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NSW Service for the Treatment and Rehabilitation of Torture and Trauma Survivors

Upcoming Clinical Master Classes

The March 2023 event will be announced soon.

Working Clinically with Older People who have Experienced Torture and Refugee Trauma: Treatment Implications for Trauma and Ageing

8 March 2023 | 6.30-8pm | Free webinar

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Zimra Segall
Social Worker
JewishCare NSW

Amparo Landman

Event outline

Older people from refugee backgrounds often experience multiple traumatic events and losses. Subsequently they may face multiple challenges that are additional to those of the Australian-born and migrant ageing population. This may include: a higher risk of mental and physical health issues such as PTSD; triggering of their past traumatic memories; depression and anxiety; memory loss due to trauma and ageing; dementia; chronic physical health problems; as well as experiencing complex psychosocial adjustment to the country, loss of customary lifestyle and culture, dignity, identity and pride within their communities. Evidence suggests that cultural bereavement and transition period is much longer with older people from refugee backgrounds than the younger population. They are deprived from what that is known and familiar to them, struggling in the daunting task of adaptation in the new environment.

In this Clinical Master Class, Zimra Segall, Program Manager at JewishCare NSW, will share her expertise by looking at how earlier, prolonged and major trauma may affect individuals in their older years and how they can be best supported. Although the focus will be on Holocaust Survivors, the aim is that the principles of the extensive research on Holocaust Survivors, and the modalities of work with them will serve to inform the work with survivors of other earlier trauma in their older years. The first part of the presentation will outline the main issues faced by survivors of trauma and the triggers in the environment which elicit post-traumatic stress symptoms. The second part will look at the implications of therapeutic work with survivors including the tasks and goals of psychotherapy. The third and concluding section will briefly reflect on the impact of the Holocaust on second and third generations, and on the community. Amparo Landman, STARTTS’ Student Clinic Coordinator/Counsellor, will demonstrate STARTTS’ work with a case study of one of her older clients.

Previous Clinical Master Classes

Sleep Impairment in Survivors of Torture and Refugee Trauma: From Research to Clinical Implications and Treatment

Held on 6 December 2022

Dr July Lies
Senior Clinical Psychologist
Monash University

Mirjana Askovic
Senior Psychologist/Neurofeedback Coordinator

Event outline

People who have survived torture and refugee trauma are often exposed to prolonged and complex trauma and multiple losses resulting in complex presentations, with psychological and physical problems. Sleep disorders are a very common presentation, resulting in chronic tiredness, fatigue, impaired memory, excessive day time sleepiness, relationship stress, greater risk of car accident, as well as impacts on physical health such as high blood pressure, risk of heart attack, heart failure and stroke. In this Clinical Master Class Dr July Lies, a senior clinical psychologist, will present a summary of the literature on the relationship between sleep disturbance and mental health in refugees, the prevalence estimate of sleep disturbance among different groups of the refugee population living in Australia, the psychosocial and demographic factors associated with greater sleep disturbance, conceptual models that combine trauma exposure, post-migration stress, sleep symptoms, and mental health symptoms, as well as  providing a review on the available treatments for sleep disturbances and nightmares for refugees. Mirjana Askovic, a senior psychologist, the Neurofeedback Program Coordinator at STARTTS and the Director for the Australian Neurofeedback Institute (ANFI), will demonstrate STARTTS’ work with a case presentation.

Clinical Treatment of Functional Seizures in People with Torture and Refugee Trauma Experiences

Held on 14 November 2022

Dr Kasia Kozlowska
Child and Adolescent Psychiatrist/Researcher
Westmead Children’s Hospital

