Nora Sveaass

Refugee families in therapy: from referrals to therapeutic conversations

Refugee families referred for therapy present a wide array of problems and expectations, not always in accordance with what therapy may offer. Major differences between referring professionals, families and therapists regarding problem definitions and solutions may complicate collaboration. Interventions that may overcome these barriers and move initial interviews into a therapeutic context are described. Three patterns regarding referral process, problem presentation and expectations (here called referral contexts) are outlined: ‘the relational’, where families ask for psychological and interpersonal assistance, ‘the unfocused’, where families are referred to therapy without expressing any wish for it, and ‘the fixed solution’, where families seek support for solutions that are not of a therapeutic nature. The interventions described form part of a negotiation where motives and interest for therapy are explored and agreements regarding further therapy are outlined.

From war hero to cripple: An interview study on psychosocial intervention and social reconstruction in Nicaragua.

An interview study among mental-health professionals working with victims of war and violence in postwar Nicaragua suggests that the professionals frame their understanding of problems, methods of interventions, definitions of aims and goals, as well as their professional role, in a sociopolitical context rather than in a clinical or an academic one. They tell about war heroes becoming marginalized and excluded as the sociopolitical context changed, and about the onset of posttraumatic stress reactions in relation to poverty and social isolation. In response to these conditions, community-oriented psychosocial work, with emphasis on social reconstruction and reconciliation, is emphasized. The experiences of the professionals and their ways of framing and confronting postwar issues are discussed as important contributions to a contextual understanding of trauma and reactions to traumatic events. The role of cultural understandings and meaning systems in which events and reactions are embedded is highlighted.

Gross human rights violations and reparation under international law: approaching rehabilitation as a form of reparation

The strengthening of international criminal law through an increased focus on the right to reparation and rehabilitation for victims of crimes against humanity represents an important challenge to health professionals, particularly to those in the field of trauma research and treatment. A brief outline of some developments in the field of international law and justice for victims of gross human rights violations is presented, with a focus on the right to reparation including the means for rehabilitation. The fulfillment of this right is a complex endeavor which raises many questions. The road to justice and reparation for those whose rights have been brutally violated is long and burdensome. The active presence of trauma-informed health professionals in this process is a priority. Some of the issues raised within the context of states’ obligations to provide and ensure redress1 and rehabilitation to those subjected to torture and gross human rights violations are discussed, and in particular how rehabilitation can be understood and responded to by health professionals.

Do No Harm? How Psychologists Have Supported Torture and What to Do About It

Torture is used not only by deranged individuals but by many states, including presumably democratic ones. This chapter examines two cases in point—apartheid South Africa and the US post-9/11—and how to prevent psychologists’ involvement in or support for torture. The South Africa case illustrates how most psychologists failed to speak out against the government’s blatant violations of human rights on a wide scale. The US case illustrates the dangers of allowing national law to trump international law and human rights standards, particularly the UN Convention Against Torture. It shows that psychologists played a direct role in torture, while the American Psychological Association collaborated with the Department of Defense in ways that supported torture, thereby undermining human rights and politicising psychology. Efforts to prevent psychologists’ support for torture include, among others, human rights education, strengthening codes of professional ethics, engaging with government in ways that reduce psychologists’ involvement in torture and mistreatment, international monitoring of professional ethics codes, encouragement and support for whistle-blowers, and vigorous prosecution of psychologists who support or engage in torture. Ultimately, all psychologists must take a stand against torture.

The preventive approach: OPCAT and the prevention of violence and abuse of persons with mental disabilities by monitoring places of detention.

Adopted in December 2002, the United Nations Optional Protocol to the Convention against Torture and other Cruel, Inhuman or Degrading Treatment or Punishment establishes a system of regular visits undertaken by independent international and national bodies to places where people are deprived of their liberty, in order to prevent torture and other cruel, inhuman or degrading treatment or punishment. The article explores how this collaboration between national and international bodies, with independent mandates to carry out such unannounced visits, represents an important effort in the process of protecting persons with mental disabilities who are detained and who are particularly exposed to exploitation and other forms of serious human rights violations, contrary to Article 16 of the Convention on the Rights of Persons with Disabilities.