Groupwork with Refugees and Survivors of Human Rights Abuses: The Power of Togetherness. Eds, Jude Boyles, Robin Ewart Biggs, Rebecca Horn and Kirsten Lamb. Routledge. 2023
Memory, Forgetting and Corporate Culture. Review of ‘Groupwork with Refugees and Survivors of Human Rights Abuses: The Power of Togetherness. Eds, Jude Boyles, Robin Ewart Biggs, Rebecca Horn and Kirsten Lamb. Routledge. 2023 Pp241.
“The struggle of man against power is the struggle of memory against forgetting” Milan Kundera.
The birth of a project and the development of ‘groupwork’.
In 1985, the Medical Section of Amnesty in London broke away from the main organisation to form the Medical Foundation for the Care of Victims of Torture, with Helen Bamber as its director. Helen had been the first civilian to arrive with the British Liberating Army at the Belsen Concentration Camp in 1945. Her biography, The Good Listener (Belton 1998) tells the story of her work from that time through to the founding of the Medical Foundation (MF) and its development into the 1990s as well as the development of tyranny and torture around the world over the same period.
I joined the MF in 1987, about 18 months after its official birth. There had already been a therapy group co-conducted by Helen and John Schlapobersky (Schlapobersky and Bamber 1988) parts of which are also recounted in John’s book, from the Couch to the Circle (Schlapobersky 2016).
The second therapy group to be organised was for Latin Americans co-conducted in Spanish by Perico Rodriguez and Mick Venables. As I described in my small book, Counselling and Psychotherapy with Refugees (Blackwell 2005), I had already co-opted Perico as my unofficial ‘supervisor’ for the individual therapy I was doing there (since I knew next to nothing about refugees and their experiences) then he and Mick took me as their official ‘supervisor’. In those days I was naive enough to think that the important thing was to get to the recollections and accounts of torture and violence. Perico and Mick knew better the importance of developing what we would identify as a matrix based on the shared experience of being Latin Americans in exile.
The third group was the one I conducted which brought together four African clients I had seen for a while individually. Although the countries from which they came were thousands of miles apart, they soon began talking about their shared experience as Africans and being colonised, particularly by the British. None of them had mentioned this subject in any of the individual sessions that preceded the forming of the group. It seemed they needed the solidarity of the group to raise an issue that could potentially challenge me. At some point when I naively suggested that perhaps a lot of the talk about culture and identity was serving to avoid their more painful memories, I was put firmly in my place by one of them telling me that they needed to spend time getting to know each other before they could talk about ‘the bitterness’.
Around the same time, Rachel Tribe and Jane Shackman broke new ground co-conducting a group of different nationalities with several interpreters in attendance. (Shackman and Tribe 1989). It sounds potentially chaotic but it worked.
In 1988, Helen, John Schlapobersky and I presented some of the MF’s work at the first conference of European Society for Traumatic Stress Studies, (which gave birth to the International Society for Traumatic Studies,) introducing a group analytic style large group discussion after three short presentations.
Although the term ‘football therapy’ was never used, Rachel Tribe became the manager of the MF clients’ football team which played in an East London league, displaying the sort of passing game that was years ahead of the standard ‘direct approach’ characteristic of English teams of that era. Despite the racism the team suffered and the occasional violent confrontation that ensued, the players gained considerable satisfaction and confidence, not only from just playing football but from being able regularly to outplay their more laboured and predictable opponents.
In the early 1990s, the MF itself set up a large group for its staff, what was then called ‘staff support’ and would now go by the name of ‘reflective practice’. That was convened by two group analysts, Sheila Ernst and Norman Vella.
Soon a groupwork department was formed: Jeremy Woodcock set up a Hearth and Story Telling Group which began with the sharing of food and stories being told leading into more free associative group discussion; Karen Callaghan started a dance and movement therapy group; Sheila Melzak introduced groups for children and adolescents, to be followed later by members of her child and adolescent team conducting groups for refugee children in schools; and I believe some music therapy was also developed. Later, another group analyst, Seda Sengun conducted a group analytic group, to be followed some years later by Sarah Tucker. Supervision for the volunteer counsellors and psychotherapists that I co-ordinated was conducted entirely in groups for over fifteen years.
Art Therapy was begun by Rosemary Levy in the organisation’s earliest days, and subsequently developed by Claire Manson, Sally Skaife, Frederica Brooks and others. while Diana Brandenberger initiated an Art Studio which later moved on to become the independent New Art Studio founded by Tania Kaczynski and Jon Martin. In 2005 Debra Kalmanowitz and Bobby Lloyd published Art Therapy and Political Violence.