Jeanette Ninnis
Counsellor/Social Work Practitioner

Event outline

Refugee survivors of torture and trauma often experience multiple losses and complex prolonged accumulated trauma. They can have complex presentations that are often misdiagnosed in general clinical settings. One of the complex presentations STARTTS sees, particularly in the Yazidi community, is functional seizures (non-epileptic seizures) which can be anxiety provoking for clients and challenging for the treating clinician. These functional seizures are not caused by abnormal electrical discharges. Instead, they arise in the context of chronic or severe stress in the resettlement context. Unlike epileptic seizures, which can be dangerous, functional seizures are not. In this Clinical Master Class, Dr Kasia Kozlowska, a child and adolescent psychiatrist, a clinician researcher and the author of Functional Somatic Symptoms in Children and Adolescents: The Stress-System Approach to Assessment and Treatment, will share her expertise on functional seizures including research, clinical implications and treatment, as well as giving practical strategies on how to help clients. Jeanette Ninnis, a social work practitioner and an experienced STARTTS counsellor, will illustrate STARTTS’ work with a case study of one of her female Yazidi clients who presented with severe functional seizures. Note that Dr Kasia Kozlowska’s slides will not be made available as they contain unpublished work.

Moral Injury in People with Torture and Refugee Trauma Experiences: From Research to Clinical Implications and Treatment

Held on 20 July 2022

Dr Joel Hoffman
Clinical Psychologist/Postdoctoral Fellow
Refugee Trauma and Recovery Program

Joshua Hall
Clinical Psychologist

Event outline

People from refugee backgrounds are often exposed to traumatic events, which are not only life threatening, but can also involve moral violations. There is growing evidence that these moral violations can result in complex psychological responses to trauma, referred to as moral injury.  Outcomes associated with moral injury can involve emotional reactions which can go beyond traditional fear-based conceptualisations of posttraumatic stress disorder (PTSD), including emotions such as anger, shame and guilt. In this Clinical Master Class, Dr Hoffman will provide an overview of moral injury research, including its original conceptualisations in non-refugee populations, working models of moral injury and emerging research in moral injury among refugee populations. Clinical implications will also be shared regarding assessment and treatment of moral injury while working with people from refugee backgrounds. STARTTS’ work will be demonstrated with a case study presented by Joshua Hall, a psychologist and trainer at STARTTS.

Re-traumatisation of People who Identify as LGBTQIA+ with Torture and Refugee Trauma Experiences: Clinical Implications and Interventions

Held on 25 May 2022

Elvis Caus
Team Leader/Counsellor
Survivors & Mates Support Network

Event outline

People who have survived torture and refugee trauma and fled from their homeland because of fear of persecution based on their sexual orientation and or gender identity, are often re-traumatised, experiencing further discrimination after their arrival in Australia. Communities born overseas who identify as LGBTQIA+ may have been in severe danger in their country of origin for their LGBTQIA+ status, in addition to being exposed to war, trauma, migration, loss and dislocation. In Australia, people may experience homo/transphobia from their cultural communities, as well as experiencing racism and stereotypes from the wider LGBTQIA+ community, which can affect their psychosocial wellbeing. In this Clinical Master Class, Elvis Cause will bring together his personal experiences and professional expertise to exploring the re-traumatisation of people from LGBTIQA+ CALD communities, the impacts, the clinical implications, as well as strategies and interventions on how to support this vulnerable group of clients. Heather Grace Jones, LGBTQIA+ Project Coordinator, will demonstrate STARTTS’ work encompassing clinical and community interventions with a case study.

The Crucial Role of Australia’s Torture and Refugee Trauma Rehabilitation Services in Responding to the Afghanistan Crisis

Held on 23 March 2022

Nooria Mehraby
Senior Clinician/ Trainer

Claudia Thoms

Event outline

Four decades of war and unrest in Afghanistan have had, and continue to have, a profound impact on all aspects of life in Afghanistan. Millions have fled the country, are internally displaced or have lost their lives. The current crisis, due to the fall of the country to the Taliban in late 2021, saw a major rescue operation, where over 4000 Afghans were who were at high risk, were evacuated to Australia. The crisis has also had a significant impact on the Afghan diaspora in Australia, many of whom are still dealing with deep physical and psychological scars of their traumatic experiences. Many have experienced re-traumatisation with severe posttraumatic symptoms, grief and loss reactions, acute anguish, anger, resentment, survivor guilt, anxiety and depression. Concern about family members in Afghanistan who are at risk but cannot leave Afghanistan, as well as the pressure to provide financial support to them, are additional sources of stress. This has placed an enormous demand on service providers.

