Baden-Wuerttemberg Cooperative State University (DHBW)
Aug. 26, 2018, 1:06 p.m.

‘Psychotherapy Education and Training Psychotherapists in Northern Iraq’


Prof Dr Dr Jan Ilhan Kizilhan (Baden-Wuerttemberg Cooperative State University, DHBW)

Prof Dr Martin Hautzinger (Tuebingen University)



Collaborating Partners:

University of Dohuk, Iraq

Directorate General of Health of Dohuk, Iraq



Prof Dr Dr Jan Ilhan Kizilhan

Course Coordinator

Social Work Studies for People with Mental Illness and Addiction

Baden-Wuerttemberg Cooperative State University (DHBW), Villingen-Schwenningen

Department of Social Work

Schrambergerstr. 26, 78054 Villingen-Schwenningen, Germany

Ph. + 49 7720 3906217


This version current at: 29/01/2016

  1. Einleitung. 3

1.1      Kriegsbedingte Ausgangssituation im Nordirak. 3

1.2      Psychische Auswirkungen von Kriegen. 4

1.3      Austausch von Wissen und Umgang mit anderen Kulturen. 5

  1. Projektziele. 6

2.1      Aufbau eines universitären Instituts für Psychotherapie und Psychotraumatologie. 6

2.2      Ausbildung in Theorie und Praxis. 8

2.3      Nachhaltige Ausbildungsstruktur durch E-Learning-Module. 10

2.4      Netzwerkbildung vor Ort 11

2.5      Zusammenfassung. 12

  1. Meilensteine. 13
  2. Finanzierungsplan nach Zielen und Meilensteinen. 14

4.1      Kostenplan Ziel 1: Institutsgründung. 15

4.2      Kostenplan Ziel 2: Ausbildung. 15

4.3      Kostenplan Ziel 3: E-Learning. 18

  1. Weitere Unterstützung. 19
  2. Anhang: Letters of Intent 19

1.        Introduction

1.1      The effects of war: The background situation in Northern Iraq

For several generations, people in Iraq have found themselves in wars or war-like circumstances. Flight, expulsion and mass destruction have influenced this society to a particular extent. The hope that democracy might develop after the Saddam era, and that the various ethnic and religious groups might live together peacefully, has been shattered, since 2014 in particular. Rather, it is now evident that the country is facing dissolution.   

 Since 16 June 2014, the IS is occupying large parts of Iraq and Syria and commiting gruesome massacres against the population, especially against religious minorities such as Yarasan, Shabaks, Christians, Mandaeans, Alawites, Shiites and Yezidis. For example, more than 7000 Yezidis have been killed in Iraq. Thousands of women and children have been enslaved, men executed, and towns, villages and holy sites destroyed. With the influx of Syrian civil war refugees into Northern Iraq and the Iraqis who are refugees in their own country, there have been, since 2014, around three million refugees in the Kurdish region of Northern Iraq alone. Basic supplies and services for people barely meet the needs. Severely traumatised young women who, as IS hostages, have lived through torture, slavery and rape, then finally escape, are suffering especially badly, as medical and trauma treatment are hardly available.   

The state government of Baden-Wuerttemberg has therefore created the  ‘Sonderkontingent für bedürftige Menschen aus dem Irak 2014’ (‘Special contingent for Iraqis in Need 2014’) project. Through this project, it has been possible to bring up to 1000 women in need of protection and their relatives to Baden-Wuerttemberg for treatment by the end of 2015. This is important and urgently needed, as this group of people, given the severity of their trauma, does not have access to treatment options in Iraq or Syria.  At the same time, however, it is necessary to train specialists locally, who will be able to help people with a mental illness and to train their own specialists in order to guarantee broad-based health services in the long term. This requires establishing scientific institutions for research, teaching and practice in order to, among other things, build up the currently non-existent psychotherapy services infrastructure with a focus on trauma. It is therefore especially necessary, apart from training practitioners, to enable local specialists to train 30 others using a train-the-trainer approach to provide psychosocial services, especially trauma treatment, in the region of Iraq and Syria. 

 1.2      The psychological effects of war

Life-threatening experiences can be so significant that nothing in life is as it was before. Accidents, disasters, war, acts of terrorism, rape and abuse are some of the events that can cause a deeply traumatic psychological breakdown and can hit a person at any time in their life.  Some people who experience such an event, and also some of those who witness it indirectly as helpers, witnesses or relatives, find it difficult to regain their mental balance.

