Paper
Ritual and physical exercising in the treatment of traumatized bereaved children in the context of political violence
- issue: Issue 1 / 2009
- authors: Vered Slonim-Nevo, Itzhak Lander
- keywords: children, violence, israel
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- downloaded: 0
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abstract
Background. In recent surveys, it has been estimated that throughout the globe one million children have been orphaned due to inter-group conflicts. The psycho-emotional problems associated with political violence are predominantly related to fear and anxiety that such violence and loss may reoccur. Studies of the effects of the exposure of children to political violence show that up to 30-50% experience Ptsd and related psychological conditions. Moreover, these responses continue to be demonstrated long after the violent event, with many children experiencing insecurity, concerns with safety, a diminishing sense of future perspectives, difficulty in enjoying life, a tendency to expect the worst, and a diminishing sense of the future and its possibilities. Traumatic bereavement as a specific stressor related to political violence and war is said to be among the most damaging in its consequences.
Rituals are an important part of culture the world over. A large proportion of daily ritual is related to and facilitative of life transitions. Recently, practitioners have taken renewed interest in this powerful therapeutic tool. The ritual has been applied as an intervention by non-western healers and western psychotherapists alike in cases of anxiety, depression, substance abuse as well as grief and trauma. Importantly therapeutic rituals can serve to transform client identity, sense of self, and in particular a victim-centered self narrative to a non-victim-centered schema. Non-western healers often intercede in cases of spirit possession through the practice of ritual. Spirit guidance rituals may be used as interventions for such conditions as multiple personality disorders, anxieties and depressions.
The physical and psychological benefits of physical exercise are well recognized. It has recently been proposed that physical exercise may be explicitly and systematically integrated into the practice of psychotherapy. In contrast with traditionalist thought, it is suggested that therapists actually conduct psychotherapy while both therapist and client are exercising together, usually by way of walking or jogging. The advantages of this therapeutic method are its ready availability as well as the minimal equipment and physical training needed. An issue associated with exercise therapy is that it may alter the therapeutic contract. It differs substantially from traditional psychotherapy in that it is a shared activity, which encourages a more equal balance between professional and client. Other issues include the possibility of competition and potential for sexual suggestiveness. The use of these therapeutic approaches, ritual and running, will be illustrated through the case of a youngster whose father was a victim of a political violent.
In this presentation we provide a case-study of a child whose father died in an act of political violence. We will illustrate the use of innovative therapeutic approaches to alleviate the suffering of a young adolescent and his family. Dominant in this boy's coping was the self-destructive utilization of death related rituals. We countered this morbid behaviour through therapeutic intervention of healing and movement. The case study methodology provides an opportunity for in-depth understanding of the treatment process and assessment of therapeutic outcomes through the perspective of both the client and therapist. We will provide an analysis that focuses on understanding the problem, intervention and subjective outcomes.
Purpose. This paper is aimed at providing an understanding, through a description of one case, of the suffering, anger, mourning and acting out behaviour of children who experience political violence and death in their families. We further explore the potential contribution of two therapeutic approaches: the use of rituals and the use of physical exercise with these children and their families. We will use clinical observations, client's quotes, and subjective assessments of outcomes in order to confirm our claim that these two interventions are helpful.
Key findings, implications, and recommendations
Understanding the problem. The child expressed in his behaviours aspects of complicated bereavement caused by the sudden, untimely, unjust and violent death of his father. Unable to accept this reality he searches for an alternative world that makes more sense to him, a reality in which there is an element of revenge for his father's death. This flight from day to night, from mortality to immortality, from unjust reality to supernatural fantasy which is more in keeping with his own inner logic, however, brings along with it uncomfortable side effects - isolation and guilt.
Understanding the intervention:
- The ritual has been applied as an intervention by non-western healers and western psychotherapists alike in cases of anxiety, depression, substance abuse as well as grief and trauma. Importantly therapeutic rituals can serve to transform client identity, sense of self, and in particular a victim-centred self narrative to a non-victim-centred schema. Ritual interventions may be prescribed to tame monstrous or bad spirits that tend to visit small children at night evoking terrible fears. The use of rituals in this case will be demonstrated. Specifically, we will show how therapeutic rituals can replace harming and self-destructive rituals that are used by the angry child.
- The physical and psychological benefits of exercise are well recognized. In terms of the latter, exercise has both ant-depressant and anxiety relieving effects. Moreover, it has recently been proposed that physical exercise may be explicitly and systematically integrated into the practice of psychotherapy, on a par with the incorporation of such techniques as free association and desensitization. In this case, we will describe how exercise is offered as an alternative to acting-out behaviour and as a tool for encouraging a client-therapist alliance.
Recommendations. Therapists are encouraged to include both rituals and exercise in their practice with bereaved children and families. Future research should focus on the effectiveness of those interventions in treating bereaved clients in general and those who are the victims of political violence in particular.
Key references
Gurvitch, R. H., Sitterle, K. A., Young, B. H., & Pfeffebaum, B. (2002). The aftermath of terrorism. In A. M. Le Greca, W. K. Silverman, E. M. Vernberg, & M. Roberts (Eds). Helping children cope with disasters and terrorism (pp. 327-358). Washington DC, American Psychological Association.
Hays, K. (1994). Running therapy: Special characteristics and therapeutic issues of concern. Psychotherapy: Theory, Research, Practice, Training, 31, 725-734.
Wyrostok, N. (1995). The ritual as a psychotherapeutic intervention. Psychotherapy: Theory, Research, Practice, Training, 32, 397-404.
Contacts: Vered Slonim-Nevo, Ben Gurion University of the Negev, Department of Social Work, 84105, Beer Sheva, Israel, E-mail:slonim@bgu.ac.il, Phone 972-8-647232.