Torture assessment and treatment: The wraparound approach.

Abstract

The paper explores the dimensions of torture trauma, its assessment and treatment. Simple PTSD does not account for the potential effects of torture. I propose a modified model of complex PTSD or cumulative trauma disorders that describes more the effects of torture. Most of the current evidence-based treatments for PTSD do not work with torture. A wraparound approach that proved its success with different kinds of cumulative traumas has been modified to fit torture treatment. Wraparound is multi-systemic and ecologically valid. It is conducted by community treatment teams that include community liaison and therapeutic case management teams. They provide community support and networking as well as direct treatment to the survivor and his family members. Social support is an important component of the wraparound process.

The Mental Health Effects of Torture Trauma and Its Severity: A Replication and Extension

“…Holistic, interdisciplinary torture rehabilitation models emerged early on (by 1984) in Copenhagen by RCT group (e.g., Ortmann, Genefke, Jakobson, & Lunde, 1987). Variants and expansions of the model have been emerged and further developed, for example, the wraparound approach for psycho-social rehabilitation of torture survivors (e.g., Silove, Tarn, Bowles, & Reid, 1991;Kira, 2002Kira, , 2010, ecological group therapy models that focus on community healing (Kira, Ahmed et al, 2012b), post-disaster ecological recovery model, (Abramson et al, 2010). While such models have social and ecological validity as inherent programmatic feature, empirical evidence of its effectiveness is not yet established through controlled double blind studies.…”

Counseling Arab and Chaldean American Families

“…The history of conflict, war, and civilian displacement in the Middle East plays a role in the mental health of even those individuals who are exposed vicariously through the impact of trauma on family members, friends, and acquaintances (e.g., Kira, 2001Kira, , 2002. Thus, even though an immigrant or refugee may not have been directly affected by war trauma, secondary traumatization is possible since other close family members and friends may still be in the homeland.…”

“…Research studies have shown a high rate of depression, anxiety, and post-traumatic stress disorder in this more recent group of immigrants from Iraq (e.g., Jamil et al, 2002;Jamil, Nassar-McMillan, & Lambert, 2004;Jamil, Nassar-McMillan, Salman, Tahar, & Jamil, 2006;Takeda, 2000). Treatment strategies include a multidisciplinary wraparound approach that provides a variety of diverse services to support the affected families and manage the symptoms (Kira, 2002). First-and second-generation adolescents with families from Iraq are particularly prone to depression, and research studies are currently underway to address their mental health needs (e.g., Bouffard, 2004).…”

“…The close ties within large extended families and the collectivistic values of Arab and Chaldean Americans may serve to heighten and exacerbate the salience of the traumas that have affected significant others, and some individuals and families are affected both directly and vicariously. Thus, the impact of history of traumas can be complex, cumulative, and ongoing in nature (e.g., Kira, 2001Kira, , 2002.…”

Obstacles to torture rehabilitation at Guantánamo Bay

“…Many people involved in rehabilitation of torture victims advocate holistic approaches which seek to restore the individual's functioning in the context of family and community (Kira 2002). This approach is precluded by the restrictive environment at Guantánamo, which permits only specific group classes in Camp 6, [the camps], no classes in Camp 7, and only rare communication with family, largely via letters.…”