CBT For Syrian Women Essay Sample

Program Overview

As the literature review detailed, this program will consist an integrated model of cognitive behaviour therapy and traditional coping or healing strategies based on Syrian culture. It is very important for therapists to understand the cultural and worldview of the clients, especially non-Western clients. Research suggests that therapists who are open to culturally relevant techniques and interventions to integrate culture wisdom with Western group counselling can help move clients toward more fulfilled lives (Loewy & Williams, 2002). More specifically, in Arabic cultures, approximately 72% of six Arab groups believe that women clients should be treated by female counsellors and men clients should be treated by male counsellors (Al-Owidah, 2003). For this reason, a female counsellor trained in group therapy will be chosen to lead or supervise the group. The program is designed for registered Syrian female refugees who are of age 35 to 50, in Saudi Arabia, and meet the criteria of PTSD and MDD. Individuals screened and meeting these criteria will attend 10 closed 2-hour sessions. The goals of this program are to provide affected members a safe place to gather and talk about their concerns and experiences, psycheducation about their symptoms, counselling to diminish symptoms of PTSD and depression, teaching basic coping techniques of adaption to a new culture, and providing information about community resources. The program will run for one hour a week and is supported by the Department of Civil Crisis, Department of Psychiatry, and Department of Social Services at the National Guard Hospital in Riyadh.

Pre-group Screening, Selection, Recruiting and Orientation

First, the project will make a presentation to the Department of Civil Crisis at National Guard Hospital to have all the legal processes cleared and to get logistics supports. A summary of the project will be submitted with an official signed request by the group leader to establish a group therapy program for Syrian women refugees in the outpatient building at National Guard Hospital in Riyadh. Similar official requests will be sent as well to the Department of Psychiatry and Department of Social Services. The reason for sending official requests to these two departments is to get access for referral members to individual therapy or social services, if needed.
The group members will be interviewed and screened by the group leader to determine if they meet the criteria for participation. Two assessments will be used for screening: 1) Beck Depression Inventory and 2) PTSD Checklist. The reasons for using these two assessments are that both of them are translated to Arabic and the items in both assessments are adapted to Arabic culture. These assessments have been previously used specifically with Syrian refugees (Farhood & Dimassi, 2012). When individuals are screened, they will receive complete information about the purpose of the program and ethical considerations, such as confidentiality and self-determination. Subsequently, 8 to 10 members will be selected and asked to complete the Informed Consent Form (see Appendix). There will be some equipment such as a screen connected to the internet to play music, video clips, and machines for hot and cold drinks during the tea break. All these equipments can be prepared by the group leader.

Session One

Introduction to the Group
The leader introduces herself
Explains the concept of group therapy
Explains the purpose of this group
Reviews the informed consent and confidentiality
Opportunity for members’ questions
Member introduction
In a go-round, each member introduces herself (starting with the eldest)
In a go-round, each member describes hope and expectations for the group
Tea Break, Syrian’s Game
Members will have the opportunity to talk to each other during the break
The leader will hand the Syrian’s Favourite Sheet (Appendix)
In the sheet, each member will write about their favourite Syrian items (food, songs, TV show)
Each member will pass their sheet to the one beside them, and each one will read to the group members what is written in the sheet

The leader will collect the sheets and prepares some songs and clips for use in the next sessions

Homework: Write down 5 strategies that you have used to cope with your new situation
Session Two
Check In
How were your symptoms this week?
How did they find the homework? (5 coping strategies)
Opportunity to share their coping strategies with the group
The leader will ask the group to categorize their coping strategies (personal, spiritual, social, physical, etc.; see Appendix)
All the coping strategies be will be written in the Coping Strategies Sheet and each member will have a copy.
Psycho-education
Explain the concept of cognitive-behavioural therapy “A-B-Cs”.
Knowing the roles of our cognition, emotion, and behaviour in depression and PTSD, and how negative thoughts can lead to emotional and behavioural consequences

Opportunity for members to give some examples, and ask questions

Explain how to record automatic thoughts (Appendix)
Tea Break
Members will have the chance to chat about their daily life with others
The leader will pick a song from the Syrian’s Favourite Sheet and plays it
Homework: Try to practice one coping strategy of each category by using Coping Strategies Sheet. Record your automatic thoughts by using the sheet

Session Three

Check In

How was your week?

How did they find practicing the coping strategies?
How did you find recording your automatic thoughts? What did you notice?
Opportunity to share their opinions, and ask questions about coping strategies, and automatic thoughts.
Psycho-education

Explain the reasons for recording automatic thoughts as a first step to challenge automatic negative thoughts

Awareness: “what is going through mind? Am I being realistic?”
Will ask members to do a small exercise: pick one automatic thought from the sheet you have and ask yourself the above two questions

Share your opinions with other members

What did you notice?
Tea Break
Members will have the chance to chat about their daily life with others

The leader will ask one of the members to pick a song from the Syrian’s favourite sheet

Homework: keep recording your automatic thoughts, and practice one coping strategy for each category by using Coping Strategies Sheet (should be different from last week). Also, ask yourself this question: What is the effect on me of having these thoughts?

Session Four

Check In
How was your week?

How was your experience of practicing more coping strategies?

How did you find recording your automatic thoughts? What did you notice?

