Pardon Me I Think I Have Lost Me, Have You Perhaps Seen….I Last Saw Her….

Stop all the clocks, cut off the telephone,

Prevent the dog from barking with a juicy bone,

Silence the pianos and with muffled drum

Bring out the coffin, let the mourners come.

Wystan Hugh Aude

 

I am a therapist and have been ever since I could remember and it has become my identity, and I have never had qualms about my profession being a part of my identity but lately I find myself missing something. I find myself searching as though I have lost myself. It was not till I had a tiff with a friend a few days ago that I had to sit myself down and find out what is happening. What one needs to understand about this tiff of ours is that words were thrown out there and I can’t say I was offended at the time, but I was a bit irritated later. I mean the woman said I was no longer fun, all because the one time we went out and it was all hip hop,I dissociated and couldn’t wait till we went home, but then she went on saying I was not even bothering to compromise and I said, ‘it’s that time of the year’. I mean really, and she went on to say, ‘what do I mean it’s festive’. So I went home and came to the conclusion that I was a not fun friend and with all my complaints about my friend neglecting me, truth of the matter is, I am tired and I don’t enjoy some of the things I used to before. When did I become this person who looks for excuses when friends call up for coffee or a night out? As I sat to think about the person I have become it dawned on me that I am someone else, but where did I lose me?

 

I sat down and recalled  times when life was simple, when I had my innocence and naivety and I was accepting of that, I recalled  days when I could go to the park,throw a ball and run around and fall on the grass and look at the sky and  see forms in clouds and just be content with that. I remembered days when I could still go out with friends and drink, jive and flirt shamelessly and come back on Monday and go out for Mogodu night. Those were the days I could laugh from my belly. It’s days when I looked at the Soweto light and felt I am going home and be happy. The truth is, being a trauma therapist, that identity has swallowed me whole. My world is no longer a simple black and white, it’s got grey linings now, even as I laugh from my belly my eyes have a tint of grey. I look for soul music now as hip hop does not make sense. I usually feel too tired and old to run around the park but once in a while I still see forms in the clouds, but it’s usually with the help of my daughter. I have in my head stories of people and at times I look for their truths in my world so that I can go back and we can have meaningful conversations. I may have become a bit more dismissive and boring, even my physical self has changed: I need navy beans now, but I have not lost myself, I have merely taken a different shape. My friend must get with the program.

Written by: Thembisile Masondo

Dreading my 18th birthday: the plight of refugee children in detention centers

The CSVR Trauma Clinic presented two oral presentations at the 10th annual International Society for Health and Human Rights conference held in Novi Sad, Serbia from the 26-29 September 2017. While the two oral presentations were well received, I would like to focus on one of the interesting learnings from that event: The treatment of unaccompanied minors and the implications for them across countries and age cut-offs. An example of this was a presentation given by Lilla Hardi, Medical Director of the Cordelia Foundation for the Rehabilitation of Torture Victims which operates in Hungary. One of the factors which increases the risk for further trauma in children seeking refuge in Hungary, is the fact that children over the age of 14 years are kept in what is known as a transit zone for the duration of their refuge period. A quote from the UNHCR sums up this transit zone best, “Hungary’s transit zones are really just detention centers, said UN High Commissioner for Refugees Filippo Grandi after wrapping up a two-day visit to Hungary. In his meetings Grandi expressed his concern that asylum-seekers, including children, were being kept in the “transit zones” during their asylum process. “Children, in particular, should not be confined in detention,” he said Tuesday after touring the Röszke transit zone on Hungary’s border with Serbia”. [i]

Similarly, Gunnar Eide and Torunn Fladstad from RVTS South in Norway reported during their workshop session that unaccompanied minors are returned to their country of origin when they turn 18 years old. Essentially, they are returned to the source of their trauma and to a country often still in conflict after having been provided with education and support from the government up to that point. The Nordic Page, reported on the impact that this new legal restriction has on children, “This permit has come under criticism from NGOs and other commentators, and it appears that some permit holders abscond from reception centerss prior to the transition to adulthood in order to avoid return. Also, the number of suicides attempts and anxiety disorders among this group has dramatically increased since the introduction of the law. Norwegian Immigration directorate (UDI) saw a significant deterioration in the situation of UAMs at reception centers.”[ii] Speaking to other colleagues in the field and doing some research on my own, it became apparent that this was not unique to Norway. An organization called The Bureau conducted a study on how different countries in Europe treated unaccompanied minors. Their report can be found here:

https://www.thebureauinvestigates.com/which_countries_treat_children_like_children/#Netherlands.

