Counselling Victims of Warfare

Person-Centred Dialogues

Richard Bryant-Jefferies

• Publisher: CRC Press
• Year: 2018
• Topic: Psychology
• eBook ISBN:
  9781315358604
• Subtopic: Medical Theory, Practice & Reference
• Index: Psychology

In the United Kingdom since 1987 38,000 people have been referred to The Medical Foundation for specialist psychological treatment relating to warfare, and in the past 80 years 75,000 military personnel have received counselling from the Ex-Services Mental Welfare Society. The topic of warfare induced psychological stress and trauma is a vast one.

This book gives an unique, person-centred insight into counselling victims of warfare (either civilians or military personnel) whose trauma is physical or psychological. It covers such topics as anger, death, nightmares, recovered memories, emotional and physical pain, and alcohol use. It also contains a list of useful contacts for further support and helpful tips. Counsellors, trainees and other healthcare and social care professionals dealing with civilian or military victims of warfare will find this guide invaluable.

PART 1

Ania’s story

The soldiers had come in the night…, Ania had tried to hide, tried to escape, but she had been seen. She was raped. They left her for dead, bleeding in the dust. Her brother lay dead, shot in the head in front of her, but only after they tortured him. They’d cut off his hands. When she was found and brought to the hospital she was barely alive herself. She was still carrying one of his hands, holding it to her heart … it was five days later …

CHAPTER 1

Counselling session 1: silence and a focus on Ania’s daughter, Maria

Debbie was an experienced counsellor. She had been working with people who had been victims of warfare for a few years, but she had never lost the sense of shock when she heard the stories, the horrific and tragic events that her clients brought to the counselling relationship. But it wasn’t just the tales, it was the people, the way they were, the terror, the sadness, and, yes, the strength that they demonstrated in their struggle to cope. She hoped she would never lose that sense of shock. It was important for her to remain open and to be fully present, to bear the pain of being affected as a person, as a fellow human-being, when listening to others describe what had happened to them, or what they had witnessed.

She had regular supervision and she needed it. Now, she sat in the kitchen area at the counselling centre which specialised in helping people who were, and still are, the victims of war and torture. Her new client, Ania, was due any time. She had already been assessed and Debbie had seen the report. She always found it difficult knowing things about her clients before the client had told her. She didn’t want to spend the first session telling the client what she knew, although she knew that would be appropriate to a spirit of openness. What she wanted was to give her client the time and the space to tell her own story, in her own way, at her own pace, something which didn’t always happen in assessments. For Debbie, the process of hearing a client’s story was a key element in the therapeutic process, and so she had decided some while back not to rob her clients of that by telling them what she had read. She would concentrate on building the therapeutic relationship, offering the ‘core conditions’, and thereby facilitate what she considered to be a healing process.

She knew that Ania had been brought over by an agency helping people affected by the war. She had refused counselling previously, not wanting to talk, simply wanting to try and make a new start. She had got a part-time job, and was making progress in her new life, but had recently started to withdraw and she had been encouraged by a support worker to seek counselling.

There was a knock at the door. ‘Ania’s here, Debbie.’ It was Julie, the receptionist.

‘Thanks, Julie.’

Debbie took a quick look around the counselling room where she now was; it was tidy, tissues and water on the table. She got up and went out to the reception area.

Ania was sitting, looking down. She looked quite thin and pale, and was holding her hands in her lap in a tense sort of way. ‘Ania?’

She looked up. ‘Yes.’

‘Hello, I’m Debbie. Would you like to come through.’

‘Yes. Thank you.’

Ania got up and followed Debbie to the counselling room.

‘Please, have a seat.’

‘Thank you.’ Ania sat down, still wearing her coat.

Debbie wanted to keep to the non-directivenes of the person-centred approach. She was already sensing that Ania was quite withdrawn and she didn’t want lengthy silences to start becoming a problem for her, or putting her off from attending. At the same time, she didn’t want to come across as some well-meaning friendly face that was out of touch with the seriousness of the events in Ania’s life.

