07.01 2019

Who is this training for?

This is a training manual, not a therapy manual. The training is designed for individuals who directly provide care, help and assistance to people who have been exposed to human rights violations and abuse, notably gender-based and sexual violence, and for personnel who support other care providers involved with the same survivor group.

  •  Personnel working in primary health care settings.
  •  Humanitarian workers in emergency settings.
  •  Staff connected to refugee camps.
  •  Service providers from different agencies.
  •  Voluntary care providers affiliated to NGOs.

How to use the manual?

The manual is designed for use by a group. At the same time, it can be used as a resource by practitioners in direct contact with survivors, independently of any training setting. Each step is described, with instructions. Our hope is that, through practising the exercises, listening to the story, and exploring approaches to trauma and reactions to it, helpers will learn skills that establish a sound foundation for their work with survivors. They should be able to apply the skills they have learned immediately, and find them practical and useful. Some of the manual’s exercises and group activities are for training purposes, to communicate particular insights. Others are practised many times because the participants will use them in their work with survivors.

How to read the manual?

  •  In Parts I and III, the text is laid out normally and pages are to be read sequentially.
  •  In Part II, by contrast, both the left and right pages should be read together. The left hand page contains advice and background information, usually addressed to the Trainer. The right hand page describes what the Trainer says to the participants and what the participants do.
  • Participants see and can use the left hand page during the training. They can make use of it afterwards as well, when they start to act as trainers themselves.
  • An experienced trainer may skip parts of the manual that are not relevant to the group or context, and may spend more time on topics that are particularly relevant.
  • Throughout the manual, the Trainer and participants are addressed directly rather than in the third person.
  • Part III contains additional information on issues that are discussed in the training (Part II). The materials in Part III appear in roughly the same order that they appear in Part II.
  • Some sections in Part III discuss issues the training does not address. In particular, it provides information on the situation of children born as a result of sexual violence. Part I and Part II refer readers to Part III for additional information.
  • We indicate suggested breaks in the training. Before the training starts, trainers should discuss with the group the length of each session. This is often a matter of social practice. Some societies take breaks every 45 minutes; others prefer long sessions of 90 minutes or two hours. Trainers should evaluate and be attentive to the group’s need for breaks.

Who can conduct the training?

Those who conduct the training need to know the manual well and study the sections in Part I as well as the information provided in Part III. Part III provides additional reference material that may be useful during the training, or for more in-depth reading.
The Trainer should also know the group or at least the context in which the training takes place, and should understand or be in command of the local language, culture and traditions.
If possible, professional health personnel should be available for consultation during or after the training, to respond to difficult questions or situations that may arise.
It is important to bear in mind that the training may create distress or anxiety among participants who experience on a daily basis the grim nature of the problem it discusses. Some participants may themselves have been exposed to violent acts and may be triggered during the course. If this happens, the Trainer and the group may need to allow time for reflection and support and find ways to deal with special needs.

Why do we use the butterfly woman metaphor?

Therapeutic metaphors are stories or images that convey something that can amaze, inspire or open the mind. Metaphors can be simple and effective tools for teaching and learning. They are more than a way to talk about an experience. They can describe our experience; and they can be lenses through which we can understand and make sense of the world. They can help us to shift between insights and experience. A metaphor is a charged meaning, a mental map that can show us how things are or how they can be understood, and help us to see what we have not yet seen.
Based on this incident, we developed the Butterfly Woman metaphor as a tool for working with individuals traumatised by severe violence. The metaphor allows us to talk about very difficult themes in a different way; it creates room for thoughts and new reflections and may sometimes symbolise hope. When we draw the butterfly, her wings symbolise the past and the future. Between the ‘wings’ is a narrow space that represents the ‘here and now’. Through the help she is given, the Butterfly Woman gradually feels that she can be more ‘here and now’ and more able to control her life. She may also gradually be able to reconnect with her resources, symbolised by her ‘antennae’, which she stretches out to reach good memories from her past and her hopes for the future. Step by step she can restore her wings and create conditions in which eventually she can fly again.

Who will answer my questions regarding the manual?

For practical questions regarding the manual the secretariat of HHRI will do our best to answer you enquiries. HHRI has also gathered a group of highly qualified professionals for the development of this Manual. We will draw on their expertise in responding to your questions regarding mental health in a therapeutic setting in relation to the manual.

Where can we ask further questions if survivors have other needs?

The survivor might have other needs than what is covered in this manual. There are other valuable guidelines and manuals that will cover different needs of the survivor. Check out page 2 in the manual for more information.

What do I do if the survivor will not cooperate?

Be patient, you cannot force people to cooperate. Give the survivor time and space to open up.

What if the grounding exercise do not work?

We have outlined several different grounding exercises.  Sometimes one have to practice the exercise several times before you can master it. Survivors have different needs regarding where they are in their life situation. Try optional grounding exercises to find one that is suitable for her situation.