Risk, Resilience and Rights: Therapeutic Approaches to Working with Children, Families and Separated Young People who have Survived Torture

By Jocelyn Avigad and Tina Puryear, Freedom from Torture

Governments and regimes who torture people have very clear intentions. They carry out physical and psychological acts of violence against targeted individuals and families in order to break a person and fragment families and communities. And they do this to invoke such extreme fear and shame that victims and their families will remain silent.     

Such was the case for Ali and his family who are survivors of torture and organised violence. In 2003, Ali was three-years-old when he claimed asylum in the UK together with his maternal grandmother and her two daughters (Ali’s aunts), then 10 and 19.

Before the Taliban seized power in Afghanistan, Ali lived in a close and stable extended family unit in which traditionally the younger adults (including Ali’s parents) worked and the older generation of women took responsibility for child care. This stability was shattered when the Taliban murdered and raped close family members and caused others to flee for their lives at a moment’s notice. In flight, Ali was separated from his parents and baby brother. Until December 2009, he feared they were dead.

In the first sessions with Ali (then aged three) and his grandmother, the family therapist working with Ali was overwhelmed by his capacity, through use of toy people and animals, to share with the therapist through an interpreter, his last memories of his parents – particularly those of his father being attacked by ‘soldiers’. Ali’s story unfolded in those fortnightly sessions, confirmed and expanded on by his grandmother and witnessed by the therapist and the interpreter in their different roles.

At Freedom from Torture, we have learned that in order to provide safe and appropriate support to families and separated young people who are survivors of torture, practitioners need to adapt a holistic approach. This includes attending to the risks, the resilience and the rights of clients such as Ali and his family:

Risks
All practitioners are trained to assess for and to respond to risks, yet in the main, the focus is on personal risks, such as self-harm or suicide risks, or relational factors such as child protection risks. But when working with survivors of torture, practitioners need to also assess for and be mindful of asylum related risks such as detention and removal as well as practical/support related risks such as homelessness and destitution.

The family therapist was particularly concerned with the risk that Ali’s mental health could deteriorate significantly the longer the separation from and lack of information about his birth family continued. This would have impacted his physical health, his capacity to engage in school, and his ability to socialise and enjoy close, robust relationships.

Resilience
Again, practitioners working with complex trauma know the importance of building on the clients’ resilience in helping them to re-build their inner strength and improve their functioning in daily life. However, when working with survivors of torture, such as Ali, this can be especially challenging because resilience can be seriously undermined by the extremeness of the experiences of torture, loss, dislocation and relocation.

In other words, life in exile, dealing with the aftermath of torture, grief and loss, separation from the young person’s usual support networks, and the liminal stress of awaiting a decision on an asylum claim can dangerously erode a person’s capacity to access their former strengths and resilience. 

In the case of Ali, he was struggling at school. For instance, the pain of watching parents take and fetch their children from the school gate was acute, as was his inability to control his anger and the impact this was having on his friendships and learning.

The therapist drew on the fact that Ali was acknowledged by his peers as a good footballer and was passionate about the great Argentinian footballer, Messi, whose story was not dissimilar to his own. This did at times motivate Ali and provided a source of inspiration for him.

The family therapist’s input to school staff through sharing a ‘traffic light metaphor’ that Ali used to describe his feelings and understand the rapid changes in them was well received. It offered a strategy for both school staff and Ali to work together with considerable success.

Rights
Torture is political; it is a violation of one of the fundamental human rights. Torture is part of a wider experience of war, conflict, turmoil and/or persecution. Survivors of torture have often experienced years of discrimination and persecution before and after experiences of torture. As practitioners, our role is not just to respond to the therapeutic need of the client, but to also to support the fulfilment and respect of the rights of the survivor while here in the UK.

This can begin with the ‘witnessing’ of the story but ultimately includes supporting a client in realising their rights here in the UK (including the right to rehabilitation, to access services and support such as housing, to non-refoulement – see end note 2). 

