Solidarity Minded (Contributing Author: Ryan “Rayan” Capozzi)
Author’s Note:
This report is highly informal and the first constructed for the collective. It is imperfect in its composition but serves as a practice for the future and a general demonstration of relaying the reality of the participant’s lives in Beirut and barriers they face, their first experiences with therapy, what our project has done in general with minimal resources, and what we can improve on going forward. Including future reports. That being said, while evidence-based practices in psychotherapy were involved with the implementation of the work, this document is not to be regarded as being a fully scientific document due to its hybrid approach.
It also serves as a practice in formulating our voice and how we would like to communicate our work and intentions in the future. This report is created with the idea that we will spend considerable time looking back on this as a point for supplementing expected constructive criticism with reflective and learning opportunities. We hope that individuals or groups in various parts of the world may read this report and wish to join our collective to support it in the capacity in which they are wanting and able. We also hope that we could educate readers by giving them a very brief idea of the reality in Lebanon, the lack of justice and mental health barriers for refugees (which have some universal themes with others elsewhere), and encourage any person to utilize their abilities and resources around them for the means of local and international solidarity.
At the time of publication, we are working to produce a translation of this report in Arabic.
Finally, any kind of revolution you are seeking is located in the people next to you and yourself. Death to borders, fascism, and all that stands in the way of practicing and realizing our innate and incredible humanity.
Abstract:
Lebanon is a country where between 30-35% of the population are refugees, the highest per capita refugee population in the world. Refugees have little to no rights (housing, labour, healthcare, etc) within a country where discrimination is rife. The threat for (illegal) deportation by the military is pervasive, educational opportunities are lesser and hampered significantly, and refugees are especially vulnerable to arguably the world’s worst current (2023) economic crisis. Refugees typically earn between 50.00 to 90.00 USD a month, working mostly informally, often for 10-12 hours a day. Families often rely on their children to work to provide an income from a young age, which typically separates them from education and psychosocial development while putting their physical and mental health at risk – with no means or access to care simultaneously. UCL Global Health estimates from their study in Bar Elias focused on adolescents that PTSD, depression and anxiety are most common in psychological disorders amongst refugee youth and that ‘70%’ of neuroses also begin in adolescence, highlighting the potential importance of the availability of psychosocial support.
119 free therapy sessions were conducted along with the provision of a myriad of language, psychology and music classes, and a variety of group sessions revolving around psychology, emotions and games for youth in Dar El Fatwah – in Beirut. In Al Marj, in Bekaa Valley, a series of lectures on psychology, philosophy and politics were provided, as well as the assistance in other media and creative workshops in collaboration with Araqa Collective.
A survey conducted afterwards showed 93% of interviewed participants (13/14) expressing their experience in individual therapy as positive. Within therapy, presenting issues ranged from focusing on violence and abuse in the Lebanese public schools and family, to existing after a traumatic incident, depression, issues with trust, etc. Although successful, an assortment of problems and critiques also arose both logistically and in practice with therapy. In consulting with different local mental health practitioners, grassroots organizations, participants, students, and also other groups outside of Lebanon, all signs indicate that while individual therapy for refugees in Lebanon is undoubtedly both good and something desired, future implementation of work should prioritize psychoeducation and collective focuses more.
Report Structure:
The report begins by first introducing the initiatives which SM spent its time in Lebanon with as they are unsurprisingly referred to quite heavily throughout the document. Since all of the organizations mentioned also work in the realms of education, and seeing as it is one of the greatest problems currently facing refugees there and worldwide, it was important to write about this as most people in the world will probably be unfamiliar with the education system in Lebanon. Many participants in therapy and many students of all three of these projects mentioned the detrimental impact which the education system has had on them, not to mention the great degree of importance on one’s development such an environment has on one’s intellect and being as a whole. After familiarizing the reader with this core issue, we then widen the scope to talk about the demographics and day-to-day backgrounds of the people who we are working with. We also dedicate a separate section to discrimination and human rights to compliment the education experience as the two (with education) compose a significant portion of the reality of the individuals who we both worked with, in and outside of therapy. We believe this is important as illustrating psychological distress and problems without describing the conditions and circumstances of one’s environment is fruitless, counterproductive and also unjust.
The next sections are dedicated to illustrating the process itself, who is the person that did all of this (what is their background and qualifications), how did this whole thing come about, what did the system for mental health support for this project structurally look like? How did it function? We follow this up with the bulkier sections describing therapy for the participants and then a follow-up section featuring responses, thoughts, and observations by participants and the therapist that were not focused entirely on therapy. While the first two of these sections ends up focusing on what went well, we formulate a third section discussing our various shortcomings, where things went wrong, how can we improve, and what should mental health support look like going forward. An interesting, very late, final addition to this report was commentary and comparisons to themes in a report which was released at almost the exact same time as ours which focuses on gathering the experiences and psychosocial impact of refugees of the same age range in Bar Elias. The city which is also adjacent to Al Marj, where SM also volunteered.
To end this report, we illustrate how much money we spent and attempt to argue the cost effectiveness of our work. This is not the most important element to what SM does, nor does it need to be cost effective in order to be valid or pertinent,but rather it is a passing criticism in most western state-supported models toward psychotherapy which aims for the most cost-effective solution regardless of the needs of a person – frequently resulting in a neutral or unsatisfactory experience, especially for persons of colour and without papers. Rather than end with a conclusion, we make a very brief summary and attempt to focus on what we ought to be doing going forward.
Background of Primary Partner Organization(s):
From March to June, one mental health practitioner from Solidarity Minded volunteered full time as a therapist at 26 Letters in Beirut, Lebanon – providing free therapy sessions five days a week (Mon-Fri) at various times of the day on a rolling basis, for adolescents, teenagers, and adults (including workers and volunteers), as well as some of the student’s parents. All of the students attending 26 Letters are children and teenagers who are Syrian refugees. The curriculum at 26 Letters is based on the student’s interests with the school workers and managers attempting to bring in international volunteers and external organizations to implement programmes catering to said interests. Students typically receive 1-1 or 2-1 attention from teachers for their classes. No part of the work or position was remunerated.
The school is run democratically by six workers whose ages range from 18 to 22, all of whom were once students themselves at the school when they were children. 26 Letters was initially founded by a Spanish woman in 2015 who began teaching English to a child selling flowers on the streets in Dar Al Fatwah, the neighbourhood where the school is located. The project then gradually expanded to what it is today – a school and community offering English, math, Arabic but also workshops for kids, teenagers and even local volunteers revolving around filmmaking, music, crafts, etc.
The report will also at time feature details with secondary organizations who Solidarity Minded also engaged with consistently in this period of time:
–> Araqa Collective (Al Marj, Bekaa Governate) – a group organizing free workshops for young adults who are refugees from Syria and Palestine and local Lebanese in Bekaa; the project focuses on media skills and hands-on projects across a variety of expressive mediums – photography, writing, journalism, etc.
–> Greenhouse For All (Deir Zenoun, Bekaa Governate) – a free school for children and adolescents living in surrounding camps teaching classes focusing on Arabic, English, the environment, art, and life skills.
Education for Young Refugees in Lebanon:
The public schools which the students attend are split into lessons for one half of the day for Lebanese students and the other half of the day for Syrian students attending the schools. It’s estimated that 51% of refugees are able to attend school in Lebanon (UNHCR, 2021). Typically refugee students attend school in the afternoon shift, which is shorter in time than what Lebanese students receive. Teachers ordinarily earn 90.00 USD a month in Lebanon and receive little support (AP, 2023; New Arab, 2023; Reuters 2021). Within the divide between Lebanese and Syrian students, Syrian students are often given less attention as well as less time for education, subjected to harsher punishments, and given less time for breaks in the school day (25 minutes for Lebanese students, 5 minutes for Syrian students). Perhaps of equal concern to readers of this report not familiar with discrimination against refugees in Lebanon, as well as the school system in some Arab countries, is that Syrian refugees are often subject to repeated physical violence by ‘managers’ and even some teachers of the school. One young girl coming to therapy describes the object used by school staff used to physically beat her younger brother as a “thin log”. This account was repeated similarly, often casually, in dialogue with other participants throughout the three months spent in Lebanon.
26 Letters offers an alternative in many senses for the students attending public and ‘semi-private’ schools. Students typically report schools as ‘stressful’, ‘controlling’, ‘boring’, and ‘oppressive’ (as described in English or translated by multiple public school students attending therapy at 26 Letters). Students also report significant bullying from teachers and staff members directly on top of receiving physical violence. Such is either an origin of considerable psychological distress for young girls under 15 especially, or a point of exacerbation of psychological distress which already exists for minors irrespective of age. These aforementioned problems outside of therapy sessions are spoken of rather casually and accepted as a norm, albeit one which 26 Letters students, workers, and volunteers strongly oppose. For teenage and adult males at the school, tertiary/university education was seldomly discussed or within the realm of possibility given costs, current workload, and obligation to family. For younger girls and teenagers, university was considered but seemed inaccessible within Lebanon (Turkey, France, and Canada were mentioned or, for two participants at 26 Letters, being actively pursued in terms of submitting a university application). Following graduation from school, the options of refugees are fairly limited due to their lack of working & legal rights and protections within the country which would facilitate being able to afford both a university programme and life itself.
Demographics and Beneficiary Conditions:
To best understand the starting point of conditions for refugees in Lebanon, it is important to understand that there is no legal refugee status which the state gives. The UNHCR will give a refugee status to some who apply (over 800,000 are registered nationally), but legally within the Republic of Lebanon, refugees are seen as ‘guests’ since Lebanon never signed on to the 1951 Refugee Convention following WWII (Reuters, 2023). Citing members of the World Refugee & Migration Council, ‘the guest approach was to a large extent put in place to prevent integration of the Syrian refugees into all sectors of Lebanon, including the economic sector’ (Brun, Fakih, Shuayb & Hammoud, 2021).
