Training local health workers to help women affected by violence

Over eight days in April, 22 new health workers in South Kivu, eastern Democratic Republic of Congo (DRC) were trained in Cognitive Processing Therapy by the International Rescue Committee (IRC) and the University of Washington.

Cognitive Processing Therapy (CPT) is an innovative form of group therapy, which can significantly decrease trauma symptoms of physical and sexual violence. The therapy has been specifically adapted to the DRC context and targeted at survivors of sexual violence who report high trauma and depression symptoms and difficulty completing day-to-day activities. The training of the new health workers will be followed up by monitoring and supervision sessions.

Two experienced clinicians from the University of Washington facilitated the training in Kabare Health Zone. A total of 22 participants were trained in the therapy, including 14 health service providers from seven selected pilot sites, six supervisors from the Provincial health inspection (L’inspection provinciale de la santé - IPS), Mental health coordination (Coordination Santé mentale – CSM), Psychiatric treatment centre (Centre de traitement psychiatrique – SOSAME), and two International Rescue Committee (IRC) supervisors (one from the Women’s Protection and Empowerment (WPE) programme and one from the IRC Health Programme).

During the training, the participants learned how to administer the therapy, how to manage the group and how best to facilitate the process. The participants reflected on the way in which symptoms can emerge after survivors experience sexual violence, which symptoms can most affect survivors, and the consequences of these symptoms. The consequences include real memories of the trauma, distressing thoughts, feelings and repressed memories related to the traumatic incident. The training facilitators explained how the CPT approach can help people affected by violence change their extreme thoughts, called “stuck thoughts”, and balance them, to help them deal with the emotions that they experience, which leads to more positive behaviour. The twelve CPT sessions were analysed and practiced during the training to ensure that the participants and especially those who will facilitate the CPT sessions can ask questions and become comfortable with the issues.

During the training, participants identified their own concerns and hesitations about Cognitive Processing Therapy, such as the notion that CPT is a ‘Western form of therapy’ and cannot be applied to the Congolese context, that it is “too complicated”, or “too structured and cannot respond to the needs of the communities”.

To respond to these concerns, the facilitators encouraged participants to take ownership of the CPT method, explaining that CPT is a form of therapy adapted to survivors of sexual violence in the DRC. The facilitators also explained that CPT has greatly helped people in Iraq, Afghanistan and the USA, and has shown to be more effective than medication in treating Post-traumatic stress disorder (PTSD). This explanation helped to convince the participants of the usefulness of the CPT method. Through their participation in the training, including interactive exercises, the participants began to feel more confident in the method and their own ability to carry it out.

At the end of the CPT training, participants did 50-question post-test and received an average score of 58%. Two more post-tests will be administered to service providers and supervisors trained in two consecutive groups of the pilot after they begin practicing CPT to evaluate their application of the therapy.