Throughout the therapeutic process, the family therapist advocated on behalf of Ali’s grandmother in order to help the family claim their rights in the UK. This included the right to international protection by writing a medico-legal report in support of his grandmother’s asylum claim; the right to family life by exploring legal ways for Ali’s family to join him in the UK; the right to appropriate housing by challenging inappropriate housing department offers of accommodation.

Ali
After four years of silence, the UK family received the joyous news that Ali’s parents, brother and new little sister, Nina, were alive and safely back in Afghanistan after years in hiding. Nina was born in the depths of a harsh mountain range during the family’s long, arduous and solitary walk back to their country. Her birth was violent and attended only by Ali’s father. Sadly it has left Ali’s mother a wheelchair user and suffering from acute physical and psychological trauma.

The impact of the family’s ‘reunion’ through phone calls and letters had a profound effect on all involved, in both countries. At this time, Ali (now 12) used the metaphor of a roller coaster to describe his inner world at home and at school. Outwardly, this manifested in extreme mood swings, depression, lack of concentration and motivation, loss of appetite, poor sleep patterns – in fact many of the symptoms that together began to alert the family therapist to the potential onset of Post Traumatic Stress Disorder. 

In the sessions Ali helped the practitioner at Freedom from Torture understand that the trigger for these feelings was the acute fear that his mother might die before he ever saw her again. Fortunately, Ali’s grandmother shared this concern and took the risky but brave step of taking Ali ‘home’ on a visit.

In the sessions since Ali’s return from Afghanistan, a new young adult voice in him has emerged – that of an activist who wants to be heard. He has plans to write to his MP, to those who hold decision-making power in the UK Border Agency and, with the support of Freedom from Torture’s service users’ network, to speak out.

Ali has asked his family therapist to walk alongside him in this new part of his journey, something she is doing by helping him to find ways to enable his voice to be heard by those who have the power to make decisions about his life and future.

Perhaps with his and his UK family’s support, resilience and resourcefulness as survivors of torture, he might yet succeed.

About the authors:
Jocelyn Avigad is a registered social worker and family therapist working at Freedom from Torture. She is the Manager of the Children, Young People and Families Team, and the lead clinician on child protection for the organisation.

Tina Puryear is the Training and Capacity Building Manager at Freedom from Torture. She is a human rights practitioner and has developed training programmes for Refugee Council and Freedom from Torture for the past 12 years. She has worked with refugees since 1992.

Endnotes:
1) Article 1.1 of the 1984 UN Convention Against Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment defines torture as: “Any act by which severe pain or suffering, whether physical or mental, is intentionally inflicted on a person for such purposes as obtaining from him or a third person, information or a confession, punishing him for an act he or a third person has committed or is suspected of having committed, or intimidating or coercing him or a third person, or for any reason based on discrimination of any kind, when such pain or suffering is inflicted by or at the instigation of or with the consent or acquiescence of a public official or other person acting in an official capacity. It does not include pain or suffering arising only from, inherent in or incidental to lawful sanctions.”

2) Article 33 of the 1951 Convention relating to the Status of Refugees: "No Contracting State shall expel or return ('refouler') a refugee in any manner whatsoever to the frontiers of territories where his life or freedom would be threatened on account of his race, religion, nationality, membership of a particular social or political opinion" (Article 33(1))

The training:
The Freedom from Torture (formerly The Medical Foundation for the Care of Victims of Torture) training programme: Risk, resilience and rights: therapeutic approaches to working with children, families and separated young people who are survivors of torture

This course is aimed at multi-disciplinary health and care professionals, including social workers, who work therapeutically in a range of settings with separated young people, children and families who are refugees or are seeking asylum in the UK.

The course what you might need to ensure that your own practice is in line with the latest thinking in the field of complex trauma for those working with vulnerable migrant groups.

Asylum seekers and refugees, many of whom are survivors of torture or other degrading human rights violations, may present with complex needs. This course will help you unpick their complexity and support them confidently. The training programme will be piloted in Manchester, starting 16 October.

To learn more, please visit the Freedom from Torture website: www.freedomfromtorture.org. The official closing date for applications is mid-August, but we’re willing to extend this for BASW members. If you think you might be interested in applying, call Tina Puryear on 020 7697 3705 to discuss your application.