26 Letters has 130 students with over 1,100 presently on the waiting list. The manager of the school estimates the age-range as follows:
6-10: About 50%
11-13: About 15%
14+: About 35%
Girls: About 55%
Boys: About 45%
Also estimated by 26 Letters workers – The full-time workers of the Syrian families specifically, usually the father, typically earn around 50.00 USD a month, or, 600 USD annually. For many, this number is even less. As a result, many children do not attend or continue school and begin working to attempt to support their families from a young age. From firsthand experience and conversations, from ages as young as 9. This is also reflected in the fact that nearly all of the teenage students at 26 Letters are girls, with boys having to either work or both work and study. In Bekaa Valley, the founder and long-term volunteers of Greenhouse For All have expressed the significant challenges of having teenage boys, and adults who are both men and women engage in programmes at their school.
Lebanon is home to the largest refugee population per capita in the world, with over 1/3rd of the nation’s reported population being individuals and families who have fled from their home countries (World Bank, 2023). In 2023, Lebanon experienced statistically, the worst currency inflation globally with the value of the Lebanese Lira losing over 98% of its value (IMF, 2023). The country also experienced, without exaggeration, the sharpest rate of inflation in the world for prices of food (MEM, 2023) in the time which Solidarity Minded’s work was conducted. Lebanon also set the bar for the most expensive prices of petrol per litre in the world at over 6.10 USD per litre, making transportation extraordinarily difficult or inaccessible for the ordinary working person in the country. 6.10 USD is however a drastic improvement from when the price was over 36.00 USD just before when SM arrived (Take Profit, 2023). For Araqa Collective and a handful of other organizations in Bekaa Valley and Beirut too, whether they are grassroots or not, a substantial percentage of organizational funding will be spent on transporting refugees from their residence and back.
For individuals who are registered with the UNHCR, financial support from the organization fell from 50.00 USD a year to 25.00 USD a year since 2022. A joke heard on a few occasions from young refugees registered with the UNHCR, due to severe inflation and a lack of timely human and financial support, was “The United Nations made me a millionaire.” (this refers to the approximate 50.00 US Dollars a year in support being converted into about 4,600,000 Lebanese Lira)
Cost of living has been especially affected by the ‘triple crisis’ in Lebanon – notably rising prices for rent and electricity. The latter being something which the majority of inhabitants do not have 24 hours or consistent access to. Electricity and warm water run on different schedules for different neighbourhoods and greater regions, and vary in availability, outages and spontaneous government cuts. Several participants in therapy discussed poor conditions at home such as having one’s entire family sleeping in one room, a lack of windows or ventilation (often with constant cigarette smoke), cockroaches and insects, rats, flooding in and around the building including with faeces, constant fighting and shouting without peace – often leading to violence to minor and major degrees, a lack of electricity or food or appliances, supervision with no privacy, etc. Many boys and men alike described going out into the city until late into the night, often without anything to do, to avoid going home to stress, feelings of deep depression, unbearable living conditions, resentment from family members, or all of the above. Girls and women expressed the desire for freedom. The economic reality of refugees being able to realistically effect these conditions has become exponentially lower with the unraveling economic crisis in Lebanon. One other area which the economic crisis has disproportionately affected Syrian families and low-income families in Lebanon has been with healthcare.
Two workers, one in charge of organizing and supplying medicine to students at the school as well as the school manager, collectively estimated that one basic hospital visit incorporating treatment and medicine for a student who is generally sick (I.e – a bad flu with a persistent fever) will cost one month’s salary of a working family member. This provides a substantial challenge for children or family members who are chronically ill, are struggling with conditions that require regular amounts of medicine, or are in need of specialized medicine or a significant procedure – which for some may involve having to go back to Syria and risk their safety and future for their current health problem.
With physical healthcare being next to an impossibility to access affordably, this has made something such as mental healthcare beyond the realm of possibility for refugees in Lebanon, as well as most Lebanese themselves. While very very few participants may have encountered psychologists at other points in their life for one or two sessions, or have participated in a one-off workshop with one, when SM surveyed workers and volunteers of 26 Letters, no participants reported presently having access to mental health support, and, no participants would know how to continue accessing psychotherapy upon the departure of SM’s practitioner due to financial barriers if they wanted it.
Before Solidarity Minded’s first arrival to Beirut, an initial needs assessment carried out by the staff and founder of 26 Letters showed that the majority of students themselves expressed an interest in psychotherapy, or, their parents had expressed the interest on their behalf out of concern for their child. After formulating a practical plan for conducting individual therapy sessions as well as conducting classes with psychological and emotional themes, and confirming the availability of interpreters, SM departed for Lebanon. Given the practitioner’s lack of training for working with younger children, the ages of individuals who attended therapy with Solidarity Minded were between 12 to 39 with the median age being 17.5.
Although mentioned in the previous paragraph, it is important to add that many of the therapy sessions were only possible with the help of an interpreter. The SM practitioner themselves had already had training and 1.5 years of experience working in psychotherapeutic sessions with refugees and an interpreter present during sessions. Multiple staff members and volunteers were available to work as an interpreter in sessions, interpreters varied most predominately around who participants felt most comfortable with.
Abridged Discrimination & Human Rights:
Within Lebanon, like Turkey and other nearby countries, discrimination toward Syrian refugees is widespread. Many are under constant threat of deportation to either certain torture or military service. More than one individual coming for therapy at 26 Letters was unable to go see their respective dying family members who have been stuck in Syria (on one occasion, a student attending therapy entered a stage of grieving because of a family member who passed away while they had been with SM). Although these conditions of systemic prejudice existed long before SM’s arrival, a campaign conducted by the Lebanese military attempting to deport refugees (often illegally) en masse and the ensuing extreme rise of the threat of deportation created a significantly difficult and existential situation on top of a score of challenges in daily life in Lebanon for refugees. Curfews are in place for refugees across different municipalities and are enforced without leniency (UNHCR, 2023). From one list associated with the Zaman Al Wasl leak alone, it was revealed that at least 1,500,000+ exiled Syrians are wanted for arrest – over 13% of the nation’s current population (Zaman Al Wasl, 2023; Megaphone News, 2023). The Assad regime is also known internationally for its implementation of brutal systemic torture – often targeting suspected political dissidents, citizens, permanent residents, long-term Palestinian refugees who are evading mandatory military service, family members and relatives of suspects, and even kidnapping individuals arbitrarily – in many cases resulting in their disappearance or death (Rizkalla et al., 2022; SNHR, 2022). Based on UNHCR data, 14 million people have fled Syria, near to half of its current population of about 18 million (UNHCR, 2022; Worldometer, 2023).
In Solidarity Minded’s time in Lebanon, arguably the central focus in both media and politics in the country shifted from the severe collapse of the country’s currency and its lack of a president and fully functioning government, to a colossal scapegoating effort to pin much of the negativity emanating from Lebanon’s prevailing triple crisis onto the country’s refugee population.
In the second half of SM’s three months working in Lebanon during “Operation 1”, the Lebanese military began rounding up Syrians en masse and deporting them (illegally) to Syria with no prior communication with Damascus (Megaphone, 2023). These operations were focused in our areas of work – in Beirut and Bekaa Valley, although the latter more consistently and aggressively. Additional checkpoints and roadblocks were spontaneously created, military and undercover soldiers would follow those suspected as being Syrian to different locations, raids in community spaces and residences both public and private were conducted at all hours of the day (L’Orient Du Jour; Syria Direct, 2023). The campaign targeted not only unaccompanied minors and adults who were either awaiting papers from the UNHCR or didn’t have them, but also saw the arrest and deportation of adults and unaccompanied minors who had the proper paperwork to reside (Reuters, 2023).
In the final week of our work, reports emerged stating that following forced deportation by the Lebanese military, the Assad regime then sent at least 75 persons who were not imprisoned or forcibly conscripted back to Lebanon via human smugglers – whose services were paid for by state officials (Megaphone News; L’Orient Du Jour, 2023). Others paid smugglers to cross the border again themselves individually, once free from state custody. Although Lebanon is not a signatory to the 1951 Refugee Convention, they are a signatory to the Convention Against Torture which specifically binds parties to engage in nonrefoulement practices (The Syria Campaign, 2023).
Some students at Greenhouse For All, and to a much lesser extent 26 Letters, had reported a shared phenomena of not sleeping due to the fear of removal – largely as their parents would not sleep staying awake through the night worried if they and their family would be ‘sent back to their death’. For the vast majority, there is no home awaiting them in Syria, no friendly welcome, nor the funds or support to begin constructing new homes from nothing following the destruction of the civil war or the Assad regime’s claim of ownership of abandoned homes.
Although most students and individuals associated with SM’s work in Beirut were concerned, those from Bekaa, young men especially, expressed a deep existential fear from this situation. The situation became exacerbated to the point where many refugees stopped leaving their home after the late afternoon/evening out of fear altogether. Otherwise locally well-respected organizations such as Action For Hope began being unable to operate in-person classes and workshops in Bar Elias (and elsewhere in Lebanon) due to fears of raids in class. Mass notifications were sent out on the channels of Helem, an organization supporting LGBTQIA+ individuals in Lebanon, specifically focused on rights and advice for members who are refugees from varying countries because of these events.
Girls and women routinely face oppression and systemic discrimination. Current and former students of 26 Letters have reported their parents forbidding them from seeking work. Others have reported their siblings being prohibited from leaving the house or pursuing their education past a certain stage. Teenagers and young adults have described having their families attempting to wed them from as young as 14.
Marriage typically spells an end to the educational and professional pursuits of refugee girls and women in Lebanon, this will be the case quite often and quite prematurely for minors. UN Women report that 78% of women in Lebanon were notengaged in formal, paid work, although it is unclear what this number will exactly appear as for Syrian refugees and refugees altogether in Lebanon (Arab States UN Women, 2023). The same report cites data from the World Economic Forum’s 2020 report on gender disparity which ranks Lebanon near dead last worldwide on the myriad of problems centred into the category (145 out of 153). Both minor and adult wives will often not have finished high school. Girls and women will typically be expected to have their time after marriage focused on taking care of their husband and the house full-time, including visiting friends and family members. When having children of their own, they will bare almost the entirety of the responsibility for the domestic labour and childrearing. Should a girl or a woman manage to get a divorce, something of which is exceedingly more uncommon in the Levant than the west, the family and society will perceive this as a massive shame, often resulting in the girl or woman being kept at home without permission to go out in an effort to hide the aforementioned shame. Participants of therapy described this as akin to being held as a prisoner by their family. Many divorced women are not allowed out of their house alone, and must be escorted by a male. (One woman who participated in therapy was serially abused and tortured by a man in his 30s who she was forced to marry by her family when she was in her early teens.)
