EMDR and trauma healing in Palestine

Palestinian society has been and continues to be profoundly shaped by the trauma of political violence, both through mass displacement in 1948 and ongoing military occupation since 1967. In 1989 the East Jerusalem YMCA, a long-standing MCC partner, founded its Rehabilitation Program, aimed at meeting the needs of the many Palestinians who sustained lifelong, disabling injuries during the first Palestinian intifada (uprising), including their physical, mental and livelihoods needs. Mona Zaghrout has worked with the Rehabilitation Program since its founding. Over the past quarter century, Zaghrout has become a leading practitioner in the Arab world of a trauma healing approach called Eye Movement Desensitization and Reprocessing (EMDR), finding EMDR to be an effective therapeutic tool in helping traumatized clients cope with and heal from traumatic incidents.

The East Jerusalem YMCA Rehabilitation Program utilizes a holistic approach to rehabilitation, supporting interventions ranging from home or school modifications for persons using wheelchairs, to vocational assessments and trainings, to awareness workshops in schools for teachers and students about how best to support classmates with physical disabilities. The program’s holistic approach includes psychosocial support both for persons who are traumatized by political violence and for persons with disabilities coping with trauma.

The program started by using an eclectic approach to trauma healing, trying everything from psychoanalysis to behavioral therapy to gestalt therapy. While each therapeutic approach had its strengths, Zaghrout and her colleagues found that the real challenge they faced came with providing clients with maintenance support that would reinforce resilience in the face of new disruptions in clients’ lives. Seeking to respond to this challenge, Zaghrout started searching for approaches that would be suitable for persons living in ongoing conflict situations. This search led her to EMDR.

EMDR is an evidence-based approach designed by Francine Shapiro in 1989. The World Health Organization recommends EMDR as one of the best approaches for addressing trauma. Zaghrout explains that when people are traumatized by a specific incident, something may become stuck in their brains, and then, she continues, “the self-healing of the brain is stuck as well.” In EMDR sessions clients recall and focus on distressing, traumatic images, while receiving different types of bilateral stimulation, such as side-to-side eye movements. Through these sessions, Zaghrout notes, “we try to reach the touchstone event, which may go back to childhood, and when we solve it, when we reach it, everything else will be solved or ‘un-stuck’ and the self-healing process of our brain will go on.”

An asset of the EMDR approach is that it gives space for clients to re-live and see what happened in traumatizing incidents they underwent while allowing their brains to process those events. Zaghrout has found that EMDR is an effective therapeutic treatment for “people who did not want to speak about the details or felt there was something that they did not want to share with anybody.” EMDR enables such persons to process traumatic events without talking in depth about those incidents.

As the Rehabilitation Program started using EMDR, Zaghrout encountered skeptical criticism that suggested EMDR was a Western approach that could not be applied in Palestine. Zaghrout countered that EMDR could be successfully modified for the Palestinian situation and pointed to EMDR’s positive results in providing maintenance therapy to clients. Zaghrout and her colleagues were particularly struck by the positive therapeutic results they saw using EMDR. She notes that when “we (Zaghrout and her colleagues) were trained in EDMR, when we practiced it on ourselves at the beginning, we could see that it was very useful, very effective, very quick.”

Zaghrout grants that using EMDR in home visit settings in Palestine poses specific challenges. Most of the Rehabilitation Program’s psychological counseling work is done in clients’ homes. Some clients’ homes may consist of only one room. These conditions present an obstacle, because privacy is needed to carry out EMDR sessions. “With EMDR, you expect many things to come out, things that the client might not even be aware of,” Zaghrout states. For that reason, “it is best to have a setting of privacy and to ensure that whatever the client sees or says will be confidential.” Zaghrout acknowledged that Rehabilitation Program staff sometimes found it difficult to convey to clients’ families the need for privacy. However, she continued, “when the parents and the family see the difference that it is having with their children they would voluntarily collect themselves and sit outside until the session is finished.”

YMCA staff started seeing the effectiveness of EMDR through clinical observations. When visiting clients, they heard stories about how EMDR had changed their lives for the better. Zaghrout shares that she could see the positive impact of EMDR “in the eyes of the clients and the counselors. It is very rewarding when you succeed with a client, they can move on with their lives, they can face anything else and can handle it.”

Zaghrout notes that rural Palestinians typically do not care much about the names of therapeutic approaches: “They only know: ‘I’m not feeling well, I have symptoms, I cannot sleep and I want you to help me.’” Yet as they have started being treated with EMDR, they have begun asking for it by name. “People began asking, ‘What is this? What are you doing with me? What is the name of this?’ Then people started referring to each other as ‘EMDR.’ It was the first time that people were saying the name of the theory or the approaches that have been used.”

The Rehabilitation Program has also found EMDR effective when working with children. Staff counselors have used an EMDR-related technique called the group protocol butterfly hug and have trained school counselors in the technique through the Ministry of Education. Zaghrout has heard from several of the counselors that children will informally tell one another about the technique’s effectiveness and specifically ask counselors to do the butterfly hug with them.

According to Zaghrout, the Rehabilitation Program’s use of EMDR is not an instance of an outside intervention but rather represents Palestinians supporting other Palestinians. “It’s not that I’m coming from the outside and helping people who are suffering here,” she explains. “We are all living under what is happening, so it is not easy for us and for the counselors to do the work and to help others while we also have our own situations.” The Rehabilitation Program is accordingly intentional about caring for its counselors. They have structured retreats and stress releases to help them be more aware of potentially traumatic stresses in their own lives and of how to manage that so they will be able to continue helping others.

Zaghrout is the first Arab EMDR trainer and is now taking what the YMCA counselors have learned and accomplished using EMDR for trauma rehabilitation and sharing those learnings more broadly within the Arab world. Zaghrout says that she advises practitioners across the region to build on the YMCA’s experiences and not start from the beginning. She has recently led trainings in Lebanon, Jordan, Turkey, Libya and Iraq, as well as for Syrian refugees. “We are trying to take this approach which has proven very effective in responding to traumas, especially in ongoing situations, and show how people can use it and how they can heal the traumas of their communities with it,” Zaghrout states. “So we are not creating new things but building upon what we have learned.”
Krista Johnson Weicksel interviewed Mona Zaghrout Hodali, Head of
the Counseling and Services Department of the East Jerusalem YMCA
Rehabilitation Program.