Traumatic events trigger feelings that life itself is in jeopardy as well as helplessness and shock. The reactions that may follow in the first few days afterwards may inlude disturbed sleep, nightmares, nervousness and lack of concentration, but also distrust in others, being on edge, joylessness and a general sense of lack of purpose. Often, such changes, which are not necessarily recognised as connected to the traumatic event, creep up on people without being noticed.  In the long term, physical and psychological symptoms such as multiple types of pain, anxiety, sleep disorders and depression etc. can develop, and in some circumstances may expand into long lasting and complex disorders. I many cases, those affected feel ignored and abandoned by their surroundings.

In countries such as Iraq and Syria, violence and aggression have been persisting over several generations and have dominated people’s lives. Over the long term, this also impacts the whole society and the generations that follow. Apart from psychotherapeutic treatment, working through the numerous stresses as well as forgiveness and reconciliation are central during wars, and for several generations after times of war, which is essential for peace in a country. In this context, dealing with the past also means reconstruction and planning for a healthy and peaceful future.

 Sexualised violence as humiliation of an entire society is of particular significanc. Especially the de-humanising sexualised violence against women in the former Yugoslavia, and now against Yezidi women in Iraq ad Syria, has shown us the cruelty that people are capable of. The victims, and the collective to which they belong, may be traumatised for decades as a result (Kessler et al., 1995). Forms of violence range from rape, harassment, mutilation, enslavement and physical marking to the killing of the victim (Wenk-Ansohn, 2002; Kizilhan, 2004). Rape is an extreme assault on the intimate self, triggers massive feelings of invalidation and humiliation, and violates privacy (Neuner et al., 2004). I understand sexualised violence as targeted, systematic violence against women that is using the means of sexual abuse, humiliation, threat and rape. Many of the victims develop post-traumatic stress disorder (PTSD) and numerous comorbid disorders such as depression and somatic symptom disorders (Kulka et al., 1990; Basoglu et al., 1994; Kessler et al., 1995).

 In general, the proportion of comorbid disorders in patients with PTSD is very high in cases of war trauma  (Kulka et al., 1990; Kessler et al., 1995; Creamer et al., 2001). In Vietnam veterans with PTSD, the comorbidity rate for at least one additional mental disorder was found to be as high as 98.8 percent (see Kessler et al., 1995). The most common were alcohol abuse, alcohol dependence and major depression, followed by generalised anxiety disorder (see Kessler et al., 1995; Creamer et al., 2001).

Over the last 20 years, research has also examined psychological effects. However, in this case, mainly the short-term effects of terrorist activities such as hostage taking, bomb attacks and shootings  (Curran et al., 1990; Galea et al., 2002; Verga et al., 2004; Miguel-Tobal et al., 2006). According to estimates, the probability of acquiring PTSD after a terrorist attack lies between 7.5 and 50 percent, depending on the degree of victimisation  (Verger et al., 2004). Although terrorist attacks are increasing globally, there is hardly any evidence on their medium to long-term psychological effects; this is especially true for post-traumatic stress disorders (Desivilya & Ayalon, 1996).

Road accident victims, for example, show a high susceptibility to PTSD; rates for the period between one and five years after the accident are between 11 and 46 percent  (Mayou et al., 1997). Studies on earthquake victims show that long-term PTSD is present in up to 45 percent, even one year after the disaster (Livanou et al., 2005; Basoglu, 2009).

 1.3      Exchanging knowledge and dealing with different cultures

Another aspect – in this context a truly innovative approach – is intertwining psychotherapy training with transcultural transfer. Trainers as well as trainees in psychotherapy must face up to the frames of reference within which different cultures and academic institutions operate.  There is no longer any doubt that the need for a transcultural approach to research, professional development and treatment, on the basis of specific transcultural competencies, is increasing. This can lead to better service provision and therefore to a reduction in the risks of mental illness becoming chronic. For this to occur, a transcultural perspective on health and disease is a fundamental prerequisite. 