Students studying at an advanced high school, vocational, or university level might have parents who view these environments as unsafe for their daughters and require one of their brothers to escort them to and from these spaces. Others reported being escorted to different locations out of distrust, while another participant in therapy reported family members and friends of family following and spying her at times whenever she left the house. Monitoring exists in other ways such as being tracked on their phone or persistent phone calls. Girls at 26 Letters, one in particular who was an adolescent recognize these patterns not only across their society but intimately with their classmates and teachers and spoke of this distress girls face in sessions.
One adult male at 26 Letters reported an instance at their friend’s family home while in the same room as his friend and their family, including his younger sister (who was 5), that the toddler’s parent remarked that if the toddler were ten years older, then her and the male student (aged 20 at the time) should be getting married to each other.
Other examples of discrimination of many include difficulty finding housing and work without technically having any legal right to either, although this has been alluded to. Beyond basic necessities and work, in terms of social life and integration, an instance occurred where the staff of 26 Letters were not allowed into a large nightclub in the city after entrance staff suspected they were Syrian based on their dialect and darker skin colour. After being demanded to show their passports, they were then turned away based on their origin. This was described by a 26 Letters worker as ‘fucked, but it’s normal.’
On the therapist’s final day working at 26 Letters, one worker who became aware of me writing this section told me that this happens extremely regularly – and that just the day before, an instance of discrimination happened to them in the parking lot of a big cinema in the city. They described a huge parking section and the security guard by the entrance saying that they could not park their motorbike inside. Three individuals with motorbikes had just gone through in front of him, but then the guard claimed his bike had the wrong numbers for registration. The worker explained that the office for registering new motor vehicles was almost always closed, never mind accessible when he was not already working throughout the day when it actually was open. At this point he realized that his accent was Syrian, asked for his documents, and then turned him away. He stayed around, only to see two motorbikes enter without a problem, with the security guard claiming the men who had entered worked there. The 26 Letters worker replied that he doubted this considering that the two men who had rode in ‘were dressed far better than the two of them combined.’
With discrimination surrounding access to housing, legal rights, residential rights, working rights, rights to equal education, and discrimination in social and recreational settings and spaces, on top of the lower-paying informal work sought in perhaps the worst economy in the world – life for Syrian refugees in Lebanon is remarkably difficult, marred by prejudice, and getting increasingly harder with the exacerbated severity of Lebanon’s economic and political collapses. This is before acknowledging the profound stress that can exist in many familial structures and invarious psychological distress endured from war and political persecution – as well as the many consequences of the escape from it, and lack of opportunities to meaningfully begin healing from it.
Practitioner Information and Background:
The practitioner received their preliminary and initial skills training remotely for counselling and psychotherapy from IICP College in Dublin. They spent a summer semester partaking in an Existential Psychotherapy course organized by the University of Oxford. The most substantial portion of their training was completed in their postgraduate Person-Centred Counselling programme at the University of Aberdeen, for which they received an MSc (Master of Science).
While pursuing their MSc, they undertook a placement providing therapy for refugees and victims of hate crime at the Grampian Regional Equality Council (GREC). At GREC, they received training for conducting therapy sessions with a foreign language interpreter present in the room and how to facilitate this. They became extremely familiar with working in this format, also working with interpreters in therapy sessions for a short period of time during the war in Ukraine.
Prior to becoming a therapist, the practitioner had recorded years of experience working with refugees in community centres in Denmark, Serbia, and the United Kingdom, as well as in other capacities – often dealing with creative mediums and English. They will have spent about nine years of their life traveling and living in different parts of the world and have become proficient at adapting to other cultures while working within them in local capacities.
Process (Pre-Arrival):
26 Letters was first reached out to by a therapist organizing for Solidarity Minded who contacted different projects across the middle east. In contacting many different organizations, the group which showed the most openness and enthusiasm for incorporating a mental health support project for their beneficiaries and to generally incorporate into the daily life of the project’s programme was 26 Letters. In an exchange of emails and initial discussions, the therapist also provided their qualifications, their previous experiences, their limitations as a therapist (such as working with younger children and in a clinical capacity), a clear idea of how their modality (Person-Centred Therapy and Existential Phenomenological Therapy) operates, the ethical framework (BACP) which the therapist abides by, an explanation around what therapy generally is and isn’t, followed by goals that projects and surveyed participants would potentially like to achieve. The conclusion of these first stages of dialogue was the creation and proposal of a working structure.
After the proposal of a framework for a working structure which would be flexible in regards to being modifiable for the needs of participants and the limitations of resources/space/personnel for the school, members of 26 Letters conducted an evaluation amongst their students, volunteer, workers and family members of these same individuals to discover who would be interested in participating in free psychotherapy over the course of a three month period. It was also made clear that the person providing psychotherapy from Solidarity Minded did not speak Arabic or has ever worked in an Arab country before. After the evaluation was complete, the names of interested individuals were added to an organizational document.
Mechanisms for safeguarding youth through initial assessments by familiar persons were present. It was also made clear that an interpreter who they felt comfortable with would always be provided for translating the sessions between English to Arabic. The option for debriefing and decompressing would be available to participants, the concepts of these two ideas were explained further in initial therapy sessions, the therapist and the participants individually created what would work best for them.
A document was created by the therapist and brought to the beginning of each individual session to sit alongside participants and slowly outline therapy. Elements of what was explained were as follows, this was especially important to combat the massive amount of stigma in the region but also to address the initial power imbalance that always exists in the therapeutic relationship: Confidentiality & safety, session time length, what I won’t do as a therapist (prescribing medication, analyzing the participant, telling the participant what to feel, hypnotizing the participant), intervening or responding if I am doing or saying something that is not aligned with your experience in the case of summarization/reflecting/discussion, an emphasis on acceptance and the absence of judgement, that periods of silence occur within therapy and that there is not an expectation to speak all of the time, the different ways people have used talking therapy in the past, what my role as a therapist will typically entail, the explanation and encouragement for participants to express themselves in mediums other than dialogue (ex: drawing, music), that therapy shouldn’t be a mystery and the process is always open to questions and being changed to best fit the needs of the individual.
Psychotherapists who are trained in the United Kingdom are expected to have a supervisor for their vocation, who they discuss difficulties with their work, potential ethical dilemmas, as well as personal difficulties and impacts from work, etc. The therapist arranged to continue to have their former supervisor from GREC work with them remotely while they worked in Lebanon.
Process (Present/How Did It Work?):
Results, emerging themes, data, and other feedback will be in the following section and be provided by participants. This section will focus on how therapy practically operated within the space and include other observations from the practitioner.
119 therapy sessions were conducted between the beginning of March until the beginning of June. This number is perhaps low due to considerable difficulty in scheduling during Ramadan and individuals arriving at a point in their life in May where they were ready to finish therapy. Outside of therapy sessions, the practitioner also taught classes relating to English, music, psycho-education while created weekly sessions of games for youth to play. Participants were informed before therapy and in the first session when the therapist would be departing, everyone was offered a weekly session within this window. Some participants had weeks where they would not want a session, or felt more comfortable approaching therapy for the first time beginning with having a session every two weeks.
Therapy sessions were scheduled from Monday to Friday, the therapist was present at the school from the morning to the late afternoon. Sessions would take place on average for about 40 minutes, although 45 minutes was what was communicated in the beginning, and 50+ minutes were allocated in the time slot in the event of an emergency subject needing to be discussed. Many students, volunteers and workers who were adept in English were adamant about conducting sessions in English and pushing themselves to express their self in this language. For others who could not, the weekly plan would always incorporate an interpreter on standby who they mentioned feeling safe with.
Due to the very limited space present at the school, the office became the designated therapy space for the school. Because of a combination of small children, new volunteers, individuals passing through who speak Arabic or English, sometimes there would be knocks at the door so that people at the school could get paper or materials for teaching. Sometimes people would even enter abruptly which quickly became a problem that needed to be addressed. As a result, the following two signs were made by students and placed outside of the office door, they became staples both for therapy sessions and as signs in general for school.
From the feedback from participants – the space was not ideal in terms of ventilation, space, and not completely isolated for sound in terms of hearing things outside the room. However, very little taking place in the office could be heard from outside. The singular light inside was a dim fluorescent light, the walls were white and falling apart with old graffiti from a former shisha shop still on the wall. In one of the very first sessions in March, myself and a man who I was in a session with seemed to agree that the room looked like a place that one would be taken hostage in. As many of the girls and women also mentioned feeling unsettled in the space, but also as a theme of being disconnected from their passions and art began to emerge through the first sessions, we created a group project where on Fridays (and occasionally during the week), we would all create the therapy space together. Everyone agreed on a design while decorating other parts of the room, below is the result.
This appeared to make quite a positive difference with not only having an additional experience to look forward to and not only engaging in something which had a great meaning to them and where they felt like they could express themselves, but was something where after the participants felt they could begin to more deeply share and explore parts of themselves in a space that they were responsible for having created. Not just the girls and women, but also the boys and men mentioned the difference in how the space felt as well.
Other presenting challenges observed were often a lack of energy which students and workers often had, often due to the aforementioned difficulties addressed in previous sections surrounding economic, social and discriminatory challenges posed in Lebanon. The impact of these aforementioned challenges on energy levels for youth and young adults were especially present during the holy month of Ramadan, where a handful of sessions were postponed or canceled, as well as other activities so that fasting students could rest. In this period, and in the month afterwards which is associated with preparation for final exams for several classes for students, participants would sometimes request to have shorter therapy sessions as they wanted to attend but did not fully have the energy (or the presenting subject matter) for a full session. The participant always had the option for shorter sessions or to end early, whether expressed before the session or in the moment.
In the first month in Beirut, group sessions were also incorporated for three groups of young students, separated typically by age. From the first month to about halfway through Ramadan, it became apparent that much of what had been previously designed in terms of psychoeducational classes and expressive therapy exercises was not working well, and was subsequently halted. Typically what would happen is that for half of the students there would be a considerable interest in the class, and for the other half, complete disinterest. It was impossible to manage this balance, or rather, the practitioner claims they did not have the skills to do so. It should also be mentioned that any form of education or collective discussion or engagement in psychological or therapeutic discourse should be completely voluntary. However, a number of students in these classes who did attend therapy nevertheless held the experience of individual sessions with a high regard.
