Introduction

Political violence has captured the attention of social scientists for many decades. Interest in this topic has ranged from conceptual and empirical endeavors directed towards an epidemiologic understanding of the phenomenon (e.g., Hill 1997; Lupsha 1971; Ross 1986) to a large body of research studying the survivors of political violence (e.g., Cummings et al. 2009; Goenjian et al. 2000; Jones and Kafetsios 2005; Punamaki 1990; Snider et al. 2004). An overwhelming number of studies have focused on understanding experiences of survivors through the lens of diagnostic criteria common to the Western conceptualization of mental health (e.g., Miller 1999; Miller et al. 2006).

Such a perspective has been criticized as being reductionistic, with critics claiming that the Western diagnostic lens risks overlooking the complex mechanisms and contexts that come into play in societies struck by the scourge of political violence (Miller et al. 2006). Researchers have asserted the need to consider ecological models in conceptualizing and studying the survivors of political violence (Cummings et al. 2009; Dubow et al. 2009). However, literature that reflects this framework remains scarce.

This paper aims to analyze and synthesize conceptual and empirical findings on survivors of political violence. Conceptual and measurement issues related to political violence will be discussed. An overview of the two primary discourses in the literature on survivors of political violence are examined, with attention to conceptual clarifications and research findings. Ecological interventions aimed at helping affected individuals and communities are also reviewed. Prior to the literature review, several epidemiologic theories of political violence are highlighted.

Political Violence Theories

A review of the literature on the theories of conflict and political violence reveals that researchers have drawn on sociological, anthropological, psychological and ecological theories in their conceptual and empirical studies (Lupsha 1971; Ross 1986). Lupsha (1971) noted a few decades ago that political scientists were explaining the phenomena of political violence solely through a psychological framework. He indicated that the complexity of political violence cannot be reduced to explanations based solely upon the dynamics among psychological variables. His argument rested upon two main points. The research outcomes in experimental psychology were challenging the stimulus-response nature of the relationship between frustration and aggression (e.g., Milgram 1965), suggesting that other variables may have the potential to explain aggression and violence. Secondly, he believed that “any psychological explanation of violence should be filtered through the socialization mechanism and the normative structure of the society being studied” (Lupsha 1971, p. 97).

He proposed a new theory that recognized individuals’ responsibility and intentionality behind the act of political violence, while still acknowledging the complexity of the context in which it occurred. Political violence was no longer seen as just the result of psychological mechanisms at an individual level, but rather as a phenomenon that occurs in the context of multiple social, cultural and political norms of a specific society.

Political scientists have since emphasized the importance of accounting for multiple factors when researching political violence (Ascher 1986; Ross 1986). In establishing the conceptual framework for his study, Ross (1986) posited that conflict is an integral aspect of political life, and that the presence of political violence in society should, therefore, be represented on a continuum. Indeed, literature suggests that manifestations of political violence are culturally determined (Anderson 1976 ; Miller et al. 2006). Moreover, some societies shattered by political violence legitimize physical violence as the main acceptable approach to solving conflict at any level (Buitrago Cuellar 2004), whereas in other societies such violence is deemed a crime against humanity. International organizations (e.g., the United Nations) are positioned on the latter end of the continuum, usually characterizing political violence as a violation of basic human rights.

Political Violence: Concept and Measures

Political violence is conceptualized as a phenomenon that involves the use of violent means (e.g., suppression of riots, bombings, shootings, public and/or private torture and executions, forcible detention, disregard for basic human rights) by political entities to achieve certain political goals (Hill 1997). Such violence is inflicted onto a population by the State in a more or less concealed manner (Basoglu et al. 1994; Gledhill 2005), or by paramilitary organizations (Buitrago Cuellar 2004) to gain or maintain political control. At the other end of the continuum, collectives can use violence to rebel against political regimes (Lupsha 1971).

Violence of a political nature is sometimes inflicted upon communities in sectarian conflicts that politically advance religious ideologies (Cummings et al. 2009; McAloney et al. 2009). Political violence also includes international political violence that is manifested through temporary or prolonged invasion of another country, sabotage, assassination of foreign rulers, terrorist activities, and embargoes (Hill 1997).

