NOORIA MEHRABY describes how she helped a traumatised boy from Afghanistan come to terms with his horrific past.

I first met Omar* in 1996 when he was nine years old. Omar was a refugee from Afghanistan and his mother, concerned about his sleeping problems and social withdrawal, had brought him to STARTTS for counselling. Omar had lived in a situation of continuous insecurity for six years. He had been exposed to a variety of combat situations, including rocket attacks and shelling, and had also experienced periodic starvation. Worst of all, Omar had been the person who discovered his own father’s corpse, strangled by members of a rival political group. He was a deeply troubled little boy.

Omar was born into a middle-class family in Afghanistan in 1987. Both his parents were qualified professionals and Omar was their first child. He was raised with tremendous attention and care and his physical growth and mental development was normal during the first few years of his life. He was a happy, healthy little boy with no history of childhood diseases.

Omar’s father was politically active in the Mujahideen (freedom fighters), a group who were trying to expel the Soviet regime in Afghanistan. His mother also joined a women’s freedom fighter group. Because of their political involvement, Omar’s parents began experiencing harassment and death threats and these eventually escalated to the point where they were compelled to flee Afghanistan with their family. It was 1990 when they escaped and Omar was two and a half years old. He had no understanding of the escape nor was he prepared for it.

The family spent eight days and nights walking through lofty mountains and deserts with a very small amount of food and water. Throughout the journey they ran out of food, and the few loaves of bread left were given to Omar. The family experienced shelling bombardments, gunfire and rocket attacks and Omar’s father was tied to a tree and bashed by the military forces. After nine days of travelling in this manner, they arrived in a refugee camp in neighbouring Pakistan, where they lived arduous conditions.

Nine months later, Omar’s mother gave birth to a baby girl, Fatima. It was only three months after this that Omar’s father was murdered. Omar was the first one to find his body after someone from a hostile political group had strangled him with wire. He screamed and yelled for help and tried to untie the wire from his father’s neck.

Omar’s mother was totally devastated by the death of her beloved husband. In addition, the murderers threatened her with death and with the kidnapping of her children to prevent her seeking justice. Omar’s mother and her children had to hide to save their lives. They could not continue living in the camp, as it was too difficult for a widow to live alone without male protection. They were also unable to stay with relatives who lived in a nearby residential area as these relatives were concerned about their own safety and security and rejected them. Therefore they went back to Afghanistan where there was a renewed outbreak of fighting.

The family witnessed a variety of combat situations as well as rocket attacks and shelling. They also lacked basic necessities such as food, water and medicine. They stayed in Afghanistan for 10 months until they were again able to escape to Pakistan where they remained for a year.

Omar, and his mother and sister were finally accepted as refugees by the Australian government in 1995 and arrived in Sydney in August of that year. Omar was suffering from a sleep disorder where he woke up several times during the night. He also had a fear of darkness and noise. He was extremely isolated and withdrawn and had difficulties socialising with other children.

Omar fantasised about how he would avenge his father’s death and was often observed watching violent movies on television. He had poor concentration and, as a result, was experiencing learning problems at school. He was also having difficulties adjusting to the Australian school system after his lack of formal schooling in previous years. Omar seemed to have lost interest in most of the recreational activities that a boy his age would normally enjoy.

It was evident that Omar had taken on responsibilities far exceeding his nine years. He was aware of all the families’ problems, including financial problems and details of bills and other expenses that had to be paid. Omar was attempting to take on his father’s role as carer and provider for his mother and Fatima.

Omar’s mother was also suffering from severe post traumatic stress disorder, depression and anxiety. She was offered a holistic rehabilitation program at STARTTS consisting of supportive counselling, physiotherapy, group work and assistance with settlement problems. These interventions with the mother would gradually change Omar’s family life, providing a context in which Omar could grow and change.

My therapy plan for Omar consisted of weekly counselling and psychotherapy sessions that included art therapy, game playing and story telling. In the first counselling session Omar was shy and hardly spoke to me. He looked much smaller than his nine years. He had no idea why he was coming to see me or what he was supposed to do. His mother had told him beforehand that he was to meet his new ‘teacher’.

Eventually Omar began to write and draw in his counselling sessions. One of his earliest drawings depicted two birds and a small story in his first language, which was sad but with a happy ending. A translation of the story is as follows:

The story reflected his experience of lack of food both in Afghanistan and in Pakistan. However, in his fantasy world Omar wanted to have a happy ending for this story. He also remarked that he liked birds, as they are "beautiful, they are innocent and they can fly". For Omar, birds were symbolic of peace and freedom and the ability to fly away from conflict.

When he finished drawing he returned the pencils to their proper place, cleaned up the table and turned off the light while leaving the room. This not only reflected the ‘responsible adult’ in him, but also the very real concern of his family to conserve resources and save money on bills.

During the early art therapy sessions, Omar’s work often drew on the theme of war. For instance, he would draw dead bodies, jet airplanes, rockets, guns, "muscle men", snakes and soldiers. He described guns as a tool, which can kill bad people, "muscle man" as a symbol of a strong person who can fight against bad people and snakes as dangerous animals that could bite other dangerous animals.