In the final two weeks of the therapist’s work at 26 Letters, they began the process of interviewing participants attempting to gather qualitative data. The reason for having the therapist conduct the interviews rather than a third-party was based on the established trust and rapport related to the content emerging from the participant’s therapy, and, for the experience the practitioner has with conducting psychotherapeutic research related to knowing when to ask the participant to clarify or additional questions or to adequately engage in dialogue about therapy in stags of the interview where this occurred. The results are the following.
Abridged Therapy in Lebanon – Results, Data, Experiences, Etc:
14 out of 19 Syrian refugees who partook in more than one therapy session were interviewed for the following section. The 5 individuals who were not interviewed weren’t present in the final two weeks in which the practitioner was present in the community space and conducting interviews. 5 other clients were not interviewed for this section as they only participated in one therapy session – their problems which they presented were either resolved, or, the individual was looking for someone to speak with in general and were not necessarily seeking therapy. In the case of the latter, time was made to spend with these same students (and local volunteers) of the school to follow-up outside of therapy, even if they were no longer actively participating in it. Identities will be extremely anonymized to gender and age as a safeguard given the openness and visibility of the school/community. In participant quotations, when “you” is used, they are referring to the therapist who is conducting the interview. The data collection process utilized semi-structured phenomenological interviews featuring ten prompts for participants. The analysis process was brief but vaguely followed Eliot’s ‘Comprehensive Process Analysis’ and was modified slightly for the purpose of this report.
Consent was acquired verbally from all participants after reading off of a form explicitly explaining the purpose to the survey, that participation was not mandatory, that they could end the interview at any point, that their identity would be anonymized, example prompts from the survey, that information from their therapy would be included to the most minimal degree possible as to protect their identity. For those who did not speak English, the information from the form was translated to them. It was also offered to most participants that they could read and have a copy of the transcript. The reason consent was acquired verbally was due to problems with the printer in the building during the first days the surveys began. Participants could also decide later on to have their information excluded entirely from the report. They were given ample time to consider if they wanted to participate, and if they did not want to, or if they did not make a decision before the departure of the therapist, then they were not included. Quotes from the survey were the focus and were sometimes supplemented with themes from either therapy or the person’s life, but done so with lesser detail to err on the side of caution.
Amongst participants, common presenting themes in therapy were negative or oppressive intra-familial dynamics, familial conflicts, severe depression, oppressive gender norms, difficulty with trust, bullying, themes related to trauma, suicidal ideations, self-concept and the search for self, and coping with other present challenges. Direct content from the therapy sessions themselves with participants will also not be included side-by-side in this report, not only because of confidentiality, the vulnerability of a community whose ideals are typically at odds with local conservative values, but also because the participants themselves are familiar with each other.
The average age of participants was 17.5 with ages ranging from 12 to 24. Parents who participated aged as high as 37, but were not available for interview.
Of the 14 individuals who participated in therapy that were interviewed, 8 identified as male while 6 identified as female.
13/14 (93%) participants reported an overall positive experience with psychotherapy accompanied by changes to their selves which they were satisfied with. The remaining participant reported having a neutral experience in therapy.
Although located two different prompts, one positive element accompanying the positive therapeutic experience at 93% revolved around the therapist’s regular presence at the school.
Typically in psychotherapy, the therapist has their own office, they see their client once a week and interact seldom-to-never with them in any form of communication outside of the session. However, the needs of the individuals were typically different, as well as the culture, resources, presenting problems and the space itself both within 26 Letters and Lebanon as a whole. Verbatim replicating and installing purely western practices and expectations without adapting to local factors, and varying individual preferences within this, would be counterproductive and colonial.
The meeting space was communal and belonged as much to the participant as it did the therapist. The therapist was present each day at the school and engaged in activities, conversations, and even celebrations outside of classes in the space. In the initial session for therapy, the practitioner explained that they would be present in the school and if this was something which felt uncomfortable, then both parties could meet to reconfigure how the presence of the therapist would work in collaboration with the school. This was not one conversation which was had but a dialogue and theme which was returned to throughout the course of therapy. In the west, typically the distance between the therapist and the individual, and arguably community as a whole, is great. This is implemented for a number of reasons – to maintain partiality, to maintain clear expectations for a therapeutic relationship in which relational-depth can be reached and readily worked with without interference, to protect from emerging dependencies, but also as a means of safeguarding for the therapist as well. In Beirut, the school was small and the presence was extremely consistent. When asked to describe what the ‘irregular’ presence of the therapist was like, participants described it simply when saying “It was good actually. You didn’t make me feel that you had a session with me the day before and I liked this” (22, F); “Yes, it was really good you were here” (15, F); “It was pretty normal” (16,M), while others went into further detail:
–> “It was not weird having the therapist everywhere, I think it is really good. I prefer it. I think its good that you let us choose which room we go to, where we feel safe. That you let us walk and talk. That you let us be this guy that we can talk to normally or outside of the session. I can feel more relaxed. I prefer that because you spend all this time with us.” (18, M)
–> “Actually, I feel this was something really positive because I feel you know more about me, it makes me feel like I could find more help here. And it is about the person… If I did not like you then I would mind this. But you are a good person, so I did not mind it, I actually liked it a lot. I did not have to put in a lot of effort to explain things or talk to you about some things because you seem to know. I think it is about the therapist… Because I did not feel like you were totally the same person in the session as I know in the rest of the day. It is very changed. But you are looking to me all the day with respect.” (24, M)
It seems like a combination of a regular presence, a warm and well-paced explanation to therapy in the initial stages that is very clear, but also the disposition of the individual therapist and their openness itself proved to be the foundation to combatting a prevailing issue of trusting others in life, expressing one’s thoughts and emotions, and allowing the formation of a strong connection within therapy. This emerging notion of the regular presence of the mental health practitioner/psychosocial worker appears to have a greater significance for the future for similar organizations given that the implementation of regular psychotherapy sessions by foreigners, or even locals, may not be possible or have the resources to do so. In dialogue with other organizations such as Helem and Joint Help Kurdistan amongst others, such presence seems to also be a prescribed first stage related to fulfilling the direction where the work of the humanistic and existential therapist seems to point to – and that is facilitating both group therapy sessions and psychoeducational courses.
Returning to a point from the previous paragraph for participants, issues related to trust existed almost universally in sessions and addressing and beginning to overcome this within the therapeutic relationship allowed for therapy to work for the individual. As has been alluded to in different points throughout this report, these therapy sessions were for the vast majority of clients the first encounters of which they had with a mental health practitioner and support (whether it was counselling, therapy, psychiatry, etc). Based off therapy sessions with participants, origins of issues pertaining to trust came from negative family dynamics (abuse, neglect, controlling dynamics, parents saying that the child is ‘useless’, ‘stupid’, ‘lazy’, or ‘would never amount to anything’), a tendency for friends and others to gossip, the creation of impossible standards in the early stages of life for one to adhere to followed by frequent berating that what the individual actually thinks is right about themselves is inherently wrong, physical and verbal bullying with all social institutions the participant had been/is engaged with as a youth, others saying that the participant should not be who they are as a person and should specifically act like another. Furthermore, boys and men especially relayed that an underlying expectation in society was for one to not talk about the struggles they are enduring and negative emotions they are experiencing so as not to burden another or go against one’s culture. These ideas seem interconnected with capitalist expectations of success and a successful person, and fulfilling patriarchal tenets within a society which negatively effects and oppresses men, women and non-binary individuals while hindering their growth, recovery and personal & emotional development.
Accompanying collective presence and related to the concept of trust for participants, amongst the most common positive responses regarding the therapeutic experience was the therapist’s ability to patiently listen. In Person-Centred Therapy, and other forms of talking-based therapy, it is a given that these will be two of the most basic pillars for meaningful practice (the ‘common factors of therapy’) but it seemed to play a significant role in the formation of the therapeutic relationship here specifically:
“You always need someone to hear you. The therapist is always hearing us. We don’t have someone to listen to us and to just to tell us anything… That is such a positive thing about therapy.” (19, M)
“The therapist listened to me and the kids, he listened to others and the story does not go outside… I ask you why I feel bad and you give me, I give you a question and you talk to me and we get a solution. You were patient and knew how to act.” (12, F)
Connecting the previous two ideas on listening and presence, one participant said the following of one of the most helpful elements of their therapeutic experience: “It really caught me. It made me, he really listened. He put all of the attention on me. When you talk, he is a good listener. It’s the small things that really push and make you think, and the therapy, he is almost like two persons. One person when we are in the session, he is different than when were are outside. It’s like we know each other but we also don’t.” (22, M)
Internalization of the behaviour of others while looking outwards for both validation and sense of self were subjects which emerged within therapy frequently. The unlocking and release of repressed emotions and experiences alongside one searching for themselves amidst persisting feelings of distress were patterns for all participants who were 16 and over especially.
One adult male mentioned the importance of this process as it led them to be open to encountering different attitudes, ideas and ways of being which could change who they were and not have them be the person that they were or others wanted them to be. In early sessions, while talking about their issues with anger, they spoke of the difficulty of changing this behaviour because growing up as a child in Syria, it was ‘all they were exposed to’. Anger and violence is something which makes him perpetually anxious and they do not like it, yet it is something which is seen as a normal part of life. These are feelings that they had still felt at times, and have responded in the past with. He spends a great deal of time with young people and thinks it is important to educate them, but also finds it hard to understand how to also think about some related feelings from childhood when he does not feel he had one.
To facilitate validation, the addressing of internalized self-concepts and behaviours that the participant sought to alter or eliminate, and the ‘practice of a new self’ – The therapist also incorporated open questioning and dialogue, tenets from existential phenomenological psychotherapy compatible with the frequently presented uncertainties toward life and self, existential anxieties, and explorations of relatedness. The incorporation of greater directivity was requested from participants more than once and the therapist utilized this within the relationship.