Unaccompanied minors appear to have two experiences, either they are sent back to their countries (which are often still in conflict) or they have to apply for asylum as an adult (which may be rejected and then they are deported).

So, what does this mean for the mental health of children? Especially children who have experienced high levels of trauma within country; en-route to refugee receiving countries; and within the country of refuge itself? A research paper written by Catherine Gladwell and Hannah Elwyn in 2012 with the assistance of the United Nations Refugee Agency around the impact of deportation on Afghan children is a good indication of the organic as well as psychological impacts on children who live in fear of their 18th birthday. While other children cannot wait for the 18th birthday as it means that they have greater legal independence from their parents such as the right to drive a car, and in South Africa drink alcohol and smoke legally; other children from around the world, who had no part in the war that has robbed them of their home; family; friends and safety, live in perpetual fear of being sent back to a country where there is a very real possibility that they may be killed. Add to that the fact that they were unaccompanied at the time of seeking refuge; and so often do not know where their family members are or even if they are alive. Add further to that the realization that depending on their age of arriving in their host country, that life is the only life that they know, and you can see the reason why anxiety and depression are at a critical high within this group.

Think of yourself at 18. How equipped were you to navigate the world as an “adult’? Would you have been employable and able to sustain yourself with just a Matric certificate? These children are severely traumatized; they do not have a University degree, they do not have skills that can be used to support themselves back in their countries. They have learned the language of their host country and possibly to read and write in that country. We now send them back to Iraq and Syria and expect them to still be able to speak Arabic; to read and write Arabic, which uses a completely different system to what they have learned. Once again, they need to adapt and adjust into the unfamiliar. This time with no support.

We as Nations need to consider the atrocities that we perpetuate against each other, both “big” and “small”. We need to examine ourselves and our so called humanity and see whether our fear of the other (even children) is able to co-reside with our sense of compassion. As a mental health practitioner we have to ask ourselves some very hard questions. What is our role in ensuring that we stand by our ethics of believing that every person matters, every life matters? Are we doing enough to advocate on behalf of these and other vulnerable groups, whether they are part of our Nation or another’s? Is it enough to sit in a counselling room and deal with the aftermath of these and other practices or should we be extending our boundaries and scope of practices to include the active call for change regarding political migrant/refugee laws and practices across the world? In my opinion, it is unequivocally our job to ensure that all people are protected, not just when they become our clients. Otherwise we are just like these law makers who state that you are worth help only if you are a child and then lose value when you become an “adult”. We should work tirelessly to combat this hierarchy of which people matter and which do not.

By Celeste Matross

[i] (Novak, B. (13/09/2017). The Budapest Beacon. https://budapestbeacon.com/unhcr-chief-says-hungarys-transit-zones-are-really-just-detention-centers/.

[ii] ) (Norway to send back half of unaccompanied minors (UAMs) (07/07/2017) https://www.tnp.no/norway/panorama/norway-send-back-half-unaccompanied-refugee-minors

Can a white person practice/embody African psychology?

As a young white female what do you have to offer as a community based psychologist?

Now those might not have been the exact words but it is the essence of what I heard. Prior to that the question, an awareness of my race had always only been at the periphery of my consciousness. During my masters training as a community based counseling psychologist, I was forced to become increasingly aware of my whiteness, as I was introduced to concepts of white privilege and white guilt. Even though my engagement with my whiteness was then primarily done in relation to my professional practice in training to be a psychologist, and I knew that professional development does not occur without shifting one’s personal mindset and conscious awareness of the world around you, I think I initially engaged with it from a theoretical and logical level. This was until I started working in the field. My client group is predominantly black, originating from South Africa and other parts of Africa.

Thus, I started seeing and feeling my whiteness slightly more in my interactions with my clients and the broader organization that I work in. Recently it was at the forefront of my thinking and awareness as I prepared for a presentation for the first Pan-African Psychology conference.[1] The presentation was titled “The decolonization of psychotherapy: the current state of African Psychology as an exploratory reflection on current practices within the South African context as seen through the lens of CSVR practitioners”. The idea of the paper was born out of two main thoughts; my reflections on my ability to provide effective therapeutic interventions to my clients and the team’s current conversations and reflections on how we work in the room.

