Pathways to Resilience Workshop Promotes Leadership and Peer Support

by Anne Stewart, Ph.D., and Lennie Echterling, Ph.D. [ JMU Dept. of Psychology ], Cameron Macauley, MPH, and Nicole Neitzey [ JMU Center for International Stabilization and Recovery ], and Hasan Hamdan, Ph.D. [ JMU Dept. of Mathematics and Statistics ] - view pdf

Pathways to Resilience (P2R) created a unique leadership program to help landmine survivors promote resilience and create secure collegial relationships. This article provides background regarding the curriculum and training activities and recounts how P2R helped survivors experience posttraumatic growth after tragedy.

Pathways to Resilience attendees participated in a variety of creative activities designed to promote positive crisis resolution.
Pathways to Resilience attendees participated in a variety of creative activities designed to promote positive crisis resolution.
All photos courtesy of CISR.

A young woman flashed a bright smile and gracefully performed a traditional dance. The other women in the room responded with delight and encouragement.

A man announced to the people gathered that he had gone to town to purchase short-sleeved shirts to wear. His pronouncement was welcomed with spontaneous, heartfelt applause.

An accomplished country leader proudly introduced his younger colleague to conduct the final presentation. Each graciously acknowledged the support they have offered each other in troubled times.

These seemingly unremarkable events occurred during a mine-action training program conducted in the countryside north of Beirut, Lebanon. The events, however, actually constitute remarkable milestones for participants attending this innovative workshop. The dance was the first the young woman had performed since a landmine explosion injured her while dancing at a relative’s wedding. The man had not worn short sleeves since a mine injury resulted in the loss of his forearm. The junior colleague, a landmine-injury survivor, delivered his inaugural professional presentation.

Pathways to Resilience is an inventive regional training program developed and implemented under the sponsorship of the Office of Weapons Removal and Abatement in the U.S. Department of State’s Bureau of Political-Military Affairs (PM/WRA), and through partnership with the Lebanon Mine Action Center. The project was the vision of Kamel Sa’adi, a Jordanian landmine survivor who established a nongovernmental organization, Lifeline for Consultancy and Rehabilitation, to assist and support other survivors. Staff from the Center for International Stabilization and Recovery, Program Manager Nicole Neitzey and Peer-Support Specialist Cameron Macauley, coordinated P2R’s planning and implementation. Faculty from the Departments of Graduate Psychology and Mathematics and Statistics at James Madison University participated in the program to provide training, curriculum development, program evaluation, needs assessments and follow-up surveys.

Participants engaged in role-playing practice in small groups to improve their peer-to-peer support skills.
Participants engaged in role-playing practice in small groups to improve their peer-to-peer support skills.

The program took place in Beirut for landmine survivors from different landmine-contaminated regions of the Middle East, as well as representatives of organizations that assist these survivors. Twenty-nine participants from Iraq, Jordan, Lebanon and Yemen came to learn how to conduct peer-to-peer projects for survivors in their own countries. The intensive schedule involved experiential learning, theater-based activities, role-playing activities, improvisations and other exercises designed to promote post-traumatic growth. Within a culturally responsive framework, the leadership training addressed disability rights and laws, peer-to-peer support, post-traumatic growth and program-development skills for landmine survivors.

Disability Rights and Laws

Work with survivors of landmine injuries requires a human-rights perspective. Persons with injuries from war-related violence are not incompetent individuals requiring charity. Rather, they are persons entitled to full participation and inclusion in society. Participants were provided an overview of the historical and current context of the United Nations’ Convention on the Rights of Persons with Disabilities, and other relevant regional and global initiatives, including the Cluster Munitions Coalition and the meeting of States Parties to the Convention of Cluster Munitions in Beirut (September 2011). The presenter discussed the definition of terms, the status of states as signatories or ratifiers, as well as the role of the CRPD in calling for nondiscrimination and access for persons with disabilities. The workshop participants discussed the importance of recognizing persons with disabilities as a valuable part of human diversity.