This Clinical Master Class will explore how torture and refugee trauma treatment and rehabilitation services in Australia have responded to this major crisis. Claudia Thoms, an AHPRA registered psychologist who has worked with survivors of torture and refugee trauma for over 15 years, leads the Afghan Community Response Project at the Victorian Foundation for Survivors of Torture (VFST) in Melbourne. Claudia will focus on the VFST therapeutic work with Afghan arrivals and will outline how counsellors work closely alongside Afghan community project workers to meet the needs related to settlement during the early stages of trauma recovery. Nooria Mehraby, a Senior Clinician/ Clinical Trainer and a former Afghan refugee with over 30 years’ experience with refugees, will present STARTTS’ response to the crisis in Afghanistan, through a holistic approach that integrates clinical and community development work.

Perinatal Psychology and Refugee Trauma:
Clinical Implications of the Impact of the Mother’s Experiences on the Unborn Baby

Held on 10 November 2021

Dr Jennifer Fenwick
Clinical Midwifery Consultant
Gosford Hospital

Naila Hassan
Early Childhood Counsellor

Event outline

Refugee women and their dependent children count for 80% of the world’s refugee population. The context of motherhood is frequently traumatic for refugee women; from conception to delivery and the neonatal period there are many vulnerable moments where trauma impacts on both mother and growing baby. While the most confronting trauma is rape that results in pregnancy, there are many other sources of trauma. This might be in the course of the chaos of war, refugee flight and resettlement but the birthing process is also traumatic for some women. Separations from family result in reduced support at times when most connection with attachment figures is needed. As the mother’s body is providing the care to the child (at symbolic and physiological levels), any stress the mother experiences can transfer to the child. If the type of stress is particularly traumatic, this can cause trauma to the growing foetus and baby. Trauma in utero is commonly caused by chaotic or unpredictable lifestyle factors including the mother’s exposure to war, domestic violence, lack of antenatal care, or substance misuse during pregnancy. In this Clinical Master Class, Dr Jennifer Fenwick shared her expertise on the implication of a mother’s traumatic experiences on the mother and  baby. Naila Hassan, STARTTS’ Early Childhood Counsellor, demonstrated STARTTS’ work using a case study of a woman who had experienced significant trauma during pregnancy and labour. She reflected on the impact of these experiences on the mother and the unborn child as well as on her work with the dyad.

Treating Hopelessness and Helplessness in People Seeking Asylum Facing Deportation

Held on 1 September 2021

Prof Nicholas Procter
University of South Australia

A/Prof Mary Anne Kenny
Murdoch University, WA

Amanda Labron Johnson
Counsellor/Art Therapist, STARTTS

Event outline

Asylum seekers are one of the most vulnerable groups of clients in our society. Evidence suggests that asylum seekers have much higher rates of mental health difficulties than are usually found within the general population. The process of seeking asylum in Australia places demands on this group, beyond the expected stressors faced by most refugees. These include several situations which are re-traumatising and triggering of their past trauma. For example: prolonged unsafe journeys, being in detention for an extended period of time, uncertainty about their future, and separation from family. There are additional financial difficulties and stressful, complex legal processes. In fact, the refugee determination process is regarded as one of the most stressful and challenging experiences for asylum seekers. In our experience clients present with PTSD, anxiety, depression, grief, with suicidality and feelings of helpfulness and hopelessness being prominent. In particular these symptoms are more pronounced when the asylum application has been rejected and the client is in the final stage of deportation. Professor Nicholas Procter and Associate Professor Mary Anne Kenny have extensive experiences of working with asylum seekers. In this Clinical Master Class, they will discuss ways of working with this vulnerable group of clients; in particular how to hold and contain them, and together find meaning and purpose. Amanda Labron Johnson, an experienced STARTTS counsellor, will illustrate STARTTS’ work via a case study of one of her clients.