This brings up a small, but relevant tangent on this work in this area – While in the west, one of the most common debates revolves around which modality of therapy is the most valid or useful, a debate which seldom exists because of howstigmatized or even forbidden it is in the Levant, is if therapy itself is even valid or useful. It appears that regardless of the direction which therapy might take in other parts of the world, which modality might gain more prominent, and irrespective of the preferences of the therapist’s inclination toward existential and humanistic modalities – the notion of flexibility within a practitioner’s work seems doubly important in Lebanon. A pluralistic understanding and approach to individual therapy (and potentially group therapy), especially for the experienced, politically competent and culturally competent practitioner, could prove extremely useful going forward given the significant need for it in the region explicitly expressed by participants, the various psychological personalities and needs which comprised the body of participants in therapy, and the notion to adapt to said needs as the individual discovers both their self and their own therapeutic process throughout the course of psychotherapy.
Throughout the course of therapy, participants were informed in the first session of the option to draw or write to communicate what they were feeling, as well as bring in legos and other toys for expressing themselves. Participants were invited to also bring in music, lyrics, videos and other media to be used as a starting point or an aid to go deeper into an experience or something they were trying to understand about themselves. Including videos or anything else that the participant felt useful was open to to being included in the therapeutic process. Half of the total participants (7/14) ended up using creative forms of expression in the therapy session, with a slightly fewer number of individuals using this regularly.
For one participant, in the first five sessions she would scribble and draw when discussing traumatic interactions or intense internalized feelings which were coming to surface. After five sessions, she no longer felt nervous, no longer picked her nails and was able to delve into these issues and emotions while feeling more confident outside of therapy sessions.
Other presenting issues revolved around a number of participants who were kidnapped or had relatives who were kidnapped. A girl who came to therapy because of bullying and coping with the aftermath of a kidnapped parent while not knowing where they are or how they are doing summarized her experience in therapy as such:
“The feeling before was chaotic, there were a lot of feelings and it was overwhelming. After I talked, I feel like all of the things that were in my head, step by step, I was able to acknowledge this and let it all out and come to terms with it… Like I can talk and I can take the things from outside and put them outside.” (16, F)
After intense sessions or in ones which concluded before the 45-minute mark, participants were offered an opportunity to either debrief or have the therapy space to themselves. A number of times, the latter opportunity was taken up. When this happened, the therapist would sit in front of the door to the therapy room for the remainder of the block of time to ensure that no one would enter the room. The therapist would speak to the client when they were about to run out of time during this period. Participants reported this as a positive element to their therapeutic experience.
Individuals in therapy at 26 Letters made use of creative mediums to express themselves in various ways which also served as a positive component to their therapeutic experience. More than one client in therapy would draw or colourwhile actively speaking about difficult subjects. For these clients, by the end of their time in therapy, they were able to speak about and explore sensitive and difficult material without the aid of colouring. Sometimes clients would claw at their arms, pick at the skin around their fingers, bite their nails, etc, while previously engaging with this. Aside from moments in which participants would struggle to actively bring up distressing issues, some would create drawings to illustrate the depths of how they were feeling, where they felt they were in their life, or even as a means to try to better digest something the therapist had said. Meeting them at their point in their own process, the therapist would also at times speak but then reply with drawings involving the material in the session. One participant would attempt to draw out a situation or dynamic they were experiencing which they did not understand in an attempt to investigate it further and why it had the effect it had on them, another participant would draw exclusively when hitting a block in therapy sessions.
In a more specific example, a young participant who was facing abuse in school from students and faculty, and who recently self-harmed before entering therapy while experiencing suicidal ideations, felt entirely hopeless and at a loss in their life. They felt that the situation that they were in was inescapable and doomed to be repeated. While being present, providing a space of security, introducing different strategies relevant to their presenting problems, and validating their feelings and experiences, the therapist and the interpreter (who was also very familiar with their specific public school in Beirut having been a student there) made a plan to send a member of 26 Letters to meet with the director/principal. However, the principal quickly dismissed proposed ways of handling problems differently in the form of improved manners of communication. They also dismissed the severity of abuse that the participant was experiencing (and abuse as a whole) culminating in the school’s headmaster eventually saying the student ‘brought it on their self and deserve it’.
When getting to know the participant in therapy early on, the therapist wanted to know about their passions and things they felt strongly for – amongst which were drawing, music and stories. Seeing that they had been disconnected from their passion, therapy served partly as a space to reconnect with the things which brought them life in moments where they otherwise did not want to live, all while being in a space where they felt free to discuss the depths of what they felt. Over time, the drawing in the sessions continued outside of sessions, and then brought the drawings into therapy for the therapist to see and discuss. Sometimes, the work would be just for seeing and not for delving into further. While the situation at the school remained abhorrent and her mood generally low, they reconnected with both an outlet and a purpose. Observing the positive influence of this, toward the end of their time in therapy, the therapist challenged the participant to also write stories for the drawings they made. The participant came back to the next session with four short pieces based on a series of drawings that were found on the front page of the stapled booklets, they said they planned to continue this process in the future. In an interview after the conclusion of therapy, their experience was summed up as the following in combining the responses from two prompts – “Therapy was so good and I learned a lot of things – that I do not have to listen to the bullies and that I can live my life like a normal person. I can really go on… The challenges for me are easier. People were not right about the things that they were saying to me and I was actually right about myself.”
Drawing aside, participants would bring in music that would illustrate what they were feeling or be a point of connection reminding them of a past experience or current dilemma. Lyrics themselves were brought in, and for one client, presented them to the therapist to read and ask what they thought about them. The therapist allowed participants to play music in sessions, but this was not done by everyone. Two young girls had specific music that they would want to listen to while drawing in sessions where art would be the focus for them, providing a soothing environment and also drowning out any lingering noises from outside. Aware that the therapist had been teaching music classes outside of sessions with guitar and a music production application on their laptop, two young participants who wanted to talk about similar subject matters together also wanted to experience playing music together. One played piano and the other began singing, which then turned into them cathartically attempting to rap out their problems. Two clients made use of legos in lieu of a sandbox in therapy sessions which proved positive, but arguably not therapeutic. The lack of a therapeutic effect could arguably be due to the therapist’s lack of training with sandboxes and play therapy specifically.
Drawing, music, legos and other creative exercises were not limited to just one age bracket or gender either. While half the clients at some stage utilized some form of creative medium within therapy sessions, clients from the youngest to the oldest and many in between had art serve as a positive influence to their therapeutic experience. Art served a myriad of purposes in therapy – as an aid for exploring trauma and repressed feelings, as a starting and continuing point for exploration and growth, for transcending language in regards to explaining the complexity of a situation one was feeling, as a vehicle for expressing things when the body would genuinely not allow words to be spoken, as a means for harbouring a feeling of safety, as a vehicle which one could better focus with as opposed to conversation, and more – including that which has already been alluded to.
Other Collected Responses & Statistics
In post-therapy interviews, respondents were given additional prompts outside of the therapeutic experience.
When participants were asked about what area(s) of life more mental health practitioners should be working, the answers included were as follows: “My family!” (20, M)
“I want more people who can just be able to listen to me. Maybe my friends, actually.” (16, F) “Lebanon!” (16, M)
“I would have my friends get therapy too.” (19, M)
“In the house.” (16, F)
“In my house.” (14, M)
“Across uneducated societies who consider psychotherapy a disease or madness. Working against the stigma.” (22, F)
“Everywhere in Lebanon. I feel like it’s a very undiscussed topic about dealing with stuff in therapy, and going to therapy, and is should be normalized. There should be more therapists.” (14, F)
Some participants responded in further detail with the prompt, one student spoke about the importance of the individual forming their own relationship with freedom through therapy:
“In life… In schools. Because you know there’s a lot of students, sometimes they don’t feel right or have rights. And if there is a therapist that can talk to them and they can say whatever they want, then they will experience freedom. More freedom.” (18, M)
“Therapy works everywhere. But therapy is needed for children between 14-18, I think this is so important in any place. Like here in school, out of the school. But people need someone to explain to them what therapy is and means and then they will be able to do therapy in any place. And everyone needs therapy in our community, in our family, everyone in our community could use therapy sessions.” (19, M)
“In the village where I lived in Syria, because they are crazy. They hit too. In Syria, I sat with a girl and with my friends, she tells me that we need to wear hijab at 9 years old. And she was 9, she says to me, why do you not wear hijab? I said to her, its not like this- I live here and I am here and I do not want this… Then she cries, and then she tells me to wear hijab. Why?” (12, F)
“School. 100%. Do you understand the bullying that goes on here? The bullying is insane. The LGBTQIA community has been more open than ever and social media has been much more darker in thoughts, children need therapy. They need it and there are a lot of people in my life that are going through some shit and if there was a place where at least, no one likes school, but if therapy was there and the therapist was like very well connected then I feel like they would be more excited to go because of that. And the benefits of therapy and how to deal with their own emotions instead of roasting other people as the bully would help them out to deal with their emotions and their problems in a different way. And to have less stigma around therapy because mental health is like, what the fuck.” (16, M)
Returning to prompts from the survey pertaining to therapy, nearly all respondents stated that they felt more prepared to deal with psychological and emotional challenges which might face them in the future, and, that the regular presence of the therapist helped deal with stigma. The latter prompt proved difficult to discuss given that there is no specific word in Levantine Arabic for ‘stigma’, and thus, the concept always had to be explained differently with the help of another. One participant went into length about their emotional experience with just the idea of talking about therapy as a concept:
“It’s good for me when people know that I am doing therapy… Because everyone needs therapy sessions. It is something which there should not be stigma, it does not help us. People might feel shy, like no I didn’t have these sessions… A lot of people have this idea that you are sick or diseased if you are going to therapy. But when you explain to them what it is, they they would like to take a session of therapy because they will know how the therapy will help them. But they have this idea about it that they don’t what therapy even means.” (18, M)
This illustrates not only the bridges that need to be built in regards to the work before therapy about educating individuals and families about what therapy is, but also, that the amount of work which might need to be put into this is greater than anticipated. One participant reflected briefly that they used to hold beliefs that were quite different from what they held now:
“I was like this, I used to have a stigma around therapy. That only crazy people go to therapy. And one time I tried to go, and it was really good and I liked it. You can breathe and you are not crazy.” (19, M)
On this subject specifically, adult males appeared to be particularly reflective about stigma surrounding mental health, potentially because of the change of perspective which they themselves had firsthand on this subject, the norms and expectations placed on youth entering their adulthood who must more fully ‘be a man’, and a recent positive experience in therapy. As they are also educators working with young people and young refugees themselves who are experiencing changes in their respective lives, these ideas seemed to be both important to them personally and aligned with the students they support who benefit from the school’s open and inclusive vision. Another participant added:
“Before, I know that people went to therapy and thought they have a problem. But I did not take it so much. But I tried it, you know, it is so fine. It’s good or healthy to go. It is a good thing, I don’t think it is scary. I thought that if you go to places like this then people there would be so strong or strict or make a big thing out of it, but I saw this and it is very normal, like it is the opposite to all of this.” (20, M)
Irrespective of what modality of psychotherapy may be implemented, the unconditional acceptance and genuine focus on the individual in therapy as a human being as a foundation appears to be especially vital in environments where much stigma is present. This perhaps echoes many suggestions and findings within this report that it is not only the education of therapy itself which is important, but also, a strong effort which ought to be made by practitioners in communities to normalize it, and not only speaking about ideas of being oneself and of acceptance but actively practicing this. If these first steps are not meaningfully attended to or accomplished, then it could arguably said that meaningful therapy may not occur and the chance for communities to be able to formulate their own mechanisms of support based on their own needs and beliefs might become significantly hindered.
