The Needs And Resources Of International Torture Survivors Living In The Dallas Fort Worth (DFW)Metroplex: An Investigation Of Healing And Assimilation Perceived By Center For Survivors Of Torture’s Clients And Staff As Well As The Greater Resettlement Community Ryan J. Trubits Thesis Prepared for the Degree of Master of Science University of North Texas August 2015 APPROVED: Celia VanDeGraff, M.A., Executive Director Kristen Orakwue, LMFT-S., Clinical Director Doug Henry, PhD., Committee Chair Alicia Re Cruz, PhD., Committee Member Lance Rasbridge, PhD., Committee Member Trubits, Ryan J. The Needs and Resources of International Torture Survivors Living in the Dallas Fort Worth (DFW) Metroplex: An Investigation of Healing and Assimilation Perceived by Center for Survivors of Torture’s Clients and Staff as well as the Greater Resettlement Community. Master of Science (Applied Anthropology), August 2015, 94 pp., bibliography, 90 titles. Torture survivors find difficulty navigating through an unfamiliar healthcare and social service system. Many survivors who already face Post Traumatic Stress Disorder (PTSD), anxiety, and depression also endure a secondary threat which leads to re-traumatization through the struggles of acculturation. The aim of this study is to determine: 1. Identify differences and assumptions between service providers’ and clients’ definitions of self-sufficiency; 2. Examine prominent barriers to self-sufficiency that survivors encounter; 3. Pinpoint the survival strategies that survivors use in order to cope with life in DFW; 4. Determine what resources CST staff, area service providers, and survivors feel need to be improved for CST and the DFW metroplex. Copyright 2015 by Ryan J. Trubits ii ACKNOWLEDGEMENTS I would like to thank my committee members Dr. Doug Henry, Dr. Alicia Re Cruz, and Dr. Lance Rasbridge for their advice, patience, and encouragement throughout the completion of my applied thesis. In particular, I am forever grateful to Doug for his sincerity in helping to simplify for me an often unfamiliar experience. I also want to thank my site sponsors at the Center for Survivors of Torture (CST), Celia VandeGraff and Kristen Orakwue. My experiences with CST were memorable and will greatly shape the way I conduct future research. To my cohort, I will always cherish the moments we shared. There were many highs and lows and we were all there to experience them together. I will never forgot the times we shared. Josh, Chris, Amanda, Jackie, Shelly, the Mollys, Natalie, and last but not least Elizabeth, thank you all for being there to lend an ear. Being away from home was at times difficult and all of you provided support and friendship. To my parents, thank you for encouraging me to pursue my dream of becoming an applied anthropologist. I know at times it may have been difficult to understand why I chose to devote my life to this subject, but you were there with loving support. Lastly, to my mentor Dr. H. James Birx, your guidance, support, and insight throughout my academic and professional career has been pivotal to my development as an aspiring applied anthropologist. Please accept my sincere gratitude and I hope that our paths will continue to cross in the near future. iii TABLE OF CONTENTS Chapter 1: INTRODUCTION…………………………………………....……………………......1 1.1: Organizational Background………….……………………………………………….1 1.2: Program Mission……………….……………………………………………………..2 1.3: Stakeholders………………….………………………………………………….........3 1.4: Study Purpose………………….…………………………………………………......4 1.5: Research Goals……………………...………………………………………………5 1.6: Methods……………………………………………………………………………..5 1.7: Limitations…………………………………………………………………………....8 Chapter 2: CONTEXT AND BACKGROUND..………………………………………………..10 2.1: Literature Review…………………………………………………………………...10 2.2: Political Economy and Migrant Studies…………………………………………….11 2.3: Refugees and Asylum Seekers……………………………………………………....13 2.4: Idioms of Distress…………………………………………………………………...16 2.5: Foundations……………………………………………………………………….....17 2.6: Embodiment Expressed Through Political Violence………………………………..18 2.7: Neuropsychological Anthropology………………………………………………….19 2.8: Closing Remarks…………………………………………………………………….20 Chapter 3: EMERGING THEMES………………………………………………………………22 3.1: Emerging Themes…………………………………………………………………...22 3.2: Self-Sufficiency- Overview…………………………………………………………23 3.3: Self-Sufficiency- Staff/Service Providers…………………………………………...23 3.4: Self-Sufficiency- Clients…………………………………………………………….27 3.5: Self-Sufficiency- Closing Remarks…………………………………………………29 Chapter 4: BARRIERS.………………………………………………………………………….30 4.1: Cultural……………………………………………………………………………...30 4.2: Perceptions of Barriers Staff/Service Providers…………………………………….30 4.2.1: Cultural Sensitivity and Detection………………………………………..30 4.3: Perceptions of Barriers Clients……………………………………………………...35 4.3.1: Challenges Navigating System……………………………………………35 4.3.2: Developing Support Network………………….………………………….37 4.3.3: Re-traumatization…………………………….……………………………38 4.4: Structural Barriers…………………………………………………………………..43 4.5: Economic Barriers…………………………………………………………………..44 4.6: Legal Barriers……………………………………………………………………….47 4.7: Access to Care………………………………………………………………………52 Chapter 5: COPING STRATEGIES.…………………………………………………………….55 Chapter 6: NEEDS FOR IMPROVEMENT.…………………………………………………….63 Chapter 7: CONCLUSION………………………………………………………………………72 iv Chapter 8: RECOMMENDATIONS.……………………………………………………………76 Chapter 9: APPENDICES...