Medium 9781782201939

Handbook of Working with Children, Trauma, and Resilience

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This book is a psychoanalytic discussion of the effects of trauma and torture on children, with a specific focus on how professionals can use an approach focused on resiliency rather than vulnerability to help the child reach wellbeing.Aida Alayarian argues that in a world where the torture, maltreatment, and neglect of children shamefully persist, it is incumbent upon all of us to intervene appropriately to put a stop to it. Whether in conference rooms developing a more comprehensive policy to hold perpetrators accountable, or working in clinics where traumatised children and their families seek help, the question of how we act to improve the opportunity for recovery in children and young people subjected to such inhumane treatment should be our primary concern. Handbook of Working with Children, Trauma, and Resilience discusses this salient issue, drawing on psychoanalytic perspectives of the effects of trauma on children, and looking specifically at the case of refugee children and families. Understanding challenging behaviour in traumatised children and the effects of refugee experience on families can help all concerned to offer more appropriate and effective support. Through the presentation of case studies, this work traces the complexity of individual refugee experience while demonstrating the impact of good practice underpinned by an intercultural, resilience-focused approach. In an effort to eradicate torture and maltreatment of children globally, the author points to the necessity of developing appropriate methods of intervention as a responsibility to the children and families we serve and our societies as a whole.

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8 Chapters

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Chapter One: Overview

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Examining theoretical approaches to working with children of refugees and unaccompanied minors, I will map several useful psychoanalytic concepts for working interculturally with children therapeutically. The discussion aims to present several key concepts that underpin the development of effective psychotherapeutic treatment: an understanding of the self and others in the context of mourning; prior experience and capacity of resilience, dissociation (healthy and unhealthy), and repression (Freud, 1915d); the concept of the True and the False Self (Winnicott, 1965a), dissociation, and the development of resilience (Alayarian, 2011).

In this chapter and throughout the book, clinical vignettes and case studies are presented and discussed. These invigorate and stir the diversity of the experiences of unaccompanied minors and children of refugees while also demonstrating the impact of appropriate therapeutic intervention. They further explore a resilience-focused approach to working with children of refugees or unaccompanied minors.

 

Chapter Two: Traumatic Experiences of Children of Refugees

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It is not uncommon for children of refugees to experience the violent death of one or both parents. Some witness the massacre or casualties of friends and close relatives and members in their communities. They go through the experience of forced separation and displacement. Some suffer extreme poverty, starvation, physical injuries, and disabilities, as well as sexual, physical, and emotional abuse. Often children are exposed to direct combat; they may be kidnapped, arrested, imprisoned, tortured, sexually abused or forced to participate in violent acts. Some children are born or conceived in prison as a result of their mothers’ involvement in opposition parties or human rights activities. In our clinical work we have the evidence from children's narratives of young children being raped or massacred and of other children being made to witness these horrific events.

In some cases, specifically in African countries, children are forced to join the army and become child soldiers to participate actively in armed conflicts. They are often given extremely dangerous tasks, for instance: mine detection, spying, messengering, or taking valuables from corpses in conflicted and military areas.

 

Chapter Three: Anxiety, Depression, Post-Traumatic Stress, and Dissociation

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In this chapter I focus on anxiety, depression, and post-traumatic stress.

Anxiety

Anxiety is a warning signal that may present in the form of overwhelming emotions and feelings which give rise to a sense of unmanageable helplessness. In it, the threat may be perceived as arising from either external or internal sources and be the conscious response to a variety of powerful fantasies in the unconscious mind.

Anxiety's physical symptoms include butterflies in the stomach, a pounding heart, unpleasant sensations or a persistent sense of unease. Anxiety is certainly not just a product of irrational fears. If we look at the cases of anxiety in people that have encountered traumatic events, it is clear to see that their anxiety is often justified and in many cases it is existential. Some of the existential causes of anxiety in refugee and asylum seekers include: being in a new culture, struggling with a new language, not knowing what to do, not knowing the Home Office decision about immigration matters. Some of these are enough to make anyone anxious—in fact I would be more concerned if patients in such circumstances did not present anxiety. This type of anxiety is a normal reaction to a pressured and abnormal situation. Although individual fears may appear irrational, it is easy to see that the base of that fear is perfectly normal, rational, and to be expected.

 

Chapter Four: Rationale for Development of New Measures

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Intercultural psychoanalysis and its implications in provision of therapy for children

Theoretical approaches to working with refugees

I argue that drive theory and its development—the object relations theory, the concept of the self, and some aspects of attachment—constitute important factors in working with refugees.

