Group treatment for survivors of torture and severe violence: A literature review
DOI:
https://doi.org/10.7146/torture.v26i1.108062Keywords:
group, treatment, torture, therapyAbstract
Methods: The authors conducted a systematic review of scholarly journals and manuscripts. The search was limited to articles published in English that focused on group treatment with torture survivors.
Findings: The authors identified 36 articles and chapters for review describing a variety of group interventions for survivors of torture, including:
- Supportive Group Therapy
- Empowerment Workshops
- Group Treatment for Sleep Disorders
- Den Bosch model
- Wraparound approach
- Stage-oriented model
The literature examined varied in approach and format: present-day and past-focused groups; structured, time-limited groups; and flexible, ongoing support groups.
The studies took place in diverse locations, including Denmark, Germany, Guinea, Namibia, the Netherlands, Palestine, Serbia, the U.S., the UK, and Zimbabwe, and, in conflict, post-conflict and/or humanitarian settings. The interventions were facilitated by licensed mental health professionals, paraprofessionals, and bilingual/bicultural staff – or a combination of the latter two.
Interpretations: Group treatment is an approach which can be administered to larger groups of survivors to address a range of treatment issues. The authors examined key clinical practice issues for group treatment including group composition and content, facilitation and measurement strategies. While the literature does provide a compelling conceptual rationale for using group treatment, the empirical literature is in fact very limited at this time and needs to be strengthened in order to build confidence in outcomes across contexts and survivor communities.
Conclusions: This paper points to a growing interest in the topic of group treatment for survivors of torture and severe violence, providing a comprehensive picture of group-based interventions and highlighting the need for additional research and knowledge-building.
References
1. Herman JL. Trauma and recovery: the aftermath of violence—from domestic abuse to political terror. New York: Basic Books; 1992.
2. Amnesty International. Annual report: the state of the world’s human rights [Internet]. 2012. Available from: http://www.amnesty.org/en/ annual-report/2012
3. Higson-Smith C. Center for Victims of Torture: Updating the estimate of refugees resettled in the United States who have suffered torture [Internet]. 2015 Sep. Available from: http://cvt. org/sites/cvt.org/files/SurvivorNumberMetaAnalysis_Sept2015_0.pdf
4. Mpande E, Higson-Smith C, Chimatira RJ, Kadaira A, Mashonganyika J, Ncube QM, Ngwenya S, Vinson G, Wild R, Ziwoni N. Community intervention during ongoing political violence: what is possible? what works? Peace and Conflict: Journal of Peace Psychology. 2013 May;19(2)196-208.
5. Akinsulure-Smith AM. Using group work to rebuild family and community ties among displaced African men. Journal for specialists in group work. 2012 Jan 5;37(2):95-112.
6. Cvetković J, Đorđević B, Vujadinović SŠ. Group psychotherapy in patients with the experience of torture and forcible mobilization. In: Opačić G, Jović V, Radović B, Knežević G, editors. Redress in action: consequences of forcible mobilization of refugees in 1995. Belgrade: International Aid Network; 1995. p. 133-152.
7. Kinzie JD, Leung P, Bui A, Ben R, Keopraseuth, KO, Riley C, Fleck J, Ades M. Group therapy with Southeast Asian refugees. Community Ment Health J. 1988 Summer;24(2):157-166.
8. Kira IA. Torture assessment and treatment: the wraparound approach. Traumatology. 2002;8(2):54-86.
9. Salo J, Punamäki RL, Qouta S, El Sarraj E. Individual and group treatment and self and other representations predicting posttraumatic recovery among former political prisoners. Traumatology. 2008;14(2):45-61.
10. Tucker S. Psychotherapy groups for traumatized refugees and asylum seekers. Group Analysis. 2011;44(1)68-82.
11. Von Wallenberg Pachaly A. Group psychotherapy for victims of political torture and other forms of severe ethnic persecution. In: Klein RH, Schermer, VL, editors. Group psychotherapy for psychological trauma. New York: Guilford Press; 2000. p. 265-298.
12. Drožđek B, Bolwerk N. Group therapy with traumatized asylum seekers and refugees: for whom it
works and for whom it does not? Traumatology. 2010;16(4)160-167.
