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“It is about finding our reward in the eyes of those to whom we owe nothing” - A week as i

Towards the end of a small, narrow street in Camden Town there is a small human rights organization known as the Helen Bamber Foundation (HBF). You would not be able to find it, if you did not know what you were looking for. The office spaces are quite small and the corridors are narrow, yet the organization is overflowing with compassion and knowledge to help the most vulnerable clients with the most complex cases. Embraced by the typical British cultural norms of large sized tea cups and biscuits the organization is hard at work five days a week- working with survivors of human cruelty. In the following blog post we, Sophia Berntzen and Hege Kristine N. Dahlen, would like to take you along on our experiences from a single week’s internship at the foundation. If you do would like to learn more about what HBF is all about, we would advise you to check out the foundation’s official website.

October 22nd- day 1 The first day at HBF was filled with strong impressions, both from the staff and the clients. We spent the day having many interesting conversations with the employees learning about the structure of the organization, as well as reading research papers and observing a therapy session. When we first arrived we were welcomed by one of the psychology trainees there and were given a brief introduction to HBF’s work and client population. We got the opportunity to ask all the questions we wanted, but were also told that we would get to meet with all the heads of the various departments at HBF during the course of the week. We took a tour around the office space and noticed that it was very intimate and had a relaxed atmosphere, which makes sense considering how important it is to create an environment where any client could feel comfortable and safe. First off, we met with with Maria - referrals coordinator, and Kat - head of legal. All potential clients have to submit a referral to HBF to be considered as a client. There are certain criteria that the potential client has to meet to become an actual client of HBF. E.g; you have to be an asylum seeker who has experienced torture and/or any form of human cruelty. All the potential clients are discussed in the weekly referrals meeting; a multi-disciplinary meeting where representatives from all the departments collaboratively decide which cases to take on, and which to decline. They usually receive 2-4 referrals a week, but can only accept approx. 2 new clients a week. Even though they cannot, for several reasons, accept every referral they still forward the clients to other organizations that are currently more suitable to help with their situation. Thus, HBF will always help clients to the best of their ability. We have been told that we will get the chance to attend the referrals meeting on Thursday. The legal team at HBF helps compile and structure legal evidence through medico-legal reports (MLR) and attend appeal hearings as expert witnesses. The MLR document the physical and psychological harm of the client and are used as evidence in court for their story and why they should be granted leave to remain. Within HBF they collaborate closely with the medical- and psychological departments in writing the MLR. The legal team also works with the Home Office, human right lawyers and help clients find solicitors to take on their cases. There has been a lot of information to take in today. I cannot imagine the workload these employees have every single day, and the combination of distress and reward they must be feeling in the work they are doing. It must be overwhelming, but mostly in a good way, it seems. One thing I can tell you for sure is that they are highly motivated to do a great job every single day, compassionate to their clients and they all have an incredible mental strength that gets them through each day. The departments we got an insight into today are only two out of six departments that operate here to take care of the clients’ of HBF. We cannot wait to learn more about the other departments later this week. The rest of the day we spent a lot of time reading research articles about PTSD which is the most common mental disorder amongst the clients at HBF (approx. 80 % has it). Many of the clients have comorbid disorders and suffer from both depression and anxiety, as well as PTSD. HBF offers different kinds of therapy suited to the specific client’s situation and mental disorder. Today I got the opportunity to participate in a therapy session with one of the psychological trainees. This was the sixth out of seven planned sessions for the client, who had been trafficked at 14/15 years of age to forced labour, and experienced sexual assault and torture. Today he is 20 years old, and recovering well from his traumas. It was inspiring to experience a human being, who has been exposed to such inhumane actions, to be so optimistic about life and his future. It was amazing to be able to witness the client’s extreme willingness to work towards a life worth living. I admire their strength and their ability to never give up the fight to regain the humanity that was stolen from them in the past. October 23rd- day 2 On our second day, we began to know our way to and around the clinic. Most of the day was spent immersing ourselves in the articles that we were given yesterday and eavesdropping conversations amongst the staff members passing by in the office spaces and in the hallways. We just wanted to soak up as much knowledge about HBF as possible by learning from everything going on around us. Today we were given the opportunity to listen to some recordings of baseline, end-of-treatment and 6 month follow-up therapy sessions using CAPS- clinically administered post-traumatic stress scale. One would expect that most clients were doing very well at a 6 month follow-up, however in the recording I listened to, the client was clearly feeling emotionally exhausted and had an emotional breakdown. She was still unable to verbalize her traumatic experiences despite several stabilization assessments and therapy sessions. This just underlined the fact that traumatized and vulnerable individuals need sufficient time in order to be able to fully process their experiences and learn how to live in the present without letting their past define their future. However, this is very difficult considering the legal, medical, therapeutic and welfare situation most of the clients are in. We also met with Astrid- head of the counter-trafficking team who gave us a better insight into the nature of trafficking. The worst part about it is that most people remain naïve to the fact that trafficking, torture and modern slavery at large is happening in their own country. According to the global slavery index, there are more than 136 000 people living in modern slavery today. Thus, someone who is already quite vulnerable may be re-exploited or trafficked upon arrival in the UK which is seemingly a safe haven. Therefore an important part of the job done by the counter-trafficking team is to evaluate whether or not the client is still at risk for exploitation i.e. essentially assessing their safety. HBF tries to ensure their clients’ safety as best as possible through for ex. providing sufficient accommodation for them. It also seems clear that when the National Referral Mechanism (NRM), a part of the UK government which acts as a framework for identifying victims of human trafficking and modern slavery in order to ensure that they get the support that they need, is a necessary, but difficult system. As a result of the assessment, most victims of human cruelty receive a reasonable grounds decision to stay and claim asylum. Then, there is a 45 day window which should be used to gather enough evidence to reach a conclusive grounds decision and finally give the individual legal status. However, as we quickly learned this is an insufficient system which is essentially built to hinder immigration and to minimize the chances of filing for an appeal. This is why is so important to ensure the HBF clients needs are fully met on all levels including medically, psychologically, legally and in terms of safety so that they have the best possible opportunities to succeed in gaining legal status and start a new life. A few hours later, we strolled down to Camden market and bought some Indonesian street food. What really strikes you is how surreal many of the HBF clients’ worlds seem compared to your own; you are free to do whatever you desire and you’re fortunate enough to take a break from all of the atrocities you’ve been learning about all morning by simply stepping outside of the four walls of the clinic.