Omar relived many of his traumatic experiences and his desire for revenge through drawing. He often depicted the killing of "bad people". It was difficult for him to verbalize the trauma and he was not naming his enemies as the murderer of his father, rather he was labeling them "bad people".

Game playing was the focus of some counselling sessions, particularly games about animals. Omar wanted to take the role of a strong animal for example, a lion or tiger, while I was asked to play a fox and later a deer. Omar killed all the animals and was the hero of the game. This game was played several times during the following sessions. He needed to be the strong one rather then the victim; I was to be the victim. This reflected his fixation with bringing vengeance to the murderers of his father.

After the 10th counselling session Omar was referred to a STARTTS residential camp held at Rivendell Child & Adolescent Unit in Concord Hospital. It was hoped that the camp would help to reduce his isolation and facilitate his interaction with other children.

Omar was initially withdrawn and shy and took time to engage with other children but he eventually mixed well with them and enjoyed his time at the camp. He participated in almost all of the camp activities such as small group exercises, acting and games. This gave him the opportunity to share his experiences, to feel he was not alone and that other children had similar experiences.

The camp gave him a break from his difficult environment and from his mother, who usually relied on him for support. It also gave him a chance to be a child, not an adult. Omar’s participation in abseiling and rock climbing helped him to overcome some of his fears about noise, darkness and the likelihood of re-experiencing trauma. The camp also provided an opportunity for him to identify differences between refugee camps - places of sorrow and sadness - and residential camps - places of pleasure and joy.

In the first counselling session after the camp there was an obvious shift in Omar’s mood. He was very excited about the camp and talked throughout the session about it.

Gradually, through regular counselling sessions, Omar’s drawings and craftwork began to change. It became more creative and lively with themes relating to his family, school, friends in Australia, flowers, trees, gardens, the sun and sea, mountains and the Sydney Opera House. Also, Omar was no longer concerned about the cost of the electricity bill and the need to turn the lights off. He began sitting in a larger chair and he was also able to talk about different things at home and at school. He now described a gun as a toy and a snake as an animal that can be made easily from clay or plasticine. When he learned some new art or craft at school, such as book-covering, making fans or cards, he provided examples of these during therapy and talked about what he had learnt.

It was obvious that he was much less preoccupied with his past trauma experiences and more focused on his present. An important therapeutic goal had been achieved. Omar came to have trust in me and saw me as someone with whom he could share his happiness and success and talk about his problems. He enjoyed talking about sports, school carnivals, friends and family. Often he brought his school reports with him and talked about his progress and weaknesses.

One day he was very excited and told me: "I have a great news for you, l have been chosen for the special art and craft group". Another day he was able to express his feelings about his mother: "I don’t like when my mother cries or gets upset, I feel sorry for her". In another session, when he was drawing a map of Australia, he said that he liked Australia because it is beautiful and there is no" fight" here.

At home things changed dramatically. Omar became another child in the family and felt he did not have to carry on the responsibilities of his father. He was allowed to behave like a child and began watching cartoon instead of violent movies. He was more involved in outdoor activities and sports.

At school, changes also occurred in terms of Omar’s learning and behavior. His school reports were a clear indication of his improvement. He was no longer the withdrawn child who could hardly communicate with other children.

As progress was noted in the clinical setting it was decided to discharge Omar from therapy. The termination process was discussed eight weeks in advance and a calendar was marked to prepare him for the ending.

The therapy had lasted for 20 months and comprised 58 individual counselling sessions with Omar. In the last session Omar chose to draw. He drew a picture of himself and I together. He gave the original to me and said that I should keep it so I would remember him. He also wanted a memory of our relationship and he kept a photocopy for himself. At the end of the session Omar asked if he could take his previous drawings with him. I felt this reflected his need to take what he had learnt during therapy with him. He asked if he could go to future STARTTS camps and whether he could contact me if he needed to. These questions reflected his anxiety about separation and his concerns about the future. Was this going to be a permanent loss?, as his losses in the past had been, or was it just the end of a positive experience?

This last session had a significant impact on me. I was worried about his well being and had my own feelings of separation, sadness and loss as therapy came to an end. Because of my own refugee experience, loss and separation is always difficult for me. I felt both of us were reliving the trauma and uncertainty. It was obvious that I experienced some counter transference reactions, but this was communicated and shared and, while it was painful, it was no longer overwhelming.

This article was first published in The Child Psychoanalytic Gazette, No.11, Dec 99.

Afghans constitute the fourth largest group of arrivals to New South Wales under the Refugee & Humanitarian program. Between 1991 and 1999, 2420 Afghans have arrived in NSW and of those, 1147 (47%) were children aged 18 or under (Department of Immigration & Multicultural Affairs, 1999).

At STARTTS, 20% of clients receiving individual therapy are from Middle Eastern backgrounds, and of those, 18% are from Afghanistan. Nine percent of Afghan clients are children under 18 years of age whereas children only comprise 5% of the clientele of other nationalities. There are a total of 204 Afghan clients who have received individual therapy and/or group therapy.