Different cultures have developed different coping strategies to deal with the multiplicity of different stresses. In general, these strategies often represent the most important resource for integration into a society that will remain successful in the long term. Especially in a culture characterised by collectivist values such as that of Iraq, the individual can hardly be understood without looking at the collective whole. In this society, above all in rural areas, relationships with the people in one’s closest social circles are, as a consequence of traditional upbringing and socialisation, particularly important, including the relationships with the treating doctor and therapist.

Today, the transcultural process ensures that the existing treatment concepts from the western world (individual perspective) can be used successfully with people from other countries (collective perspective) (Annunziato et al., 2009; Behrens & Callies, 2008).

 2.        Project objectives

To support Northern Iraq in its development, it is therefore necessary to build up psychosocial service provision.  This in turn requires the establishment of a training institute at a university, and the training of therapists at that institute. Making the institute sustainable is intended to also ensure a sustainable infrastructure for psychotherapeutic service provision in Northern Iraq. Three main objectives contribute to this goal:


Objective 1

To found and establish an ‘Institute for Psychotherapy and Trauma Studies’ at the University of Dohuk

Objective 2

To train an initial cohort of up to 30 therapists. Of these, 50% will be trained as trainers.

Objective 3

Sustainable course structure using e-learning modules

Objective 4

To develop local networks

  2.1      Establishing a university institute for psychotherapy and trauma studies

A Department for Psychotherapy and Trauma Studies will be founded at the University of Dohuk and the necessary infrastructure provided. This institute will research the topic of psychotherapy and trauma in its entire breadth and develop culturally sensitive modules and approaches for psychotherapeutic practice. This also covers interdisciplinary crossover with medicine and psychology and their sub-disciplines. Psychotherapy research can today no longer be reduced to the application of classical theories of learning or psychoanalytical theories, but builds on the combined body of research from medicine, psychology, biology and the social sciences, and will be further complemented by transcultural aspects of trauma.

 Moreover, the institute will support participants and other researchers in combining the goals of postgraduate training with accreditation as practitioners. This allows synergetic effects to be used.

The applicants are confident that it is possible to establish a training institute including a three-year programme to train up to 30 persons as therapists specialising in trauma.

 The structure of the institute is intended as follows:

 Organisational structure of the Institute for Psychotherapy and Trauma Studies; Dohuk University Board; College of Human Sciences; Faculty committee membership of the project management team from Germany for the duration of the project; Directorate of the Institute, NN Iraq, NN Germany, Directorate General of Health of Dohuk; Scientific Advisory Council members from Germany and Iraq; Administration; Outpatient Clinic (outpatient services start in 2020)

 In the long term, it is intended that the institute will be integrated into the departmental structure of the University of Dohuk and networked with the faculties in Dohuk, Erbil and Sulaymaniyah. This would also make the institute unique in the middle east, as not even a remotely similar institution exists to date, and as it would also contribute to optimising of the tertiary education system in Iraq. This is deemed realistic, given the reputation of the German education system as being of high quality.

 The scientific expertise of the applicants makes it possible to put together a standardised support package for those survivors of organised violence who have been severely damaged emotionally, and, as a consequence, physically.  The project is also about building bridges between science and development aid. It intends to create the same kind of infrastructure for people who have been traumatised as are called for in cases of epidemic outbreaks: immediate help should be available, which in turn should comply with the latest standards. Trauma studies – in combination with effective psychotherapy modes – provide the most recent evidence base for treating people in acute as well as chronic mental distress  (acute stress disorder, adjustment disorder and post-traumatic stress disorder).

 2.2      Training in theory and practice

Because of the background situation in Northern Iraq as described above, a training course in trauma studies as well as appropriate, concrete therapeutic intervention options are intended to commence immediately at the start of the project. At the end of the course, the planned practical phase can start immediately with the first patients being treated. We are confident that the trainees will, under supervision, be able to stabilise and care for people who have been traumatised.

 In parallel to the training, at least 12 to 15 trainees are intended to also have the capacity to work at the training institute as lecturers as well as in management roles. This ensures that, after the end of the project, 30 candidates can be trained in every subsequent year. In addition, the institute will in future years also take on the evaluation of psychotherapy training and the training of trainers. 

 Four years are allocated to the establishment of the institute and the training of trainers on account of the preparations needed before the start of the course, the evaluation to be conducted afterwards and the preparations for the following group of trainees (see also the time line on page 13).