In relation to the first thought, I always go back to the question asked of me in my masters selection and in practice I have always tried to be authentically myself. However, the reality is that when I sit in the room with one of my clients, we do come from two different subjective realities and will have two different world views. The assumption of me may at times be that because I am white, female, young and South African that I cannot understand their experiences but also that with these things I have a certain amount of privilege and power that should be able to assist them in what they are going through. Whereby, this is often not the reality of it and becomes a difficult conversation that we engage in and in doing so there is a relationship and alliance that develops from it that becomes, in my experience, the greatest catalyst of change in the therapeutic process. Because often beyond my whiteness and their blackness, the therapeutic process gets stuck and that is what has been facilitating the discussions the team has been having on how we work in the room with our clients.

As much as we try to socialise to this “talk therapy” way of working, a Western idea of doing therapy, it still feels like there is something missing and creating certain blockages in the process of healing. In reflecting on this we have become increasingly aware that there are different cultural backgrounds of our clients and that their understanding and belief of what has happened (trauma) and should be done (healing) is different from what we assume it to potentially be, in relation to our training on mental health, and that this conventional talk way of working needs to be changed up. So with that we started trying to introduce different therapeutic tools such as the photo assessment and more activity based tools in the room that we found clients and families responded very well too. We hypothesized that this may be due to the degree of externalization that it allows individuals in trying to discuss what has happened and how they are feeling? Or is it the shift to a deeper cultural understanding of our clients where arts and storytelling is more in line with their traditional ways of expressing what is/has been happening to them? This is in line with some of the critical contributions of African Psychology which is to bring in greater cultural awareness and sensitivity but within that also understanding that the African worldview is different to that of the traditionally Eurocentric  worldview in that there is a greater influence of a communal way of being and with that a greater connectedness to people, nature and time whereby things are not always a linear process[2].

This was what had evoked a lot of thinking in me in trying to understand African psychology and what it means in practice and enmeshed within this is the concept of decolonization. A lot of questions comes to mind in thinking about this: What would it look like? What would it mean and to what extreme do we go? And naturally within these particular conversations I felt my defenses raise and then my guilt increase. But through these conversations and really hearing what other people’s perceptions and experiences in relation to colonization were I feel like I developed a slightly clearer picture of others experiences and what my whiteness represents to many. That through colonization and an ever increasing western way of living there is a certain homogeneity of culture that has been forced and is continuing to become the norm, the standard. And through this the loss of certain knowledge, language and practices has occurred.

Thus, in line with the discussions in African psychology and some about decolonization, I would agree that there is a greater need for African knowledge systems being incorporated into everyone’s thinking and the amazing work which is being done to make this achievable. Furthermore, attending the Pan African Congress also exposed me to a variety of different presentations and symposiums over the three days and each gave me a slightly different perspective and insight. To name a few they raised for me the importance of transdisciplinarity in a changing world. Understanding the different cultural understandings that people have in understanding their trauma and being creative and innovative in assisting people heal through the various forms and ways of using psychosocial rehabilitation models or the arts. The role that psychologists can have in relation to various aspects like peace building, human rights and achieving the SDG,s[3]. And lastly the need to incorporate traditional healing practices but more than that to focus on the strength that comes through African connectedness and the culture there in.

This has left me with a lot of reflections and thoughts that I am still processing. As a psychologist what is it that I can do outside of the room to assist in shifting the contextual challenges? How do I become more culturally and contextually relevant in my practicing and implementation of my work? Within this amending practical aspects and ways of working with tradition healers or the practice as per related to my client.

As a concluding thought, particularly related to the last presentation I went to, and how it evoked further a lot of what I had been feeling up to the conference. Conversations related to race and the impacts of colonization and apartheid make people uncomfortable, especially white people and so they will try to avoid them. But I feel there is an important role that decolonization of thinking and being can have on all races and cultures, that can allow a shift away from an individual, capitalist and materialistic way of being in the world to one with a focus on the communal and ability to see past the superficial aspects that divide us to one in which differences are appreciated and valued. This may sound idealistic and I don’t deny that a lot of hard work will have to go in to achieving this potentially in the future. But it is something that can only be achieved in unity.

