Peer Support and Trauma Recovery

Journal of Conventional Weapons Destruction

Volume 15 Issue 1 The Journal of ERW and Mine Action Article 6

April 2011

Cameron Macauley Center for International Stabilization and Recovery at JMU (CISR)

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Recommended Citation Macauley, Cameron (2011) "Peer Support and Trauma Recovery," The Journal of ERW and Mine Action : Vol. 15 : Iss. 1 , Article 6. Available at: https://commons.lib.jmu.edu/cisr-journal/vol15/iss1/6

This Article is brought to you for free and open access by the Center for International Stabilization and Recovery at JMU Scholarly Commons. It has been accepted for inclusion in Journal of Conventional Weapons Destruction by an authorized editor of JMU Scholarly Commons. For more information, please contact [email protected]. Macauley: Peer Support and Trauma Recovery

Peer Support and Trauma Recovery

Peer support is becoming an important strategy to help survivors of war-related violence recover from psychological trauma. After a short training in counseling techniques, peer-support workers seek out trauma survivors in the community and help them reintegrate into society, find work, engage in sports and come to terms with their traumatic memories. Peer-support programs incur costs related to transportation and communication, but support groups may recover some costs through income- generating projects.

by Cameron Macauley, MPH [ Center for International Stabilization and Recovery ]

or most people who survive injuries from land- A Brief History mines or other explosive remnants of war, friends Peer-support programs for military veterans date and family can significantly aid in the recovery back to just after World War I, according toThe New York Fprocess. Survivors rarely recover in isolation; support Times: “A corps of ‘cheer-up’ men, themselves cripples of from concerned people in the survivor’s life is often the various kinds, has been organized at the base hospitals single most crucial element in the period of healing. in France and … in the United States. Through their ef- Survivors call upon their own inner resources to tol- forts, example and precepts, the injured man is stimu- erate physical pain, mental anguish, flashbacks, night- lated to use his brains on his own behalf.”4 Following mares, fear, difficulty with daily activities, loss of World War II, amputee veterans were often employed employment or school interruption, as well as stigma, in prosthetics centers to teach ambulatory skills, daily- discrimination and the humiliation of depending on living activities and residual limb care.5 Still in use and others for assistance. Yet emotional support, compan- similar to the current peer-support model, Alcoholics ionship, sensitivity and affection are natural human Anonymous, a group for recovering alcoholics, devel- responses and, in this painful time, often make the dif- oped the “sponsor method” in the late 1930s.6 In the late In 1996, when Kemal Karic˘ (right) was four years old, an artillery shell severed his right leg below the knee. His mother was killed in the ference between suicidal depression and the desire to 1990s, the Amputee Coalition of America began train- same blast. He received peer support from LSN Outreach Worker Nusret Pleho (left). All photos courtesy of Reverend Paul Jeffrey. move forward and recreate a “normal” life.2 ing Peer Visitors to talk with new amputees while they Some organizations providing victim assistance for recovered from surgery in the hospital.7 In 1997, Jerry Landmine Survivors Network es- Because peer-support workers home, a skilled peer-support worker survivors recognize the power of psychosocial sup- White and Ken Rutherford established Landmine Sur- tablished peer-support programs in are survivors, some of their train- can encourage a survivor to return port and incorporate it into their programs. In partic- vivors Network (later renamed Survivor Corps) to take 12 countries before closing in 2010. ing includes how to deal with their to the social network, which im- ular, many victim-assistance programs recognize the this approach to mine-affected countries worldwide Peer support is offered to survi- own feelings of fear, anger and grief, proves self-esteem, increases prob- strength and power of bonds between peers—people with the intent of creating a global network of landmine vors as either one-to-one individu- which is important in coping with lem-solving capabilities and reduces similar in age, gender and social background, and espe- survivors to provide victim-assistance services.8 al counseling or in group sessions emotions that other survivors’ sto- the incidence of suicide. cially those who share a history of trauma survival. Peer where all members are survivors. ries may trigger. Once survivors are comfortable support has become a standard way to help survivors re- The Implementation of Peer Support Peer-support workers receive some Peer-support workers are some- in a social setting, they usually ben- adjust during their recovery. A variety of nongovernmental organizations use training on how to: times referred to as “outreach work- efit from a survivor-support group. Peer support is particularly attractive in post-con- peer support in programs for survivors of war-related • Provide effective counseling ers” because they seek out survivors Support groups meet for a variety flict settings because it encourages survivors to help one violence, including but not limited to those injured by • Deal with suicidal behavior and in the community who may not have of reasons, not always overtly relat- another, occurs in natural community settings, can be landmines or ERW. Peer-support programs exist for am- substance abuse received treatment or attention for ed to trauma recovery but frequent- adapted to specific ethnic and cultural circumstances, putees, military-combat and torture survivors, refugees, • Help survivors obtain profes- their psychological trauma. Trau- ly for more practical activities such avoids the stigma associated with psychiatric care, em- and survivors of kidnapping and sexual violence relat- sional services, such as dealing ma survivors may isolate themselves as income generation, entertain- phasizes outreach and people’s strengths, and is likely ed to war. Programs for landmine survivors use peer with health problems, starting a and avoid social contact, remain- ment or sports. In the midst of these to be culturally sensitive since it is delivered by commu- support as a principal tool in Afghanistan,9 Bosnia and business/finding work or apply- ing bitter and depressed for years. events, peer support takes place and nity members.3 Herzegovina,10 Cambodia,11 Rwanda12 and Vietnam.13 ing for financial assistance By visiting a survivor in his or her survivors benefit from contributing