Psychoanalysis continues to make important contributions to the clinical understanding of psychological development, its disruptions, and its consequences. In this section, I draw on important theoretical conceptualisation useful in working with children of refugees. Starting with a reading of Freud's “Mourning and melancholia” (1917e), and its development, including the major tenets of a revised model of the mind that he later termed object-relations, and which Klein (1946) and other contemporary psychoanalysts developed further. Freud's fundamental contributions have provided the skeleton for a wide range of contemporary psychoanalytic formulations and understanding of various forms of psychopathology deriving from disruptions to a child's normal developmental processes. My main focus and attention will be given to object relations theory, taking into consideration both internal and external reality and the intra-psychic relationship as it relates to working with children of refugees and other children who have endured trauma. A perception of self and its relation to the external world, along with a distinction between secure and insecure attachment in early development, will also be discussed. The self (true and false) and disruption of self in relation to trauma, vulnerability, re-traumatisation, and resiliency are also considered as major tenets.

 

Chapter Five: Assessment

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Assessing resilience and vulnerability in children who have endured trauma

Although psychoanalysis is mainly practised privately, therapeutic intervention for children of refugees, asylum seekers, and unaccompanied minors is, by and large, catered for by CAMHS, social services, schools, and other voluntary and statutory services. Within this context, I see our tasks as therapists to be:

Working to serve children and young people of refugees who typically have little faith or trust in themselves or their parents and whose views are often not understood or valued in institutional settings and in which they may be met with suspicion and even contempt is challenging. Although it is not without challenge, the intercultural therapeutic approach can be much more helpful for an effective outcome. We need to accept that we all might have preconceived notions about what is best for others and, working interculturally, we need to constantly remind ourselves to come back to what people themselves are asking for—and not what we want to give them. Putting this perspective into practice is essential for ensuring services are relevant and meaningful for those we set out to serve.

 

Chapter Six: Resilience

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Resilience and vulnerability

This chapter focuses on the methodology and evaluation of the development of a resilience approach. Using case studies, this chapter further explores a resilience-focused approach to working with children of refugees and unaccompanied minors. I will be illustrating two vignettes, a boy and a girl, whom I shall call Abdul and Nastaran.

What is the problem?

The frequently held view has been on deficit, disorder, problem behaviour paradigm with too much emphasis on risk factors that define what is wrong, missing, or abnormal, rather than considering the roots of a person presenting problem and how they can be helped to make positive changes. Viewing people's difficulties through a deficit lens proscribes grasping and valuing strengths, resources, resilience, and capabilities. This leads professionals to categorise individuals, families, and groups only for their vulnerability to negative life outcomes. Risk factors have historically been identified as biological, psychological, cognitive, and environmental conditions impeding normal developmental processes. Once normal development is delayed, vulnerability is increased. This particular view labels people according to their problems or deficits without recognising their resilience.

 

Chapter Seven: Working with Unaccompanied Minors, Trafficked Children, and Child Soldiers

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In this chapter I discuss working with unaccompanied minors, trafficked children, child soldiers, and children of refugees and their families. Here, I aim to give an idea of what is faced by children of refugees, the necessary and frivolousness need for therapy by outlining the stories of four such children as illustrative examples of the varied and extreme experiences endured by an individual child.

Unaccompanied minors

A large number of children of refugees are unaccompanied minors who are left facing the struggles of building a future alone. These brief vignettes illustrate the importance and necessity of their access to therapy.

Aran

Aran was seven-year-old boy during initial stages of ethnic cleansing in his country. The police in his village (from the majority ethnic group) had a station next to the village football pitch. Shooting the ball while the children were playing became a favourite pastime, followed by beatings of any child who protested.

 

Chapter Eight: Working with Family

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One of the common issues that we face working with children and young people is that adults tell us that they don't want the child to talk about what happened in the past and if they do we should tell them not to. Many parents, and some foster carers for unaccompanied children, indeed sometimes the child's contact person from social services, desperately want the child or the young person to change their behaviour, not to think about past and get on with life—because they care. However, as therapists we must remember that they, the carers, and we know less than the child about the traumatic events that they have endured.

When children are having difficulties, establishing links with their home can be crucial; however, working with the parents of traumatised children of refugees is not always easy. They may find it hard to acknowledge that their child may have a problem, especially of a psychological nature. Parents may be eager for their children to forget the past, look to the future and do well at school. They may really want to believe that the horrific experiences the family has gone through have not affected their children, so they convince themselves that the children are OK and are reluctant to accept evidence to the contrary.

 

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