So yes, I am a young white South African female, with privilege, working in South Africa and Africa, mindful of my impact on others, clients and my work; mindful of my clients world, cultures and way of being; and mindful that I am continuously developing and need to be open to views that may shift my own to be able to contribute to the evolving concept of an African Psychology.

by Jacqui Leigh Chowles

 

[1] The 1st Pan-African Psychology congress hosted by the Pan-African Psychology Union (PAPU) and the Psychological Society of South Africa (PSYSSA)

[2] Mkhize discusses these in detail in a chapter in Critical Psychology

[3] Sustainable Development Goals

Winter Interns 2017: Denver students reflections on time spent interning at CSVR

Studying International Disaster Psychology at a university in the States, we had the opportunity to complete an internship abroad with the Center for the Study of Violence and Reconciliation (CSVR). Other students in our university program traveled to various areas of the world and part of our preparatory work included researching and learning of our internship country. We focused on learning of Apartheid and post-Apartheid, along with some current political context. Looking back, it would have been valuable to research other African countries and the conflict within, particularly the home countries of CSVR clients. We arrived in Johannesburg, South Africa on June 10th and started our first day at CSVR the following Monday where we learned what our role would be in the organization for the next two months.

Interns are provided with a variety of different opportunities.  As interns one of our main priorities was to help with screenings for the clinic and to determine if the clients met criteria to be served by the clinic or if another organization or resource would be a better fit.  Screenings consisted of about a thirty minute interview asking about certain demographic questions as well as past trauma and torture and current stressors that the individual is facing in South Africa currently.

Another aspect of helping clients was for us to help with client progress reports.  These consisted of looking at clients certain scores when it came to a variety of mental health needs and then assessing which still needed to be worked on for the client.  The aspects that were assessed were PTSD, depression, self-perception of functioning, external stressors, impact of pain on functioning, anxiety, dealing with angry situations and psychological difficulties, connection to others, and locus of control.  These would be used to help clinicians focus on what clients still need to work on and show how they have improved.  These reports are done for clients about every three months.

While we were mostly at the office in Johannesburg, we also had the opportunity to visit two other offices of CSVR – one in Pretoria and one in Cape Town.  While at the Johannesburg office and the Cape Town office we worked on a variety of literature reviews and annotated bibliographies for upcoming papers that different clinicians and researchers at CSVR are working and collaborating on.  One literature review was about The Exilic Consciousness and its Impact on Belonging and Identity in Refugee and Asylum Seekers within South Africa, which will be presented at the 10th annual International Society for Health and Human Rights Conference in Serbia this year.  And the main theme of the annotated bibliographies in Cape Town were about transitional justice and gender and how women can be better incorporated into the conversation of transitional justice.

During our internship, we also helped with the capacity building of CSVR, specifically working on training manuals for clinicians and then a shortened version for trainees.  The different topics we created manuals for were self-care, which focused a lot on the book Trauma Stewardship by Laura Van Dernoot Lipsky; torture; and trauma.  We drew from the resources CSVR has as well as from resources from our university and outside sources in general.  For the shortened versions for the clients, we made sure the main points were covered and explained in a way that is easily understood.

Trainings were an area where we were able to gain a different perspective and see how those impacted the work at CSVR.  We were a part of a week long Feedback Informed Training (FIT), which is discussed in another blog post (link: https://traumaclinicblog.wordpress.com). This was something we were not familiar with in the past and gave us a different perspective about how gaining feedback from a client can be extremely beneficial and can help strengthen the therapeutic alliance.  We also attended a Monitoring and Evaluation (M&E) training with an emphasis on why gender is important in M&E.  We were a part of a domestic violence training that was for community members to help with their outreach and education to the community about this issue.  This was different than other trainings that would take place in the states about domestic violence and was more of a focus on introducing what domestic violence is in order for people to be aware of it and prompt them towards change in the communities based on gaining more knowledge surrounding the issue.

Another area we focused on was entering data for Monitoring and Evaluation (M&E) methods. After providing trainings to community members regarding psychosocial issues, CSVR asks the community members for feedback via survey. The results from these surveys aid CSVR in adjusting their trainings to be more beneficial, effective, and satisfying for the community members. After submitting the data, graphs are formed to represent the information and the graphs and data are then distributed to appropriate team members. Receiving feedback and distributing information is important for both funders and CSVR employees alike. Seeing these different pieces work together was beneficial in understanding how CSVR works as a whole.

