Course syllabus. Culture, Trauma and Healing: Applied Skills for Cross-Cultural Trauma Therapy. Canadian Counseling and Psychotherapy Association

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1 Course syllabus Course title Instructor Contact details Affiliation Course format Culture, Trauma and Healing: Applied Skills for Cross-Cultural Trauma Therapy Jonathan Nattel, M.A., C.C.C. Canadian Counseling and Psychotherapy Association Workshop Number of hours 30 Number of ECTS credits 3 30 hours - Class Time 25 hours Reading 25 hours Written assignments Brief course description While cultures around the world show remarkable diversity in terms of how they relate to trauma and recovery, there are certain underlying traits that seem to be common across all cultures. This course is designed to help students learn key concepts and gain fundamental skills for engaging in cross-cultural therapy with survivors of trauma. We will look at how various cultures make sense of post-traumatic experience, and how the western-trained psychotherapist can engage in therapy that is both culturally appropriate and clinically effective. Full course description Cross-cultural therapy with survivors of trauma provides a unique set of challenges and learning opportunities for the emerging therapist. On the one hand, the therapist must engage with the client in ways that are meaningful within the client s own cultural viewpoint and social reality. On the other hand, the therapist must remain firmly rooted in their own skillset, professional competencies and body of knowledge. This applied course is aimed at helping students to develop essential skills for working with survivors of trauma from diverse backgrounds. Through the use of case studies, group discussions and in-class exercises, students will become familiarized with some of the key topics in the field, and will be introduced to applied techniques for engaging in trauma therapy that is safe, effective and culturally appropriate. The following components will be progressively interwoven throughout the duration of the course: 1) Key Topics: Students will be introduced to some of the central themes and current debates pertaining to the field. We will look at questions such as: How applicable are western conceptions of trauma to non-western cultures? What ethical considerations are pertinent to

2 this field? How cross-culturally applicable is the western therapeutic frame? What kinds of adaptations and alternative frames have been developed in order to make psychotherapy for trauma more culturally appropriate? 2) Evaluation Skills - Trauma in Context: While trauma symptomology may have roots in psychophysiological processes that are biological innate, it is the way that these processes are given shape, context and meaning that form the culturally specific manifestation of posttraumatic symptomology. Factors such as social structure, cultural worldview, availability of social support and rules for emotional expression all influence how trauma manifests as well as how it is healed. Students will learn to identify ways that these factors are influencing the lived experiences of their clients, and to use this understanding as a basis for therapeutic intervention that is attuned to their clients social and cultural realities. 3) Applied Techniques: Students will have the chance to learn concrete skills for engaging in therapeutic relationships that are both meaningful to the client within their own cultural framework as well as being clinically effective from a western therapeutic standpoint. This will include techniques for forging a shared vocabulary with clients about trauma, resilience and healing, supporting the client s increasing capacity for self-regulation and symptom management, as well as support for the processes of memory consolidation and meaning-making that lead to long-term resolution of symptoms. We will give particular attention to the embodied experience of the client, which serves as both a doorway to language for subjective experience as well as being an entry point for clinical work that addresses some of the more universal aspects of human psychophysiological response to trauma. 4) Current themes: Students will be introduced to current themes pertaining to support and care for trauma-exposed populations. Group discussion and practical exercises will be geared towards helping students gain a grasp of current issues in the care of traumaexposed populations in Europe, with a particular focus on asylum seekers and refugees. Learning outcomes Upon completion of this course, students will: Be able to think critically about how cultures (including their own) conceptualize and relate to trauma and healing Recognize the ways in which the social and cultural environments of their clients are shaping the trajectory of trauma and recovery Have cultivated the capacity to create therapeutic relationships with clients of diverse cultural backgrounds Have become familiarized with techniques for supporting resilience, symptom management and resolution

3 Learning activities and teaching methods The learning activities of this course will involve a combination of interactive lecture (30%), group discussion (30%) and experiential exercises (40%). The lecture and group discussion portions will help students gain a working familiarity with the subjects at hand. The experiential exercise portion will be an opportunity to cultivated applied skills for engaging in cross-cultural trauma therapy. List of topics/classes and bibliography The following is a list of topics to be covered, together with corresponding readings. (*Please see below for full bibliography) Monday March 27 th (Hours 1-2) Introduction Overview of key topics Tuesday March 28 th (Hours 3-6) Western conceptualization of trauma and recovery Biological foundations of trauma symptomology Body-based skills for stabilization (part one) - Rothschild 2000 (pages 3-110) Thursday March 30 th (Hours 7-10) Cross-cultural perspectives on trauma and recovery Body-based skills for stabilization (part two) Dynamics of cross-cultural therapy The therapeutic alliance - Miller et al Rothschild 2003 Friday March 31 st (Hours 11-14) Social ecology of trauma, resilience and recovery Cultural and contextual challenges and resources - Groleau and Kirmayer 2004

4 Monday April 3 rd (Hours 15-16) Review of week one Western perspectives: cultural context and cross-cultural limitations - Summerfield Ayber and Ager 2001 Tuesday April 4 th (Hours 17-20) Refugees: In Europe and beyond Body language and cross cultural communication - Hobfol et al Einhorn and Cantor 2016 Wednesday April 5 th (Hours 21-22) Working across cultural and religious belief systems Cultural transference and countertransference Luhrmann 2013 Thursday April 6 th (Hours 23-26) Clinical skills for supporting recovery Community interventions resilience and recovery Reading - Rothschild 2000 (pages , ) Friday April 7 th Class 10 (Hours 27-30) Reflection and review