October 24th- day 3 Today started off with a very informative meeting discussing the complex cases of HBF. The complex cases are cases that the foundation is currently having difficulties with. There are several reasons why a case gets «stuck» like this. A client may have comorbid mental disorder which makes it necessary to discuss what treatment would be best. The complex cases clients have very long and complicated histories of torture and usually several diagnoses, most commonly severe PTSD (80 %) with depression and anxiety. As a result of this the HBF staff may experience that the client does not make significant progress in therapy, either because they are receiving the wrong treatment or because they are not ready to receive treatment at all at that point in time. Complex cases are also typically very «messy» regarding the client's legal status, housing- and integration situation. Other problems can evolve around a client’s history of not showing up to appointments or that it is difficult to get in touch with the clients’ solicitor. It is therefore not possible to follow the ‘standard protocol’ for these clients, and that is why they are being discussed in this multi-disciplinary meeting - to decide what is next. Present at the meeting was head of legal, HBF psychiatrist, head of therapy, head of housing and welfare, counter-trafficking case worker, medical lead and Hege Kristine and I. We went through twelve complex cases during the meeting. Several issues were discussed, including: clients not showing up for appointments, clients with limited medical or psychological records, their legal case, decide suitable therapy, clients who do not receive any financial support nor are allowed to work, clients with children that suffer from severe autism or other diagnoses, suicidal clients in need of immediate help, clients that are dissatisfied with their General Practitioner (GP) or solicitor, ethical issues regarding clients needs and HBF’s capacity to satisfy those needs, clients who are still in a trafficking situation(forced to work/abused at home), forced to criminal activity by traffickers and clients in danger of detention or deportation. We went through each of these cases, reviewing the clients’ background history and current complications, before discussing what HBF specifically needs to do next to achieve some progression on the case. It was a very interesting meeting to attend. HBF has a managing director, Kerry- CEO, as well as managers in charge of each of the six specific departments. These managers all meet regularly to coordinate their work. It must be very rewarding and meaningful to be a part of a team that is able to provide such a wide spectrum of services to their clients. It must also be very educational to be a part of a disciplinary team that provides an insight into other professions. In my opinion this is an ultimate workplace for challenge, development and growth. We also got to meet with Zoe today, the head of welfare and housing. This department helps two kinds of clients; people with no claim at the Home Office (H.O.) and people granted leave to remain. Housing and welfare helps the clients with no claim, to apply for asylum support from the H.O., and while they wait for this to be granted, HBF supports them financially so they can survive. When/if they get granted asylum support this includes receiving £37.75 per week for an adult individual to live of off, which is basically nothing. £37.75 is just above NOK 400 per week, and it should cover the clients weekly needs including food, public transportation, clothes, phone bills, etc. That amount does not even cover what I spend on food every week as a student with economical restraints. Many end up living in dangerous places and continue to develop relationships based on previous exploitation. Although the living- and financial conditions are unbearable without this financial support from the H.O., many choose not to apply for it. This is because it may entail being forced to move out of London, most often to somewhere north in England or Scotland. This has a strongly negative impact on the clients mental health, having to move away from whatever friends and family they have in London. Luckily, HBF has a formal agreement with the H.O., that any of their clients should be granted stay in London, to be able to continue receiving their services. HBF can also assist clients with some additional financial aid, in addition to what they receive from the H.O. - but the total amount will still not be enough to live a “normal” life. One of the biggest problems might be that the asylum seekers do not have the right to work, something which could benefit both their financial, social and integration situation.