We participated in a focus group about African Psychology and our understanding of what it is and if it was something that was discussed while studying at university.  Part of the focus group time was also dedicated to thoughts around decolonization of psychotherapy practices within the African context. It was interesting to learn what the different perspectives were regarding these topics and, coming from a different culture, these perspectives broadened our view of African psychology. Decolonization of psychotherapy practices is something that we did not fully understand prior to the focus group and being a part of the discussion was enlightening. Further, it was valuable hearing the drastically different approaches between African clinicians and recognizing that each member had value to add.

Towards the end of our time at CSVR, we were invited to attend a supervision meeting off site to discuss one of the clinician’s case as a team with a supervisor outside of CSVR. This was a beneficial experience as it provided insight as to how the clinic team works together to encourage and support one another, as well as offer ideas and suggestions. It was a very collaborative and respectful environment and very interesting in hearing other perspectives regarding the case. These supervision meetings occur once per month and provide a space outside of the organization for reflection and brainstorming.

Written by Kristin Griffith and Sarah Richards

Feedback Informed Treatment (FIT)

In various research the claim has been that across treatment modalities one of the strongest predictors of a successful therapeutic outcome is the therapeutic alliance. Although some therapists develop a sense of what their alliance is with a client, it can be something challenging to speak about and measure during the therapeutic process.

Studies done have highlighted that getting real time feedback from clients in therapy is a growing culture. An article I read by Alexandra Bachelor titled, ‘Clients and Therapists Views of the Therapeutic Alliance: Similarities, Differences and Relationship to Therapy Outcome’, explored how clients and therapists view of the therapeutic alliance differs and overlap and how this relates to post-therapy outcome.

Overall, the study highlighted that therapists should be mindful of taking as a given that their views of the therapeutic relationship and work are shared by the client. Asking for feedback on this is important to the process and therapeutic outcome. Furthermore, engaging with the client’s perspective on problems and relevant work is valued. To achieve this, therapist may need to explicitly ask how am I being helpful? How is the process being helpful?

Based on this from the 11th-14th July 2017 the clinical team underwent the Feedback Informed Treatment (FIT) training, given by one of our partner organisations, DIGNITY. FIT is a web based program that captures clients voices and experiences of not only the therapy process but the therapist. It has a scoring process that is done before and after the session by the client. The Outcome Rating Scale (ORS), which is completed at the beginning of the session looks at the clients current wellbeing; The Session Rating Scale (SRS), which is completed at the end of the session looks at the client’s experience of the therapist approach. Asking the client if they felt heard, understood and respected in the therapeutic interaction; if they got to talk about what they wanted; if they felt the therapist approach was a good fit for them; or if they felt something was missing. This may seem daunting and it was experienced as daunting by therapist at the CSVR Trauma Clinic, at first. However, after much reflection and training, the purpose of such a tool was welcomed.

Jason Seidel, founder and director of The Colorado Centre for Clinical Excellence in Denver, explains it as a tool that use’s client feedback to inform treatment, stating that it “is all about empowering the client and increasing the client’s voice…routinely and most importantly formally soliciting feedback from clients about the process of therapy, working relationship (with the therapist) and overall wellbeing”.

Margarita Tartakovsky notes that it has been shown to “boost the effectiveness of therapy, including enhancing client’s wellbeing and decreasing dropout rates and no-shows”. Furthermore, allowing therapists to know how the client is feeling about their approach and thus, they are better equipped to adjust their approach to meet the client’s needs.

In the training it was emphasized that FIT encourages a culture of feedback from clients. As therapists we often ask clients, ‘how are you?’ ‘How does that make you feel?’ But rarely ask the client to reflect on us as therapist and how do they feel about us? (unless its relates to counter-transferential discussions). How do they feel about the way we are working? The approach that we are using? Does it fit for them? FIT creates a  space for this. In my experience of using this feedback tool with clients it has been interesting to engage with clients on their experience and what about us as therapist work for them and what does not. Are we helpful? And are we helping them in the way they need?

