Saturday, 19 October 2013

CBT Training Behind the Wall

Article Published in CBT Today Vol:41 Number 3 September 2013
October 3, 2013 at 11:48pm
CBT Training Behind the Wall


David Raines visited Ramallah last December to deliver an introductory course in cognitive behavioural therapy for mental healthprofessionals working for the Palestinian Counselling Centre (PCC). Here he talks about his visit and the issues facing CBT professionals in Palestine

For 30 years the PCC has struggled with limited resources to develop and improve mental health services in Palestine. They now have five departments providing individual and group therapy in Jerusalem, Ramallah, Nablus and other centres. My visit was organised by Sumud Palestine (Steadfast Palestine), a new charity raising funds to provide training and supervision for mental health professionals in the West Bank and Gaza.

Cognitive behaviour therapy is in the early stages of development in Palestine. Most of the PCC staff had read about and received some lectures on the theory of CBT but they have few opportunities for practical training and supervision in this evidence based therapy.They work in a challenging environment with a range of clients, many of whom have been traumatised by the on-going conflict between Palestine and Israel.

For four days I had the pleasure of introducing the theory and practice of CBT to an enthusiastic and enquiring group of mental health workers. Using case examples suggested by the organiser of my visit we examined and explored the assessment and treatment of Jamal, a 40 year old married man with four children who has suffered from depression since his employers closed their business because of the loss of trade caused by the Separation Wall, and Rama, a student at Birzeit University who had a panic attack whilst trapped in a crowded checkpoint and then developed agoraphobia.


Using standard CBT assessment techniques we explored Rana and Jamal’s problems and the relationship between what they experienced physically, their thoughts and emotions and how these had influenced their subsequent behaviour. We looked at how their problems started, How they developed and the impact on their daily life. We considered in detail what was happening before and after their problems occurred and discussed Rama and Jamal’s goals and ambitions.

I was intrigued by the students as they developed their role plays and six versions of Jamal and Rama emerged. In each I gained a privileged glimpse into the lives of ordinary Palestinians living in the
Occupied territories. Drawing on their own experiences or those of their families, friends and patients they developed the characters of Rana and Jamal. I cannot think of any way to gain a better insight into the impact of the on-going Israeli occupation of the West Bank and Gaza on ordinary Palestinians.


There were interesting discussions about the dissonance experienced by the therapist building hope for the future to combat depression in their patients while at times struggling to see a positive future for their country and themselves.

By the end of the second day the group had reviewed the assessment information Rana and Jamal had given us and developed a formulation that helped to explain onset and maintenance of their problems.
We finished by discussing how the students would counsel and support people experiencing similar problems.

During the last two days we reviewed a range of evidence based treatments familiar to every cognitive behaviour therapist (exposure, behavioural activation, cognitive restructuring and problem solving). We looked at how we might help Rana and Jamal to use these strategies. Together we tried to identify common elements of treatment where there were similarities between their present practice and the cognitive behavioural treatments I was introducing.

The students participated with interest and enthusiasm and the feedback was excellent but each recognised the need for on-going training and supervision. That’s where Sumud Palestine needs your help.

Sumud plan to build a network of experienced therapists prepared to give a little of their time to provide internet supervision to the Palestinian health workers who attended the introductory course.
Sumud is also seeking to recruit experienced trainers willing to journey to Ramallah in the West Bank to provide training as part of a modular CBT programme. Sumud will meet travel costs and other essential expenses.


I have little doubt that anyone suitably qualified and ready to give their time to
will be rewarded, as I was by the warmth and hospitality that Palestinians offer to all their visitors.


David Raines

Please email Sumud Palestine’s chair, Mohammed Mukhaimar
(mkm1975@hotmail.co.uk) CBT therapist and
BABCP member, on for further discussion if you are interested.

To learn more about Sumud Palestine visit: http://sumudpalestine.org.uk/

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