13. Fischman Y, Ross J. Group treatment of exiled survivors of torture. Am. J. Orthopsychiatry. 1990 Jan;60(1) 135-142.
14. Hubbard J, Pearson N. Sierra Leonean refugees in Guinea: Addressing the mental health effects of massive community violence. In: Miller KE, Rasco LM, editors. The mental health of refugees: ecological approaches to healing and adaptation. Mahwah New Jersey: Lawrence Earlbaum Associates Publishers; 2004. p. 95-132.
15. Nicholson BL, Kay DM. Group treatment of traumatized Cambodian women: a culturespecific approach. Soc Work. 1999 Sep;44(5)470479.
16. Smith H, Impalli E. Supportive group treatment with survivors of torture and refugee trauma. In Smith HE, Keller AS, Lhewa DW, editors. “Like a refugee camp on First Avenue”: insights and experiences from the Bellvue/NYU Program for Survivors of Torture. New York: The Bellevue/ NYU Program for Survivors of Torture; 2007. p. 336-374.
17. Stepakoff S, Hubbard J, Katoh M, Falk E, Mikulu JB, Nkhoma P, Omagwa Y. Trauma healing in refugee camps in Guinea: a psychosocial program for Liberian and Sierra Leonean survivors of torture and war. Am Psychol. 2006 Nov;61(8)921-932.
18. Drožðek B, Wilson JP. Uncovering: trauma-focused treatment techniques with asylum seekers. In: Drozoek B, Wilson JP, editors. Broken spirits: the treatment of traumatized asylum seekers, refugees, war and torture victims. New York: Brunner-Routledge; 2004. p. 243-276.
19. Kira, IA, Ahmed A, Wasim F, Mahmoud V, Colrain J, Rai D. Group therapy for refugees and torture survivors: treatment model innovations. Int J Group Psychother. 2012 Jan;62(1)69-88.
20. Reeler T, Chitsike K, Maizva F, Reeler B. The Tree of Life: a community approach to empowering and healing survivors of torture in Zimbabwe. Torture. 2009;19(3)180-193.
21. Tucker S, Price D. Finding a home: group psychotherapy for traumatized refugees and asylum seekers. European Journal of Psychotherapy and Counseling. 2007;9(3)277-287.
22. Akinsulure-Smith AM, Ghiglione JB, Wollmershauser C. Healing in the midst of chaos: Nah We Yone’s African women’s wellness group. Women Ther. 2009;32(1)105-120.
23. Smith H, Akinsulure-Smith AM. Needed – not just needy: empowerment as a therapeutic tool in the treatment of survivors of torture and refugee trauma. Afr J Trauma Stress. 2011 Jun;2(1)17-31.
24. Smith H. Despair, resilience, and the meaning of family: group therapy with French-speaking African survivors of torture. In: Carter R, Wallace B, editors. Understanding and dealing with violence: multicultural perspectives. Thousand Oaks, CA: Sage Press Inc; 2003. p. 291–319.
25. Kira IA, Ahmed A, Mahmoud V, Wasim F. Group therapy model for refugee and torture survivors. Torture. 2010;20(2)108-113.
26. Manneschmidt S, Griese K. Evaluating psychosocial group counseling with Afghan women: is this a useful intervention? Torture. 2009;19(1)4150.
27. Tocilj-Simunkovic G, Arcel LT. Group psychotherapy with victims of torture. In: Arcel LT, editor. War violence, trauma, and the coping process: armed conflict in Europe and survivor responses. Copenhagen: International Rehabilitation Council for Victims of Torture; 1998. p. 143154.
28. Tribe R, Shackman J. A way forward: a group for refugee women. Group Work J. 1989;2(2)159166.
29. Hess DB. The mental health sequelae and treatment of massive community violence in West Africa. [PhD thesis]. University of Minnesota; 2008. Available from: ProQuest Dissertations and Theses.
30. Stepakoff S. The healing power of symbolization in the aftermath of massive war atrocities: examples from Liberian and Sierra Leonean survivors. Journal of Humanistic Psychology. 2007;47(3)400-412.
31. Fürstenwald U. Group therapy for severely traumatized refugees with a focus on sleep disorders. Monroe Institute [Internet]. 2005 [posted 2009 Mar 2; cited 2014 Jun 1]. Available from: http:// sincspain.com/wp-content/uploads/2011/08/HSy-los-trastornos-del-sue%C3%B1o.pdf .
