> Gordana Hol-Radicic is a Clinical Psychologist and team leader at STARTTS.

Background
Tenzin, a 14 yr old Tibetan girl, was referred for counselling because of symptoms indicative of clinical depression. She appeared to be very isolated at school; had stopped eating; experienced disturbed sleep patterns; and showed symptoms of sadness and hopelessness. Tenzin also had strong feelings of guilt about surviving multiple traumas in the context of organised violence.

An assessment of Tenzin’s history and family background revealed that she had arrived in Australia in 2005 with her 16 year old sister. The major trauma for these two siblings – who were now living with distant relatives in Sydney – took place four years ago when their family home in Tibet was invaded by military personnel. During this incident, their mother was killed in their presence; their father was arrested and taken to a concentration camp; and an older brother (19 years old) ran away.

Intervention
Therapy for Tenzin utilised an eclectic approach with the aim of decreasing her depressive symptoms, increase her self-esteem, address life goals and develop interpersonal skills.

At the beginning of treatment, rapport and trust were developed through supportive counselling and the instillation of hope. Narrative therapy techniques, with elements of mindfulness, breathing and visualisation, were all utilised. Later in therapy, CBT was introduced to address pessimistic ideas and deal with guilt and unrealistic expectations. Tanzin presented as very self-critical, so it was important to encourage a more objective self-evaluation and to normalise her reactions to what were very critical events.

The problem-solving elements of therapy involved addressing stressful situations and analysing the trauma material, with elements of graduated exposure therapy, in tolerable doses. When Tenzin became too emotional - or when the memories seemed too intense or vivid – Tenzin would be reminded that she was in control, and elements of breathing and visualisation would be applied.

Tanzin was also helped in developing interpersonal skills through interpersonal therapy (IPT) This addressed the issues of loss, grief, interpersonal dispute, and interpersonal sensitivity that were of concern.  Through this, Tanzin learned to express her feelings and to share them with others, especially her sister, in healthier and more socially acceptable ways.

3 Major Learnings
The clinician learned the following through her work with this client:

• The value of developing rapport and trust with the client, respecting the client’s religious beliefs, and incorporating these in treatment. As Tanzin was a Buddhist, her spiritual habits were re-iterated and applied in many of the sessions to great advantage.
• The importance of approaching therapy from a strengths-based perspective. It was important to see Tanzin as resilient, and a person of great potentials and adaptive capacity, and to communicate this to her. This helped to develop her self-esteem, which is particularly important with clients who have a negative self-perception.
• Transference and counter-transference issues. I was well aware of the likelihood that the client could see her lost mother in me as a counsellor, and of the potential for me to see a young daughter needing rescuing in her. These issues were discussed and addressed in clinical supervision.
  

> Gordana Hol-Radicic
Gordana is a Clinical Psychologist and team leader at STARTTS. She has a Masters degree in clinical psychology and 28 years experience as a clinician. Gordana has presented at international conferences on the psychological assessment and treatment of torture and trauma survivors.