Peer-to-peer Support

Consistent with the workshop’s experiential and collaborative approach, the format of the peer-to-peer support training included presentations, group discussions and practice sessions. The training activities were grounded in key theoretical literature in transformative and experiential learning in which the learning process begins with a concrete experience and is followed by reflective observation, conceptualization and active experimentation.

Participants engaged in role-playing practice in small groups to improve their peer-to-peer support skills.
Playwright and actor Ghannam S. Ghannam worked with participants all week to create a theatrical presentation derived from the survivors’ own stories. Dealing with themes of adversity and resilience, the play was performed on the closing day for media and distinguished guests in attendance.

The workshop participants began identifying actions they considered helpful (visiting and listening to the survivor, helping the survivor make decisions about the future) and not helpful (pitying, ignoring, doing too many things for the survivor) as they healed from their injury. This identification led to a discussion of the use of peer-to-peer support as a natural process where survivors of a traumatic experience are ideal resources for helping other survivors. Participants explored what defines a peer, discussing the relevance of comparable experiences, injuries, gender and age for successful peer-topeer support. The participants concluded that similarity is only part of the equation, and what is most important is the relationship between peer-support worker and survivor.

Participants were introduced to peer-to-peer support worker skills, such as listening, understanding and validating the survivor’s story, along with looking for strengths of the survivor and resources available. The participants engaged in role-playing practice in small groups with facilitators to develop their skills.

Based on resilience and attachment theories, the participants practiced asking Getting Through questions, such as “Who was especially helpful in supporting you to do that?” or “What did you draw from inside yourself to make it through that?” They also practiced asking Making Meaning questions, such as “As you make more sense of this, what have you learned so far?” or “What advice would you give somebody else?”

Participants learned ways to effectively use and combine individual and group formats of peer-to-peer work. The curriculum also examined funding challenges and how to manage peer-to-peer programs.

Post-traumatic Growth

Traditional trauma perspectives have focused on the deficits and disorders of survivors. However, recent research findings on resilience and attachment have exciting implications for mine-action programs. While acknowledging a trauma’s impact, the P2R activities also emphasized personal strengths and increased feelings of resolve. As a consequence, most survivors experience post-traumatic growth, reflected in enhanced psychological well-being, deeper appreciation for life and more meaningful relationships.

The personal growth and peer-to-peer activities focused on building secure relationships between survivors and the four main factors promoting resilience: developing social support, attributing meaning to the experience, regulating emotions and learning successful coping skills. Importantly, the program created a transitional community to promote resilience so that survivors could apply these principles to themselves in addressing the consequences of war-related violence.

Immediately after a traumatic event, survivors are likely to experience a crisis of meaning. The participants learned that survivors tell their stories to give form to this painful experience, to gain some sense of cognitive mastery and to make important discoveries about possible resolutions. The program leaders discussed and guided participant survivors to tell their stories in a variety of ways such as talking, playing, drawing, sculpting, singing and writing. Through experiential learning, participants discovered that whatever form their stories take, the process helped them identify meaning from the catastrophic event.

Workshop participants learned ways to acknowledge the negative impact of the trauma and to simultaneously recognize the survivor through respectful and engaging interviews and activities. An activity called Out of the Ashes gave participants practice in how to help other survivors envision new possibilities in their lives. The activity was designed to help survivors explore achievements they have already accomplished, gain a sense of direction and hope, and increase their momentum toward post-traumatic growth.

The Out of the Ashes activity began by asking participants to write down or draw on paper a crisis event that they experienced. Then they burned the slip of paper and rolled the ashes in a piece of modeling clay. Using what they have learned and discovered in dealing with their crisis so far, the survivor then molded a symbol of hope from the ashes and the clay. At the workshop, all the participants moved from table to table to view each other’s artwork and to hear, not about the traumatic event, but about the person’s future hopes.

Playwright and actor Ghannam S. Ghannam worked with participants all week to create a theatrical presentation derived from the survivors’ own stories. Dealing with themes of adversity and resilience, the play was performed on the closing day for media and distinguished guests in attendance.
Feedback from participants was overwhelmingly positive. One participant said about the workshop, “You cannot imagine how helpful this workshop is to get us beyond our crisis.”

