Treatment Components

Treatment Program Components

The Equator treatment program consists of the following components:

Sociotherapy
During the 1-day and 2-day treatments, sociotherapy forms the link between the various components of the program. Participants are together as a group, men and women from different countries and cultures.

The main goal of sociotherapy is that the participants regain confidence in others, fellow human beings. The sociotherapists provide a safe environment, where group members treat each other with respect and caring. Participants in the group have an equal role. Because they spend much time together, they become acquainted with each other and mutual trust is established and can grow. Because of these factors (safety, respect, caring, trust) sociotherapy makes it possible for participants, sometimes for the first time since long before, to feel connected with others.

During sociotherapy, participants speak about the role and importance of the above mentioned elements. They also talk about daily experiences, though in general not about traumatic experiences, which are addressed in individual discussions. Apart from talks and discussions, everyday activities are undertaken together, such as preparing lunch, eating together, playing games, and taking educational trips to the city.

Trauma-focused psychotherapy
Where appropriate, Equator offers psychotherapy to outpatients and to patients in day treatment. In this case, the psychologist or doctor dedicates a series of individual sessions with the patient to addressing the traumas or losses which the patient has experienced. The aim is to reduce the negative impact of traumatic memories and mourning on the daily life of the patient.

For this therapy, a variety of methods which have been shown to be effective may be used: Cognitive Behaviour Therapy (CBT), Narrative Exposure Therapy (NET), or Eye Movement Desensitization and Reprocessing (EMDR). Sometimes a combination of these therapies might be used.

In the course of any of these treatments, the patient will be asked to examine his or her traumatic memories and feelings once more. For many patients, that is still too heavy an emotional burden, and for that reason not all patients will be offered psychotherapy. In this case, treatment is directed towards achieving greater emotional stability, perhaps through a stabilization course or through medication.

If the patient and the therapist agree together that psychotherapy is appropriate, the first steps are always psycho-education and an explanation of the methods which will be used. During the psychotherapy the therapist carefully evaluates whether the patient is able to continue the treatment, and modifies the method to meet the circumstances when needed.

Medical Care & Medication
The Equator Foundation offers psychiatric and medical care to patients of the 1-day and 2-day treatment and to outpatients .

Psychological and psychiatric problems are common among refugees. As a consequence of traumatic experiences and stressful circumstances, thoughts, feelings and behaviour can remain disturbed for a long time. Some are confused, depressed or very anxious. These feelings are referred to as psychiatric symptoms and in the event that they occur, professional help and medication can be necessary or helpful.

Two doctors and a psychiatrist work at Equator. The doctors have individual interviews with patients and can prescribe medication if necessary. The psychiatrist speaks with each new patient, supervises the doctors, and gives advice.

People can also be referred to Equator for diagnosis and treatment advice or a second opinion. Usually two or three appointments are needed.

Social orientation
During the 1-day and 2-day treatments, social orientation is a fixed part of the program for the entire group of participants. During this therapy, many issues which are important to participation in Dutch society are discussed. In addition, problems and complaints which might hinder a person in this are addressed.

Within this program, various topics are focused upon, including education, employment, law, culture, health and welfare, finance and housing. Thanks to the information transmitted through this exchange and on the basis of exercises, participants get a better understanding of life in Dutch society. They also develop a greater understanding of the differences between the society of the country of origin and the Dutch society. Attention is paid to the difficulties individuals can experience in this field, and how to handle these potential problems is discussed as a group.

Occupational Therapy
During the 2-day treatment offered by Equator, occupational therapy is an integral part of the program for the entire group of participants. The goal of occupational therapy is to help people to act as independently as possible in accordance with their own ambitions

Everyone has things they enjoyed and are or were good at. They can be things in work or education, but also leisure and social contacts, or in any area of life. In occupational therapy, participants are helped to find those things again, to hold onto them, or improve them.

During the meetings the participants do various activities. These can be creative pursuits, cooperation, or orientation towards daytime activities. At the beginning of treatment, the potential of each participant is assessed, and how this can best be utilized. After some time participating in occupational therapy, advice can be given on the type of work and working environment. When appropriate, social functioning & activity support is offered.

Social Functioning & Activity Support
Many patients receive social functioning & activity support from Equator, whether they are participating in outpatient or day treatment. This service offers individual support in seeking and retaining employment and / or a daytime activity.