Getting honest feedback from our clients may be challenging at times, especially taking into account the power dynamics in the therapeutic encounter and so getting clients buy-in, that, I actually wanted to be told, ‘this approach is not working for me’, ‘you missed the point today’ was hard. Personally, I had to ready myself to receive the feedback. No therapist wants to be told, ‘you’re not getting me’. As I think of a case in which this did happen, in hindsight, I think without the SRS score at the end of the session, I would have missed this and the client may not have returned or continued in therapy feeling frustrated. Addressing it in the session, led to me being aware that I may be perceiving something as carrying less weight, when it was clearly something of importance to the client. Furthermore, it made the client feel accepted and that I am keen to understand, all parts of them, not only the nice parts (exercising unconditional positive regard).

In my experience it has led to richer, genuine conversations which has enhanced the therapeutic relationship and made me reflect on my approach in the room and its impacts on individuals and their growth in therapy. Am I being helpful to the client and if not what can we do about this? For the client I noted it reduces the frustrations they may have in the therapeutic process and intensity of not being able to verbalise if the treatment works or not for that particular day. Opening up the conversation about the relationship itself, the way the interaction took place. This opportunity in itself empowers the client to take control and see themselves as part of their process and not coming to an expert whose prescribing to them how this medication needs to be taken.

Seidel states that, feedback measures such as FIT, gives the therapist the opportunity to repair damages in the therapeutic relationship sooner or making therapeutic adjustments sooner. I have also noted that it assists in developing a treatment plan and identify when therapy is just not working for a client and have an open and honest discussion about it, utilizing the tool as evidence of this.

In my original introduction to the tool I thought that FIT focused a lot on the therapist and questioning the ‘good enough-ness’ of the therapist, but in using it with clients I found that it’s really about helping the client and placing them at the center of treatment and wellbeing. Not that I don’t cringe when I see a client scoring me low on the SRS. But, understanding the rationale behind the process has opened me to exploring and having an open honest discussion with a client about our ‘fit’ together: as therapist and client (therapeutic alliance); does the therapeutic service offered meet their presenting problem?; and does the therapist approach work for them? (therapeutic effectiveness).

Therapist at the clinic, struggled with this idea of asking for direct feedback in sessions initially, holding in mind that most of us had been trained in traditional psychotherapy that somewhat goes against this method, and does not necessarily call for direct conversations about the therapeutic alliance and feedback from the client on the therapists approach, from day one of the interaction with the client.  Is there a place for this (FIT) in the psychotherapy of today? Will it or is it being introduced at an academic level in the training of future therapist in South Africa? More importantly, I am interested in how this tool can be used in an African context. A context in which psychotherapy as a healing modality is still a very Western concept. Can it play a role in socializing clients into understanding ‘talk therapy’ and be aware from an early point in therapy if it’s something that meets their needs or not. If it’s the right ‘fit’ for them or not?

Written by: Sumaiya Mohamed

Sources:

Alexandra Bachelor: Clients’ and Therapists’ Views of the Therapuetic Alliance: Similairities, Differences and Relationship to Therapy Outcome in Clinical Psychology and Psychotherapy Journal, Volume 20, Issue 2 (pg 118-135).

Margarita Tartakovsky: Feedback Informed Treatment: Empowering Clients to use their voices. Website address: psychcentral.com/lib/feedback-informed-treatment-empowering-clients-to-use-their-voices/

Who is the keeper of the keeper?

 

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Written by Thembisile Masondo in collaboration with Sumaiya Mohamed 

On the 9th of June the Psychosocial Forum hosted the first Service Provider Dialogue Meeting/Indaba, and I was asked to write a reflection on the event. I explained that I found it hard to write on the subject because in all honesty I didn’t know what to say, I mean people were saying it was a wonderful event. For me this event was anxiety provoking between venue booking and preparation to finding a catering company and attending the task team meetings when I had little time to spare. At some point it became an issue of: these are professionals! Not that planning for nonprofessionals is less anxiety provoking, but the issue was, these are peers; and I wanted to make an impression. I honestly did not want to put on paper something I had not felt, because in the end I just wanted to forget and move on. It was not till I attended a seminar at Wits University that my reflection came. I can’t say what triggered this need to all of a sudden want to express my view.