There was also the ‘Write to Life’ group that engaged clients in creative writing, and Michael Korzinski’s Somato-psychotherapy bringing Reichian ideas to develop ways of working with the body and the mind.
During the early years various connections were made with other workers both overseas and in the UK. We had visits from Argentinian colleagues who had provided psychological assistance to Las Madres de Plaza de Mayo, elaborated in ‘The Psychological Effects of Political Repression (Kordon et al 1988), and from South African colleagues from OASSA (Organisation for Appropriate Social Services in South Africa). One of our staff, Israeli peace activist Rami Heilbron, made links with the Gaza Mental Health Centre and also developed links in Somalia. Through meetings of the International Society for Health and Human Rights we met colleagues doing similar work in the US, Australia, Canada, Chile, Palestine, Denmark, Sweden, the Philippines and elsewhere, generating a substantial sense of international solidarity and support.
In Africa, after the defeat of Milton Obote in the Ugandan civil war, the new president, Yoweri Museveni, invited the MF to send a team to respond to the needs of Ugandans traumatised by the war. Pat Bracken and Joan Giller were sent by the MF on this mission and were amongst those who, echoing some of the issues already raised by Latin American colleagues, spelt out the problematic nature of medical diagnoses and Western concepts of therapy particularly their individualisation. (Bracken and Petty1998, Giller 1998 and Bracken 2002). A similar critique was developed from the MF’s home base by Derek Summerfield (2003, 2005) who argued clearly that the health and wellbeing of survivors in London was more intimately connected to political justice than to what was conventionally regarded as ‘therapy’.
In the North East of England a group of former prisoners of war from Japanese prison camps approached Helen Bamber because late in their lives memories of their prison camp experiences were caching up with them. Helen began travelling to their location on a regular basis to participate in their group that met in a pub. A project that subsequently produced Eric Lomax’s book, The Railwayman. Lomax was a railway enthusiast and while in the prison camp he had drawn a map of the Japanese railway system. The prison guards on finding the map assumed it was an act of espionage and had tortured him to find out what he was up to, refusing to accept his pleas of innocence. (Lomax 2014)
In 1998 Ditty Doctor edited a collection of papers, ‘Arts Therapists, Refugees and Migrants: Reaching Across Borders’, which included reports of music therapy, art therapy, movement therapy, dance therapy and drama therapy.
Jenny Grut (2003) describes the natural growth project she created where clients who were too devastated to relate to others, began by working in a garden/allotment relating to life through ‘nature’. Gradually communication could develop in the garden, with conversation about the garden eventually leading to group discussions and what might be termed group therapy. This project was further developed by Mary Raphaely who introduced ‘body mapping’ as an artistic way of facilitating memory and dialogue.
In 1990, I visited the Red Cross Treatment Centre in Stockholm and later that year one of their therapists, Marika Lindbom Jacobson, and I conducted a workshop at the second conference of the European Society for Traumatic Stress Studies, on ‘Countertransference’. We wanted to explore with colleagues working with different traumatised populations what motivated them/us to take up such work and what impact it made on them /us and their own lives. Two things emerged conspicuously from that event. One was how exclusively attached we all were to our own particular field of traumatic experience. Those working with victims of sexual abuse would not want to work with victims of sinking ferry boats, or with victims of war and torture. Those of us working with victims of torture and war had relatively little interest in fires at football stadia or child sexual abuse. The second thing was the appreciation for the workshop because ‘We never talk about these things back at our home organisations. We never have the opportunity’. The impact on therapists of working with acute levels of shock, horror and terror seemed to be routinely overlooked by senior managers and those in charge of the organisations for which the therapists worked.
In the late 1990s as refugees began to arrive in significant numbers from the wars in (former) Yugoslavia the MF was asked to provide consultation to the Red Cross and the Refugee Council. Being directly involved in the consultations I placed some emphasis on support for staff in the various establishments working with the newly arrived refugees. The resistance to this idea at management level was considerable. What was wanted was ‘training’. This seemed to be based on the belief/fantasy that if sufficiently trained, staff would not need ongoing support and reflection. It was a dangerous belief in professional omnipotence that, curiously, was not coming from the professionals. The other duck and dive was the suggestion that such support might be valuable for the interpreters who were closer to the clients by virtue of them being members of the same traumatised population. Shifting the burden onto the interpreters in this way was an example of the way interpreters are frequently exploited. Although recognising the stress of the interpreters’ task and providing some support for them is perhaps better than the partial negation to which they are not uncommonly subjected.