Patients usually have work experience in their country of origin. In the Netherlands, those seeking work or daytime activity often encounter problems, such as language differences or an education completed in their country of origin but not recognized in the Netherlands. Patients who have no work, have work but are unable to develop, or who are looking for a suitable day time activity, may receive social functioning & activity support.

First, a person's needs and opportunities for work and daily activities are determined. (If they are attending day treatment this assessment takes place during occupational therapy.) The final goal set by the patient might be paid work but could also be leisure, education, social integration or social contacts, or voluntary work. Together with the counsellor the patient creates a working plan to seek out an environment in which he or she can participate as fully as possible

The counsellor can also help by contact with civil society organizations (like UWV, CWI and DWI), accompany the patient to the workplace or other institutions, and offer advice to employers and employment counsellors.

Social Work
All patients who receive Equator outpatient treatment can at some point consult the social worker, in the case that problems in their social environment or of a social nature arise.

The social worker will first assess in which areas patients themselves are able to solve problems, and refers to these skills and responsibilities where appropriate. Patients will subsequently be assisted in raising and developing their own knowledge and skills to solve or reduce current issues.

Social work at Equator aims itself at, among other things:

Advice and information, e.g. on the asylum procedure, agencies, and legislation.
Support, mediation and advocacy, e.g. in the case of financial problems, problems at work or at home, housing problems, or conflict with authorities or others.
Referral and guidance to agencies and facilities such as debt relief, youth wellfare work or supported accomodation.
Activation and guidance.

Goal Attainment Group
During the 1-day treatment, individual goals are established for each participant. This is done through a fixed structure, where the barriers to achieving the goal are identified. A plan is formulated to eliminate the obstacles and achieve the goal. The participants report each week on their progress with the implementation of this plan to the rest of the group.

The goals are focused on daily activities in the own living environment, for example getting (volunteer) work, identifying an education aspired, improving Dutch language skills and / or enhancing a social network. Emphasis is placed on communication skills, and on stimulating and encouraging one another.

Psycho-education
Psycho-education forms an element of each individual appointment and any treatment component (for example, stabilization course). During both forms of day treatment it forms an integral part of the program for the entire participant group.

Psycho-education is a form of education. It explains the relationship between adverse, sad, shocking or traumatic experiences and the complaints the patients have. Often these take the form of physical symptoms, nightmares or feelings like sadness, fear or anger. It explains how the mind and the body interact. By understanding where the complaints come from, people feel less powerless. Moreover, it feels less lonely when one realizes that many people display these symptoms following such experiences.

Psycho-education can also provide advice on how people in everyday life can handle their complaints, and give explanations about the treatment or medication.

Stabilization Course
For some patients in outpatient treatment at Equator, the stabilization course provides a suitable form of treatment. This is a series of 8 group sessions, held once every two weeks. Through psychoeducation and exercises, participants learn to cope with their psychological and physical symptoms.

Participants receive information on the causes of common symptoms, and discuss these within the group. Often people do not know that their complaints are shared by others. By discussing these experiences in a safe and confidential environment, patients can recognize them in others and feel, for example, less ashamed.

During the meetings participants learn techniques that are helpful in dealing with their complaints. They might practise relaxation exercises for example, or learn to focus their thoughts upon the here and now as opposed to letting them drift to (painful) memories.

Psychomotor Therapy (PMT)
Psychomotor Therapy (PMT) at Equator is a regular feature in the program for the entire group of participants of the 1-day and 2-day treatments, but it is also offered to individual patients. PMT focuses on the perception of the body and on body motion, and helps people to relax, discover and enhance their skills, and deal with physical symptoms resulting from trauma.

People who have been through traumatic experiences sometimes struggle with the sesnations of and in their bodies. In PMT, one learns to recognize physical tension, and how this can be reduced. By becoming more aware of the body, the patient becomes more aware of him or herself, and it appears that through this better grip on the emotions is achieved.

PMT at Equator includes sports, games and relaxation techniques. Sports done in groups. This can be very helpful for people who tend to isolate themselves because of the violence they have experienced; through taking part in sports, they learn to have fun with others.

During the 1-day treatment personal advice on sport and exercise forms an important aspect in the PMT.