October 25th- day 4 We started off our day around 0900 am meeting Christina, the co-head of therapies, who told us more about how the psychologists at HBF support asylum seekers through therapy in tandem with other processes. The therapy team does not provide crisis support, but helps clients with complex and multiple instances of PTSD over the course of 10-20 therapy sessions. HBF receives several referrals per week which is why members of the staff meet every Thursday at noon to discuss the referrals they receive; are there causes for safeguarding concerns regarding the client's children? have they received sufficient diagnostic information from the clients general practitioner (GP)? does the client have a history of persecution? what does the legal representative need to do now? Based on the outcome of their discussion of each case file, the team device care plans, divide tasks among themselves or refers the client to other, more suitable organisations. The day ran on by oh so quickly, that we were instructed to take a lunch break and we did not even realize it was 0200 pm already! Later on, Roxy- one of the members of the legal team popped on by our desks with her extra large coffee cup and had a chat with us about how we could use our psychology background in a legal context. I also asked her about some of the necessary changes that she thinks need to be made in the UK legal system in terms of the asylum seeking process. She told us that there are currently too many loopholes in the appeals process and there needs to be a change in policies for witness testimony. Furthermore, one needs to review the standards for evidence, but as a whole one needs to examine the detrimental effects of the legal process on these clients including taking their housing needs and current situation into consideration when they are pending status i.e. stuck in between the reasonable and conclusive grounds decision. So, how is one able to keep fighting for one’s clients when the system is so difficult to work with? “You draw strength from your clients. That is what makes you take on this line of work.” It is clear that HBF is willing to keep on fighting for and helping their clients as best as possible no matter what. They help build trustworthy relationships to clients, most of whom have never experienced this form of trust in their life. At the end of the day, both Sophia and I felt that we wished we could have stayed there for longer. Perhaps we may return one day for a full internship as therapeutic trainees? October 26th- day 5 Our week at HBF suddenly same to an end and we’re reluctant to leave as there were so many things we still wished to do! We started off the day, bright and early, by meeting Fran, co-head of therapies, who answered some questions that we had compiled throughout the week. We then tagged along in a clinical supervision session- were Fran met with two of the psychological trainees, Leo and Jamie, for a weekly catch-up and feedback session. Leo brought up an interesting dilemma I think is quite worthwhile sharing: how does one say goodbye to a client when the client clearly expresses his gratitude towards you as a therapist and you as the therapist feel responsible for his well-being, thus feel reluctant to “let him go”? All of us agreed that you cannot avoid addressing the issue. Fran pointed out that you will not be saying goodbye for the unforeseeable future as he will still be at HBF from time to time for other appointments. I got the impression that this is something the staff regularly has to deal with and as it turns out HBF does not have a formal discharge policy, which merely emphasizes how difficult this dilemma really is. Fran suggested that it will be very important to end on good terms without causing additional and unnecessary distress for the client. It is okay to be transparent and kind by acknowledging your appreciation for the sessions you’ve had together and wish him all the best. This kind of acknowledgment is not something a vulnerable client will not have experienced a lot in their life and is important in helping build up the client’s self-esteem as well as trust in other people. She also advised that in future client-therapist relationships one could start off by setting some expectations for the relationship. Some even find it useful to exchange letters as a part of the transition process in order to avoid significant misinterpretations and serve as a definitive aspect of a planned ending. This is something I had been thinking about as the week went by and it was interesting to take part in these chains of thought with quite experienced therapists. Later on that day, we were both able to shadow a clinical assessment session each as well as read up on the respective clients’ case files. Being able to get a hands-on impression of the unimaginable experiences the client had experienced for 20 years in three different countries on two continents stirred up a lot of emotions for me. First of all you feel disgusted by the fact that human beings can treat others in such inhumane ways, but at the same time you feel slightly optimistic about the client’s future because of what you now know about the work they do at HBF. Time is not refundable, but what you can do is to make sure to make the most out of the time that you have got. HBF helps clients learn how to take care of themselves and guide them to what hopefully will be the start to a new and prosperous life in the UK.

As you might have understood by now, we have learned so much and we are so grateful to have experienced an internship at HBF. Although the organisation’s physical parameters are relatively small, their core values, knowledge and compassion stretch far beyond Baynes street in Camden. It is clear that they want to help everyone, even though they might not be able to take on the client themselves. They always refer the client to another suitable organisation. We would really like to encourage all psychology students reading this to understand that your psychology degree and knowledge is highly applicable and valuable in a variety of contexts not merely on campus grounds, in a research lab or within a national institution. Stay tuned for an upcoming presentation this spring were we will be talking more about PTSD based on a cognitive therapeutic approach to therapy, human cruelty as well as presenting more thoughts and reflections from our internship at HBF. And if you want to keep up to date with HBF you can follow their twitter account.

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