A common way to operationalize political violence in studies exploring the experiences of survivors is to measure levels of exposure to traumatic events (e.g., Basoglu et al. 1994; Goenjian et al. 2000; McAloney et al. 2009; Snider et al. 2004; Punamaki 1990; Jones and Kafetsios 2005). Researchers’ choices of instruments indicate that there is no commonly accepted measure to assess exposure to political violence. Some authors adopt scales developed in previous studies (e.g., Haj-Yahia 2008; Kerestes 2006) while others revise and adapt them (e.g., Jones and Kafetsios 2005; McAloney et al. 2009; Paardekooper et al. 1999). For example, McAloney et al. (2009) and Paardekooper et al. (1999) drew on scales from the ‘Harvard Trauma Questionnaire’ in order to assess experiences of political violence in samples of children. The measurement used by McAloney et al. (2009) comprised nine experiences categorized into three types of violent events: knowledge of violence, witnessing violence and direct victimization.

The development of new scales typically is specific to large research endeavors, such as research programs or longitudinal studies (e.g., Cummings et al. 2009; Thabet et al. 2004; Thabet and Vostanis 1999). For example, studies pursued through the ‘Gaza Community Mental Health Programme’ in Palestine developed and employed the ‘Gaza Traumatic Events Checklist’ (Thabet et al. 2004; Thabet and Vostanis 1999). Other measures include in-depth interviews (e.g., Jones and Kafetsios 2005), semi-structured interviews (e.g., Basoglu et al. 1994) and focus groups (e.g., Snyder et al. 2004).

Two common themes are addressed through these measures: exposure to trauma and the experience of loss. Trauma is experienced (e.g., beatings, killings, shootings) through direct and indirect exposure to the victimization of community and family members, or through direct victimization. Loss takes many forms: for example, death of friends or family members, the loss of housing, property or communities, and displacement. The meaning these traumatic events hold for survivors is likely to be best explored and interpreted within cultural contexts (Miller et al. 2006).

Survivors of Political Violence – Conceptual Frameworks

Two discourses emerge in a review of literature concerning survivors of political violence: (i) psychological and (ii) ecological. These seem to mimic the previously reviewed conceptual frameworks adopted in the epidemiological studies. The psychological discourse focuses upon understanding the effects of political violence on individuals by observing them through the lens of Western diagnostic criteria for mental health (e.g., Basoglu et al. 1994; Goenjian et al. 2000; Paardekooper et al. 1999; Thabet et al. 2004; Thabet and Vostanis 1999). The ecological discourse, on the other hand, has a multilevel focus that includes individuals, families, neighborhoods and other institutional systems (Cummings et al. 2009; Dubow et al. 2009). Researchers employing an ecological lens do not negate the importance of considering the psychological effects on individuals, but emphasize that individuals should be regarded as constitutive elements in the multiple systems affected by political elements.

As noted by Miller et al. (2006), very few studies employ an ecological discourse in their explanation of the experiences of survivors of political violence. The results of a comprehensive literature review by those authors lead them to claim that there is a considerable gap in having a thorough understanding of the experiences of survivors. The section that follows will focus on identifying the conceptual frameworks employed in these two discourses, the research designs specific to each of them, and their major findings.

Psychological Discourse

Research within the psychological discourse conceptualizes individuals and their characteristics as the main dependent variable and operates from the belief that trauma is a universal response to political violence (Goenjian et al. 2000; Thabet et al. 2004; Thabet and Vostanis 1999). A short synopsis of the main paradigms identified in this literature is presented in this section. Then, an abridged review of findings from studies that aimed to reveal the psychological effects of exposure to political violence is introduced. Finally, a critique of the research operating from this discourse is presented.

Paradigms

Miller et al. (2006) identified psychiatric epidemiology and traumatology as the two main paradigms adopted in explorations of the effects of political violence on the mental health of survivors. These authors proposed the concept of ‘trauma focused psychiatric epidemiology’ (TFPE) to reflect the shared roots of both psychiatric epidemiology and traumatology in the biomedical model and in the scientific framework of logical positivism.

Most studies using these conceptual frameworks employed simple research designs: they have explored differences between groups (e.g., Basoglu et al. 1994; Goenjian et al. 2000; Paardekooper et al. 1999), determined correlations between scores of exposure to political violence and scores of psychological measures (e.g., Goenjian et al. 2000), and tested regression models (e.g., Thabet et al. 2004; Thabet et al. 2004). Some researchers have controlled individual characteristics such as age, gender, coping style, or ideological commitment. Findings from the literature using the psychological discourse are reported here in two categories: 1) adults and 2) children and adolescents.