Later, in the life of the MF Jeremy Woodcock conducted a research project on the impact the work made on the therapists doing it. Although he presented his findings to his fellow therapists it seemed to attract little interest from managers and trustees. It seems that the defences against recognising that counselling and psychotherapy calls for the therapist to enter imaginatively into the clients’ horrific experiences as they are recounted, and that such activity might have consequences for those engaged in it, are ubiquitous. And this denial carries serious dangers for the organisation.
In those earlier years the MF could be a fraught place to work. Like any organisation operating in such a grim and painful field it had its faults of which many of us were aware and to which we all contributed in some way or other. There were always tensions and the inevitable problematics of white middle-class professionals trying to provide a service rooted largely in western scientific, philosophical and medical paradigms, for a population coming predominantly from what we then called the ‘third world’ and is now perhaps better referred to as the Global South.
But there was also a camaraderie and an egalitarian and democratic climate. Some of us at least were clear that we were engaged in a political project. A project opposing not only torture but the systems of power and domination that facilitated it and relied on it to retain their power to maintain those patterns of domination and exploitation. We shared a warmth and a sense of solidarity so that when the Sandinista government in Nicaragua was finally overthrown by the US sponsored terrorism of the ‘Contras’, I drove in to the MF on a day I didn’t normally work there in order to be with friends and comrades who I knew would share the pain and sadness at this defeat. There was also an underlying humility that may not always have been evident and may not have been shared by everybody but it was there nevertheless. Helen never referred to ‘clients’ or ‘patients’ but to ‘our people’. She told me once that she often thought that they taught us how to help them. This, in spite of the all the expertise we might think we had. And Helen really did know a lot more about torture and its consequences than most people in the world. There was also Perico’s prophetic warning of the danger of becoming part of ‘an industrial system of production in which somebody is torturing at one end and we are curing at the other end.’ (In Belton 1998 Pp394.)
A Matricide? A Coup d’Etat? An Industrial System?
All of this is now gone and the organisation has been slowly but surely managerialised and corporatised beyond recognition. First, back in the 1990s there was an assistant/deputy director who, in response to some staff complaints, uttered the familiar mantra, ‘Management’s Right to Manage’! For anyone unfamiliar with this ‘right’, it means in practice, management’s entitlement to do whatever they like without any accountability to those they manage. It’s a defensive resort of authoritarian managers who don’t know how to engage in dialogue with their staff. His appointment was later followed by that of director of finance, followed by the establishment of an ‘Opps Team’ that became the group that essentially ran the place. ‘Then came the ‘New Building’.
The MF had begun its work using one floor of the National Temperance Hospital in North Central London. When NHS managers decided they needed the space for more pressing requirements necessitating a search for accommodation, a new home was found a mile or two further north in Kentish Town. It was a somewhat ramshackle four story building in which anyone descending the stairs with heavy feet could cause echoes and vibrations through the whole place. Yet it had a sort of charm with a proximity to a sandwich bar, a cafe and initially a pub around the corner, which were popular with many of the staff. But from somewhere came the desire for another bigger and more ‘suitable’ building. And so it came to pass that a supposedly purpose designed premises was built to the east in Finsbury Park. The design, so it was rumoured, won an architecture award.
I was uneasy about it from early on. Flash premises somehow didn’t go with the culture of a project like the MF. There’s something about such wonderfully ideal and idealised projects that, I suspect, invariably overlook some thing crucial. This one was designed with curved corridors, supposedly to differentiate the building from the prisons in which our clients might have been detained and tortured. Wonderful! But arriving at a meeting soon after we moved in, I was advised as I sat down to be careful not to scrape my chair on the floor. I asked if that was because the floor had the sort of delicate polished finish that could be easily scratched. “No!” I was told, “It’s because Mary is conducting a group next door.” The purpose-built large room that could accommodate staff meetings and sub-divide into three smaller rooms for smaller meetings and small group therapy had partitioning doors that were not sound proof. Surprise, surprise! So much for ‘purpose built’, ‘architectural awards’ etc. Soon afterwards, as spring changed into summer, I discovered that the windows could not be partially opened for ventilation because there was no mechanism to control how open they were. Either they stayed closed or were wide open flapping in the wind. Alternatively, as I was advised by the Facilities Manager, you could ‘shove a book or two into the gap to prop them open’. Form was by now taking over from substance.
