e o p l e

w ho established two support groups that met in a baseme nt in the town, one for sex ually abused women and the other for the mo t hers of disabled children. As mo re townspeople became involved, new groups were org a n i z e d, inc l ud i ng a sex ual educ a t io n

d i s c u s s ion group (which became a teen support group), an elde r - c a re pro g ram, a da y -

c a re cent e r, and teena ger-led sports teams. The re h a b i l i t a t ion of the dilapidated basement by soldiers and youth from the town gra dually ex p a nded to the re f u r b i s h me nt of

s c hool and other community buildings in outlying are a s. In short, within the space of

two years, this war-tra u matized community helped rebuild itself and other commu n i t ie s

by mo b i l i z i ng tho u s a nds of local volunt e e r s. In so do i ng, the community moved toward s

s ig n i f ic a nt recovery from the war tra u ma it had suffere d.

Lessons Learned

S e v e ral essent ial the mes eme rged from the workshop discussio ns :

• Ind i v iduals and groups suffering from the tra u ma of armed conflict have psycho l o g ical needs that need to be addressed at the ind i v idual, commu n i t y, and na t io nal leve l s. Prof e s s io nals working in differe nt fie l d s — p s y c h ia t r y, psycho l o g y, commu n i t y

dev e l o p me nt, educ a t ion, and conflict re s o l u t ion—all have differe nt skills and

s t re ng t hs to offer to tra u ma vic t i ms. 

• Trai n i ng pro g ra ms that involve int e g rated appro a c hes to ne e d s, reflect a sophistic a t e d

u nde r s t a nd i ng of the social, econo m ic, and political fo rces that led to conflict in the

first place, and account for power dy na m ics in the community are likely to be the mo s t

s uc c e s s f u l .

• Ma ny zones of conflict have relatively small numbers of tra i ned psycho l o g ical prof e ss io na l s. Acc o rd i ng l y, tra i n i ng pro g ra ms must often focus instead on tra i n i ng educ at o r s, NGO prof e s s io na l s, community leade r s, and othe r s.

• Local prof e s s io nals working with tra u ma vic t i ms almost always have personally ex p er ie nced tra u ma, or may suffer from the secondary effects of working with the tra uma t i z e d. Pro g ra ms de s ig ned to train local tra i ners must take into account the ne e d

first to help the tra i ners deal with their own tra u ma .

• Su s t a i ned appro a c hes to tra u ma are far mo re likely to have lasting positive effects

than pro g ra ms organized on a one - t i me basis. Groups involved in tra ns f e r r i ng skills

to tra i ners working with the tra u matized must be committed to ma i nt a i n i ng cont a c t

with, and support fo r, the tra i ners over a long period of time.
Of Related Intere s t

Many other public a t io ns from the United States Institute of Peace address issues that

relate directly to tra i n i ng and to post-conflict situa t io ns. 

Recent Institute reports include:

Conflict Management Training: Advancing Best Practices, by Robert M. Scho e n h a u s

( Pe a c e w o r k s, January 2001)

Training to Promote Conflict Management, edited by David Smock (Pe a c e w o r k s, July

1 9 9 9 )

To obtain an Institute report (available free of charge), write United States Institute of

Pea c e, 1200 17th Street NW, Suite 200, Wa s h i ngton, DC 20036-3011; call (202) 429-

3832; fax (202) 429-6063; or e-mail: usip_re q u e s t s @ u s i p . o rg .

Recent books from USIP Press include:

Turbulent Peace: The Challenges of Managing International Conflict, edited by Chester A.

C ro c ke r, Fen Osler Hampson, and Pa mela Aall (2001)

Peacemaking in International Conflict: Methods and Te c h n i q u e s, edited by I. William Za r tman and J. Lewis Rasmussen (1997)

Transitional Justice: How Emerging Democracies Reckon with Former Regimes, edited by

Neil J. Kritz (3 vols., 1995)

For book sales and order info r ma t ion, call 800-868-8064 (U.S. toll-free only) or 703-

661-1590, or fax 703-661-1501.

For mo re info r ma t ion, see our website (www. u s i p . o rg), which has an

o n l i ne edition of this report cont a i n i ng

links to related websites, as well as

a dd i t io nal info r ma t ion on the topic.

SP E C I A L RE P O R T 7 9

United States 

Institute of Pe a c e

1200 17th Street NW

Was h i ngton, DC 20036