At least temporarily, trauma robs survivors of their dreams for the future. By using a resilience-focused approach, peer-support workers practiced ways to help other survivors envision new life possibilities. By drawing attention to these instances of dealing with challenges, survivors are given opportunities to discover unknown strengths, appreciate unrecognized resources and achieve a sense of hope.

Workshop participants learned that landmine survivors not only tell their stories, but the themes that emerge from these stories shape their personal identity. In other words, the narratives that survivors create do more than organize their life experiences: They affirm fundamental beliefs, guide important decisions, and offer consolation and solace in times of tragedy. Peer-to-peer support workers can help other survivors transform their crisis narratives into survival stories. In the experiential activities, the participants practiced offering comments and questions to facilitate a successful resolution to a particular crisis. The resilience lens served as a reminder to look for strengths, rather than focus on deficits, when working with landmine survivors. Participants also heard about the impact of trauma on the brain and how emotional regulation is disrupted after a trauma. Using experiential and playful activities, participants practiced ways to help survivors reduce their distress, soothe themselves when upset and enhance positive feelings of resolve.

Exploring dimensions of resilience, building secure relationships and developing a transitional community was further facilitated by the survivors’ participation in a series of experiential, expressive exercises (original movement, voice and story activities). These creative activities provided an opportunity for survivors to join in the production and performance of a play. The dramatic and theatrical presentation originated from survivor stories. (Ghannam S. Ghannam, playwright and actor, conducted this portion of the workshop based on a curriculum he developed entitled “The Seven Mirrors.”)

Trauma is a time of intense emotions, but a common assumption is that individuals in crisis have only negative feelings, such as fear, shock and grief. Participants were informed about recent research that demonstrated survivors actually experience not only painful crisis reactions but also feelings of resolve. These feelings include courage, compassion, hope, peace and joy. Acknowledging and giving expression to the gamut of emotions, both negative and positive, can promote a positive crisis resolution.

Group Project Development

Another group project also addressed leadership and teamwork skills. The participants were grouped by country and given the assignment of developing a plan for a project in their home country. The projects were to incorporate elements of emotional, psychological and practical support to survivors of landmine/unexploded ordnance injuries and/or their families. Participants were told that they may wish to work on matters related to health, education, mobility or accessibility, human rights, employment or income generation, sports, or other survivor issues.

Staff and facilitators helped participant groups develop their project plans by considering the goals and objectives, logistics, funding, personnel, legal restrictions, and desired results. At the end of the week, the groups presented their ideas. Participants created projects related to rights, accessibility and sports programs in this useful learning exercise. The project sites were community-based and addressed survivors across the lifespan.

Follow-up surveys are polling participants on their use of the knowledge and skills they gained in the project-development exercise. The program created a blog and website where photos and comments can be posted to help preserve the relationships and connections.

Evaluation Results and Conclusion

The feedback from participants was overwhelmingly positive. For example, 96 percent reported that they learned more about leadership, and 96 percent agreed that they had learned new ways to meet survivors’ needs. Sample comments included, ”The activities were excellent—they improved our morale and strength to give peer support,” ”One of the best, if not the best, workshops on VA [victim assistance] (and there have been a lot!),” and ”You cannot imagine how helpful this workshop is to get us beyond our crisis.”

More significantly, the majority of participants also reported their experience of post-traumatic growth. As a result of the workshop, 96 percent stated they had a greater feeling of self-reliance, 92 percent reported they had a greater sense of closeness to others and 88 percent discovered they were stronger than they thought.

In conclusion, P2R is a culturally-sensitive program that enhances the potential of landmine survivors for leadership in offering peer-to-peer support services to others. The attachment-grounded, resilience-focused and strengthbased program can be easily adapted to other cultures. With this positive feedback, P2R plans to assist other countries and expand its use to additional victim assistance programs. For additional information about the project, see J



Anne StewartAnne Stewart, Ph.D., is a Professor in the Combined-Integrated Doctoral Program in Clinical and School Psychology at James Madison University. She has worked to promote the resilience of children and families in projects throughout the world, including Sri Lanka and India following the massive tsunami. Stewart has designed and implemented grant-funded projects to address the psychosocial problems of landmines in Bosnia, Cambodia, Jordan, Lebanon, Mozambique and Vietnam. She is a licensed clinical psychologist with expertise in play therapy, systems and family therapy, and the application of attachment constructs to clinical work, supervision and consultation. She is the president of the Virginia Play Therapy Association and the recipient of the James Madison University “All Together One” Award, the International Association for Play Therapy Distinguished Service Award, and the College of Integrated Science and Technology Award for Distinguished Service.