Findings in regard to adults are inconsistent, perhaps highlighting deficiencies in research designs, but also indicating the necessity of accounting for contextual factors. Some authors have reported high levels of psychiatric symptomatology in the presence of or during the aftermath of exposure to political violence (Goenjian et al. 2000; Punamaki 1990; Snider et al. 2004). For example, Goenjian et al. (2000) reported, in a longitudinal study, severe and persistent rates of PTSD, anxiety and depression among Armenian survivors of political violence, with 89.5% of the individuals meeting the DSM –III-R criteria for Post Traumatic Stress Disorder (PTSD) 1.5 years after exposure to political violence. No significant changes in the PTSD scores were observed 3 years after the initial assessment, when 94.7% of the subjects were diagnosable.

Findings reported by Basoglu et al. (1994) contradicted the stance that trauma is a universal response to political violence. Low prevalence of anxiety and depression disorders among survivors of political torture was noted (e.g., 4% current depression, 31% past major depression, 33% lifetime PTSD, 18% current PTSD), with most scores being within the normal range. Moreover, these results did not differ significantly from the percentages observed in a comparison group (not exposed to torture) whose demographic characteristics and political ideology and involvement mimicked those of the first group. An average of 61 months elapsed from the time when the torture victims were released from prison to the time they participated in the study.

Age and coping modes were found to be significant predictors of the effects of political violence in a sample of 239 Palestinian adult women (Punamaki 1990). The author found that both greater exposure to political violence and youth predicted social-political activity as a coping mode. In contrast, older and poorer women who had greater exposure to political violence had more mental health symptoms.

In regard to children and adolescents, in reviewing the developmental research conducted through the ‘Gaza Community Mental Health Programme’ from Palestine, researchers Qouta et al. (2008) emphasized multiple individual levels at which children and adolescents can be affected. These involved mental health, cognitive and creative capacities, and symbolic processes.

High levels of PTSD and depression among children exposed to political violence were indicated in studies that used reports from parents or teachers or self-reports from children (Paardekooper et al. 1999; Thabet and Vostanis 1999; Thabet et al. 2004). Significant positive correlations were reported between scores from different measures of psychological symptoms and exposure to political violence (Thabet and Vostanis 1999; Thabet et al. 2004).

The number of traumatic events experienced was the best predictor for the presence and severity of PTSD in a study conducted by Thabet and Vostanis (1999) with a sample of 239 Palestinian children of ages six to 11. The number of traumatic events and the PTSD scores were significantly associated. Best predictors of moderate to severe PTSD reactions were exposure to tear gas attacks or having witnessed the killing of a friend.

Critique of the Psychological Literature

Although this review of the literature is not exhaustive, the inconsistent findings in the reviewed articles, along with methodological problems, challenge the conceptual assumptions of the psychological discourse. Extremely small samples used in some of the studies (e.g., N = 19 in Goenjian et al. 2000; N = 55 in Basoglu et al. 1994) pose serious questions about the external validity of the results. Additionally, the designs of the studies mostly were very simple, focusing on comparisons between groups and correlations or regression models (e.g., Thabet and Vostanis 1999; Thabet et al. 2004) with those accounting for very few variables.

Interestingly enough, some authors discussed their results in a broader context, although no ecological factors were accounted for in the actual research design (e.g., Basoglu et al. 1994; Goenjian et al. 2000). For example, Basoglu et al. (1994) hypothesized that the low psychological distress found among survivors of torture may have been mediated by strong social support, and by the subjects’ status as non-refugees. Goenjian et al. (2000) explained the decrease in depression and anxiety over time as a result of increased hope at a national level or of changes in survivors’ environments. Yet none of these elements were included in these authors’ conceptual models.

Political violence is a complex phenomenon that activates social, economical, cultural, political and historical mechanisms manifested at multiple societal levels. Attempting to conceptualize and understand it solely through psychological mechanisms may be an overly reductionist endeavor. Furthermore, the focus on individual trauma places the burden of change mostly on survivors (McKinney 2007)

Ecological Discourse

Ecological approaches emphasize the complexity of political violence and the importance of considering its effects across multiple levels and in multiple contexts (Cummings et al. 2009; Miller et al. 2006). Such an approach allows an exploration of the problems as well as an understanding of resiliency factors (Dubow et al. 2009). Several conceptual models and theoretical frameworks employing ecological approaches are reviewed in this section. Empirical findings of ecological endeavors are then presented.

