Monday, April 13, 2009

Iraq: Virtual therapy for real pain and suffering

By Julio Godoy - IPS
Republished permission Inter Press Service (IPS ) copyright Inter Press Service (IPS) and

BERLIN, (IPS) - "Oh, dear Lord, what I am going through," 'N', a 25-year-old Iraqi from Baghdad wrote several months ago. "Am I going to see my family again? Sometimes, I even see my own dead body, lying somewhere. And I imagine the pain my death would cause to the people I love the most."

N survived an attack on the transport enterprise he works for in Baghdad. He never managed to admit his trauma to anybody. Until he started psychotherapy – online.

N is one of some 300 mostly young Iraqis who over the last year have been undergoing psychotherapy through the Centre for the Treatment of Victims of Torture (BZFO, after its German name), which operates from Berlin. BZFO was founded in 1992, but its online therapy project for Iraqis started in the spring of 2008.

Christine Knaevelsrud, psychotherapist and director of research at BZFO says the first phase of the therapy is the most sensitive one. "The patients must comprehensively describe the experiences they want to repress the most, write them down, without giving up," she told IPS. "At this stage, most people want to break up the therapy."

The therapists insist that confrontation with the traumatising experience is indispensable to surpass it, to learn to live with it. In N's case, it was the sheer terror of the attack - the gun one of the assailants put on his temple, the executions he witnessed, the beatings he suffered in detention.

Knaevelsrud says the visual style of writing itself presents a picture. "The size of the characters they use, the way they distribute words on the page make me sometimes hear a cry coming out of my computer."

After several months under therapy, N reports he is better now. His fears and his vertigo have reduced, and he even manages to sleep well. Towards the end of his treatment, he wrote, "the bullet that does not kill you makes you stronger."

The style of N's closing letter was very different from his first, Knaevelsrud said. "It is better structured than his initial mails, the thoughts are clearer, and suggest inner calm."

Iraqis taking the therapeutic treatment online have been victims of violence, or witness to attacks, kidnappings, rapes, and executions. Sitting in Berlin, a dozen or so of psychologists communicate with them to work out ways of dealing with their distress.

"Almost half of our patients are women," says Knaevelsrud. "Our staff in Berlin is mostly female, and this helps to establish a trustful relation with Iraqi women who have been victims of rape or other forms of sexual violence."

Some of the counsellors working from Berlin are Muslim and speak Arabic, which makes communication easier. The Western counsellors use Arabic translators.

BZFO works together with numerous psychologists and psychotherapists in the Arab world. "We have cooperation with psychologists in Syria, Egypt, Dubai, in Iraq, and with colleagues of Arab origin who live in Europe," says Knaevelsrud.

BZFO has two actual clinics in Iraq, in the northern cities of Kirkuk and Sulaimaniya. A third is to be opened in Erbil, also in northern Iraq. "In those clinics, our patients are mostly women, and also children," says Knaevelsrud. A clinic in Baghdad is not considered feasible as yet. "No colleague would want to go to Baghdad, it is simply too dangerous."

Web therapy was developed in the Netherlands in the early 1990s, and is now applied in numerous countries, especially in Scandinavia, Australia and the U.S. "It is still seen with a lot of scepticism, because in it the sacrosanct relation between the psychoanalyst and the patient seems non-existent. But the relation is there," says Knaevelsrud.

"Actually, because of its anonymity, the therapy online helps many people overcome the inhibition associated with the admission of suffering psychological trauma," she said. "For victim of rapes and other forms of sexual violence, the extreme confidentiality associated with this form of therapy constitutes a real advantage."

Web therapy may also help overcome some traditional notions of pride and of honour. "Many people suffering from psychological trauma derived from the kind of violence prevalent in Iraq tend to see themselves as responsible for their despair," says Knaevelsrud. "For those people, to recount the incidents that provoked the traumas is extremely difficult. The anonymity of our scheme makes it less difficult."

In any case, Iraqis accessing the service have no alternative. "Most Iraqi psychologists left the country long ago," says Knaevelsrud.

Before BZFO psychologists begin therapy, the client must answer a questionnaire aimed at establishing the nature of the trauma. The patient must then write ten emails following a schedule set by the therapist, in which she describes her troubles. Each mail must be written within 45 minutes.

"All this is aimed at facilitating and forcing the patient to speak out, to describe her predicament," says Knaevelsrud. "The framework helps the patients to be efficient in overcoming their fear of losing dignity, and in their coming to terms with their trauma."

And yet, the method doubtless has limitations. For one thing, few Iraqis have access to a computer and to Internet access at home. Internet cafes rarely provide the privacy needed for such treatment. And the number of patients BZFO is able the treat is miniscule compared to those who need such treatment.

"Our method is better than doing nothing at all for the Iraqi people," says Knaevelsrud. "And we cannot also deny the growing presence of modern telecommunication in societies facing such violent crises as in Iraq."
Published by Mike Hitchen, Mike Hitchen Consulting
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