Opportunity to share their experiences with coping strategies, recording automatic thoughts

Explain the Ten Common Cognitive Distortions
Hand an Arabic copy of the ten cognitive distortions (Appendix)
Answer members’ questions about cognitive distortions
An exercise: ask members to use their Recording Automatic Thoughts for the last two weeks, and find what cognitive distortions can describe their thoughts

Members share their answers and discuss (optional)

Tea Break

Members will have the chance to chat about their daily life with each others

The leader will pick a short video from their favourite TV show list the Syrian’s to watch it during the break
Homework: For the leader: as one the goals of this project is to assist adaption to a new culture, and to provide members with information about community resources, leader required to arrange a meeting with one female social activist to give a speech about the local social activities, and any other opportunities. For members: write three social difficulties that you found in Saudi Arabia. What are most common cognitive distortions that you are doing and when? Continue using different coping strategies.

Session Five

Check In
How were your symptoms this week?
Did you find any difficulty tracing your automatic thoughts and your cognitive distortions? What did you notice?

Does recognizing your automatic thoughts and your cognitive distortions help you to control your way of thinking? (Discussion)

Introduce the speaker and the goal of the lecture
After the lecture, members will have the chance to share their social difficulties in Saudi Arabia (homework from last session)
The speaker will answer the questions and provide them with some resources and opportunities
Tea Break

Leader will discuss during the break:

How was the lecture?
What did you get from it?
Did you find the information and the resources helpful?

Would like to have another lecture?

Homework: the speaker provided members with different social activities in the community and different opportunities that can increase their ability to adapt in a new culture; member will be asked to try one of the recommendations the speaker gives.

Session Six

Check In

How did you do this week?

Have you try some of the social activities that the speaker gave last session?
Share your experience; what did you find difficult?
Change your Thinking to Change the Way you Feel
In this part of the session, we will try to challenge some old automatic thoughts
We will review the A-B-Cs of model (it can be by one of the member)
The role of negative assumptions in feeling and behaviour (should, must, everyone)
Practicing and correcting negative assumptions (Appendix)
Exercise
We will use the automatic thoughts sheet for the last two weeks and use some of the automatic thoughts
We will use the Corrective Automatic Thoughts sheet (Appendix); members will be asked to come up with three different corrective thoughts and share their answers.
Tea Break
Members will have the chance to chat about their daily life with each others
The leader will pick a song from the Syrian’s Favourite Sheet and plays it
Homework: Use the two sheets to challenge your automatic thoughts and negative assumptions by having different alternative thoughts and assumptions. Then write a small paragraph explaining your experience.

Session Seven

Check In
How was your week?

As you are working on your thoughts and beliefs, how is it affecting your symptoms? (Discussion)

How did you find the homework this week? What did you find difficult?
Share your corrective assumptions and corrective automatic thoughts with others (optional)
Listen to Your Body
Why is it important to know the physical impact of your symptoms (PTSD, MMD)?
What are the common physical sensations to the members?
Members will take couple minutes to write some physical sensations
Working to Let it Go: Relaxation Techniques
Introduce Abdominal Breathing:
Member will get an instruction sheet of abdominal breathing (Appendix)
Practice abdominal breathing in the session, what did you notice? Is it different than regular breathing?
Introduce Muscle Relaxation:
Members will get an instruction sheet of abdominal breathing (Appendix)
Practice abdominal breathing in the session, what did you notice? Is it different than regular breathing?
Tea Break.
Free time of chats and discussions
Homework: Members will be asked to practice the two relaxation techniques. They will be asked to keep focusing on automatic thoughts and negative assumptions, and correct them.

Session Eight

Check In
How was your week?

How did you find practicing the two relaxation techniques?

Does it help to decrease your physical sensations?
Share your experience with others
Action Plan
Go back and review the goals of the group.
What have been changed so far?
Is there any area that you want to focus on it?
How can we put things together as we getting to the end of our program?
Members discuss and share their ideas, and therapist can write down the important feedback.
Tea Break

Discussion and listening to some songs

Homework: For the group leader: arrange a meeting with a speaker from Employment Services to provide members with information about job opportunities in the community, continuing education, training, founding a small business. For members: write in one or two paragraphs your education, employment or a business plan. Use the Action Plan sheet to set a plan after ending the group sessions.

Session Nine

Check In
How was your week?

Discuss their action plans

Review what they have done
Traditional coping strategies (physical, personal, social, and other strategies)
The role of cognation in depression and PTSD (A-B-Cs)
Automatic thoughts, cognitive distortions, and negative assumptions
Relaxation techniques
Listen to your body
Opportunity to share their experience and asking questions
Introduce the speaker and the goal of the lecture

After the lecture, members will have the chance to share their education, employment and business plan with the speaker

Asking questions
Tea Break

Plan for the last session

Homework: None this week
Session Ten
Check In

Anything from last week that a member wants to talk about?

What has been your biggest accomplishment over the past few weeks?
Is there any area that you would like to continue work on?
How can we find help after ending the program?
The leader will give members sources of information for individual therapy
Discussion and feedback
Congratulate Members for Completing the Program
The leader will thank members for participating, and wishes all the best for them and Syria
Provide Certificate of Completion
Snacks and cake will be served
Pick a movie from the Syrian’s Favourite sheet and watches it together