Conceptual Models

Bronfenbrenner’s (1979) model of the ecology of human development captured the attention of researchers interested in the complex understanding of children and adolescents’ experiences in the context of political violence (see, for example, Barber 2001; Cummings et al. 2009; Dubow et al. 2009). Other theories used in ecological conceptualizations and approaches are: social capital and social disorganization (Barber 2001), social identity and social learning (Dubow et al. 2009; Cummings et al. 2009) and emotional security (Cummings et al. 2009).

A longitudinal study conducted by Cummings et al. (2009) offers a good example of an ecological approach that integrates different theories (e.g., social identity, emotional security) using the framework of Bronfenbrenner’s (1979) model of the ecology of human development. The authors proposed a social ecological model for the impact of political violence on children that included variables representative of the four levels identified by Bronfenbrenner: microsystem, mesosystem, exosystem, and macrosystem.

The microsystem is “a pattern of activities, roles, and interpersonal relations” (p. 22) experienced by a child “within the immediate setting” (p. 7), such as the child’s family (Bronfenbrenner 1979). The mesosystem is a system of microsystems that interact with each other, such as the relations among home, school, and neighborhood peer group. The exosystem consists of settings in which the child is not directly influenced, “but in which events occur that affect, or are affected by, what happens in the setting containing” the child (e.g., parents’ place of work; parents’ network of friends, etc.) (Bronfenbrenner 1979, p. 25). Finally, the macrosystem comprises “subculture or the culture as a whole along with any belief systems and ideology” that underline consistencies at a micro-, meso-, and exo- level (p. 26). The study conducted by Cummings et al. (2009) has a longitudinal design, thereby addressing the chronosystem (elements of time), one of the last levels included by Bronfenbrenner in his model.

Political violence was conceptualized by Cummings et al. (2009) as operating at the macrosystem (cultural) level. The researchers planned to account for the characteristics of political tension (e.g., patterns, intensity) between Catholics and Protestants by coding randomly chosen relevant articles from ‘The Belfast Telegraph’ and ‘The Irish News’. The exosystem was conceptualized by different forms of community conflict and violence, by the intensity zone and by ethnic areas. The microsystem was defined by marital conflict and violence and parental adjustment. The effects at an individual level were measured through regulatory processes (e.g., child emotional security about family relationships, and about the community) and through children’s adjustment (e.g., externalizing, delinquency, internalizing). As part of this study, the researchers developed and tested their own measures in order to account for culturally-specific elements. Phase 1 of this study included a stratified random sample of 700 mother-child dyads (N = 1400) from 18 working class areas in Belfast. Data were collected through 1–2 h long interviews that took place in participants’ homes.

Ecological approaches also differentiate themselves from the psychological discourse through a shift in the conceptualization of trauma. The concept of mass trauma is advanced to explain that political violence, like man- or nature-provoked disaster, affects communities as groups of individuals (Webb 2004; Wieling and Mittal 2008). Wieling and Mittal (2008) defined mass trauma as an “event involving multiple people simultaneously experiencing, witnessing, or being confronted with actual and/or threatened death, serious injury, and threat to self or others” (p. 127). As highlighted in this definition, individuals are not affected in a vacuum, so their experiences should be understood in this context, especially when attempting to help survivors of mass trauma.

Similarly, Martín-Baró (in 1989) coined the concept ‘psychosocial trauma’ to affirm the importance of considering the extent to which social and institutional networks are affected by political violence when attempting to understand experiences of individuals. As Peltzer (2001) noted, “this means looking at experiences that affect the whole population not only as individuals per se, but as social beings in a social context” (p. 245).

Research Findings

As previously noted, few studies have considered an ecological approach when exploring the experiences of individuals in this context; either children or adults. Although not claiming an ecological orientation, some studies considered the mediating roles of various contextual factors (e.g., Haj-Yahia 2008; Kerestes 2006; Punamaki 1990; Qouta et al. 2008; Sachs et al. 2007) in models that seek to explain the effects of political violence on individuals.

In terms of research design, most studies using an ecological approach utilized multivariate research techniques, such as structural equation modeling (e.g., Barber 2001; Cummings et al. 2009), hierarchical multiple regression, or a combination of qualitative and quantitative techniques (e.g., Jones and Kafetsios 2005; Snider et al. 2004). A review of the main categories of findings is provided in this section.

One of the main categories was ‘Family characteristics’. Family, as a social unit, is directly affected by political violence when parents get killed or abducted and when children are required to take on adult roles (Barber 2008; CODEPU 1989; Jones and Kafetsios 2005; Snider et al. 2004). Studies revealed associations between political violence and higher levels of family conflict (Cummings et al. 2009; CODEPU 1989) or domestic violence (Snider et al. 2004). Cummings et al. (2009) reported that marital conflict mediates the effects of community sectarian violence on children’s adjustment.