Perhaps it was the subject of secrecy. The truth is this event and the process leading up to it did not unfold as I envisioned, in fact it surpassed my expectations and not in the way that one would expect. For me it was the team that I had that made this happen, it was such a humbling process, it was so beautiful and one could say stunning in the way it progressed, up until the last minute of when we bid goodbye to each after the event. I remember looking at the people gathered in that room and having this profound sense that the world is not doomed after all. I remember feeling a sense of accomplishment, not because we managed to put people in a room, but because I was not alone.  The comfort felt in organizing and doing the event with others, not alone, spoke to that unspoken truth: we as practitioners hold the need to break the silence: silence around our loneliness in hearing, holding the pain, darkness of the others experiences and the need to be strong and not seen as not able to do this.  That when we sit down together and reflect on our experiences in a non-judgmental; empathetic space, we realize that we are not alone in the experience of fearing the darkness.

The work we do isolates, it changes the way in which we see and feel the world. The work we do wounds, and breaks, it brings forth binaries like love and hate, light and darkness and good and evil. As practioners in this field we are constantly at war within and without, constantly questioning our sanity because we are privy to secrets and ethics binds us and dictate that we have to be keep these secrets. Ironically the people that come to unburden themselves do so under the promise that those secret shall be kept. Has anyone asked the secret holder the burden of holding, has anyone asked what the price is for holding? I love my work, at some point in my life I had to come to terms with my “specialness”, however there have been unspoken things about this job, no one ever tells you of the burden of being the secret holder, of being a mirror and compass.

I often wonder, if I stated our fear of the darkness, would it be seen as a weakness in my team, my work place, among my peers? If I expressed my burdens would I have supportive spaces offered to me, or would I have been banished into the darkness (on my own) to resolve my conflict, chew on it, digest it and let it go? Or will I be freeing my peers in this field of work; giving them the strength to finally say ‘whew! I thought I was alone!’

All this is hidden under big words such burn out, clinical supervision, vicarious trauma, secondary trauma…and there is the suggestion to get counselling. But have healers sat with each other and had real conversations about what this means to them? How about someone say: body, mind and soul you change; how about they tell you that you become part of the secret, that it also infiltrates your life and by the time you are conscience of it, it has manifested itself into something incomprehensible. I am tired, and yet I have this fire inside of me of that justice, which I cannot stop. After all what excuse do I make when I know evil exists in the world and I don’t do anything?

We are the tool; the listener; the person that holds the unbearable parts, and yet there is this presumption that I am unaffected, untouched by the pain, the trauma, the darkness. A colleague and I reflected on this, stating that it brings to mind the image of a person in a dark hole, as the therapist you aim to help this person, bring them out of the hole, out of the darkness. Yet, as therapist we fear being engulfed, overtaken, and consumed by our clients’ darkness.

A famous quote by Madeliene L Engle comes to mind, ‘you have to know the darkness before you can appreciate the light’. I think it speaks to our ability to believe that clients can overcome, are resilient, and are powerful……to be able to see their light through their darkest moments. And similarly, as healers we have to know our own and acknowledge our own darkness to know our light (our ability to function as a healer). I believe we enter into this field because we know of our light and aim to use it to lead others out of their darkness.  But  darkness consumes and we get lost in the dark, where do we go, where do we seek support and do we feel we will be held by the very structures that say, ‘I am here for you’? Who shares their light with us?

Chatting with a colleague about these struggles has helped me to feel liberated in my struggle. As I sat that feeling came, ‘it’s not only me’, and ‘I am not alone’. And we could have an open and real conversation that led to us both acknowledging the light in each other and in ourselves. This dialogue may have not opened up the conversation but those that showed up there were curious, to know is this the day when we get to open up and share the secret that is being held and that healers are people too. I believe that day is upon us  and are we as healers ready to face our own woundedness in the process of healing the other.

Linking psychosocial support with transitional justice processes

speakersSpeakers giving keynote addresses at the transitional justice workshop in Conakry, Guinea

On 8 May, the Centre for the Study of  Violence and Reconciliation (CSVR )’s Trauma Clinic co-facilitated a transitional justice workshop on atrocity prevention. This was done in partnership with the International Coalition for Sites of Consciousness (ICSC) in Conakry, Guinea.

This went towards our goal of ensuring that the importance of psychosocial support within transitional justice processes is understood by all actors, especially when these services are not prioritised or are scarce within a country context.

The workshop was unique in that it brought together NGOs, victim groups and journalists.  Furthermore, the workshop encouraged them to strategise around how they could work together to ensure that the human rights of people are restored and that transitional justice takes place within Guinea.  At the end of the workshop, media and transitional justice strategies were presented in plenary and suggestions for improvement were made by all. This ensured a clear development of  a vision which participants could use to guide efforts towards achieving transitional justice for all victims of violence from 1958 to 2009.