But even before the move to the new building, the Trustees had taken the extraordinary step of pressing Helen to allow herself to be, as the saying goes, promoted sideways. She was to give up being director but allowed to pursue her own work with clients in an annex building in Hampstead. Moreover, she was persuaded to to tell us all that she was a party to and in agreement with the decision. She was further dissuaded from having any sort of leaving party to celebrate her years as director and mark her transition to a new role, because it might leave some staff feeling upset. It was perhaps the first clear emergence of a sort of ‘double-think’ that was to become more familiar to us. It was not the first time, nor would it be the last that staff who were expected to be sufficiently grown up and resolute to deal with the horrors brought daily by our clients, were at the same time treated like fragile children who needed to be protected from painful realities.
It has never emerged quite how the trustees arrived at this decision, which on reflection seems like a mixture of matricide (for which we might seek a psychodynamic explanation) and coup d’etat (for which we might seek a political explanation). But with Helen on the way out, the door was opened to some more of the naivety that had always hovered around in the background.
Looking back, it is easy to see the quite early presence and subsequent development of the white, middle-class culture of virtue; which is of course both a cover and a compensation for a multitude of unconscious sins and desires. The consequent rescuing and saviourism were for some time kept in check by more realistic views of the political nature of the whole project; and of the complexity of unconscious motives, that often included the need to both nurture and be nurtured, that drew all of us to work in this particular setting. But, without the holding provided by Helen’s directorship, the anxieties generated in such work gained more ground.
Anxieties generated by the difficult task of assessment and allocation of referrals that actually needed sensitive and flexible negotiation could be avoided by simplistic and rigid procedures and protocols. Anxiety about the number of referrals could be alleviated by deprioritising those who were not recently arrived on the grounds that their needs must be less pressing, otherwise they would have contacted us sooner. Given the time it often took for memories and injuries to surface, this was clearly nonsense, yet it nevertheless gained traction as ideas that relieve anxieties so often do.
Helen’s first successor as director, a distinguished human rights researcher with no background in nor much enthusiasm for counselling and psychotherapy, lasted three uncomfortable years. The job, retitled as CEO, then went to the erstwhile director of finance who was about as well equipped as one might expect of a director of finance.
What had not been well known before was his pedigree of seven years working at the CBI. (Confederation of British Industry). In no time at all there was an ‘Action Plan’ and the installation of a Human Resources Department. Then began the disappearing some of our own staff. As one colleague put it eloquently in a meeting, ‘First you come in one morning and X is missing. Then you hear they’ve been suspended. Next you’re told they’re taking sick leave. Then you hear they’ve accepted redundancy.’ The CEO pleaded that it was unreasonable to talk about ‘disappearing’ people because they weren’t being taken up in helicopters and dropped into the sea. That response left us wondering how much such literal thinking, denying any kind of analogous meaning and negating the possibility of institutional countertransference, was symptomatic of a context permeated by traumatic violence or whether he and his senior management team were just playing games. Unsurprisingly, word got around outside the MF and a colleague from another agency whom I met at a conference commented straightway on how strange it was that the MF seemed to keep getting rid of its staff.
The arrival of outside consultants from NHS establishments, along with the Trustees expressed wish to make the MF more like the NHS, added further to the organisation’s drift away from its roots.
The growing ideology of managerialism was evident when the post of Director of Clinical Services was advertised, listing possession of an MBA (Masters Degree in Business Administration) in the ‘Person Specification’ as ‘desirable’. The guy appointed decided he wasn’t going to see any clients but would simply direct everyone else’s work. He had little discernible experience in work with refugees in the UK or Europe and little apparent understanding of international politics or the history of torture and organised violence around the world.
But based on a modicum of psychodynamic knowledge he set about re-organising the clinical services as if all that had preceded his arrival was of little worth or consequence. Not an approach that won him many friends amongst clinical staff. But the voice of clinical staff was becoming increasingly insignificant. Shortly before leaving the old building the Public Affairs department had proposed inviting former US president, Jimmy Carter, to formally open the new building. This was strongly opposed by staff acutely aware of the human rights record of the US particularly its contribution to the civil war and political oppression in El Salvador during Carter’s presidency. In those days, clinicians still had an influential voice. But with a new CEO and with a new Director of Clinical Services, another branch of the increasingly Thatcherite hegemony was firmly established. As one colleague put it, we were fast becoming the ‘Medical Foundation dot com’!