Managing the Co-morbidity of PTSD, Anxiety and Associated Disorders in Treating Refugee Trauma Survivors

Held on 28 July 2021

Dr Anthony Korner
Psychiatrist, University of Sydney

Tajana Bogicevic
Clinical Psychologist, STARTTS

Event outline

A significant number of refugees have experienced excessive, prolonged trauma as well as multiple losses in the course of dislocation, migration and resettlement. It follows that refugees can have complex presentations including complex PTSD, and prolonged and complicated grief. A substantial group have a comorbid disorder; with the most common comorbidities being depression, phobias, panic, somatisation, psychotic and personality disorders, and anxiety and associated disorders. The presence of comorbidities in the context of PTSD creates challenges for clinicians from assessment to diagnosis and treatment. Some research indicates that although similarities exist, the comorbidity profiles differ according to the type of trauma experienced and the population studied. Additionally, the evidence suggests that the associated psychiatric disorders are not truly comorbid, but are interwoven with the PTSD. In this Clinical Master Class, Dr Anthony Korner will share his expertise on managing comorbidity of PTSD, anxiety and associated disorders in working with trauma survivors. Tajana Bogicevic, an experienced clinical psychologist, will illustrate STARTTS’ work with a case study of one of her clients who presented with PTSD and associated comorbidity.

Utilising Remote Technology in Managing Self-Harm and Suicidality with Refugees and Asylum Seekers

Held on 26 May 2021

Maxine Rosenfield
Counsellor, Clinical Supervisor, Educator

Katherine Theodor
STARTTS Psychologist

Event outline

Suicide is a leading cause of death globally; understandably, vulnerable and disadvantaged groups are over-represented in the statistics. Refugees, asylum seekers and holders of temporary visas such as SHEVs and TPVs, are at particular risk. Suicidal ideation and behaviour is a complex combination of personal, social, and health factors, and hence suicide prevention requires a systems approach. The increased utilisation of telehealth during the COVID-19 pandemic has created new opportunities and challenges in suicide prevention and self-harm behaviour. In this Clinical Master Class, Maxine Rosenfield, the author of the well-known book ‘Telephone Counselling – A Handbook for Practitioners’, will share her expertise of using remote technology with a particular focus on suicide prevention and self-harm behaviour. Katherine Theodor, an experienced STARTTS psychologist, will share a case study of her ongoing counselling, support and containment via telehealth, of an asylum seeker on a double-negative pathway, who is experiencing auditory hallucinations and chronic suicidality.

Refugee Trauma and Addictive Behaviours: Treating Clients Consuming Drugs and Alcohol as a Coping Mechanism

Held on 31 March 2021

Prof Katherine Mills
NHMRC Senior Research Fellow

Mirjana Askovic
Psychologist/ Neurofeedback Coordinator

Event outline

Refugee survivors of torture and trauma have usually experienced cumulative and intense traumas as well as multiple losses in the course of dislocation, migration and resettlement. It follows that refugees can have complex presentations including complex PTSD and prolonged and complicated grief. A sizable group have a comorbid disorder, with the most common comorbidities being depression, anxiety, alcohol addiction, and substance abuse. The presence of comorbidities in the context of PTSD creates significant challenges for clinicians, not least due to the reliance on mood altering substances to manage the effects of trauma and loss. In this Clinical Master Class, Professor Katherine Mills will talk about improving our understanding of the relationship between mental and substance use disorders. In particular, Prof Mills will focus on the co-occurrence of post-traumatic stress disorder and substance use. Mirjana Askovic, the coordinator of Neurofeedback team and the director of Australian Neurofeedback (NF) Institute, will illustrate STARTTS’ work with a case study of one of her clients utilising NF as a part of an integrative approach to the treatment of trauma, addictive behaviour and substance abuse.

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