‘This is the first time you’ve been to counselling?’

Ania responded, ‘yes, yes it is.’

Debbie nodded and smiled, she wanted Ania to feel welcomed and accepted. ‘I don’t want you to feel you have to say anything that you don’t want to.’

Ania nodded.

‘And there’s really no rush, no pressure, and I’d really like to try and help you with what’s difficult.’

Ania nodded again. She liked the thought that there would be no pressure on her to speak. She did not know what to say, and she didn’t want to feel as though she was going to be made to talk about things.

‘I only speak English, are you OK with the counselling being in English?’

Ania nodded. ‘I learned English and it has much improved since being here. I make mistakes, but I hope you will understand.’

Debbie felt a warmth for the woman in front of her, partly because of knowing something of her background, but also because she was a person, struggling with life in her own way. ‘It is not always easy to find the right words.’

‘No, but I try. And I hope that you will understand.’

‘I will try to and if I am not sure, is it OK if I tell you? And if there is something I say that you are not sure of, please tell me. Is that OK?’

Ania nodded and smiled.

Debbie smiled back, ‘and I know we sent you information about the counselling. Did you have any questions, was there anything that you were unsure of?’

Ania shook her head.

‘And that the counselling is for 50 minutes, though we can negotiate a shorter time if that is what you feel you need.’

Ania nodded. She sat and really didn’t know what to say or where to begin. She hadn’t spoken much about anything to anyone, and whilst she knew that she wasn’t coping well, she was having terrible nightmares and feeling so low, she really had no idea what to say or how to say it. And she wasn’t at all sure that she really wanted to say anything. She didn’t know the woman opposite her. She seemed friendly enough, but she didn’t know her. She needed to know her before she felt she could talk to her. She felt sure that Debbie wouldn’t understand. How could she? She wouldn’t have experienced what she had had to go through. How could she understand? No one could understand unless they had been through it.

Debbie sensed an awkwardness in the silence, and felt that it would be therapeutically helpful to convey her awareness of how difficult it could be to start. It also offered a reaching out to her client, and showed that she was seeking to understand the silence and how difficult it could be. ‘It must be very difficult to know where to begin?’

Ania nodded but it did not take her away from her own thoughts and feelings. She felt a dark heaviness weighing her down as she continued to sit, silently staring down at the floor, but not really seeing. She was lost in her own thoughts, increasingly oblivious of the room, and of Debbie, as she sunk into those dark, heavy feelings that were all too familiar. The sounds, the noise, bombs, guns, houses, walls crashing down, screams, shouts. She closed her eyes, trying to push it away. It hadn’t been like this all of the time, but recently it had all become more present. And the soldiers …, her brother. Her parents already dead, killed in a bombing attack. Now she was alone, except for Maria, her daughter. She loved her dearly, dearly – she was all she had. She took a deep breath and sighed. Though she didn’t think of it in those terms, her psychological processes were in a sense using her love for her daughter as a barrier to the hatred and violence that had caused her to come into the world, though the memories returned in the night to stalk her and cause her to awake, sometimes screaming and always in terror.

Debbie sat silently, being with her feelings for Ania. She could only guess what Ania might be thinking. But she wasn’t going to let herself drift into her own speculations. She wanted to keep her attention and focus. It was important for her to do this. She believed it to be an important feature of effective therapy. Just because there was a silence did not mean that you let your focus slip. She was there to be present, as a person, with her client. She was there to be open to whatever her client wanted to communicate, and to her own inner processes as well. She was there to experience and offer unconditional positive regard.