While everyone reportedly felt comfortable with the therapist, this also did not mean that something as difficult as therapy was simply a walk in the park for participants. In fact, all participants had sessions varying in difficulty and had to encounter their own struggles within the process inside and outside of the session. Following up the prompt about stigma, the vast majority of participants said they would return to therapy again if they had a need for it and it was accessible. But this was not the case for all participants: “It would be difficult for me to go to therapy again. I wouldn’t know, it would be hard to talk to them about things. I know you.” (22, F)
“No, because I don’t like it. I continued therapy with you because it was nice, but it would depend highly on the person.” (16, M)
“I don’t know.” (16, F)
“I think so. Someone I can trust though.” (16, F)
“Definitely fine to do it more… To the exception of, counselling. I would not want to do counselling, it is listening and listening and listening. To be honest, counselling isn’t anything more than that. That’s at least what my friend said… It becomes therapy when there is more therapy.” (16, M)
“I don’t know. I feel like I spent time in therapy to know myself more while I can be comfortable with sitting with myself and talking to myself. I don’t normally like to talk about my life.” (24, M)
The idea of the participant ‘not wanting to talk about their life’ to another is something that came up in the early stages of therapy. Excerpts from participants show that there are likely still lingering feelings of uncertainty regarding therapy, even though all of the quoted participants reported a positive experience overall. The prompt itself (asking the participant to contemplate about their inclination toward going to therapy again in the future if they had access to it and needed it) was perhaps a difficult one given that no one could genuinely foresee the depths of a problem they might face in the future.
A prompt in the post-therapy interview asked for participants to reflect on the changes they saw in themselves since beginning therapy. One participant starts commenting about a change on himself but then reflects on the difficulty of holding on to emotions and the lack of open communication in his environment:
“It’s a big difference from before because I find a place to know how to trust myself more. But another person, like my friend, he also needs to take sessions for therapy… they come to me to talk about their issues because they do not have anyone… No one is trusting them either… But now I feel different to them.” (19, M)
“I am more relaxed” (14, M)
“That people were not right about the things that they were saying to me and that I was actually right about myself and how I feel.” (16, F)
“I feel stronger.” (16, M)
“Yes, I have changed with people especially. The bad things with other people around me bothered me a lot, but now I am more focused and at peace.” (16, F)
“I see myself now as prepared. Like for my feelings. Like I start to now how I can talk with people.” (20, M)
For one client, they exited therapy more understanding of their self, while also being kinder and more connected too. They found their self in a situation where they were devoting much of their time and attention into a relationship with their best friend where there was no reciprocity and which did not consider their feelings. In therapy, they began exploring this as well as their attitudes toward themselves, and aspects of their self-concept which permitted this pattern to unfold:
“I’m more prepared now because here was a door that has opened for me. Like oh shit, I need to take care of these parts of myself more… Like before I went to therapy, my world was pretty different, like it was already going through a change… I took people for granted, and I gave everything I can… But then after, or after this point, now, yeah there is still meaning in the people there and it so awesome, but there is a reason why they came to me. I am as awesome. And to treat each others equally is now much more important than it was before.” (16, M)
On this subject males again tended to be more reflective when talking about their self and experience. This perhaps reflects some of the dynamics of the general environment where even though women are free at the school and in this community, and delved to great depths while in therapy, within the responses there at times appears a disparity in outward self-expression. Although the responses hint that they see the therapist as male-presenting. Going forward, anonymous surveys to be submitted digitally or within the school could be a better form of data collection to most fully understand the experiences of girls and women. In addition to this, fewer prompts and giving the participants additional time to reflect could provide in the compilation of a richer dataset to inform future practice. Three participants also reported having no recognizable change in their self while doing therapy: 16 M, 14, F, 18 M.
Before this initial section on therapy in Lebanon concludes, included here will be a final miscellaneous assortment of reflections from participants:
“I had a few therapy sessions. I discovered a lot about myself, my feelings, my thoughts. I find it like we need to talk to discover the problems in our life and our mind and our self because we need to look at it from different perspectives. Like looking into your life from outside by talking. The therapist helped me to do this, helps look on the inside.” (M, 24)
“These things that are inside could come out and lead to better experiences. I realized so many things. And the good things I liked, you didn’t tell me 1-2-3. They let me explain my problem in the way that I have it, and then from there I know that I can make my solution.” (M, 20)
‘When you do a therapy session, it helps me to feel more secure. But you need to be more secure in life. The kids know that there is something close minded in their life. But if you are not willing to be self-sufficient or brave then they will feel something closed.’ (F, 12)
“Sometimes it is a bit hard with the language, I see it as easy, that I can trust you... I think that everything was good, even if we did not understand everything, but we really understood the idea that we needed. You understood what we needed too.” (M, 18)
“The first time we did the session I was really scared, but then when we did it the first time, I liked it. We had six sessions, or seven… It was so different in the end. It changed something inside me and my mind. When I was there, there was a feeling of safety, it was a good place, and that the therapist also made me feel more comfortable with myself.” (F, 22)
“Therapy helped a lot. Therapy, before three months till now, there is a big difference in my life with family and work and with everything… I am so proud of myself and finding that person that I can trust… He taught me about myself and how I can work with myself. It is an important thing now, myself… Therapy is so important, to the children too… It gives you that safe space for you to take the pressure from behind, the pressure in your life, and you can let it out and maybe find solutions. Therapy is something that everyone needed. Therapy is not something that is easy, you need to know it, how can you use it for yourself.” (M, 19)
Abridged Therapy in Lebanon – Shortcomings:
Like in many reports focused on the experiences of participants in therapy, one thing which is frequently lacking (historically because of security and information concerns after the individual has left the agency, centre, practice, etc) are the experiences of the individuals who stopped attending therapy for one reason or another. This report especially would have benefitted from the feedback of individuals who either temporarily stopped coming to school, no longer wanted to attend therapy specifically, or whose limited availability made it impossible to attend sessions. In the future, a second edition of this report may be published which includes a proper conclusion of their experiences – positive and negative – as well as perspectives of therapy existing outside of their self, the practitioner and the sessions.
In the grey area of all of this is one of the parents of the students who attended therapy sessions at 26 Letters. They came for four sessions focused on a score of abusive rumours circulating about her because of all the children she had, she had not yet given birth to a son. This resulted in treatment by her in-laws that started with the equivalent to bullying which became othering and outright exclusion. Meanwhile, she was working, taking care of multiple children on her own, and recently coming out of a grieving process which she was only able to begin encountering while in therapy. The sessions came to a halt after the situation she was in, which felt like it was at a ‘make-or-break’ moment, did not have a readymade solution which was able to be provided during the therapy session. Some weeks later, her path and the therapist’s spontaneously crossed in a nearby grocery store in Dar El Fatwah. In speaking with limited Arabic and then using google translate to speak with her and about how the last few weeks have been, the respondent eventually started speaking about their time in therapy. After the therapist responded with a couple questions, she reported that overall they enjoyed having sessions with the therapist and the interpreter too, that they took a lot for them and felt free in these moments, but that nothing materially changed in their life or with their situation.
This trend of therapy’s limited social impact alongside an individual context can be emphasized in the feedback from a 22 year old woman as well, “After the sessions I feel ready… There have been a lot of changes in me, but the world no.” This illustrates a need in general for the practice to continue addressing injustice and be practitioners who can work with and discuss this at length, to engage actively as practitioners in struggles against oppression and injustice outside of work, as well as giving the tools for groups and organizations to facilitate support for their members autonomously.
A frequently reported negative element of therapy was that it was ending too early and that some participants wish they had more time, one participant’s central criticism from therapy was “I wish that we had more time” (16, F). Another participant expanded upon this theme, saying in the interview that they were able to start making changes with a part of their self that had felt at times ‘impossible’, but that this process for them would be impacted by the therapist’s temporary departure from Lebanon – “I was expecting to improve my confidence, now it is going on. And expressing my feelings, I wish we could have done more with that. We talked a lot about feelings and you asked well, this was good, but I wanted more time.”
A quieter space was something desired by multiple respondents. Clients sometimes felt that the space was not often the most secure – noises could be heard outside, sometimes small children might find the small window and bang on it. There are only two rooms with doors, and one of them has a massive hole in the center which is covered up by a poster made from sandpaper. The tape of this poster sometimes fell off and people may have walked by or directly interrupted the session as it was happening. Children who cannot read the signs in Arabic or English outside the door may remove the two chairs that also separate them from the door and enter on occasion, an emergency may have occurred where staff may have had to grab a computer or phone to deal with a situation. As a result, the therapist printed a sign posting the hours that they expected to use the office and began making announcements in English and Arabic regarding “If anyone needed anything from the office!”