32. Drožđek B, Bolwerk N. Evaluation of group therapy with traumatized asylum seekers and refugees – the Den Bosch Model. Traumatology. 2010 Dec;16(4)117-127.
33. Drožðek B, Kamperman AM, Bolwerk N, Tol WA, Kleber RJ. Group therapy with male asylum seekers and refugees with PTSD: a controlled comparison cohort study of three day-treatment programs. J Nerv Ment Dis. 2012 Sep;200(9)758–765.
34. Drožđek B, Kamperman AM, Tol WA, Knipscheer JW, Kleber RJ. Seven-year follow-up study of symptoms in asylum seekers and refugees with PTSD treated with trauma-focused groups. J Clin Psychol. 2014 Apr;70(4)376-387.
35. Curling P. The effectiveness of empowerment workshops with torture survivors. Torture. 2005;15(1)9-15.
36. Berkson, SY, Tor S, Mollica R, Lavelle J, Cosenza C. An innovative model of culturally tailored health promotion groups for Cambodian survivors of torture. Torture. 2014;24(1)1-16.
37. Drožđek B, Kamperman AM, Tol WA, Knipscheer JW, Kleber RJ. Is legal status impacting outcomes of group therapy for posttraumatic stress disorder with male asylum seekers and refugees from Iran and Afghanistan? BMC Psychiatry. 2013;(13)148-158.
38. Bas, JK, Annan J, McIvor Murray S, Kaysen D, Griffiths S, Cetinoglu, T, Wachter K,, Murray LK, Bolton PA. Controlled trial of psychotherapy for Congolese survivors of sexual violence. N Engl J Med. 2013 Jun;368(23)2182-2191.
39. Center for Victims of Torture. Education and support group for torture survivors: a manual for facilitators. Minneapolis: Center for Victims of Torture; 2008.
40. Drožđek B, De Zan D, Turkoviæ S. Short- term group psychotherapy of ex-concentration camp prisoners from Bosnia-Herzegovina. Acta Medica Croatica. 1998;52(2)119-125.
41. Article 1 of the United Nations Convention Against Torture and other Cruel, Inhuman or Degrading Treatment or Punishment (UNCAT): “... 'torture' means any act by which severe pain or suffering, whether physical or mental, is intentionally inflicted on a person for such purposes as obtaining from him or a third person information or a confession, punishing him for an act he or a third person has committed or is suspected of having committed, or intimidating or coercing him or a third person, or for any reason based on discrimination of any kind, when such pain or suffering is inflicted by or at the instigation of or with the consent or acquiescence of a public official or other person acting in an official capacity. It does not include pain or suffering arising only from, inherent in or incidental to lawful sanctions.
2. Amnesty International. Annual report: the state of the world’s human rights [Internet]. 2012. Available from: http://www.amnesty.org/en/ annual-report/2012
3. Higson-Smith C. Center for Victims of Torture: Updating the estimate of refugees resettled in the United States who have suffered torture [Internet]. 2015 Sep. Available from: http://cvt. org/sites/cvt.org/files/SurvivorNumberMetaAnalysis_Sept2015_0.pdf
4. Mpande E, Higson-Smith C, Chimatira RJ, Kadaira A, Mashonganyika J, Ncube QM, Ngwenya S, Vinson G, Wild R, Ziwoni N. Community intervention during ongoing political violence: what is possible? what works? Peace and Conflict: Journal of Peace Psychology. 2013 May;19(2)196-208.
5. Akinsulure-Smith AM. Using group work to rebuild family and community ties among displaced African men. Journal for specialists in group work. 2012 Jan 5;37(2):95-112.
6. Cvetković J, Đorđević B, Vujadinović SŠ. Group psychotherapy in patients with the experience of torture and forcible mobilization. In: Opačić G, Jović V, Radović B, Knežević G, editors. Redress in action: consequences of forcible mobilization of refugees in 1995. Belgrade: International Aid Network; 1995. p. 133-152.
7. Kinzie JD, Leung P, Bui A, Ben R, Keopraseuth, KO, Riley C, Fleck J, Ades M. Group therapy with Southeast Asian refugees. Community Ment Health J. 1988 Summer;24(2):157-166.