Concurrently, themes identified by Jones and Kafetsios (2005) among 40 interviewed Bosnian adolescents revealed that domestic violence can affect adolescents in a more painful manner than the hardships of war. An adolescent from this study reported having the “best time in [his] life” during the War because his violent and alcoholic father, was “on the Front Line” and he “really felt really nice” being together with his mom (p. 168).

Parental monitoring was shown to mediate the effects of political violence on children and adolescents (Barber 2001; Cummings et al. 2009). A study that tested an ecological model of youth experience in the ‘Palestinian Intifada’ (N = 6000, age 14) (Barber 2001) found that family monitoring buffered against increasing depressive symptoms and antisocial behaviors for females exposed to political violence.

Perceived positive parenting was reported to protect children from the effects of political violence (Kerestes 2006; Qouta et al. 2008). Kerestes (2006) aimed to understand the role of perceived parenting and child’s gender in behaviors of Croatian children (N = 694) exposed to the war in the former Yugoslavia (1991–1995). Children’s ages ranged from 12 to 15 in the Spring of 1998, the time when data were collected. The researcher found that perceived positive parenting had significant effects on children’s levels of aggressive behavior as self-reported, reported by peers or by teachers.

Furthermore, parents’ mental health has been shown to mediate children’s experiences of political violence (Cummings et al. 2009; Haj-Yahia 2008; Qouta et al. 2008). Haj-Yahia (2008) reported that parents’ psychological adjustment problems significantly mediated the effects of political violence on internalizing (somatic symptoms, anxiety, and depression) and externalizing (social problems, thought problems, attention problems, delinquent behavior, and aggressive behavior) symptoms.

Another main category was that of ‘Neighborhood and communities’. Political violence affects communities at multiple levels. Both the physical location and the structure of the community are affected as boundaries change or as communities are displaced (Buitrago Cuellar 2004; Wessells and Monteiro 2004; Jones and Kafetsios 2005; Snider et al. 2004). Examples of harmonious communities whose members became enemies due to changes in political ideologies are numerous in the history of political conflict (Jones and Kafetsios 2005; Buitrago Cuellar 2004; Snider et al. 2004).

As Miller et al. (2006) conceptualize it, political violence destroys “social ties and patterns of interaction that create the basis for a sense of community and that allow community institutions to function effectively” (p. 417). Communities shattered by political hardship are dominated by and organized around a state of fear (Jarymowicz and Bar-Tal 2006).

Very few studies aimed to understand the mediating effects of community characteristics on individual experiences of political violence (e.g., Barber 2001; Cummings et al. 2009). Barber (2001) found that neighborhood disorganization was significantly associated with all measures of social context and of individual experiences. Adolescents from disorganized neighborhoods were found to be more associated with acts of political violence, less involved with school and religion, less monitored by their parents and more depressed. Concurrently, Cummings et al. (2009) confirmed that the degree and type of violence in communities directly affects the security perceived at a community, family and individual level.

The final category involved ‘Other factors’. Minority status and socioeconomic class, factors widely accounted for in the social sciences, have been found to mediate experiences of political violence (e.g., Sachs et al. 2007; Cummings et al. 2009). Sachs et al. reported that “poverty, minority status and gender/sexual injuries exacerbate trauma that results from assaults perpetrated on national backgrounds.” (p. 602). The effects of other factors, such as “anticipatory neurosis,” ideological commitment or meaning of events were also considered. One may argue that these factors can be clustered under individual characteristics. The choice of describing them under this section resides in the conviction that such variables develop significance in response to contextual factors (Cummings et al.).

The anticipation of the occurrence of acts of political violence has also been reported to have an effect on experiences of survivors (Basoglu et al. 1994; Punamaki 1990), which is consistent with findings in the literature in regard to the Second World War. Communities where violence is intermittent appear to be more disrupted than ones exposed to reoccurring acts of violence (Punamaki 1990). Finally, the meaning attached to events (Barber 2001; Jones and Kafetsios 2005) and the ideological commitment to events (Basoglu et al. 1994; Punamaki 1990) buffer against experiences of political hardship, acting as protective factors.

In conclusion, as Harvey (1996) posited, ecological approaches conceptualize “violent and traumatic events as ecological threats not only to the adaptive capacities of individuals but also to the ability of human communities to foster health and resiliency among affected community members” (p. 5). Concurrently, they shed light upon possible protective factors at individual and community level that may be considered when designing and implementing interventions for survivors of political violence.