Along with the disappearances, there was a week long consultation provided by modern trendy management consultants, and a presentation by a supposed authority on research offering a simplistic but allegedly sophisticated approach to clinical research to an audience of staff presumed to be entirely uninformed on the subject.
By this time, the board of trustees was chaired by a city lawyer from a law firm advising companies on navigating the requirements for entry and operation within various parts of the ‘developing world’. One of the ‘non disclosure’ agreements a colleague signed in order to get her/his pay-off, drew a gasp of admiration from another colleague. Wow, absolutely watertight! What an achievement for a human rights organisation to excel in what has now become a notorious practice!
At one supposedly free and open group for reflection and dialogue I suggested that the so called re-organisation of the clinical services was like a sort of ‘Year Zero’ as popularised by Pol Pot. It was an unexceptional observation based on the understanding that organisations like the MF are prone to reproduce the dynamics and patterns characteristic of the field in which they work. But the management seized on it as an excuse to begin a lengthy wrangle ending in the termination of my contract. It was claimed that I showed no confidence in or respect for senior management. That at least was true. It was also true for at least half the staff to whose discontent I had given just a little voice.
Over the subsequent decade meeting up with former colleagues I continued to hear of the low morale and staff discontent that came to characterise what had once been a fulfilling if sometimes stressful place to work. “I stay because I love the clients and the work but if only there were somewhere else I could do it!” was an oft heard refrain.
The simplistic approach to management was subsequently matched by an equally simplistic approach to therapy. Imagination and creativity gave way to manualised procedures. What now remains is an impressively smooth public relations exercise in promoting the FfT brand. The website claims ‘We stand with survivors of torture’. There’s lots of other impressive sounding words and statistics. But little real insight and a once impressive library including numerous publications by MF clinicians as well as a wide survey of the whole field, has disappeared. A google search promptly produces, ‘Freedom from Torture-Donate Now’. Leaning heavily for credibility on its recently developed ‘Survivors Speak Out’ section, it shamelessly parades the pain and suffering of survivor clients in its appeals for funds, now around £12m a year. FfTDN!
It’s a predictable outcome of what was effectively a Thatcherite managerialist coup as prelude to corporatisation. A sort of asset stripping vandalism fronted by a lot of happy, positive, ‘have a nice day now’ messages, and the development of branches in various parts of the country like a very small scale McDonalds. It is what I now regard as an occupied territory. A place that fulfils Perico’s prophecy of the production line where people are tortured at one end and cured at the other.
Why, it may be asked, do I tell this sorry story now in the course of a book review?
Firstly, because history matters and this book in many ways gives a troubling impression of ‘reinventing the wheel’. The uninformed reader could be forgiven for imagining that no-one had ever before organised or run the sorts of groups it reports. Thus is important pioneering work and those who have done it written out of history. And so is the way in which so much of that work, and the spirit in which it was done, has been destroyed.
Secondly, because this history has remained untold for too long and as Kundera says, our struggle against power is the struggle of memory against forgetting.
Thirdly, because there is so much to be learned from the past: Not only about clinical practice, but perhaps more importantly, about the workings of power, the potential for destructiveness of well meaning people, and the way oppressive ideology can permeate apparently radical and progressive projects.
One lesson is that the most important groups to pay attention to may be the ones of which one is a member in one’s own organisation. That’s where some of the most destructive dynamics can operate. Over thirty years ago, Bustos (1990) described a therapy organisation for torture survivors collapsing into authoritarianism. Over a decade later, Jeremy Woodcock’s research on the impact of the work on Medical Foundation therapeutic staff was largely ignored. And the problems of the organisational group are massively compounded by being ignored or denied.
Another is that few people are more dangerous than those who set out to do good in denial of their capacity also to do bad. Moreover, amongst some seemingly well intentioned white middle-class people there can lurk a potent mix of hubris and innocence, along with a certain conformism and the unconscious sadism that often underpins it. All of which can be found, not only in Thatcherism but also in many of those who overtly claim to be part of a liberal left that might be assumed to be anti-Thatcherite.
A third lesson is that when Mrs Thatcher said ‘We must get our people in everywhere’ she wasn’t joking, and she’s been extraordinarily successful at doing it. Moreover, even where ‘her people’ haven’t gotten in, her ideology and her modus operandi have.
Worse still, it is not just what has happened to FfT. The Refugee Therapy Service has become increasingly bureaucratised. As has my last refugee community, the Baobab Centre for Young Survivors in Exile.