5 Bibliography: Books: Rothschild, B. (2000). The body remembers: The psychophysiology of trauma and trauma treatment. WW Norton & Company. Articles and Chapters: Einhorn C. and Kantor J. (2016, December 17) Wonder and Worry as a Syrian Child Transforms. The New York Times, Eyber, C., & Ager, A. (2002). Conselho: psychological healing in displaced communities in Angola. The Lancet, 360(9336), 871. Groleau, D., & Kirmayer, L. J. (2004). Sociosomatic theory in vietnamese immigrants' narratives of distress. Anthropology & Medicine, 11(2), Hobfoll S. E., Watson P., Bell C. C., et al. (2007). Five essential elements of immediate and mid term mass trauma intervention: empirical evidence. Psychiatry: Interpersonal and Biological Processes, 70(4), Luhrmann, T. M. (2013). Making God real and making God good: Some mechanisms through which prayer may contribute to healing. Transcultural psychiatry, 50(5), Miller, K. E., Kulkarni, M., & Kushner, H. (2006). Beyond trauma-focused psychiatric epidemiology: bridging research and practice with waraffected populations. American journal of Orthopsychiatry, 76(4), 409. Rothschild, B. (2003) No Techniques Required. In: The Body Remembers Casebook: Unifying Methods and Models in the Treatment of Trauma and PTSD pp W.W. Norton and Company. Summerfield, D. (2004). Cross-cultural Perspectives on the Medicalization of Human Suffering. In Rosen, G. (Ed.). (2004). Posttraumatic stress disorder: Issues and controversies. (Pp ) John Wiley & Sons. Further Reading (recommended): Hinton, D. E., & Kirmayer, L. J. (2013). Local responses to trauma: Symptom, affect, and healing. Transcultural psychiatry, 50(5), Hinton, D. E., & Lewis Fernández, R. (2011). The cross cultural validity of posttraumatic stress disorder: implications for DSM 5. Depression and anxiety,28(9),

6 Kirmayer, L. J., Lemelson, R., & Barad, M. (2007). Clinical Perspectives on Trauma. In Understanding Trauma. Integrating Biological, Clinical, and Cultural Perspectives (pp ). Cambridge: Cambridge University Press. Mattar, S. E., Drožđek, B. E., & Figley, C. R. (2010). Introduction to special issue: Culture and trauma. Porges, S. W. (2004). Neuroception: A Subconscious System for Detecting Threats and Safety. Zero to Three (J), 24(5), Reis, R. (2013). Children enacting idioms of witchcraft and spirit possession as a response to trauma: Therapeutically beneficial, and for whom?. Transcultural psychiatry, 50(5), Seligman, R., & Kirmayer, L. J. (2008). Dissociative experience and cultural neuroscience: narrative, metaphor and mechanism. Culture, medicine and psychiatry, 32(1), Silove, D. (2007). Adaptation, ecosocial safety signals, and the trajectory of PTSD. In Understanding Trauma. Integrating Biological, Clinical, and Cultural Perspectives, Sturm, G., Baubet, T., & Moro, M. R. (2010). Culture, trauma, and subjectivity: The French ethnopsychoanalytic approach. Traumatology, 16(4), 27. Summerfield, D. (2004). Cross-cultural Perspectives on the Medicalization of Human Suffering. In Rosen, G. (Ed.). (2004). Posttraumatic stress disorder: Issues and controversies. (Pp ) John Wiley & Sons. van Duijl, M., Nijenhuis, E., Komproe, I. H., Gernaat, H. B., & De Jong, J. T. (2010). Dissociative symptoms and reported trauma among patients with spirit possession and matched healthy controls in Uganda. Culture, Medicine, and Psychiatry, 34(2), Weine, S., Danieli, Y., Silove, D., Ommeren, M. V., Fairbank, J. A., & Saul, J. (2002). Guidelines for international training in mental health and psychosocial interventions for trauma exposed populations in clinical and community settings.psychiatry: Interpersonal and Biological Processes, 65(2), Assessment methods and criteria Participation 40% Brief written responses 20% Final paper 40% Participation: Students will be graded based their level of engagement with in-class activities, including interactive lecture, practical exercises and group discussion of reading assignments and selected topics.

7 Guidelines for the evaluation of in-class participation: An important aspect of this class is the concept of collaborative learning. This refers to the way that knowledge is generated and learning emerges through shared exploration and dialogue. Class participation will be assessed based on students personal engagement as well as their participation in creation of an environment that is conducive to shared exploration and learning. Specifically, this will be based on: Full and on time arrival at all classes Preparation of reading material will be assessed based on inclass discussions as well as written responses Engagement in group discussions and exercises this involves: Attention and responsiveness to ideas of others, willingness to share one s own ideas and supporting others in doing the same, conducting oneself in a spirit of engagement, curiosity and respect Participation in the creation of an atmosphere of respect, openness and collaborative enquiry Brief written responses: Students will be asked to submit a series of brief written responses (1-2 pages each, double spaced) during the duration of the course. These texts may address personal reflection regarding course material, in-class exercises or reading assignments. Final paper: (Maximum 1500 words) Option One: How does trauma present itself in your culture of origin? What are the resources that support resilience, and what are the pathways available for healing? Option Two: Select one of the themes that we have looked at in this course, and compare how this theme plays out in two or more cultures for which relevant literature is available. Examples of topics include the role of social support, dissociative experiences, cultural worldview, and so on. Attendance rules Prerequisites This course is based on experiential learning, and in class attendance is an essential part of the learning process. Students who need to miss a class for any reason should contact the instructor ahead of time if possible, and will be personally responsible for catching up on missed work. A maximum of one excused and one unexcused absences will be permitted in order to pass the course. Completed course on Psychopathology

8 Academic honesty Basket Students must respect the principles of academic integrity. Cheating and plagiarism (including copying work from other students, internet or other sources) are serious violations that are punishable and instructors are required to report all cases to the administration. Course is part of the Psychotherapy specialization Remarks