Ecological Interventions

A considerable number of ecological interventions are presented in the literature (e.g., Blackwell 2005; Buitrago Cuellar 2004; Schwartz and Melzak 2005; Weine et al. 2008; Wessells and Monteiro 2004), spanning common themes. One such theme is the attention to culturally relevant factors, such as ways in which distress is experienced, patterns of seeking help, or traditional ways in which problems have been dealt with in communities (Miller and Rasco 2004).

Groupwork

The main criticism of individual interventions (e.g., medication management and psychotherapy) is that they typically place the burden on individuals (McKinney 2007) and pathologise normal human reactions to the hardship of political violence (Miller et al. 2006). One way in which individuals’ experiences and responses to political violence can be normalized and healed is through participation in groups (Blackwell 2005; Schwartz and Melzak 2005; Snider et al. 2004). Focus groups led by Snider et al. with survivors of political violence in Peru revealed that group members had never shared with anybody their internal experiences. Participants reported a sense of relief, both throughout and at the end of the focus group.

Participation in groups has also been found to act as a gateway for survivors seeking (Weine et al. 2008) and requiring mental health services (Snider et al. 2004). It provides a collective setting in which established therapeutic techniques and culturally specific methods encourage story telling through which participants find relief and healing (Blackwell 2005; Peltzer 2001; Schwartz and Melzak 2005; Wessells and Monteiro 2004).

Workshops

Educating individuals and communities on various issues from human rights to mental health has been the focus of ‘Corporacion Avre’ (Apoyo a Victimas de Violencia Sociopolitica pro Recuperation Emocional—Support and Emotional Recuperation for Victims of Sociopolitical Violence), a non-governmental organization from Colombia (Buitrago Cuellar 2004). As a result, individuals from displaced communities that received such training reported emotional relief, awareness of their skills and capabilities, greater solidarity and a commitment to work with the legal system in protecting their communities.

Networking

The configuration and stability of communities are put at risk when individuals lose their social and occupational roles, their environmental mastery or their financial resources (Miller 1999). This creates the scenario for increasing social isolation, especially in communities of refugees. Interventions should create opportunities for individuals to network within the new environment where they have found refuge. For communities that have not been displaced, interventions should aim at involving members in activities that recreate social connectedness (Buitrago Cuellar 2004).

Paraprofessionals

Access to mental health professionals, as conceptualized in Western models, is far from being a realistic option in some communities that lack access to fulfilling basic needs (Miller and Rasco 2004). Traditional healers and religious leaders have played an important role in treating the individuals debilitated by exposure to horrific experiences or by tremendous losses (Miller 1999; Miller and Rasco 2004; Wessells and Monteiro 2004). Interventions should aim to collaborate with these respected community figures in order to gain an understanding of how the “healthy” and the “impaired” are defined within the community, and to provide them with some extra tools with which to help their people (Miller et al. 2006).

This type of intervention is based on the assumption that community members have an awareness of both the mental health problems and psychosocial stressors in their own community (Snider et al. 2004). By combining local practices with mental health care, the number of people that can be helped increases exponentially (Miller and Rasco 2004; Wessells and Monteiro 2004).

Implications for Counselors

Counselors working with survivors of political violence should consider both individual psychological factors as well as ecological ones. While standard procedures in most clinical settings will include a traditional Western diagnostic assessment of individual symptoms, given the complex and multi-leveled nature of political violence, both clients and clinicians may benefit from a thorough ecological assessment as well. Utilizing the research findings considered in the sections above, counselors may be able to create a multi-dimensional conceptualization and devise interventions that will help clients on both individual and systemic levels. Increasing the strength of a community through group work, psychoeducation, providing opportunities for networking and utilizing helping resources within the community itself can serve to alleviate the suffering of both individuals and the collective.

Conclusion

The review of epidemiologic studies on political violence revealed an evident shift from a psychological to an ecological perspective in trying to understand the complexity of this phenomenon. Similarly, while the largest body of literature on survivors of political violence follows a psychological discourse, efforts to advance an ecological framework in this particular area of concern have started to become more visible over recent years.

Ecological models do not deny the importance of individual trauma. They challenge its universality among responses to exposure to political violence. Moreover, they shift the focus from individual to mass experiences, since the mechanisms of political violence are affecting societies and communities as a whole. Finally, ecological interventions share the responsibility for recovery and healing among state, community, international and national organizations and individuals.