In a society where the primary method of dealing with many of life’s problems is often an unhealthy reliance on medication, Marie-Dominique Genoud provides families a simple and efficient system that helps them to cope with the emotional severance that follows a divorce, death, or adoption. Her methodology of “reliance paths” is a holistic approach for all kinds of traumas, encompassing every step from the recognition of the problem through to healing and closure. This approach, founded on self-expression and the reconstruction of social links, empowers participants to come to terms with life’s painful events. Working as soon as possible on the severance, before a patient develops symptoms, enables the traumatized individual to avoid having pain turn into deep trauma.Marie-Dominique is the first Ashoka Fellow from Switzerland.
The New Idea
Too often when individuals go through a life trauma they are diagnosed with a condition and given medication and sent home. This “quick fix” medical response to psychological suffering is both too late—often waiting until the appearance of visible symptoms before making a diagnosis—and too reliant on medicines that fail to address the root causes of trauma. Marie-Dominique has designed a group therapy method of overcoming trauma that begins immediately after an event occurs. Both children and parents take part in her “reliance paths” sessions, which enable them to mourn openly in a healthy way and surrounded by a supportive community. These critical initial steps prevent a trauma from becoming too deeply internalized and causing irreversible damage.
To effectively assist someone in coming to terms with a trauma, it is essential to resist the common tendency for the traumatized to want to isolate themselves. Marie-Dominique practices the work “in group”, enabling the participants to meet people facing similar situations. Working in groups makes it possible for the affected to stop feeling guilty about their trauma as they realize that others are also going through similar hardships. This community approach also gives everyone the possibility to find extra strength among their peers, and to provide support, as well as receive it from others. Beyond this, the simple existence of the group itself helps to demonstrate to the participants that their feelings and reactions are quite normal and must not be considered a sort of abnormal disease.
By addressing the many types of emotional severance using a similar methodology, Marie-Dominique removes the barriers between the problems. Her aim is not to offer a new form of therapy, but to enable people to face their pain and overcome it. The process of “mourning” either in the case of a death, a separation, or an adoption is nearly identical: Denial, anger, depression, and acceptance. Marie-Dominique helps individuals go through those steps successfully thanks to a single process which is applicable to a large number of situations. The same process is already being adopted by professionals confronted with difficult situations, such as medical staff, lawyers, judges, and police officers.
Losing a parent, living with an ailing relative, going through a divorce or a separation are traumatic occurrences that each of us will face at some point in our lives. These events can have lasting consequences if they are not dealt with properly, especially for a child (and the adult he or she will become). They can lead to psychological, sociological, or even physical traumatisms (as some people somatize their problems). Currently, most proposed “solutions” aim at addressing only the symptoms rather than the root causes of trauma. Additionally, although this sort of trauma is a normal part of life, current treatments often call for increased medical intervention. Relying on medication however raises a number of problems. For one, when an emotional severance is regarded as a disease, medical treatment begins only after symptoms have appeared. But sometimes it takes several years before visible symptoms appear, and so treatment begins after the trauma has set in and become deeply rooted. In addition, patients are often isolated during treatment—as in the case of psychotherapy—which only increases feelings of isolation and ultimately makes remission less likely. Therapies can go on indefinitely without bringing any tangible improvements to an individual’s life.
When a divorce occurs, children often find themselves in the middle of the crisis, sometimes viewed and treated as the cause of the separation. From this a feeling of guilt often follows and continues to affect them well into their adult lives. Although years might elapse after the traumatizing event, difficult behaviors can begin to manifest, causing new family problems and traumas, and new negative consequences in terms schoolwork, delinquency, and even suicide. Beginning the cycle all over again, Youth Public Services has then to manage an increasing number of family conflicts that are again traumatic for children.
Adoption is also associated with an emotional severance for a child, as the presence of a new family often highlights the absence of their biological parents. The grief of separation, compounded by a change in environment, and often the forced acceptance of a new culture (four out of five children are adopted from abroad) make this problem particularly difficult to address, and can have dramatic consequences on the future development of children.
In the case of a death, the loss of a relative leaves an empty space in one’s life. One must have the ability to rely on remaining family members to fulfill the need of relationships and reinforce the feeling of belonging to a united group. However, most of the time, the behavior adopted towards children is based on silence, because it is already hard for the adult to cope with his/her pain, and because the latter believes that the child will be less affected if he/she acts this way. In the case of a divorce, it is necessary to involve the whole family unit, to show the child that he/she is not responsible for what happened, and to build a new way of functioning together. It is the same process for an adoption.
