"Children never forget a traumatic experience but they can understand that it belongs in the past"

23/02/2016

Marianne Straume works at the Senter for Krisepsykologi in Bergen, Norway, which is a point of reference for the UTCCB-UAB. She specialises in recovery techniques for children and adolescents affected by crises, wars or natural disasters, and she conducted a seminar for UTCCB-UAB members from 12 to 14 February, at the Faculty of Psychology. This training will help them to apply a successful model for combating psychological scars that involves the parents of those affected. The UTCCB-UAB will thus become the first centre in Spanish-speaking countries equipped to give training in these techniques, known as Teaching Recovery Techniques (TRT).

The TRT were developed by the Children and War Foundation, which includes some of the world's leading experts in the field, like Atle Dyregrov and William Yule, and they are explained in a handbook that can be used, with minimal training, by those in charge of the welfare of children and adolescents affected by conflicts and disasters: teachers, nurses, family, etc.). The TRT are designed to be used from the age of eight onwards and they work best with groups of fewer than fifteen children.

What psychological consequences do natural disasters and armed conflicts have on children and adolescents?

Many consequences. One of the most common is post-traumatic stress reactions. The episode is over but the children still feel great fear: they find the experience overwhelming and are unable to integrate it. It's too much for them. When they see or experience terrible things, these impressions can be too strong, and then they try to push away the memory of them as this is terribly painful and frightening. But the images keep coming back, over and over again. As a result they have difficulty in concentrating, they try to avoid the places where the traumatic events happened, and they also avoid thinking about them. But the memories still keep on returning and so they become distressed, jumpy, restless.... And they have trouble sleeping, concentrating and leading a normal life because they have to avoid anything that reminds them of the terrible things they are carrying around inside them.

Are children more vulnerable than adults?

Yes, and they are completely dependent on them. For this reason we train children to fight back against post-traumatic stress reactions so that they can go back to playing, attending school, and sleeping properly, but we also hold parallel sessions with the parents so that they can understand the children better and help them overcome their traumatic memories. They can never forget what happened but they can understand that it's in the past and learn to manage their own thoughts and feelings. In many cultures we try to avoid terrible events and forget them. But if we do that they will just come back again at some point. We have seen this with refugees, for example. Sometimes the parents try to help their children to avoid things. "We're in a safe country now, so don't think about the war", they say. But the children have the war inside them, in their heads. So the parents have to understand that they need to talk to their children and help them, and then they can put the war behind them.

How can they be helped?

What's happening to these children is that their memories intrude into their minds uncontrollably. What we do is teach them techniques to really integrate what happened to them and stop avoiding it, so that they can take control of their bad memories.

When is the best time to act? Is it more difficult if a long time has passed?

It's never too late. We teach recovery techniques: we give the children tools to help themselves, and we give the parents tools to help the children. This is not treatment but prevention, so it should start as soon as possible. Sometimes someone comes to us two or three years after being exposed to a war experience: it isn't too late but they may need more treatment.

What do the Teaching Recovery Techniques consist of?

What's special about them is that they are applied by the schoolteachers. There aren't enough professional psychologists or psychiatrists to cope with all the children, so we need to teach their schoolteachers, social workers and other professionals. It's a cascade approach: we train psychologists so they can train schoolteachers, who can then train other schoolteachers, as a way of reaching many more children. The idea is to teach children to recognise their own feelings and post-traumatic stress reactions: the kinds of things they try to avoid so they don't have these distressing feelings. We teach them techniques to expose themselves to what they are afraid of. We also teach them relaxation and breathing techniques, we give them tools to control intrusive memories or images. And we gradually help them to be aware of what really happened to them and talk about it. This is done over five sessions. At the end, we hope they will be able to draw and talk to their parents about what happened to them.

Is drawing very important?

Yes. But that's a very hard method to start with. First they need to be able to calm themselves and then gradually expose themselves to what they really experienced.

What happens when the parents are also affected by the same traumatic event?

They are affected, and the teachers too. So this is a problem. After the earthquake in Turkey, we designed a cascade model for debriefing the teachers first because they said they needed help themselves before they could help the children. And the same goes for the parents, so we have to take this into account too.

Is the task in the case of a natural disaster different to that of a conflict?

It's practically the same but a natural disaster is something that only happens once and then ends, except in earthquake zones, where they are usually better prepared. It's also different because it isn't man-made. In war it's more about traumas that are repeated and repeated over years. You have to be constantly on the alert and moreover these are things that people are doing to other people, so it's more difficult for a child to understand how something like that can ever happen. It might change the way children think about the world and safety. So the effects on children are different but the way of working is the same.

What results have been obtained?

Our manual has been used all over the world. We had very good results after the earthquakes in Greece, Turkey and Iran, so it has been put to the test successfully. We get many requests to use it because it is well structured and easy to learn and use, and it lets you help a lot of children at the same time.

Do you think the current refugee crisis is helping to make public opinion in Europe more sensitive to this issue?

I hope so but I don't know. Often in our countries the response is: "We won't let them in". But if you don't even meet them you can't see their suffering.

More information: UTCCB-UAB