3. Social learning theory postulates that peers, because Peer support encourages survivors they have undergone and survived relevant expe- to provide that supportive net- riences, are more credible role models for others. work for the trauma-stricken, and When survivors interact with peers who cope suc- it can often help survivors recover cessfully with stress, difficulties or illness, they are quickly without seeking help out- more likely to exhibit positive behavior changes.17 side the community. Peer-support 4. Social comparison theory suggests people are con- programs for trauma survivors can stantly comparing themselves to those around supplement thinly-stretched men- them. They are more comfortable with others who tal-health services in post-conflict share common characteristics with them, which settings and promote vital social re- helps them establish a sense of normalcy. Interact- construction following a war. ing with others who are perceived to be better than see endnotes page 81 them gives them a sense of optimism and some- thing to strive toward.18 Helping others, who they consider to be struggling or in need, enhances people’s own sense of self-worth. 5. The helper-therapy principle proposes four main Ardie Sabahudiv (left) and Popovic˘ Dragan (right) are landmine survivors who fought on benefits for those who provide peer support.19,20 As a opposite sides during the Bosnian civil war. They both work as professional sculptors Kadira Nukic˘ (left) lost her leg above the knee during the 1995 and received peer support through the Association of Disabled Persons in Banja Luka, siege of Srebrenica (Bosnia and Herzegovina). Her husband and result of making an impact on another person's life, Bosnia and Herzegovina. two children were killed in the fighting. She received peer support from LSN Outreach Worker Aladin Mujac˘ic˘ (right) in 2006 the “helper” has an increased sense of interpersonal and went on to establish a support group for female amputees in competence, experiences the reward of positive ex- Bosnia and Herzegovina. changes, learns useful skills and receives social ap- group meetings, except in very small hearing survivors’ trauma stories.25 to a group effort. Support groups expose survivors to proval from the person they help and others.17 communities. Support groups may Although there is some risk, most others who are in different stages of recovery and are request contributions from members peer-support programs have access Cameron Macauley joined CISR in August 2010 as Peer Support and in the process of overcoming various types of trauma. Establishing New Peer-support Programs in order to cover costs, or they may to professional psychotherapists to Trauma Rehabilitation Specialist. He Researchers and clinicians feel there is a solid theo- In spite of peer support’s effectiveness in promot- organize income-generation projects whom they can refer survivors with holds degrees in anthropology and psychology and became a physician retical basis for peer support’s effectiveness as a thera- ing recovery from trauma of survivors and of those such as vegetable gardens, theater or problems that are too severe for the assistant in 1983. He has worked in who help them, peer-support programs have draw- crafts. In some cases peer-support peer-support worker to handle. Peer a refugee camp on the Thai-Cambodian peutic method. When someone recognized as a “peer” border, at a district hospital in provides support to a survivor, a variety of psychosocial backs. Individual one-to-one peer support is expen- groups for landmine survivors have support is never considered to be a Sumatra, as a Peace Corps volunteer in Guinea-Bissau, in Mozambique where processes come into play, as described by Phyllis Solomon sive to implement because peer-support workers need grown into independent nongovern- substitute for psychotherapy, but it he taught trauma surgery for landmine in 2004:14 transportation to visit survivors in their homes, and mental organizations, as in Bosnia is a useful supplement, especially injuries, in an immunization program in 21 22 Angola and in a malaria-control program 1. Social support consists of positive psychosocial in- this may require programs to cover the costs of public and Herzegovina and El Salvador. in areas where health-care servic- in Brazil. Between 2005 and 2010, he teractions in which there is mutual trust and con- transportation, or provide peer-support workers with a Lastly, some psychotherapists ar- es are sparse. The training of peer- taught mental-health courses for Survi- vor Corps in Bosnia, Colombia, El 15 cern. Healthy relationships contribute to positive bicycle or a motor scooter and associated expenses such gue that support from a peer with support workers is growing more Salvador, Ethiopia, Jordan and Vietnam. adjustment and help survivors deal with stress and as fuel. Many peer-support programs pay for or subsi- only brief training in counseling sophisticated and now emphasizes Cameron Macauley challenges through emotional support (esteem, at- dize mobile phones for peer-support workers so they may in some cases be harmful to the limits of peer support, as well as Peer Support and Trauma can stay in contact with survivors as well as with their survivors suffering from severe psy- its benefits. Rehabilitation Specialist tachment and reassurance), instrumental support Center for International 23 (material goods and services) and information sup- own supervisors and can help survivors set up appoint- chological trauma. Special train- Stabilization and Recovery 14 Conclusion James Madison University port (advice, guidance and feedback). ments, or network for jobs and other opportunities. ing is needed to help survivors deal 800 South Main Street, MSC 4902 2. Experiential knowledge comes from dealing with Peer-support workers are sometimes volunteers, but with suicidal depression, hallucina- Trauma specialists worldwide Harrisonburg, VA 22807 / USA Tel: +1 540 568 4947 a particular set of challenges such as substance many programs pay them salaries commensurate with tions, drug and alcohol abuse, and recognize that most survivors are E-mail: [email protected] abuse, a physical disability, a chronic illness or sur- their experience and training. Supervisors (usually so- flashbacks. Inappropriate counsel- capable of full recovery from psy- Website: http://cisr.jmu.edu or http://maic.jmu.edu viving a traumatic event such as military combat, a cial workers or program managers) are also necessary, ing has the potential to worsen some chological trauma under the right natural disaster, domestic violence, sexual abuse or and there may be a need to hire specialists in employment conditions or at the very least, inter- circumstances and that an accept- imprisonment. When shared, experiential knowl- opportunity and advocacy. Peer-support groups can fere with the healing process.24 In ing, supportive social environment edge helps a survivor solve problems and improves be more cost-effective than other forms of support, but addition, peer-support workers can is a key factor in preventing long- a survivor’s quality of life.16 costs are still associated with transporting survivors to experience “vicarious trauma” from term psychological dysfunction.