 In collaboration with the University of Dohuk, the Dohuk Directorate General of Health, Baden-Wuerttemberg Cooperative State University (DHBW) and Tuebingen University, a curriculum made up or a range of teaching modules and practice placements in clinics, institutes and refugee camps will be taught. Up to 30 medical doctors, psychologists and social workers from Iraq and Syria will be trained as therapists with a focus on trauma, aiming to a) treat patients locally and b) teach as lecturers training new therapists every year.

Up to ten persons from Syria are intended to participate in the course in order to establish – concurrently or later, when the war situation allows it – an institute in Syria and to begin treating patients there. Contacts already exist with doctors and psychologists in the Syrian cities of Aleppo and Afrin.

 Psychotherapy training follows the German examination regulations for psychology-based psychotherapists (Prüfungsverordnung für Psychologische Psychotherapeuten, PsychTh-APrV) and psychology-based child and adolescent psychotherapists (Psychologische Kinder- und Jugendlichenpsychotherapeuten, KJPsychTh-APrV), each involving at least three years of study in full-time mode or at least 5 years in part-time mode. In Iraq, clinical placements will be conducted, among others, in refugee camps and hospitals, and organised and supported by the Dohuk Directorate General of Health. Lecturers from Germany and Iraq provide theory teaching, supervision and self-awareness development.

 The training concludes with passing a statutory examination (accreditation), which will be conducted by the Dohuk Directorate General of Health in consultation with the Ministry of Health in Erbil.

 Prerequisites for training as a psychotherapist are a university degree in medicine, psychology, social work or an educational field. Teachers offer an important potential cohort here as they are better placed to support and take care of children.

 The majority of the population of Dohuk province speaks Kurdish. For this reason, the main teaching languages will be Kurdish and English. Arabic will also be considered as a teaching language.


Catalogue of teaching modules for the ‘Psychotherapy and Trauma Studies’ course

SS[1] 2017

Fast responses to trauma

Topics specific to trauma will be taught right at the start of the project, so that the many mentally ill, and, in some cases, severely traumatised people in the refugee camps can be treated as soon as possible. It is intended that the project coordinators will supervise treatment.

SS 2017

SS 2018

SS 2019

Annual two-week theory module in Germany

Once a year, experts in theory, supervision and self-awareness development will teach the trainees during a two-week theory module. At the same time, the trainees will have the opportunity to observe the treatment of patients in psychiatric and psychosomatic medicine clinics as well as trauma centres. Cultural activities promoting intercultural dialogue and the mutual understanding of different values and norms will be made possible as part of a complementary programme.

WS[2] 2017

WS 2018

WS 2019

SS 2020

Annual two-week theory module in Northern Iraq

Once a year, experts from Germany will teach a two-week theory module with clearly defined topics modelled on the training of psychotherapists in Germany.

A complementary cultural programme (culture, language, but also visits to refugee camps, hospitals and public health authorities) will be put together for the experts from Germany.

Between the two theory modules 2017 to 2020

Clinical practice modules

As part of their training, trainees will complete compulsory clinical placements in refugee camps, clinics or similar and treat patients there.  Placements take place every year of the course, so that trainees will have completed a total practical training component of 1800 practice hours by the end of the course. Within this framework, at least 600 hours of psychotherapeutic treatment provision must be documented over the three years, of which 300 hours must have been spent treating people who have experienced trauma.  After each clinical practice module, a case study report about the treatment process with a patient who has experienced trauma will be required.

WS 2017

WS 2018

WS 2019

SS 2020

Supervision and self-awareness development

Individual and group supervision sessions as well as self-awareness development are compulsory components of the training and will be offered after each training module (theory as well as clinical practice modules).

 2.3      Sustainable training structure through e-learning modules

To improve and sustain the quality of the training, it will be complemented by an e-learning extension – similar to other tertiary professional development courses that use a ‘blended learning’ approach. Also, materials for the theoretical underpinning of the course (literature in libraries, teaching and learning materials) do currently not exist locally, so that large amounts of relevant literature would have to be procured. For reasons of expense and sustainability, we therefore advocate for the inclusion of e-learning modules.

