With a growing understanding of neuroscience and recognition of the mind-body connection in western therapeutic approaches, the Center for Victims of Torture has been providing counseling and physiotherapy services to Syrian and Iraqi war trauma/torture survivors for the past 7 years. Our clinical review, including expert clinical impressions, analysis of case studies and analysis of client outcome data assesses the benefits and challenges of a concurrent integrated therapy approach.
The clinical approach is based on a ten week cycle with weekly counseling and physiotherapy group sessions for cognitive trauma processing, coping strategies, education about pain, and physical/functional movement. Clients (survivors of torture or other war atrocities who have difficulty functioning in daily life) are assessed individually by a counselor and physiotherapist during which services are explained, informed consent obtained, and measurements taken for post-traumatic stress (Posttraumatic Stress Diagnostic Scale, PDS), anxiety and depression (from Hopkins Symptom Checklist-25), physical symptoms and behavioral functioning (using internally-developed measures and Pain and Discomfort Inventory, PDI). Group composition is based on gender and age. During the 10 week group cycle, many clients also receive either individual social work services for case management and/or group informational sessions.
We present expert clinical impressions, including the rationale for this approach and practice-based observations from seven years of service provision. Analyses of case studies provide specific examples of the interdisciplinary approach and offer insight into benefits of the interdisciplinary approach. We analyze data from outcome measures administered at intake and 6 month follow up, developing comparisons of clients who received group counseling only to those who received interdisciplinary services.
Expert clinical impressions includes improved holistic understanding among clinicians and the mutually reinforcing benefits. When clients better understand pain and improve their physical functioning, it also helps them feel less depressed, hopeless and isolated. By working through their traumatic experiences, clients also discover improvements in physical symptoms and an understanding of triggers that limit movement or increase their pain experience.
The case studies represent clients who have experienced the interdisciplinary approach and have been able to rediscover more positive thought processes, understanding the connection of their thoughts and emotions to their bodies and finding hope and enjoyment with others and in their own bodies.
Analysis of client outcome data shows significant improvements with strong effect sizes on all outcome indicators. The results indicate that providing services which address mental health and physical dysfunction simultaneously can have a positive impact on mental health, physical functioning, and other aspects of survivor well-being.
Funding & No Conflicts Declaration
CVT’s Jordan program funding: UNV, BPRM, USAID and OSF grants. Potential conflicts include presenters’ roles in developing, implementing and supervising the clinical model, otherwise none.