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Healing Body, Mind, and : The Role of Spirituality and in the Treatment of Survivors of Torture

Torture is the deliberate infliction of severe physical or psychological pain, carried out by anyone acting in an official capacity. Used by those with power against those without, torture is intended to suppress political opinions, religious beliefs, ethnicities, nationalities, or membership in a social group. (UN)

Torture can decimate the spiritual strength of survivors, often with long-lasting psychic ramifications (Piwowarczyk, 2005). Many survivors do affirm religious or spiritual beliefs, and integrating such beliefs into treatment can aid in their recovery by creating opportunities for countering psychic distortions and drawing on a familiar source of strength and courage. In the last two decades, researchers have given more attention to the role of religion in (Pose and Wade, 2009). Current research and practice reflect an increased of the benefits of a using a holistic process that honors the core values and guiding systems of clients (Post and Wade, 2009). Psychologists as a whole tend to be less religious than their clients; thus it is incumbent on professionals to communicate openness to discussing the sacred with their clients (Post and Wade, 2009). Without such openness, psychologists and service providers will be hindered in helping survivors for whom spirituality is important to reconstruct their lives following trauma.

There is evidence of a positive relationship between (Post and Wade, 2009). Making space for it fosters a therapeutic relationship that is culturally sensitive and patient-centered, two factors of utmost importance when treating survivors of torture who are from cultures markedly different from those in which they are resettling (Post and Wade, 2009). Western scholars and practitioners are increasingly aware that making an effort to account for the sociocultural context of a survivor counts as a best practice, as does conceiving of the healing process from the perspective of the survivor (Isakson and Jurkovic, 2013).

Asylum seekers who were tortured are particularly vulnerable because they are often coping with post-traumatic stress in addition to an alien in a new country. For this , it is crucial that care providers honor client beliefs that fall outside of the Western medical or paradigm (Isakson and Jurkovic, 2013). What are traditional healing processes like in Burma or Rwanda, for example? Though practitioners cannot be expected to be experts on other cultures, they can approach the dyad with and express to the client an interest in learning about the culture that individual knows intimately (Piwowarczyk, 2005). There may be specific , such as , , or , which are meaningful to the survivor and which can be incorporated into therapy with a little effort and creativity on the part of the practitioner (Isakson and Jurkovic, 2013). Likewise, the relevant components of institutionalized such as Catholicism and , as well as less mainstream ones, such as and Jehovah’s Witness, can be learned by practitioners who are unfamiliar with them (McKinney, 2011). Over time, the practitioner should develop a fundamental knowledge of numerous belief systems, though there will likely be nuances that emerge with individual clients. Research has found that, despite being much less religious than their clients, psychologists are generally positive about the spirituality and of their clients, believing it is associated with positive mental health outcomes(Post and Wade, 2009). However, practitioners must work to comprehend various belief systems and not remain complacent in their ; ignorance of belief systems can distort clinical judgement (Post and Wade, 2009).

Research also suggests that the therapeutic alliance between practitioner and client is strengthened when the survivor has the clear sense that his other beliefs are respected by the therapist (Post and Wade, 2009). Part of this process requires therapists to be cognizant of the potential for biased responses, due to their own perspectives on religion and spirituality (Piwowarczyk, 2005). One way for practitioners to prepare for engagement with a spiritual survivor is by writing an autobiographical summary of their own ; in this way, they can minimize the potential for their own unexamined biases obstructing compassionate and competent response to their clients (Piwowarczyk, 2005). Practitioners can show respect and attain insight by being an active listener and opening up space for survivors to be storytellers, conveying personal experiences and beliefs in their own mode (McKinney, 2011). This is an important component of being patient-centered; it should be a patient process as well, as the process of communicating the story is itself part of the therapy (McKinney, 2011).

Though opinions vary about what sorts of religious activities, i.e. discussion of scripture or guided , are appropriate to be facilitated by a therapist, the majority of clients feel that it is appropriate for religion or spirituality to figure in to their treatment in some fashion (Post and Wade, 2009). Researchers have formulated several methods for initiating the discussion around spirituality or religion, including one approach to spiritual assessment known as FICA. The acronym consists of the categories of questions to be asked: or beliefs; importance or influence; ; and address – how the client would prefer for these needs to be addressed during treatment (Piwowarczyk, 2005). Another approach acknowledges the that religious beliefs are often shaken or challenged by the experience of trauma; though faith can be tenacious, it is not uncommon for survivors to undergo a conflict of faith or to feel abandoned by their (Piwowarczyk, 2005). Simple, non-intrusive inquiries can provide the client an opportunity to voice these feelings for further exploration. Part of healing, therefore, may be the reconciliation of faith, despite the atrocities endured.