 Thematically, the e-learning modules will pick up on important aspects of psychotherapy and trauma studies and make them available to the trainees for in-depth and practice-oriented learning. The e-learning modules will be written in English and can – as added value – also be used in teaching at Baden-Wuerttemberg Cooperative State University (DHBW) and Tuebingen University. These interactive teaching modules will be compulsory and completed by the trainees in self-study mode.  The foundation for systematic knowledge acquisition used here is the didactic principle of course-adapted, self-directed learning following a cognitive constructivist learning strategy. Tutorial support for the trainees is ensured in the form of scheduled weekly webinars.

The first online teaching modules will be available after 12 months. Over the three years, the plan is to develop a complete e-learning package of around 120 study hours and to include an online assessment.

The applicant possesses relevant expert knowledge regarding e-learning projects, among others through a current project called ‘E-Lectures in Health – Mental Illness and Rehabilitation’ at Baden-Wuerttemberg Cooperative State University (DHBW). However, support for e-learning would also have to be ensured locally at the University of Dohuk.

 2.4      Building local networks

An additional objective for the beginning of the project will be to build a network of local stakeholders (doctors, psychologists, care workers, teachers, social workers and other professionals) that covers the settings of lived experience and is stable and sustainable in the long term.  Building on basic knowledge of the diagnosis and treatment of mental illness, service options for the support and treatment of those affected will be developed and made available.  Here, the University of Dohuk and the Dohuk Directorate General of Health intend to make a contribution.

 Achieving these objectives will also have a preventive effect. Locally active professionals will work independently and will try to prevent symptoms becoming chronic in people living in different areas (rural, city, ethnically and religiously diverse groups, gender-specific). This means providing opportunities for those affected to accept assistance easily and as a matter of course. This will require straightforward, uncomplicated and effective services.

 Educational interventions (professional development workshops, seminars, conferences, publications etc.) will not only inform those affected about trauma and trauma-induced disorders, but also the general population and the scientific community. The project will also strive for interdisciplinary collaboration with the scientific community in the field of mental illness.   

 Already existing services such as counselling centres, public authorities, crisis intervention services as well as therapists will be coordinated and networked in order to be able to refer people quickly and efficiently to the most appropriate source of assistance. In addition, this will make it possible to connect services with each other and support the establishment of psychotherapy training institutes in other cities as well.

 Within the frame of networks, professional development will also be offered to fellow specialists and other professional groups who often encounter people who have experienced trauma, such as nurses, gynaecologists, surgeons, general practitioners, police, fire fighters, paramedics etc. This is to ensure that the assistance offered does not lead to re-traumatisation of those affected and that it will be recognised more quickly when a person who has experienced trauma needs additional assistance.

 Active public relations activities will be conducted with the aim of, on the one hand, encouraging and promoting public debate about traumatising life circumstances, the preparedness to use violence and the mechanisms of violence; on the other hand, this debate is intended to serve the prevention of the development of illness and the lowering of the threshold of fear regarding accepting assistance. 

 Competent therapeutic and holistic assistance can also make a contribution to a sense of internal peace as well as actual external peace for people in this region. Stabilising these people represents an important contribution to building up civil society structures in a post-war situation and to promoting tolerance. Trauma assistance is therefore a form of working for peace.

 The University of Dohuk and the Dohuk Directorate General of Health will provide financial support for sustainable network development.

 2.5      Summary

Currently, 24 refugee camps with between 16,000 and 18,000 residents each exist in the Northern Iraqi province of Dohuk. These people had to flee as a result of the civil war in Syria or the attacks on and occupation of large areas in Iraq and Syria by the IS (‘Islamic State’). The practical component of psychotherapy training will therefore take place in the refugee camps, clinics and support services in Dohuk province. Practical training includes, among other components, conducting – under guidance – diagnostic surveys, studies and contributions to the psychotherapeutic treatment of patients with a range of mental disorders and illnesses in a range of settings. Collaborations with the different NGOs and the UNHCR are desired and important.

 The following requirements must be fulfilled to complete the training:

  • 1800 hours of psychiatric clinical practice,
  • At least 600 hours of providing psychotherapeutic treatment, including treating at least six individual patients
  • Writing at least six anonymised case studies
  • 30 hours of individual self-awareness development and 120 hours of self-awareness development in a group setting
  • 50 hours of individual supervision and 50 hours of group supervision (spread over the 600 treatment hours provided as part of the clinical practice modules)
  • Complementary studies to cover the elective course component of 930 hours, e.g. through preparation and reporting, extending the psychotherapeutic treatment hours of the practical component, extending clinical practice as well as case conferences, symposia and professional development activities.

