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A Stick in the HeartJoe Cepeda

A Stick in the Heart

In Thailand, lay counselors offer therapy to traumatized Burmese migrants

Tin Tun rides his motorbike through the Thai border town of Mae Sot.

He cruises past rice fields on the outskirts until he reaches the warehouse of a corn-processing plant. A wiry man with a broad forehead and receding black hair, he ducks into a passageway that leads to an encampment for Burmese migrant workers.

Tin Tun must travel here each week to counsel Yi Yi (not her real name) because she is afraid to leave the workers’ compound. Like other undocumented Burmese, Yi Yi fears the Thai police, who often demand bribes to ignore migrants who lack the proper papers.

Tin Tun’s counseling session is part of a study by the Bloomberg School’s Applied Mental Health Research (AMHR) group. Its aim: to test whether lay counselors with brief training and close supervision can provide effective therapy to people within their communities who have suffered from trauma or violence.

For Yi Yi and the roughly 2 million other Burmese who have crossed into Thailand, harrowing stories are commonplace. Since 2011, a quasi-civilian government in Burma (also known as Myanmar) has eased repression. However, these reforms follow on nearly 50 years of military rule that gutted the economy, outlawed dissent and waged war on ethnic groups seeking self-determination. The junta packed the prisons with dissidents.

The army burned thousands of villages, destroyed crops and forced people to do dangerous work without pay; Tin Tun’s colleague Mya Mya Win, for example, counseled a woman whose brother died doing forced labor.

Tin Tun himself has faced prolonged hardship. He was arrested for political activities the day after his daughter’s birth. Torturers deafened his right ear and scarred his body.

When the regime released him in 2009, his baby daughter was 19 years old.

“Can we make therapeutic interventions that work? Can we train people who don’t have a mental health background to provide them?” —Paul Bolton

Today, it is Yi Yi’s suffering that he will address. Tin Tun walks down the trash-strewn lane between two rows of houses pieced together from bamboo, corrugated zinc, plastic sheeting and empty rice sacks. Yi Yi emerges into the glare to greet Tin Tun. She is 45, has short black hair and dresses in stylish capris. Tin Tun kicks off his flip-flops and stoops to follow her into the wobbly 8-by-10-foot shack with a roof made of leaves. He sits cross-legged on a woven mat facing Yi Yi, and they begin to talk.

The purpose of therapy with Yi Yi and others is to help them recognize the connections between thoughts, feelings and behavior and to use this understanding to feel better. In eight to 12 sessions, Tin Tun and 16 other counselors teach their clients to notice negative or self-defeating thoughts and behaviors and then to reconsider them. The counselors guide clients in moderating their intense emotional and physical reactions to memories of trauma.

More is at stake than the clients’ psychological distress: depression and anxiety can lead to physical illness, risky behavior, fractured relationships, injuries, lost wages, even suicide.

Comments

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  • Shweta

    India 10/11/2012 01:23:06 AM

    It is interesting to see how paracounsellors use strategies of Cognitive Behaviour Therapy. This may work under strong supervision. However, it will also be interesting to know whether any other mechanisms/processes are being put in place to increase community level support for people.

  • Dfr. Leonard Feinberg

    USA 10/12/2012 02:38:54 PM

    Are there good protocols for a training program for lay counselors? What would be a referral source for funding a training program for lay counselors?

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