…………………………………………………………………….78 Chapter 10: BIBLIOGRAPHY…………………………………………………………………..87 v CHAPTER 1 INTRODUCTION 1.1: Organizational Background Center for Survivors of Torture (CST) was in the vanguard of the national movement of providing specialized care and rehabilitative services to survivors of politically motivated torture through its associations with Proyecto Adelante, where it existed as an independent project from March 1997 forward. Proyecto Adelante is a 30-year-old non-profit 501(c) (3) political asylum program in Dallas, which provides legal services. In January 1997, Dr. Frank Mabee became the first director for Center for Survivors of Torture, which he helped create out of Proyecto Adelante. The center started with five clients from Central America in 1997. Since its inception, CST has provided services to more than 3,500 clients and their families (cstnet.org 2014). While CST has offered a much needed relief to this community, estimates show that there are over 40,000 torture survivors in Texas (cstnet.org 2014) (cvt.org 2014). Furthermore, CST requires extended federal, state, and public funding to expand its resources to this growing unaddressed population. While addressing the legal needs of its clients, Proyecto Adelante staff found that as many as one-third of clients had personally suffered torture, witnessed torture, or knew someone who had been tortured. The legal staff was unable to address the mental health needs of its clients, which impeded the staff's legal representation of its torture survivors. The staff of Proyecto Adelante became aware of an international movement to assist this population, which had begun in Denmark in the 1970s, and they determined to implement such a program in Dallas because of the pervasive needs they had discovered. In March 1997, CST was established as a stand-alone non-profit. 1 The torture survivor assistance movement came to national attention in October of the following through a conference in Minneapolis, Minnesota, which was sponsored by the United States Office for Victims of Crime. The conference was entitled Caring for Torture Survivors and brought together 300 healthcare and human services professionals. In conjunction with this conference, representatives from 14 centers serving torture survivors in the U.S., prominently including CST, assembled for their first national meeting. Two years later, CST's client needs exceeded the capabilities of Proyecto Adelante and required the establishment of a fully independent organization, dedicated solely to serving the specialized rehabilitative needs of torture survivors and their families. In March of 2000, Center for Survivors of Torture was established as an independent non-profit corporation under the State of Texas and applied to the IRS for tax exemption status. In 2005 the CST Austin office opened and continues to grow now providing services at a satellite office in San Antonio. 1.2: Program Mission The International Rehabilitation Council for Torture Victims (IRCT) estimates that up to 35 percent of all refugees worldwide are torture survivors (irct.org 2011). Currently, the Center for the Victims of Torture (CVT) figures show that there are approximately 500,000 survivors of torture in the United States (cvt.org 2014). CST is the only accredited mental health care provider of specialized torture treatment services in Texas; they earned their international accreditation from the IRCT. CST provides continuous psychological, legal, medical, social services, basic needs, and acculturation assistance for torture survivors. Survivors of torture need a very specific treatment protocol and CST’s culturally-competent services are free to all indigent asylum seekers and 2 refugees who request help. Over 85 percent of their clients meet their counseling goals within six months. Survivors have gone on to develop successful coping strategies to combat the physical and mental struggles brought on by their traumatic experiences and to live healthy and productive lives. Immigrants suffer from cultural, linguistic, transportation, economic, and familial support barriers. However, in addition to these issues, torture survivors find difficulty navigating through an unfamiliar medical and social support system. Federal funding provides only four to eight months of monetary support for refugees. As a result, refugee resettlement agencies must place a heavy emphasis on finding employment and becoming self-sufficient in the most expedient manner. Alas, the case is even more critical for asylum seekers who lack the legal status to work or receive social and medical services in order to support their basic needs. Many torture survivors who already face Post-Traumatic Stress Disorder (PTSD), anxiety, and depression also endure secondary threats that lead to re-traumatization through the struggles of acculturation. CST’s work is vital to the survival and success of both refugees and asylum seekers who have been tortured. 1.3: Stakeholders Celia Vandegraff, M.A., Executive Director and Kristen Orakwue, LMFT-S., Clinical Director, are the administrative leaders of CST. They were my primary contact with the organization. Both Celia and Kristen’s interest was to determine the satisfaction of staff, clients, and service providers about CST DFW. They have a vested interest in their clients and want them to have a positive experience while also strengthening their relationships with services providers in the DFW metroplex. Their major concern was the confidentiality of clients’ personal information. 3 1.4: Study Purpose My applied thesis addressed four research goals among CST staff, clients, and service providers in the DFW metroplex. By analyzing qualitative interviews, I assessed how survivors cope with their duress and developed survival strategies to acculturate themselves. This assessment benefits CST because no formal evaluation has been conducted to examine its success in satisfying both those who assist and seek its help. The intent of this study is to help CST improve their programming for survivors by offering recommendations based on the data collected. I propose that the outcome for this evaluation is to improve the communication among CST staff, clients, and other service providers in DFW. This research demonstrates an effort by CST to have staff, clients, and service providers express their perspectives in a confidential and sincere manner. Another goal that I set out to accomplish is to shed light on the survivors’ plight in terms of integrating to life in the United States. Torture survivors are forced to flee from their native countries because of violations to their human rights. This research is significant because often torture survivors are overlooked by the general public, become marginalized, and deemed voiceless. My findings will contribute to the international torture survivor discourse by incorporating a political economic and critical medical anthropology perspective. This framework helps to contextualize the experiences of the marginalized. By painting an ethnographic picture of this population, through the documentation of lived experiences, I will promote social justice for this disenfranchised community. 4