The Helen Bamber Foundation founded by Helen in 2005 announces on its website. “The Helen Bamber Foundation saw that it didn’t matter who was the instigator of the violence against a person, but rather the impact of that extreme violence on the individual.”
This is what Helen actually said to her biographer, “You have to place torture in a proper context. Otherwise you are not actually honouring the people who have suffered, you are merely looking at a body that has been assaulted.” In 2019 I was consulted about the plight of a group of refugees who had exhausted their allocation of therapy at the HBF and could not go back for more. Helen would have been appalled. But that’s the context in which we encounter this book.
The ‘Groupwork’ book.
There are twenty chapters describing different sorts of groups in different parts of the world for different populations suffering different forms of oppression and violence. The accounts are divided into three sections, (‘Building Communities’, ‘Body and Soul’, and ‘Together through Talk’) and there are recorded discussions between the different authors at the end of each section. The accounts include work in Peru, Tunisia, Zimbabwe, Uganda, Kosovo, Congo and Colombia as well as work with refugees from many other countries undertaken in London and Manchester.
There is little doubt that these groups are highly valued by the participants who derive considerable benefits from working together to help each other rather than being individually helped by an individual counsellor/psychotherapist. There are also an impressive range of groups engaged in art, writing, sewing, football, music, gardening, most of which include some talking as well as those that just talk, and there’s a therapeutic community too.
But we’ve known the benefits of group therapy for people traumatised by war since 1945, and there’s barely a mention of 70 years of Therapeutic Community history with its variety of creative activities to develop the whole person rather than just focussing on ‘symptoms’. Not to mention the thirty years of work already recounted here.
So, this book is an extraordinary mixture of brilliant and inspiring work interwoven with, and to some extent undermined by, a contemporary neo-Thatcherite corporate language and a strange sense of disconnection: Disconnection both from the history of group working in this field and from the political contexts in which it has been and continues to be located. It struggles, moreover, with an approach in which great emphasis is laid on including the ‘clients’ and their cultural values in the development of the actual groups while at the same time appearing often to be exporting preconceived Western models: A strange mixture of self-reliance and colonialism.
The contradictions begin with Robin Ewart Biggs’ excellent opening chapter citing Fanon, Freire, Martin Baro, W E B Dubois, Kehinde Andrews and Primo Levi, talking in terms of therapy as liberation rather than cure.
Moreover, he makes the poignant observation about our own organisations. “….avoidance is not just the preserve of the trauma victim. Witnesses, helpers, communities, organisations and societies can also enter into the dynamics of avoidance. And at organisational social and political levels this can move into processes that, both unwittingly and deliberately, involve the silencing and further oppression of survivors.”
It really is ‘fighting talk’. A most promising opening. The trouble is, that’s about the last we hear of it in the book. None of the people he quotes get much of a mention from the other contributors. And there is next to nothing on the corruptibility of the practitioners or their organisations.
What we read instead are numerous accounts of creative and even heroic work in different parts of the world, some of it of substantial political import, disappointingly rendered in the leaden language of a product called ‘Groupwork’. Many of the chapters quote the moving and inspiring voices of the group members themselves; but too many of them say a lot about how much they benefit from and value ‘being in the group’ and relatively little about anything else. There is a troubling sense that these quotes have been selected as endorsements for the new ‘Groupwork’ brand.
It is fine to talk about moving away from a medical model as one voice in the third discussion between authors proposes. But it rings a bit hollow in a book that still seems much preoccupied with reifying something called ‘trauma’ (now seemingly a contemporary in-word) along with the highly disputed and contested diagnostic category PTSD, and talks constantly of healing and treatment, and includes references to Cognitive Behaviour Therapy, Dialectical Behaviour Therapy, Needs Assessments, Good Practice, Evidence Based Practice and various other forms of objectification of the ‘other’ who is assessed, diagnosed and treated according to models and modalities in which, in the interests of diversifying expertise, members of those others’ communities can be trained.
Worse still is the buying into ‘evaluation’ exercises that seem further to objectify the members of these groups as recipients of some special form of intervention, that while often well disguised seems to originate in conventional Western clinical paradigms and comes with uncomfortable echos of colonialism and cultural imperialism. It’s a very long way from therapy as a praxis of solidarity driven by the oppressed.