While some clients preferred other spaces for sessions for various reasons, it’s quite likely that the lack of a completely quiet and extremely secure space played a role in unsettling participants at times during therapy. For a prompt asking what the therapist should do differently in the future, one response was: “A better place for the future. A place that is good for therapy, not just the office where there is a lot of noise and a lot of people who can interrupt us. And… it would be good if there was air in the room.” (24, M)
While the air ventilation problem can be solved with a fan and potentially unplugging other devices as to not overload the school’s generators, there still remains a completely full schedule for classes in a building with three rooms, two doors, and one open main area. A question which follows is: what is the most effective way to conduct therapy sessions when there are minimal spatial, financial, temporal and human resources? For five participants, one solution was to either walk and talk, or have therapy in different settings: “Don’t do therapy in the room or the office. I prefer to change the setting or the place each time. The rest, good!” (20, M)
However, for many areas in the Levant outside of this community, such as in Bekaa or Iraq, it would be unacceptable for an adult foreigner, especially one appearing as male, to be in private spaces with women or children or take them alone and unsupervised for a walk. Even in Beirut, although it was the suggestion of the participants themselves, they stated that there should be more communications with the family with ‘the walking therapy’ sessions as well. For men in more conservative areas in the middle east, it has been relayed to us multiple times from workers of NGOs and individuals who used to live in the aforementioned areas that it would be next to impossible to work through the stigma and various barriers to begin individual therapy sessions with. We nevertheless seek to utilize other forms of mental health support in the future such as education, counselling skills training and group support sessions.
Better collaborative organization in regards to scheduling sessions throughout the course of an extended period of time is something required for improvement for the future. In the spring, there were three participants who had fewer sessions than they otherwise wanted to and were not able to resume their therapy sessions after Ramadan due to the new school schedule, their own public school’s schedule, and preparation for final exams (which are especially intensive in Lebanon). During Ramadan, the school was operating at a more limited capacity for the holy month. A positive for the school is that it modifies its schedule to fit in programmes that the students, volunteers and staff are wanting, but this also proves difficult when participants are still expected to be in classes or working with the new modifications to the schedule. All the while, all parties in this equation will have significantly less energy and focused also on prayer. Many of the aforementioned factors inside and outside of Ramadan were things which had to be adapted to on essentially a weekly basis, which at times was a stressful task. The difficulty of planning was increased as we also wanted to reach other individuals for therapy aside from those who were in the ‘first wave’ of participants, which also meant accommodating the schedules of the newcomers. In multiple instances, some participants did not show up to sessions or were suddenly scheduled for something else. While there is an expectation for everything not to always function 100% as it is supposed to and being open for change, multiple cancellations without communication or reasoning eventually added up in terms of time which could have otherwise been spent doing sessions for others. The therapist would sometimes teach, clean or read in that time, but is also a large reason why the final number of sessions volunteered is perhaps lower than what some might otherwise expect.
One respondent mentioned that at first the therapist was listening too much, which was unhelpful. Although over time, the therapist was able to adapt to what the client was wanting from the sessions, stressing the importance of flexibility within individual practice and modal practice:
“I wasn’t talking positively about myself and you would say this, then you let me figure myself out. Other than that, I feel like someone is listening to me, but I don’t know how important that is to me because I am the person that prefers feedback and not just listening. And I am glad that you did give me feedback… I wish there was more feedback earlier.” (16, M)
Another participant stated: “I wanted the therapist to talk. That helps me. This will push me to talk. You talked, but I want the therapists to talk” (16, F). This should not be taken as a therapeutic view for the entirety of the Syrian refugee population, one participant preferred the therapist to talk less and every person in any place may have a different preference. The same participant, who did not see the first two sessions of therapy positively, also mentioned this in terms of a negative aspect of their experience:
“My theory is that I don’t feel 100% that you are an actual therapist. Therapists have a webpage. To build trust in my opinion, you should make a webpage for everyone to see.” After receiving this feedback, the practitioner continued working hard to formulate a publicly available report of work conducted along with the backbone to Solidarity Minded’s web platform.
Participants undertaking therapy sessions in Arabic were satisfied with the setup with interpreter(s). For those who had a concern before any session, they were able to choose someone they trusted who also spoke English to translate the sessions. There was not an issue with the lack of interpreters throughout the three months at 26 Letters. A few participants still wish that the therapist spoke Arabic. The participants making this suggestion were either the ones which spoke no English whatsoever and wanted to communicate more with the therapist, or, the participants who spoke English at a completely fluent level. One participant suggested to walk and talk during sessions, which the school and the therapist agreed would be okay. However, during these sessions which would often include passing by, the language barrier came up as an issue here, “I usually do not try to speak English in the streets… So you not understanding Arabic was kind of a problem to that.”
Two other participants commented on the subject of what could be better in the future, one said: “I think we should do therapy trainings and workshops and explain what is therapy. And I think you should learn Arabic! If you are working here, you should learn Arabic! You can work on this!” (20, M)
Constructive feedback which was shared by both the students of the Araqa Collective where the therapist taught and those participating in therapy sessions at 26 Letters included the following regarding the therapist:
‘The therapist’s responses at times should be shorter’
‘Some discussion points and responses could be made simpler’
‘Two clients reported a session where they wish they had a better warning before the conclusion of the session/ effective time management’
‘The therapist at times needed to slow down the speed in which they spoke.’
Given the differences in culture and age (the therapist was 27 & 28 during this period and the participants were between the ages of 12-24), and the position of authority which mental health practitioners and other related professions might command in Arab societies, there has been criticism from peers in formulating this report that participants may have held back negative or constructive feedback as a means of being polite. While we developed trust at the beginning based also on being corrected in times where the therapist would say something wrong, inaccurate or unhelpful (which all clients seemed to be able to do), this is a definitive possibility when examining the outcome of the work.
The therapist struggled with group activity sessions for teenagers, but adolescents specifically (under 13s). Children were sometimes bored or disengaged and the therapist often was not able to manage the divide in the class between interested students and uninterested students. There was not as much of a potential to work with this given the school’s lesser flexibility for younger people, constantly changing schedules, and the therapist’s lack of training and experience for working with younger children specifically.
Perhaps the area where problems would have been most expected to arise from a third-party perspective professionally would have been in regards to the presence of the therapist in the community. Where this was seen as the biggest issue by the therapist was not so much regarding the ability to maintain boundaries or effective practice, or issues pertaining to the students or the therapist feeling uncomfortable, but rather that there were some sessions which were conducted that were arguably too narrative focused, occurring outside of relational depth, or were too casual. Simultaneously, participants in therapy the majority of the time wanted sessions every week, but for some weeks were on the fence. In many instances these sessions led to new discoveries and fruitful sessions for participants, but there were also several times where this session resulted in being a safe space for a conversation where the participant could be more open albeit, certainly not a therapy session.
In the future, while seeking out members to join the Solidarity Minded collective on the ground, having at least one or two volunteer editors to view reports and provide oversight for what to include, remove, fact check, etc, would be useful. This report in itself could have been drastically better, shortened, and more organized.
This is certainly not the extent to the criticisms and it is arguable if there has been enough expansion on the issues presented here, but more insight will be provided the more our collective is able to work with other mental health practitioners as well as gain more training and experience doing the work itself too.
Adjacent Study & Parallel Findings From Bar Elias (Sender et al., 2023)
At around the exact same time the first draft of this report was completed (early July 2023), the Journal of Migration & Health published a study from a team of ten researchers from UCL, the American University of Beirut, and New York Medical College titled: “Social and cultural conditions affecting the mental health of Syrian, Lebanese and Palestinian adolescents living in and around Bar Elias, Lebanon”
A separate section for this paper has been included because of the sweeping similarities in themes and findings regardingthe refugee adolescent experience with mental health along with social, economic and political oppressors. Much of this section will effectively be an outline of their report as it also supplements what has been written, what we may have missed, or what may have not got enough attention.
The study refers to adolescence as between the ages of “10 to 24” (Sender et al., 2, 2023), inferring the period in which the brain is continuing its development. This age range is similar to our surveyed body of participants which was between 12 to 24. The data collection for Sender et. al’s study began in April 2019 while the analysis and construction of the report altogether was completed in late 2022. A second reason deemed important for including the study in this report, and with its own section, is to briefly illustrate that little has changed positively in this four year period, and that due to the port explosion, COVID, and Lebanon’s multiple prevailing crises – that things have only moved in a predominately negative direction regarding this subject. For some, to an overwhelming magnitude.
One of the first areas previously mentioned which stood out to the therapist in terms of unanimity was the ability for the participant to trust others, the absence of someone to trust with deep issues, and the general presence of gossip and distrust throughout the whole of one’s community. Sender et al. first report, citing a Palestinian woman (17, F) that “The view of Bar Elias as a place where people ‘gossip’ and have an ‘attitude’ leads to a perception of public spaces in Bar Elias as being unsafe” (4, 2023). Similar themes were mentioned from girls and women who Solidarity Minded interviewed, indicating that the label of one ‘having an attitude’ occurred when the individual showed an interest in something or did something outside of the realm of what the parents or the community expected of the girl or woman. Such gossip at times might be started by family members or believed by family members, invalidating the interest and experiences of girls and women, exacerbating issues of trust.
Given that the majority of males interviewed in our survey were adults, our scope for information was more limited. However, Hussein, a Syrian boy interviewed by Sender et al. describes similar frustration with living conditions and labour, “Our house – a bedroom and a living room – is being rented for 300 USD is full of cockroaches, and we have expenses for the electricity generator. We have to pay 10,000 Lira or else we get kicked out of the house” (4, 2023). Hussein’s number also comes from 2019, when the currency was 59x less inflated. Girls, women and men specifically who were surveyed for SM, as well as one 16 year old boy in particular who dropped out of therapy sessions and 26 Letters to work with their father, also reported similar demands with their situations – extremely crowded living space (several people sleeping in a single room), cockroach infested living homes, and interpersonal dynamics akin to a ‘conditional’ love based on income and fulfilling external expectations.