Again, practitioners should not assume the role of experts in this realm. Some religious practices are the exclusive domain of religious leaders, and for that reason a significant component of the therapist’s role may be to connect survivors with the leaders and that can serve them beyond the therapy room (McKinney, 2011). is the key to cases in which spirituality is central to a survivor’s belief system (McKinney, 2011). Practitioners should forge relationships with pastoral professionals, as well as religious organizations associated with the population being served (McKinney, 2011). Not only can a community of care be established, enhancing effectiveness in treatment, but clients can also discover a social community that will reduce isolation in the long run (McKinney, 2011). Heartland Alliance Marjorie Kovler Center: 30 years of healing

Heartland Alliance Marjorie Kovler Center (Kovler Center) was founded in 1987 to respond to the needs of the burgeoning number of individuals arriving in Chicago having fled war and persecution in their home countries. Kovler Center serves torture survivors living primarily in Illinois, a state with the 6th highest number of asylum seekers and 10th highest number of refugees resettled (2013), populations with disproportionately high rates of torture history. Torture survivors are an underserved group often excluded from mainstream healthcare because of the unique of their trauma, lack of resources, and complicated legal status. To date, Kovler Center has served over 2,000 individuals from 84 countries. Each year, staff and a network of over 200 pro bono professionals provide integrated services to help approximately 350 individuals (including 100 new participants) who have survived the unimaginable. With no other torture treatment program within 300 miles, Kovler Center’s specialized services connect survivors of torture to the care they need to start rebuilding their lives.

The respect and acuity with which Kovler Center approaches religion and spirituality in healing evolved organically out of a particularly challenging case that forced staff practitioners to reflect on best practices early in its history. In 1989, a devout Buddhist from Cambodia, newly arrived in Chicago, sought help from Kovler Center in the aftermath of extreme sexual violence she had suffered in her country. As reported by Kovler Center psychotherapist Mario Gonzalez, who was treating her at the time, progress in recovery was blocked by her belief that was responsible for her suffering. “We were knocking our heads against a wall,” he said. How could Kovler Center help the client overcome her immense suffering while at the same time respecting her beliefs? The solution came after Gonzalez reached out to a local Buddhist who explained that there is always a positive and a negative side to karma. As a result of this consultation, Gonzalez was able to guide the survivor so that she could apply her belief in karma to the idea that she had been a caregiver in her past life, and now it was her turn to be taken care of. It worked miraculously; and from that point on, her spiritual beliefs enabled her healing. In addition to constituting a turning point for this survivor, this case formed the impetus for Kovler Center to be more intentional in integrating spirituality into its treatment approach.

Kovler Center acknowledges survivors’ spirituality and religious beliefs during the intake process— the initial history-taking and assessment of clients’ needs—and incorporates findings into the subsequent preparation of clients’ individual treatment plans. Inquiring about how survivors cope during moments of duress allows them to speak about their spiritual practices. Kovler Center’s current practice model emphasizes the importance of staff sensitivity and competence in harnessing the power that spirituality may have in the healing process. Staff also coordinates with volunteer pastoral counselors, particularly with Christian clients.

Though there are various ways that Kovler Center staff respect and draw on the spirituality of clients, two primary means of doing this are the use of prayer during therapy and making connections to religious communities. Mary Fabri, PsyD, former Senior Director of Clinical Services at Kovler Center, observed in her qualitative research (focus groups in six cities) that survivors’ faith in figured very prominently into their own explanations of how they coped. For Fabri, it is standard practice to use clients’ input about how they practice their faith – for instance, the reading of scripture – to guide how she incorporates it into therapy sessions. For one survivor that meant opening and closing each session with a prayer. Another Kovler Center therapist collaborates with his clients in creating rituals. One client of his was a priest, and praying during every session helped the survivor integrate therapy with his everyday life and his spiritual being. Because this therapist is familiar with the Scriptures himself, he is able to guide survivors desirous of this approach through meaningful comparisons of their own lived experiences – both tribulations and empowering moments – with biblical passages.

In a very concrete example, Kovler Center once served a survivor, a Catholic woman, who sought a volunteer job cleaning a church so that she would have access to a sanctuary for healing. She lacked the to seek this out on her own, so a Kovler Center staff member connected her to a welcoming and diverse congregation. In this way, she found a significant source of joy and meaning outside of therapy. Another therapist notes the significance that religious figures have played in some survivors’ lives, such as the benevolent or who harbored them from their torturers.

Many survivors seen at Kovler Center find considerable comfort in establishing and maintaining ties with religious communities in their new home of Chicago. Part of Kovler Center’s strength is its client- centered approach in which the survivor’s voice is integral to planning treatment. Often this means helping survivors reconnect to their spirituality.

For spiritual survivors, it is a significant detail that the Kovler Center offers a serene setting for healing. The building itself is a converted convent and is referred to as a sanctuary by some participants; its four floors of offices and meeting rooms are spacious and calm. Its location on a quiet residential street also helps. During their short walk from the train or bus, survivors can begin to enter a mental space conducive to healing.

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“Everything [was helpful], all the services. I’ve never been treated with respect like I have been here. Kovler [Center] is a and I feel like I'm going to Heaven when I come here. It lifts my morale and makes me happy about the ." – Survivor of torture, Kovler Center participant

“God led me to Kovler Center and I am thankful.” – Survivor of torture, Kovler Center participant

References

1) Isakson, B. and Jurkovic, G. (2013) Healing after torture: the role of moving on. Quality Health Research, Vol. 23, pp 749-761. 2) McKinney, M. (2011) Treatment of survivors of torture: spiritual domain. Torture, Vol 21 (1), pp 61-66. 3) Piwowarczyk, L. (2005) Torture and Spirituality: Engaging the sacred in treatment. Torture Victims, Vol 15 Number 1. 4) Post, B. and Wade, N. (2009) Religion and spirituality in psychotherapy: a practice- friendly review of research. Journal of , Vol 65 (2), pp 131-146.