During my masters training a large portion of our time was spent working on a community project. As masters students, we were aware of our privileged position and knew that as psychologists we would mostly get work via private clients or organisations who were also privileged. So it felt like our civic duty and moral responsibility to contribute whole-heartedly to community work. Of course from our lecturers’ perspective, community projects were just part of helping us become well-rounded clinicians. Often the work involved trekking out into poorer, far-away neighbourhoods and we would find ourselves in the middle of some severe and unfamiliar contexts.
These experiences left me feeling moved, frightened, helpless, shocked, and invigorated. As a trainee I felt out of my depths, alone, confused, and unprepared. I was confronted with difficulties I felt psychology could not help with and this left me feeling paralysed and unsure of my efficacy.
As time went on, the feelings of discomfort eased up and I worked with my feelings of helplessness. These community projects we did as students were practice runs for the work I did in the State Hospitals in South Africa. You walk into these contexts, so different from your own, armed with theory and a desire to help, and you feel helpless maybe 60% of the time. At first this feels devastating but then you start to rely on those moments of hope: the breakthrough with a patient or the moment someone tells you they’re grateful for your presence. You start to count the little things: the eye contact, the light touch, the smiles, the thank yous. It definitely doesn’t feel as groundbreaking as you imagined when you were an eager student but you learn to be satisfied with the small differences you make along the way.
My work in Berlin has been very satisfying. I love my clients and enjoy working with the client population that I have – the expats and travelers that sit on my couch and recount their stories of heartbreak and pain, adventure and discovery. After almost two years, I have fallen into a nice little routine and feel quite settled in my world here. But when news of the refugee crisis rocked Berlin last year, I felt glad to offer my services to a few aid organisations and once again be part of something community-orientated.
What I didn’t expect was the comical reality of people turning down my offers for help due to being “overwhelmed by an influx of volunteers”. So all I could do was put myself on a few lists and wait for someone to call.
It was only in February of this year that the first (and only) email came through asking for my services. Here is a brief account of what followed.
In February 2016 I began working on a project with a group of refugees living in Berlin. The name of the organization where these men were housed is called L.I.T.H.U. (Leben, Integration, Toleranz, Herausforderung und Unabhängigkeit) and their website can be found here.
L.I.T.H.U. is located in Marzahn-Hellersdorf in the east of the city. I was introduced to this organization by Mariana Karkoutly who made contact with me via the website Give Something Back To Berlin in early February. She is from Syria and holds the position of Deputy home manager (Stellvertretende Heimleitung) at L.I.T.H.U. She studied law in Syria and is currently doing her masters in social work in Berlin. In her initial request, she asked to have one of the men housed at their facility assessed to determine whether he needed therapy. I indicated that I could not offer therapy to someone who does not speak English due to the ethical reasons of using a translator. I informed her that I would be happy to conduct a mental health screening to determine whether he was suffering from a mental illness and then we could proceed with the appropriate referrals.
The assessment took place at L.I.T.H.U. in a private room. It was very chaotic due to the fact that the identified patient was 30 minutes late and another individual requested to be assessed on the day as well. I assessed both men that day, spending around 30 minutes on each assessment. I conducted an MSE (Mental Status Examination) and interviewed the men using a translator to determine their symptoms. It was clear after the brief assessment that both men were suffering from depression and PTSD symptoms.
The men in this housing facility are between the ages of 18 and 50 but the men I assessed were both in their twenties. I was informed that quite a few of the other men also had similar symptoms and so I realized that there was a need for some kind of intervention. Due to the fact that I have limited time and the organization could not pay me for my services (and due to the language barrier) I made the suggestion that we set up a support group for the men at L.I.T.H.U. I offered to train Ms. Karkoutly so that she could run the support group as she speaks Arabic. We agreed that I would train her and anyone else she could find to her assist her and that I would also provide supervision.
I conducted 5 training sessions and have been offering supervision fortnightly since the beginning of April. At first there were two groups, one Farsi-speaking and one Arabic-speaking group, but there were problems finding Farsi facilitators and the language barrier made it impossible. The Arabic group is just about to have their tenth session.
The group consists of around 10 participants but the attendance fluctuates because all of the men don’t attend each session. Groups vary between 1 and 5 participants on average. The groups are facilitated by Ms. Karkoutly and a co-facilitator. The groups take place in a quiet, relaxing environment – an art space that has kindly been donated. The men sit in a circle of chairs and share food and drinks that are provided or cooked on the premises.
At the start of the meeting, each group member completes an evaluation form that asks questions about the previous meeting. Then each person has a chance to talk about his week. A theme is selected for each session and the facilitators start by introducing the theme of the session and then each person is asked to reflect on this subject/theme. Afterwards, the facilitators provide some information about the theme and at the end of every session a new relaxation exercise is taught and practiced.
Having witnessed one of the groups I can say that I observed a really good rapport between the facilitators and group members. There is a strong sense of togetherness due to the fact that the facilitators share the same background as the group members and they feel free to discuss their traumatic memories and help each other find solutions to their problems, which range from minor details pertaining to life in Germany as well as finding solutions for boredom and depression. At first it was difficult for the men to open up. Group members were not clear on the aims of the group. They wanted concrete help and were not convinced about sharing their stories but the group is increasingly being used as a place to discuss traumatic memories.
The difficulties we have found so far have included the issue of gender. Ms. Karkoutly believes her gender is a barrier because the men struggle to feel at ease in her presence and they are not used to expressing emotions, particularly with a woman present.
So far the groups have only included male participants because the home only houses men. There is another organization that houses women and families and there is hope that in the future there will be a support group that is mixed or for women only.
Another big theme, which I could have anticipated, was the theme of helplessness for the facilitators. It’s very difficult to manage one’s own anxiety when one wishes to help and the situation feels beyond repair or the requests coming from the group cannot be handled. It takes a lot of psychological holding and containment to tolerate the feelings of helplessness and absorb the group members’ distress without rushing to try and provide solutions but rather to sit with the feelings.
I have encouraged the facilitators to go deeper and to try and talk more about emotions and respond to the emotions in the room but this isn’t a therapy group and they believe that it isn’t always safe for the men to express their feelings. The group offers the men a place to come and be heard and to share ideas and this feels helpful for them.