With education, the experiences and expressed concerns and conditions were mirrored amongst the two studies, “17 out of 30 interviewees had dropped out of school. While some were forced to leave school due to financial costs and pressure to work (including helping with domestic work), some dropped out because the public school’s environment was unwelcoming and hostile, particularly for displaced Syrian students and for differently abled adolescents” (Sender et al., 4, 2023). One boy also reported the school as being “full with hitting” (Sender et al., 4, 2023) and not wanting to return, and that also “Syrians mentioned abuse from teachers and from students. Differently abled adolescents who had been to school faced a lot of abuse” (Sender et al., 5, 2023). Unlike our study, The Journal of Migration & Health’s paper was able to include data from individuals who dropped out of their school. Amongst the data, Sender et. al reported that individuals saw ‘a lack of work opportunities, boredom, loneliness and isolation from others’ (4-5, 2023) as an effect from dropping out of school in 2019.
Freedom for youth in terms of movement and life outside of school was address, “Girls faced restrictions on their mobility due to the risk of danger, socialised expectations and norms about honour and how girls “should behave”, and significant caring responsibilities towards the family. In some cases, girls were able to spend time outside with their siblings or friends under supervision from an older family member. Syrian boys are subject to military and police checkpoints and spot checks that restrict freedom of mobility and discourage leaving the house. Maintaining a consistent job is complicated by barrier to transport and the looking possibility of detainment and dismissal” (Sender et al., 4, 2023). A common theme across therapeutic and educational efforts in Lebanon with refugees, and locals in Bekaa, was stated quite plainly “Adolescents expressed hopelessness, apathy, and great frustration when discussing these circumstances out of their control” (Sender et al., 4, 2023).
In regards to the barriers of youth for life in terms of internal and external life, the study from Sender et al illustrates that the most common ‘themes regarding emotional state were: ‘wishful’ (“something desirable but unlikely”) and ‘restricted’ (6, 2023).
Our work saw the effects which intra-familial or interpersonal violence and abuse (not only physical) effected the individual, transforming their relationships to others, to their environment, the future, and their selves in a variety of ways. Some would embrace some of the associated behaviours with violence and abuse, as well as reactions and performative gestures and attitudes as a means of survival based on oppressive or violent environments they had lived in – even if those same actions and patterns would be reported by the individual to be something they disliked and stressed them significantly. Others, as Sender et al’s report describes, that ‘interpersonal violence in Lebanon left many feeling on the brink of despair; for some it changed the ways in which they related to others in the form of learning and becoming more aware of various parts in life, while 21 out of 30 respondents withdrew in some capacity’ (5, 2023). Withdrawal is a common trauma response (Herman, 1992) which for Sender et al’s respondents took shape in two forms – the first was seeking ‘temporary solitude to gather thoughts and feelings away from friends, family, and places’ (5, 2023) and the second “more permanent” form of withdrawal was more associated with ‘fear and frustration’.
To summarize – both reports demonstrate that the following factors similarly influence the mental health of young refugees and their vast forms of psychological distress in Bar Elias and Beirut: ‘gender norms, housing costs and conditions (cockroaches, lack of privacy, etc), interpersonal relationships, traumatic experiences, gossip, public schools, work spaces, and a broad range of social, economic and political conditions’ which often cause young people to withdraw and devote energy to ‘respond to relieve stress and avoid negative encounters’ (6-7, 2023). Data compiled from refugee adolescents across Lebanon in two separate locations and two sets of prompts feature young people speaking of the future importance of the presence of ‘supporting, trusting relationships and homes which are free from violence and abuse and supportive relationships at home and school’ (Sender et al, 6, 2023).
Perhaps the biggest difference in the separate compilations is the sizeable portion of interviewees who had someone they could fully trust as found in Sender et al’s report (often the person was their “mother” or “closest sibling”; 5, 2023), versus the small number of individuals in our survey who had the same presence of support or general outlet. The youth interviewed by Sender et al illustrate the importance of having a positive and uncrowded living environment, but also illustrate the detriments which spaces and situations that feel inescapable (in terms of crowding and lack of affordable transportation around villages, camps, and cities) can have on exacerbating existing trauma and psychological distress (7, 2023). Another difference in the reports was Sender et al’s participants focusing on psychological endurance as central to their survival – many in their report believed that ‘their struggle made them more knowledgable about the world while others talked about feeling of resignation’, they attributed to this trait as being related to ‘transitions, awareness, and growth’ (6, 2023). One respondent stated, in regards to endurance, that “I run, I swim, I dive in the water and let go of everything that bothers me. I don’t let anyone know what I am feeling… When I grew up I changed a lot…” while a 15 year old respondent said, in response to one of the research team’s prompts that, “The thing I would change about my life is to get out of the environment I am living in. As I told you I used to take sleeping pills, thank god, now I have stopped it, I am not drinking it now and wasting my whole day.” (Sender et al, 6, 2023). The respondents in our report were perhaps resilient in a variety of different ways given what they had experienced up until this point in their life, but perhaps were in the first stages of crucially developing it after making various realizations about their self throughout the course of
Finances:
The funds for implementing this project came from two sources in no particular order. The first came from the therapist living inside of a friend’s van in Glasgow during the end of the year while writing their thesis and volunteering as a therapist. In this time, they had an agreement where they did not have to pay rent and were able to save money from their part-time job for volunteering full time as a therapist. The downside was that there was no running water, heat, electricity or possibility to move the small van from where it was parked in a parking lot in north Glasgow. The second source of funds came from leftover donations from the last Copenhagen Underground Film Festival in 2020. Initially, the funds were ear-marked for the creation of a community centre in Athens for refugees but due to complications with the pandemic and the landlords, as well as visa issues, the project was put on hold indefinitely. The central idea was forCopenhagen Underground to not only be a mutual aid project which was supporting the work through donations, but to bea group which was providing solidarity through its own work on the ground itself. This work marked that and the transition point into Solidarity Minded
Below are the approximate costs for providing three months of therapy, teaching in Beirut and Bekaa, etc:
800 USD – Accommodation
135 USD – Flights to and from Beirut
73 USD – Transportation (0.50 bus rides twice a day, plus transportation to Bekaa Valley and elsewhere)
110 USD – Food, Medicine, Etc,
Total: 1,118.00 USD (7,413 DKK/998 EUR/855 GBP) – Currency values as of early-July
The project currently has no regular source of income and is seeking support for its future work in the region.
Cost Effectiveness:
In the future, with new connections in Lebanon, the cost for accommodation can be halved while the other costs would likely remain the same over the course of another three month period.
In the United Kingdom, where the therapist trained, did two internships and received their MSc, the British Association for Counselling and Psychotherapy estimates the average cost of a counselling session to be 45 GBP. The average salaried primary school teacher there will also receive about 18 GBP per hour. Calculating the 119 therapy sessions with what we will conservatively estimate to be 25 teaching sessions, excluding time for lesson planning, the results for cost comparison of Solidarity Minded’s work can be made. The conversion was made to USD for the sake of comparing it to the illustration above and given Lebanon’s use of USD:
119 (57.11 USD) + 25 (22.84 USD) = 7,367.09 USD (50,288 DKK/6,756 EUR/5,805.00 GBP)
The work of Solidarity Minded demonstrated to be over 6.5x more effective and efficient economically while providing mental health support and education in areas which arguably need it most. In the future, we would like to expand our team to both internationals and locals to provide therapy, skill-building courses, art classes and more in Lebanon. We would also like to grow to where we could expand our presence or help locals in other crisis-hit areas help realize solidarity initiatives in these aforementioned arenas with both knowledge, material resources and human resources, as well as formulate emergency responses in the future to disasters and emerging crises.
Future:
The future is currently pointing to having counsellors, therapists, psychologists and psychiatrists take actions outside of traditional western roles. The first is being genuine, present and engaging members of the community that they are seeking to support throughout their duration that they are living with them, whose work and actions are simultaneously constructive toward sustainability in the form of autonomous healing practices. Next, psychoeducational courses, psychosocial programmes (involving sports, games, music, writing, etc), and group therapy or support sessions are seen to be amongst the succeeding and most optimal steps forward revolving effective use of time and resources based on participant and professional input. Moreover, this is a conclusion that is arrived upon with the idea in mind that participation in such groups will offer its members the best possible chance at modifying and continuing these groups in a capacity based on their needs, skills, and available resources. This is not new information, but perhaps nevertheless important to write as a young collective given that its experiences working in the field have pointed to these recommendations which others have likely written about in a way with much greater detail.
There is little to add regarding future goals as a collective that is not available outside of this report with SM’s general information. We still aim to gather funds to translate radical and psychological literature, hire local mental health & psychosocial professionals, educators and artists, and eventually open community spaces which could facilitate individual and group therapy as well as being educative spaces for the aforementioned areas we wish to impact. This report was slightly rushed in an effort to get the project online so that we could begin crowdfunding so that we could continue working.
We want to thank 26 Letters, Araqa Collective, Greenhouse For All, and all of our comrades and hosts who allowed Rayan to crash on their couch or floor while writing this report.
Sources:
World bank – lebanon, highest refugee population
https://datacatalog.worldbank.org/search/dataset/0064677/Lebanon---Vulnerability-Assessment-of-Syrian-Refugees-in-Lebanon-2022
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https://www.middleeastmonitor.com/20230509-lebanon-ranks-first-in-world-food-price-inflation/
https://take-profit.org/en/statistics/gasoline-prices/
https://apnews.com/article/lebanon-education-crisis-teachers-strike-economy-schools-0761ebdcb0f7ff4d83fc11d1fe9c0386
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https://data.unhcr.org/en/documents/details/75104
https://syriadirect.org/1100-syrian-refugees-arrested-600-deported-from-lebanon-in-unprecedented-crackdown/
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https://bmcpsychiatry.biomedcentral.com/articles/10.1186/s12888-022-04425-w
https://reliefweb.int/report/syrian-arab-republic/tenth-annual-report-torture-syria-international-day-support-victims
https://snhr.org/blog/category/report/thematic-reports/torture/
megaphone links:
https://www.instagram.com/p/CsivSSzqXHL/?igshid=MzRlODBiNWFlZA==
https://www.instagram.com/p/CsJZ52RKFFC/?igshid=MzRlODBiNWFlZA==
https://www.instagram.com/p/CsYlNVPqWH1/?igshid=MzRlODBiNWFlZA==
https://apnews.com/article/lebanon-education-crisis-teachers-strike-economy-schools-0761ebdcb0f7ff4d83fc11d1fe9c0386
https://arabstates.unwomen.org/en/countries/lebanon
https://www.sciencedirect.com/science/article/pii/S2666623522000733/pdf