The Coalition for Work With Psychotrauma and Peace

Complex Rehabilitation

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When we go into a community, we talk about therapy and the economy and democratization. People say, 'We don't want therapy, we want to return to our pre-war homes.' But they come around to therapy, and then they talk about what happened, when we show that we are understand what they are talking about, when we’re empathetic, they'll talk and talk. They come around when they know you're on their side."

--Dr. Charles Tauber, Head of mission for Southeast Europe
Coalition for Work With Psychotrauma and Peace

The Coalition for Work With Psychotrauma and Peace (CWWPP) sees the problem of psychotrauma in its area of work (parts of Eastern Croatia, Bosnia, and Serbia) as an important element of the breakdown of society that resulted from the wars of dissolution of Yugoslavia. Other aspects are displacement of people from their homes, unemployment, destruction of physical infrastructure, increase in chronic disease (which is also partly a result of the psychotrauma – see Profile of Trauma), and poverty.

All of these problems, and many more, are intertwined. Reconciliation will not happen without psychotherapy (better said: psychological assistance), and a person suffering from post-traumatic reactions has obstacles within him/herself to economic and social reconstruction (see the CWWPP Briefing Paper on the relationship between economics and psychotrauma). People also have to learn how to solve their difficulties non-violently. They have to learn basic attitudes such as self-reliance and self-initiative. Given the interconnected nature of these difficulties, the CWWPP's model for post-war social reconstruction and reintegration rejects a fragmented approach that gives attention only to one part of the problem. It also rejects a short-term "quick fix" approach. Rather, CWWPP has designed a strategy that it calls "Complex Rehabilitation".

Complex Rehabilitation is an intensive, integrated, long-term approach that includes therapy, capacity building within the community and research. It involves a number of elements:

• Good assessment of the local situation.  This assessment must involve all groups of the population in the assessment process (“action research”).  It also includes mental and physical health epidemiology.

• Training of local professionals and non-professionals and the population as a whole in psychotrauma relief assistance including peer-group counseling, non-violent conflict resolution, community organization, critical thinking, and self-reliance as well as in such essential skills as communication, organizational management and coordination.

•  Involvement of the population in making plans for the development of the community.

•  Work on reconciliation at a speed appropriate to the situation and the people involved.

• Encouragement of the formation of local initiative groups and NGOs, and the formation of coalitions among these organizations.

• Continuing evaluation of the process as a whole and of each element of it.

• Continuing research into the problems and the solutions to them at a theoretical and practical level.

Projects undertaken by CWWPP employ this multi-level approach to address problems by keeping in mind their connection with each other. Thus, one of the guiding principles of the organization's work is to engage a group or a community in its own future. Dr. Charles Tauber notes, "Complex rehabilitation involves getting the entire community involved. You have to be careful not to exclude anyone."

When CWWPP starts a project in a village or town, it approaches refugees, displaced persons, and long-time residents. Groups of women, demobilized soldiers, workers from a factory that no longer exists, the elderly, union activists, parent-teacher organizations and the elderly all need to be included. At the core of this approach is a strategy that emphasizes the development of civil society institutions. These grassroots institutions, armed with the skills and training provided by CWWPP, give people the tools with which to solve their own problems.

Components of Complex Rehabilitation include:

• Psychotrauma/Health

• Non-Violent Conflict Resolution

• Democratization

• Capacity Building

• Advocacy

• Research and Education

• Legal, civil, and human rights

• Economic recovery

• Cooperation among local organizations, and between these and national and international governmental, inter-governmental, and non-governmental organizations

Part of this strategy is to work at the levels of

• the individual,

• the family,

• the group,

• the community

• and, eventually, the society.

One might ask how CWWPP can possibly address so many problems all at once. The chicken-and-egg dilemma is whether, for example, to tackle post-trauma disorder first, or to get people back to work? Both are crucial problems. The CWWPP's answer is to work on whatever the group involved sees as most important first, but to remain open to tackling related problems as they arise.

In one case, CWWPP was working with a village organization on communications skills. Members were learning how to write letters to authorities, how to file complaints about harassment, and how to organize meetings. One day. a member came to the meeting crying that she had been the victim of domestic violence. With the guidance of the group leader from the CWWPP, this opened up a fruitful discussion within the group on the trauma-related phenomenon of family violence. This problem was addressed for several meetings, and then the group was able to turn back to its original goals and later deal with other, trauma-related problems.

The CWWPP launches a project slowly, so as to earn the trust of a community. This is a long-term approach. The first step is to let people talk, let them get it all out. That works. You then help people figure out the next step. If they want to figure out how to get their rights from the government, you help them learn how to write a letter, to speak to an official, to structure a discussion so that international organizations understand what they are talking about. You talk about how to organize a presentation. When this works, it raises confidence, and then you can talk about trauma. You raise people's trust in you, and in each other. Then you can work on other issues. But it takes a year and a half or more. It's a process which requires patience, persistence and creativity.

Dr. Tauber also emphasizes the importance of research to this and other areas.  “There is not a great deal of data on the mental health or physical health epidemiology of our area of responsibility.  Furthermore, we need to study, for example, the influence of coping mechanisms and the influence of psychological trauma on economic recovery, and the influence of a large number of other factors that contribute to recovery, reintegration and reconciliation.”  This is why the CWWPP is working with others to form an Field Institute for Conflict, Post-Conflict and Conflict Prevention Studies and Peacebuilding and why the organization is proposing to form an international working group with projects in a number of similar areas.

The CWWPP believes that it is only through such integrated approaches and continuing research that efficient and effective reconciliation and redevelopment can succeed.

For examples of proposals for programs of Complex Rehabilitation, see the Documents Section of this website.