Lennie EchterlingLennis Echterling, Ph.D., is Professor of Counseling Psychology at James Madison University. He has more than 30 years of experience in promoting resilience, particularly during crises and disasters. Since 2003, Echterling and Stewart have collaborated with students to provide play-based therapeutic services to the children of National Guard members deployed to Iraq and Afghanistan. They also helped implement grant-funded projects addressing psychosocial problems of landmines and unexploded ordnance in such countries as Cambodia, Jordan and Vietnam. Echterling has received the College Award for Distinguished Service, James Madison University’s Distinguished Faculty Award, Virginia Counselors Association’s Humanitarian and Caring Person Award Outstanding Faculty Award from the State Council of Higher Education for Virginia, and the national Counseling Vision and Innovation Award from the Association for Counselor Education and Supervision.

Cameron MacauleyCameron Macauley, MPH, joined CISR in August 2010 as Peer Support and Trauma Rehabilitation Specialist. He holds degrees in anthropology and psychology, and became a Physician Assistant in 1983. He has worked in a refugee camp on the Thai-Cambodian border, at a district hospital in Sumatra, as a Peace Corps volunteer in Guinea-Bissau, in Mozambique where he taught trauma surgery for landmine injuries, in an immunization program in Angola and in a malaria-control program in Brazil. Between 2005 and 2010, he taught mental-health courses for Survivor Corps in Bosnia and Herzegovina, Colombia, El Salvador, Ethiopia, Jordan and Vietnam.

Nicole NeitzeyNicole Neitzey is the Program Manager and Grants Officer for CISR, having worked at the Center since 2001. She graduated from James Madison University in 2002 with a Bachelor of Arts in technical and scientific communication, and an online publications specialization. While at CISR/MAIC, she has worked in various capacities with the The Journal of ERW and Mine Action and the Center’s websites and databases, as well as served as Project Manager for the Pathways to Resilience (Lebanon) project, Study on U.S.-Origin Landmines, Consortium for Complex Operations Portal Review project and State Department CD-ROM project. She also assisted with the Big Bang Project, the Landmine Action Smartbook, and the Center’s Senior Manager’s Courses sponsored by the United Nations Development Programme and PM/WRA.

Hasan HamdenHasan Hamdan, Ph.D., graduated from Birzeit University in Palestine with a Bachelor of Science in mathematics in 1993. He graduated from American University with a master’s degree in mathematical statistics in 1996 and with a doctorate in statistics in 2000. After graduation, Hamdan joined the Department of Mathematics and Statistics at James Madison University. In 2003, he became a national NExT Fellow, a national career-preparation program for new faculty in the mathematical sciences. He served in the Mathematical Association of America, MD-DC-VA Section as an officer for the 2007/2008 academic year, and became an International Statistical Institute elected member in 2007 and the recipient of the 2010 JMU Emeriti Association Annual Award. He is on a one-year sabbatical from JMU teaching at the Arab American University – Jenin in Palestine.

Contact Information

Anne Stewart, Ph.D.
Professor of Psychology, Department of Graduate Psychology
James Madison University
Tel: +1 540 568 6601
Fax: +1 540 568 4747

Lennis Echterling, Ph.D.
Professor of Counseling, Department of Graduate Psychology  
James Madison University

Cameron Macauley, MPH
Peer Support and Trauma Rehabilitation Specialist
Center for International Stabilization and Recovery
James Madison University

Nicole Neitzey
Program Manager/Grants Officer
Center for International Stabilization and Recovery
James Madison University

Hasan Hamdan, Ph.D.
Professor of Mathematics and Statistics
James Madison University