8. Kira IA. Torture assessment and treatment: the wraparound approach. Traumatology. 2002;8(2):54-86.
9. Salo J, Punamäki RL, Qouta S, El Sarraj E. Individual and group treatment and self and other representations predicting posttraumatic recovery among former political prisoners. Traumatology. 2008;14(2):45-61.
10. Tucker S. Psychotherapy groups for traumatized refugees and asylum seekers. Group Analysis. 2011;44(1)68-82.
11. Von Wallenberg Pachaly A. Group psychotherapy for victims of political torture and other forms of severe ethnic persecution. In: Klein RH, Schermer, VL, editors. Group psychotherapy for psychological trauma. New York: Guilford Press; 2000. p. 265-298.
12. Drožđek B, Bolwerk N. Group therapy with traumatized asylum seekers and refugees: for whom it
works and for whom it does not? Traumatology. 2010;16(4)160-167.
13. Fischman Y, Ross J. Group treatment of exiled survivors of torture. Am. J. Orthopsychiatry. 1990 Jan;60(1) 135-142.
14. Hubbard J, Pearson N. Sierra Leonean refugees in Guinea: Addressing the mental health effects of massive community violence. In: Miller KE, Rasco LM, editors. The mental health of refugees: ecological approaches to healing and adaptation. Mahwah New Jersey: Lawrence Earlbaum Associates Publishers; 2004. p. 95-132.
15. Nicholson BL, Kay DM. Group treatment of traumatized Cambodian women: a culturespecific approach. Soc Work. 1999 Sep;44(5)470479.
16. Smith H, Impalli E. Supportive group treatment with survivors of torture and refugee trauma. In Smith HE, Keller AS, Lhewa DW, editors. “Like a refugee camp on First Avenue”: insights and experiences from the Bellvue/NYU Program for Survivors of Torture. New York: The Bellevue/ NYU Program for Survivors of Torture; 2007. p. 336-374.
17. Stepakoff S, Hubbard J, Katoh M, Falk E, Mikulu JB, Nkhoma P, Omagwa Y. Trauma healing in refugee camps in Guinea: a psychosocial program for Liberian and Sierra Leonean survivors of torture and war. Am Psychol. 2006 Nov;61(8)921-932.
18. Drožðek B, Wilson JP. Uncovering: trauma-focused treatment techniques with asylum seekers. In: Drozoek B, Wilson JP, editors. Broken spirits: the treatment of traumatized asylum seekers, refugees, war and torture victims. New York: Brunner-Routledge; 2004. p. 243-276.
19. Kira, IA, Ahmed A, Wasim F, Mahmoud V, Colrain J, Rai D. Group therapy for refugees and torture survivors: treatment model innovations. Int J Group Psychother. 2012 Jan;62(1)69-88.
20. Reeler T, Chitsike K, Maizva F, Reeler B. The Tree of Life: a community approach to empowering and healing survivors of torture in Zimbabwe. Torture. 2009;19(3)180-193.
21. Tucker S, Price D. Finding a home: group psychotherapy for traumatized refugees and asylum seekers. European Journal of Psychotherapy and Counseling. 2007;9(3)277-287.
22. Akinsulure-Smith AM, Ghiglione JB, Wollmershauser C. Healing in the midst of chaos: Nah We Yone’s African women’s wellness group. Women Ther. 2009;32(1)105-120.
23. Smith H, Akinsulure-Smith AM. Needed – not just needy: empowerment as a therapeutic tool in the treatment of survivors of torture and refugee trauma. Afr J Trauma Stress. 2011 Jun;2(1)17-31.
24. Smith H. Despair, resilience, and the meaning of family: group therapy with French-speaking African survivors of torture. In: Carter R, Wallace B, editors. Understanding and dealing with violence: multicultural perspectives. Thousand Oaks, CA: Sage Press Inc; 2003. p. 291–319.
25. Kira IA, Ahmed A, Mahmoud V, Wasim F. Group therapy model for refugee and torture survivors. Torture. 2010;20(2)108-113.
26. Manneschmidt S, Griese K. Evaluating psychosocial group counseling with Afghan women: is this a useful intervention? Torture. 2009;19(1)4150.
27. Tocilj-Simunkovic G, Arcel LT. Group psychotherapy with victims of torture. In: Arcel LT, editor. War violence, trauma, and the coping process: armed conflict in Europe and survivor responses. Copenhagen: International Rehabilitation Council for Victims of Torture; 1998. p. 143154.