For example, one chapter, ‘Sew to Speak’ describes groups in which the members come together through sewing continuing a transcultural tradition of women coming together to sew stories into various fabrics. It’s great stuff in many ways. But the organisation promoting it around the world is an NGO that began in Switzerland before relocating to New York. It’s website lists its objectives as,
- Build local capacity to provide psychosocial support for survivors of violence
- Develop culturally responsive programs in collaboration with local partners
- Embed psychotherapy within an array of holistic services for survivors
- Integrate traditional practices with evidence based, trauma-informed psychotherapeutic practices
- Promote survivors’ strengths and resilience rather than simply treat symptoms
- Contribute to the field of trauma therapy
All presented as if there could be no possible contradiction between ‘traditional practices’ and ‘evidence based, trauma informed psychotherapeutic practices’.
Around ten years ago a community worker I met in South London explained her work as trying to engage members of the local community in various community projects. But these projects were devised by the local authority. Thirty years earlier ‘community work’ had meant assisting members of a community to consider and formulate their own needs, give voice to them, organise themselves and if necessary make demands on local authorities for relevant and necessary provisions and facilities. This shift in the source of the initiative is crucial in the modern approaches to population management and control that have developed in the era of a globalised neoliberal political economy, well elaborated in Jeff Halper (2015) ‘War Against the People’.
So questions need to be asked about some of these projects. Whose initiatives are they? Whose desires do they reflect? Although the participants may display less symptoms, become better adjusted and more emotionally stable, do they become more politically potent? Do they become more critical or outspoken. Where is Freire’s ‘conscientizacao’?
The most conspicuous form of people organising themselves into what might be called ‘groups’ in order to advance their rights and interests over the last two hundred years, has been in trade unions. The TU movement has arguably been the most widespread international movement advancing human rights against power and exploitation. Yet in this book I can find no mention of it at all.
Chapter 4 reports the heroic political struggle conducted by a group of mothers of the ‘disappeared’ in Peru. But it tells us little about the political context in which it takes place. It seems to blame the disappearances on both the state and the guerrillas who oppose it. My little bit of research suggests that Sendero Luminoso (Shining Path) guerrillas do some kidnapping as a form of recruitment, but the ‘disappearances’ in the sense the term is generally understood, are mainly if not entirely perpetrated by the state. There is no reference to the origins of ‘Sendero’ nor to the political economy of either the past or the present, not crucially to the place of US imperialism in the whole picture. Moreover, it is an account absolutely crying out to be connected with the similar struggle of Las Madres de la Plaza de Mayo in Buenos Aires three decades earlier. But they don’t get a mention. Instead, the whole political struggle is presented as an example of ‘groupwork’. It seems a strange contradiction between support and appropriation.
Similarly chapters on work in Zimbabwe and in Kosova have little to say about the relevant political history or political economy. It’s as if the conflicts that produce the survivors just flare up between different groups of people with neither rhyme nor reason. But the main and endlessly repeated message is how much the survivors are helped by ‘groupwork’.
I’m particularly struck by the football therapy reported from Manchester: one of the most famous cities in the world for football. The ‘clients’ seem to turn up regularly for what would appear to be a fairly standard training session followed by a sort of therapy group discussion. But they don’t seem to have a team or play any games against other teams. It looks like a step backwards from where the old Medical Foundation had already got to in 1990. More worrying still is the quote from a client saying he’s never seen any of the staff be angry. What? Football without anger? It has uncomfortable echoes of what seems to have become fashionable in some therapeutic approaches especially in some work with refugees, where the therapist is supposed to be a sort of paragon of love, peace and benevolence who never feels or owns any anger; leaving the clients to feel it all and feel inhibited about showing it in a context where it’s clearly de trop.
One of the better reported chapters is about a therapeutic community. The author had actually begun by asking a group of clients what they thought would help them, and they told him they wanted somewhere to come together and to grow food. From there evolved a ‘community’ with flexible boundaries, and what appears to be some democratic decision making and mutual learning together along with paying attention to power dynamics and the problematics of ‘whiteness’.
Another beautifully written chapter about a garden based group repeats much of the Medical Foundation’s Natural Growth Project, and echoing Bob Dylan’s recognition of the importance of the non verbal, “When you want somebody you don’t have to speak to…”
But the lack of any meaningful political history or analysis of the contexts of all these groups remains problematic. Several chapters address violence against women yet the ubiquitous, underlying patriarchy and sexism remain substantially unaddressed. While the editors write of the implications of them being white and UK-based they make no mention of their class and its consequent ideological and cultural position and perspective.