3.        Milestones

Project milestones include:

  • Establishment of the institute and its management for a period of four years
    • Organising and preparing course content and lecturers from Germany and Iraq
    • Selecting trainees
    • Supervision and self-awareness development
  • Start of the training course under the leadership of the Dohuk Directorate General of Health
    • Organising and planning the clinical placements in refugee camps and clinics
    • Supporting trainees during their clinical placements
  • Development of e-learning modules
  • Establishment of a trauma centre in Dohuk











Institute development

2 Wo Curriculum Deutschland

Two-week theory module Germany

Etablierung und Verstetigung der Ausbildung

Establishing the training and making it sustainable

Offizielle Institutsgründung

Official founding of the institute

2 Wo Curriculum Irak

Two-week theory module Iraq

1 Wo Supervision Irak

One-week supervision Iraq

Beginn der Ausbildung 1. Kohorte

Begin training 1st cohort

Beginn 2. Kohorte

Begin 2nd cohort

Abschluss 1. Kohorte

Completion 1st cohort

Treffen Netzwerk Trauma

Trauma network meeting



Milestones (work packages)

March 2016 – March 2017

Development and founding of the institute

October 2016 to October 2018

Development of the e-learning module

March 2017 to March 2020

Begin of training

March 2017 to October 2020

Establishment and development of the City of Dohuk Trauma Network

4.        Budget by objectives and milestones

Financing and budgets will be drawn up when the collaborating partners have reached in-principle agreement on the project and tasks have been clearly allocated. The attached budget is therefore to be read as a first draft.



Milestones (work packages)

Cost per year   in Euro

Total cost


March 2016 – March 2017

Development and founding of the institute



4 years

October 2016 to October 2018

Development of the e-learning module



3 years

March 2017 to March 2020




3 years

March 2017 to October 2020

City of Dohuk Trauma Network



4 years

5.        Additional support

 During the theory modules, Baden-Wuerttemberg Cooperative State University (DHBW) will provide classrooms and take care of the trainees during their stay in Germany (see also attached Letter of Intent).

 Tuebingen University supports the project through their Department of Psychology and Psychotherapy, represented by Prof Dr Martin Hautzinger (see also attached Letter of Intent).

On 23/01/2016, a meeting took place in Erbil with representatives (namely Mr Hagen Berndt, among others) of the GIZ (the German society for international cooperation). They would like to discuss our application at a GIZ conference in Dohuk in February.

 In a meeting with Prof Kizilhan on 24/01/2016, Prof Dr Mosleh Duhoky, President of the University of Dohuk and Dr Nezar, Director of the Dohuk Directorate General of Health pledged their support and will be sending their Letters of Intent in the coming days.

 6.        Appendices

6.1      Appendix 1: Letters of Intent

  • Baden-Wuerttemberg Cooperative State University (DHBW) in Villingen-Schwenningen, Germany (university executive)
  • Tuebingen University, Germany (university executive and Prof Hautzinger)
  • Overall budget

 6.2      Scientific base

Jan Ilhan Kizilhan: Prof. Dr. rer. soc., Dr. phil Dipl.-Psych., psychology-based psychotherapist, hypnotherapist, trauma therapist (DeGPT), supervisor, lecturer, court-appointed expert, co-editor of the Forum Migration, Health and Integration series of publications, course coordinator at Baden-Wuerttemberg Cooperative State University in Villingen-Schwenningen.

 Areas of work: clinical psychology and psychotherapy, trauma studies, transcultural psychiatry and psychotherapy, research in migration and social conditioning.

 Martin Hautzinger: Prof. Dr. phil, psychology-based psychotherapist, supervisor, lecturer, Head of the Department of Clinical Psychology and Psychotherapy of the University of Tuebingen, internationally known researcher and member of numerous academic associations.

 Areas of work:  depression research, alcohol and drug dependency, anxiety and stress disorders, psychosis risk, clinical geriatric psychology, psychotherapy research, psycho-physiological disorders and coping with illness, clinical child psychology. 

  [1] Summer Semester

[2] Winter Semester