Last week I was visiting the Centro de Atencion Psicosocial (CAPS) in Lima, Peru, as part of an evaluation for USAID. CAPS has been working in psychotherapy and human rights since 1994, in the latter half of the conflict between Shining Path guerillas and the Peruvian government. Those days are done, but putting the pieces back together for victims of the violence is a long-term project.
CAPS started with a group of psychoanalysts, trained in the classic Freudian tradition of long-term, insight-oriented therapy. But as Director Carlo Jibaja says, when you’re dealing with people who witnessed the terror of the Shining Path, insight into the inner workings of their psyche is not exactly what’s needed to uncover their psychological problems. In addition, most of the victims of those days were rural poor, most of whom had never considered therapy and most of whom had to scrabble to make ends meet, and therefore couldn’t go to long-term therapy. CAPS has modified its treatment to a 12 session brief therapy, after which therapists and patients evaluate the effects and discuss continuing treatment from there.
But CAPS’ work is not limited to therapy in the traditional sense. They’ve done short-term work throughout Peru, from the Andean communities where most of the violence took place to the jungles where the remnants of the guerillas remain. These communities often include a many people displaced by the violence who have not returned, and so CAPS has focused on building ties between people to build social capital. They working first with groups of children, then mothers, and then the men finally come along. The groups they run have not been therapy in the traditional sense, but more along the lines of psychosocial support and community organizing.
CAPS has also been important in the process of truth and reconciliation in Peru. During Peru’s Truth Commission, CAPS provided necessary support to victims testifying to both Shining Path atrocities and those committed by the military (I’m told it was about a 60-40 split between the Shining Path and the government in terms of who was responsible for the 70,000 deaths during that period). Currently, CAPS is involved in designing the protocol for how damages will be awarded to those who have been designated as victims of these atrocities — a tricky venture indeed.
In addition to all this, CAPS has integrated an innovative research and evaluation program into their service program (with support provided via the Center for Victims of Torture in Minneapolis, in a project funded by USAID… that’s where my trip come in). Using quantitative and qualitative methods, they have charted improvement in symptoms for their therapeutic clients, and provided some fascinating information on therapists’ and clients’ perceptions of the therapeutic process. You might think that self-evaluation would be common in this field… well, I can tell you it’s not, and the CAPS staff is to be lauded for its dedication to self-evaluate and use what they find to improve their services.