Germans pioneer Internet therapy
A new form of counseling is helping victims of torture in Iraq.
A center for the treatment of torture victims in Berlin is pioneering a new kind of therapy -- one that places the patient in front of a computer screen instead of on the couch.
The US-led invasion of Iraq in 2003 and its violent and chaotic aftermath left behind not just blood, death and destruction but also deep psychological scars.
Now psychologists at a Berlin center are offering therapy over the web, a medium whose impersonal nature often prompts victims of rape or kidnap to open up more than they would do on the couch.
The free service -- Interapy -- began in spring 2008. Already, about 20 victims of post-traumatic stress syndrome have been treated and roughly 30 other patients are still receiving care.
Christine Knaevelsrud, a psychologist at Berlin's Center for the Treatment of Torture Victims (BZFO), says 250 victims have come forward, mainly from Iraq but also some from Sudan, Syria and the Palestinian territories.
"Some victims have been raped, some kidnapped," said Knaevelsrud. "Others have been maltreated during arrests or have seen mutilated bodies."
The BZFO first established a therapy center in Kirkuk, in the northern part of Iraq, in 2005. Demand for the service was strong and plans are now afoot for two further centers in Erbil and Suleimaniyah.
Nevertheless, this caters for the relatively calm northern part of the country, leaving those most in need in more volatile areas alone with their trauma, Knaevelsrud explained.
"So, we asked ourselves the question: what more can we do?" the psychologist said.
The answer? Interapy.
The project, established jointly with the University of Zurich, takes its inspiration from treatments conceived in the Netherlands.
The German Foreign Ministry finances the Internet site; the cost of training the nine therapists is undertaken by the Heinrich Boell Foundation; and the operating costs are paid for by Misereor, the development art of the Catholic Church in Germany.
The treatment consists of three stages. The first and most difficult step is for the victim to write, in four emails, what they thought, saw and felt during the traumatic event.
According to Knaevelsrud, many patients fail to complete these emails, stopping at the key moment the event took place.
Nevertheless, she adds, the impersonal nature of the Internet helps victims to more easily confront the event.
"The Internet method is soothing for many victims because they do not have to speak to anyone specific or sit opposite someone," says Knaevelsrud.
The second stage consists of writing four letters to an imaginary friend who has experienced the same trauma. This helps the patient to shake free any feelings of guilt often experienced by victims.
Finally, the patient is encouraged to write a two more letters, one to him or herself and one to the person who carried out the atrocity. This step is intended to push the perpetrator out of the patient's life.
In theory, the therapy should last five weeks but in reality, the course tends to take four to six months, says Knaevelsrud.
The innovative method is not without its critics.
Christian Luedke, a trauma expert from Essen in western Germany, says that while Interapy may stabilize a patient, there is no substitute for face-to-face contact between psychologist and victim and yet: "For the people in Iraq, Interapy is obviously better than no help at all."