For Ania there was a succession of friends’ faces, friends from her past, friends she had not seen now for a long while, many of whom she knew she would never see again. Most were probably dead. One day she hoped to go back, one day, but at the moment she didn’t know what she wanted. She just felt trapped, trapped inside herself. And then she thought of Maria, three years old now. She felt herself smiling. How she loved her, wanted to be with her. How hard it had been to leave her when she had got a job, but the social worker had convinced her it would be OK, and it seemed to be, but she had spent the morning aching to see her again. Sweet little Maria, golden hair, blue eyes, such a happy child. And she was hers, the only thing she had in the world. She felt the darkness lifting a little as she thought of Maria and the way that she spoke. She was such a serious little girl, quite quiet in many ways, and yet she so loved to laugh and play and sing songs and dance.

They hadn’t sung and danced for a few weeks now, it made Ania sad. But they still played games together and laughed, but there was a sadness in the midst of the smiles. The social worker had picked up on it when she had seen them together, and had enquired what was wrong. At first Ania had denied anything was wrong, but she had got to know and respect Gina, who was Italian, she had such a wonderful enthusiasm for life and she knew she was concerned because she also cared. She had told Gina what was happening for her and Gina had persuaded her to come for counselling.

As she sat there in the counselling room in the present, Ania had no sense of the time passing. She felt quite warm in the room, but did not want to take her coat off. She hadn’t moved since they had sat down, not that she was aware of it. But Debbie was. And Debbie felt warm in the room and was sure that Ania must be uncomfortable. ‘If you’d like to take your coat off…’

Ania didn’t want to, yes, it was warm but she felt comforted by her coat. It was important to her. She’d had it for some while, actually since she had arrived in the UK. In fact, it was the first thing she had bought for herself. It was like a symbol of a new start, a new life, though she wasn’t thinking in those terms as she sat, holding her coat against her.

Debbie was not going to intrude further on Ania’s silence. Her two comments were genuine, and voiced out of a desire to assist. But she did not want Ania to speak because she felt she had to, or she ought to. The silence had felt awkward at first but now it felt a little easier, strangely enough, and she guessed that may be because Ania was very much in her own thoughts and maybe not so in touch with the room, with her, with the idea of being there for counselling.

Ania remained in her thoughts, still looking down. Minutes passed.

There was a crash from outside, it jolted Ania back to the room, back into the present, and she felt her heart thumping. She looked at Debbie.

‘It’s OK, but quite a shock, yes. I am sorry about that.’

Ania nodded. ‘It is OK.’

Debbie knew that there were plenty of people around that afternoon so she didn’t get up to see what had happened. She was glad of this, she didn’t want to leave Ania, or give the impression that something else was more important, unless it had sounded really serious. She guessed someone had dropped something.

Debbie took the opportunity of the eye contact, and smiled slightly before speaking. ‘You looked as though you were lost in thought, Ania.’

Ania nodded, she wanted to speak, she had things she needed to say, she felt her heart still thumping. She needed to start to say something, ‘I…, yes, yes, I was thinking about so many things.’

‘Mhmm, so many things to think about.’

Ania nodded, now looking towards Debbie. ‘But not good things, not always.’

‘No, sometimes the things that you think about are not good.’

‘Bad things.’ Ania dropped her eyes and looked back down towards the floor, rubbing her fingers together nervously in her lap.

‘Bad things, things that have happened?’

Ania nodded again. This time, however, she made herself think about Maria, she knew she would feel easier thinking about Maria.

Debbie noticed a bit of a smile on Ania’s face. ‘And things that make you smile?’

Empathy is not simply about words. Body language and facial expression are also important expressive elements for the person-centred counsellor to be sensitive and responsive to. What needs to be taken into account is the fact that feelings may be conveyed through body language and facial expression that may be outside of the awareness of the client. In other words, what may be being communicated is in effect coming direct from the client’s experiencing but is by-passing awareness. Primarily empathy is a response to what the client intends to communicate, but empathic re...

Table of contents

• Cover
• Title Page
• Copyright Page
• Table of Contents
• Forewords
• Preface
• About the author
• Acknowledgements
• Introduction
• Part 1: Ania’s story
• Part 2: Graham confronts his memories
• Afterword
• Author’s epilogue
• References
• Further reading
• Useful contacts
• Index