28. Tribe R, Shackman J. A way forward: a group for refugee women. Group Work J. 1989;2(2)159166.
29. Hess DB. The mental health sequelae and treatment of massive community violence in West Africa. [PhD thesis]. University of Minnesota; 2008. Available from: ProQuest Dissertations and Theses.
30. Stepakoff S. The healing power of symbolization in the aftermath of massive war atrocities: examples from Liberian and Sierra Leonean survivors. Journal of Humanistic Psychology. 2007;47(3)400-412.
31. Fürstenwald U. Group therapy for severely traumatized refugees with a focus on sleep disorders. Monroe Institute [Internet]. 2005 [posted 2009 Mar 2; cited 2014 Jun 1]. Available from: http:// sincspain.com/wp-content/uploads/2011/08/HSy-los-trastornos-del-sue%C3%B1o.pdf .
32. Drožđek B, Bolwerk N. Evaluation of group therapy with traumatized asylum seekers and refugees – the Den Bosch Model. Traumatology. 2010 Dec;16(4)117-127.
33. Drožðek B, Kamperman AM, Bolwerk N, Tol WA, Kleber RJ. Group therapy with male asylum seekers and refugees with PTSD: a controlled comparison cohort study of three day-treatment programs. J Nerv Ment Dis. 2012 Sep;200(9)758–765.
34. Drožđek B, Kamperman AM, Tol WA, Knipscheer JW, Kleber RJ. Seven-year follow-up study of symptoms in asylum seekers and refugees with PTSD treated with trauma-focused groups. J Clin Psychol. 2014 Apr;70(4)376-387.
35. Curling P. The effectiveness of empowerment workshops with torture survivors. Torture. 2005;15(1)9-15.
36. Berkson, SY, Tor S, Mollica R, Lavelle J, Cosenza C. An innovative model of culturally tailored health promotion groups for Cambodian survivors of torture. Torture. 2014;24(1)1-16.
37. Drožđek B, Kamperman AM, Tol WA, Knipscheer JW, Kleber RJ. Is legal status impacting outcomes of group therapy for posttraumatic stress disorder with male asylum seekers and refugees from Iran and Afghanistan? BMC Psychiatry. 2013;(13)148-158.
38. Bas, JK, Annan J, McIvor Murray S, Kaysen D, Griffiths S, Cetinoglu, T, Wachter K,, Murray LK, Bolton PA. Controlled trial of psychotherapy for Congolese survivors of sexual violence. N Engl J Med. 2013 Jun;368(23)2182-2191.
39. Center for Victims of Torture. Education and support group for torture survivors: a manual for facilitators. Minneapolis: Center for Victims of Torture; 2008.
40. Drožđek B, De Zan D, Turkoviæ S. Short- term group psychotherapy of ex-concentration camp prisoners from Bosnia-Herzegovina. Acta Medica Croatica. 1998;52(2)119-125.
41. Article 1 of the United Nations Convention Against Torture and other Cruel, Inhuman or Degrading Treatment or Punishment (UNCAT): “... 'torture' means any act by which severe pain or suffering, whether physical or mental, is intentionally inflicted on a person for such purposes as obtaining from him or a third person information or a confession, punishing him for an act he or a third person has committed or is suspected of having committed, or intimidating or coercing him or a third person, or for any reason based on discrimination of any kind, when such pain or suffering is inflicted by or at the instigation of or with the consent or acquiescence of a public official or other person acting in an official capacity. It does not include pain or suffering arising only from, inherent in or incidental to lawful sanctions.
Downloads
Published
2018-09-06
How to Cite
Bunn, M., Goesel, C., Kinet, M., & Ray, F. (2018). Group treatment for survivors of torture and severe violence: A literature review. Torture Journal, 26(1), 23. https://doi.org/10.7146/torture.v26i1.108062
Issue
Section
Research and Scientific articles
License
We accept that some authors (e.g. government employees in some countries) are unable to transfer copyright. The Creative Commons Licence Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0) covers both the Torture Journal and the IRCT web site. The publisher will not put any limitation on the personal freedom of the author to use material contained in the paper in other works which may be published, provided that acknowledgement is made to the original place of publication.