In one chapter there’s reference to a Sudanese woman whose husband and son are ‘missing’ in the Sudan’s civil war, as struggling “to accept where life had placed her.” What exactly does that mean? She’s been placed in a refugee settlement in Uganda by a civil war involving conflicts over oil and gold along with religion and tribal rivalries. These forces may have a long and complex history, but to label them simply as ‘life’ is to deny the woman a meaningful explanation and understanding of her predicament and to absolve everyone of any responsibility for it. It think that’s a strange kind of ‘therapy’.
The discussions between authors are interesting and revealing. They are built on the questions: ‘What is the core message of their chapter? Had writing their chapter changed their approach to groupwork in any way? And what statements could they come up with to encourage more groupwork opportunities?
One says that writing the chapter created the space to reflect in a context where they seemed routinely overloaded with work. Which suggests that any lesson about the need for staff doing this sort of work to have a built-in reflective space as a priority still hasn’t been very well learnt or spread very far. The comment gets no further response.
Moreover, the next comment is a reflection on the sadness and guilt of ending of a twelve week group project that left the participants “immensely sad…..and going back to being very isolated.” The project had been set up by FfT Manchester with Lancaster University, first for five weeks, then for a further ten weeks, with ‘data collection’, a ‘wellbeing questionnaire as a quantitative measure’, along with what claims to be qualitative data collection. The whole thing reads like a scientific experiment. Yet it has gained ‘ethical approval’ from the Lancaster University Ethics Committee and from FfT. It also cites Winnicott on the ‘holding environment’. Everything seems to have been thought about except what else might be on offer for the participants at the end of the five or ten weeks experiment.
It’s an example of the culture of appearances and masquerades that now permeates so much of our culture. Get the language right about co-development, participation, respect for other cultures, diversity ..etc., but somehow fail to question the export of essentially Western models even while acknowledging the limits of Western paradigms and the realities of objectification within the most apparently politically correct frameworks.
It’s not clear how much the writers actually believe in the ‘evaluation’ discourse. Funding bodies permeated by neoliberal ideology are often at the heart of it. Short on knowledge and understanding but high on the idea of ‘value for money’ and the associated belief that if something can’t be measured it doesn’t exist, they tend to inflict the equivalent of an IMF structural adjustment programme on any organisation or project they support. The common view is that around half of any funding provided is spent on evaluating what is done with the other half of it.
So despite the value of much of the work reported in the book it reflects much of the sorry state of therapeutic options available for survivors of political violence. The title itself seems strangely muted. Why is slaughter, torture and rape wrapped up in this term ‘Human Rights Abuses’. Does it reflect a need for some human rights organisations to project away somewhere else their own somewhat cavalier attitudes to human rights within their own walls? Is it a distancing from the horrors and terrors that are actually being engaged with? Is it a way of depoliticising the work, locating it in a cosy liberal concept rather than the harsher struggle against power, both in our organisations and within ourselves.
Then there’s a question of what meanings we give to the term, ‘refugee’? It is, after all, a political status not a diagnostic category. Yet it is freely used as if it symbolised some sort of therapeutic need. And those who bear the label seem often to be expected to be little more than grateful recipients of our therapeutic ministrations, learning quickly to tell us what they perceive we want to hear.
John Schlapobersky, 2021 reminds us of the original principles of the Medical Foundation project. That the consequences of torture are not so much the conditions of an illness as a form of bondage imposed by the torturer, and the concept of ‘cure’ is in many cases inappropriate. “What does it mean for someone to get better when wilful cruelty has caused lasting damage? And what counts as healing?” He emphasises the importance of the survivor finding a voice to speak, to reclaim time and space. So we return to the ideas of liberation and of struggle and the place of a politically conscious therapy in that cause.
References
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Bustos, E. (1990). Dealing with the unbearable: Reactions of therapists and therapeutic institutions to survivors of torture. In P. Suedfeld (Ed.), Psychology and torture (pp. 143–163). Hemisphere Publishing Corp.
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Schlapobersky, J. & Bamber, H. (1988) Torture as the perversion of a healing relationship; rehabilitation and therapy with the victims of torture and organised violence. Paper presented to the Annual Meeting, American Association for the Advancement of Science
Schlapobersky J (2016) From the Couch to the Circle: Group analytic Psychotherapy in Practice. Karnac. London.
Schlapobersky J 2021 When They Came For Me: The Hidden Diary of An Apartheid Prisoner. Berghahn Books. NY
Shackman J and Tribe R. 1989. A Way Forward: A Group for Refugee Women. Groupwork 2,2 Pp159-166.
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Dick Blackwell CPHR48@gmail.com