Although it is possible to solve this type of problem very quickly by adopting the best behavior as soon as possible, one of the main obstacles consists in training all the persons who are on the front line so as to teach them how to best react. Doctors, nurses, judges, lawyers, or even teachers are the first persons who may be in contact with the child and the remaining parent and their behavior can then be a highly influential factor in determining what happens next. A judge or a police officer who would give too raw and detailed a description of the death of the spouse or the parent could cause irreversible damage without being aware of it. Unfortunately, most professionals that confront such situations often do not receive specialized training.
Most life hardships are not diseases; individuals going through hardship therefore don’t need to be “cured” or begin taking medication as a first resort. Rather, the best recourse is to find support from a wide community to accept the pain and begin overcoming it. Whether a death in the family, a divorce or an adoption, the mechanisms for coping are strikingly similar. That is why Marie-Dominique designed a single process applicable to the multiple types of severance.
“Reliance paths” are composed of a series of seven work sessions, one per week for seven weeks. Each session is led by a group of professionals (psychologists and social workers) that have been trained in the approach. During the first session a family is guided through assessing their own situation. Then, the following five sessions (one hour and a half each) take place in groups organized by age; each one addresses a specific topic (personal history, emotions, self-esteem, integration into everyday life, and return back home). In the final session, there is a recap and evaluation of all the previous sessions and progress made. Individualized follow-up over a longer period of time is sometimes recommended.
While the topics of each session vary, they have in common the use of various tools to help participants express themselves and communicate their difficulties and suffering. It is often easier for people—particularly children—to express their feelings through drawings, paintings, or drama.
Over 1,000 people have followed a reliance path to date. Professionals in her field have certified her work, and several studies have validated her approach, giving it credibility and wider appeal. These include a study on children who followed “reliance paths” that demonstrated a significant reduction in the different indicators for pain and suffering, a research project with adults that validated the fundamental importance of group work as well as the replicability of the model, and finally, feedback from professionals who come in greater numbers each year to follow trainings with As’Trame.
To spread her method, Marie-Dominique pushes to open new local centers as often as she can. Organized in a network, each center offers tailored programs to the needs of local populations while maintaining the essence of the reliance path methodology. As’Trame centers are often run by former patients that have been trained and wish to provide similar services to their communities. The quality of the “treatment” is guaranteed by regional “Skill Centers” which are in charge of developing local partnerships, maintaining the network, and running training sessions.
As’Trame finances its operations with hybrid resources. Local public authorities are interested in this kind of initiative because it significantly reduces long-term medical expenses. Thus the department of Youth Protection was one of the first to finance it, as well as Lausanne Canton.
From the beginning, Marie-Dominique has worked to ensure that reliance paths are accessible to anyone, no matter a patient’s culture, history, or financial circumstances. Marie-Dominique developed an economical model that bills the families for only one-third of the total cost of the “treatment” which is already lower than classical therapy. As’Trame pays the remaining cost, thanks to public and private funds. To expand patient access further, Marie-Dominique is building partnerships with different insurance companies, who could include As’Trame’s interventions in their life-insurance policies.
Today, several centers are opening in French-speaking Switzerland. These centers are the first phase of a region-wide expansion; Marie-Dominique is currently working to get new contracts within all countries neighboring France.
Marie-Dominique also views the training of professionals to handle traumatizing situations in an appropriate manner as an important focus for her efforts; well trained professionals can help individuals avoid trauma often at the very moments when deep trauma is most likely to set in. Marie- Dominique has identified a list of key professions most involved in traumatizing situations (such as doctors, nurses, professors, lawyers, policemen, judges, and firemen). Instead of attempting to do direct training with these professionals, Marie-Dominique finds allies working within these various groups who then train their peers. This approach seems to be efficient. To date, nearly 2,500 professionals have been trained.
Marie-Dominique devoted the first part of her life to her children and to a number of social organizations. Her strong personal initiative and her wish to help others led her to create an international solidarity organization in 1984, “For them, together with them”, focused on nutrition and education issues in Colombia.
As a mother of four children (two of them adopted) Marie-Dominique personally experienced numerous problems related to the psychological and relational consequences of an adoption not properly handled, which affected the whole family and finally led her to her split from her husband.
She decided to try to understand the difficulties that she and her children had suddenly encountered, and chose to return to her studies in educational and social sciences. It was during that time that she began forming a method for helping children suffering through such hardships. After a phase of experimentation and a validation by various professionals she decided to devote her all her time to the development of As’Trame.
Recently, two little girls who had lost their mother (and had subsequently been involved in group work) a few years before returned to Lausanne and asked their father to go back to “the house where we talk and where we solve problems.” Such a positive impact on children and parents’ behavior makes Marie-Dominique want to go further and to do all that is possible so that life events will no longer be taboo or seen as diseases.