Country context

Guinea is a unique country in terms of its history with violence as outlined by ICSC representative, Ereshnee Naidu-Silverman in her trip report.

Since its independence in 1958, it is a country that has experienced ongoing cycles of violence characterized by massive human rights violations and ethnic and political tensions that were exacerbated by authoritarian rulers who failed to hold perpetrators accountable and allowed a culture of impunity to flourish. Due to the repeated cycles of violence and changing actors during different conflicts, there is no clear distinction between victims and perpetrators. The decades of impunity and the lack of vetting and institutional reform has resulted in previous structures remaining intact and perpetrators continuing to hold positions of power.

Many of the participants reported rape and other Sexual Gender Based Violence (SGBV)  violations as the most common trauma experiences of victims within the country.

Others highlighted the dissolving of the family bonds due to a relative being in prison for many years. This was particularly difficult for men who have lost their place of authority within the family as the wife had to take on that role while they were away. What was striking from the stories that the participants shared was the fact that this was the first time that they had told anyone about their trauma. Many participants stated that they shared in the group experiences which even their wives did not know about. Another powerful observation was the fact that many of the men who spoke experienced their trauma in Camp Barro, a concentration camp were thousands were tortured and murdered. The camp closed in 1984 and the men spoke as if the trauma was still very fresh for them – speaking to the power of unresolved trauma which extends across generations and decades. Another theme that was present from the stories of the participants was that of vicarious traumas and  how the experiences of others impact those who are trying to assist them. In particular, the women who are assisting the victims of female genital mutilation reported experiencing nightmares, low mood and a decrease in job motivation.

State of psychosocial resources

The participants reported that there are no psychosocial service providers based in Guinea.  The majority of services are provided by international Non-governmental Organisations (NGOs) and end when they leave the country.

In addition, these services revolved mainly around the outbreak of Ebola in the country and were not related specifically to treating psychological trauma.

An article by the International Medical Corps cited census data provided by Abaakouk (2015) and Psychology in Africa (2013) to highlight the dearth of mental health services in Guinea and the results are extremely concerning. Per 100000 people in the population, there are 4 psychiatrists; 1 child psychiatrist; 13 trained generalists; 11 psychologists; 0 psychiatric nurses; 12 nurses and 2 social workers (both of whom work for the ministry of social work). This is nowhere near enough to deal with the complexity of the population’s trauma as well as the number of people requiring assistance. As one participant stated, “I believe that everyone in Guinea is suffering from trauma.” If this is the case, something needs to be done to improve access to mental health services particularlly in the region.

Speaking to co-facilitators from Liberia and Tunisa, it would seem that the need for mental health services in Africa far outweighs their availability. The Guinean government has tried to engage the services of traditional leaders, traditional healers and faith-based leaders to assist. However, these relationships have not been smooth and much work needs to be done.

Ideas on the way forward

As CSVR, we believe there’s need to train lay counsellors who are able to incorporate traditional African healing models; ideologies and cosmologies are greatly needed on the continent.

This is far more sustainable than bringing in international professionals who have to leave after a time and who do not understand the languages and cultures of the country.

However, part of the training would also need to incorporate assistance to the potential lay counsellors to deal with their own trauma before assisting others as well as ongoing scheduled supervision and debriefing spaces.

This will all require investment and buy-in from governments and communities but could go a long way to assist healing and economic development in Africa. The continent has experienced and is experiencing a lot of pain, grief and loss. We as Africans need to do all we can to heal our mother and restore the dignity that was lost over generations.

Transcending the wounds of the past: A nation’s journey to healing

The team recently attended a research seminar at Freedom Park in Pretoria on March 31, 2017 which focused on the impact of transgenerational trauma in South Africa. The seminar highlighted work done by Prof. Pumla Gobodo-Madikizela; Prof. Sharlene Swartz; Dr Shanaaz Hoosain; and Prof Maurice Apprey.

These presentations reflected a need for us as individuals, families and communities to understand the traumas of the past, and the impact it has on the present, to begin transcending the wounds of the past and heal.

Transgenerational transmission of trauma refers to the way in which unresolved traumas of the past can be subliminally transmitted from one generation to another (Volkan, 1996). Taking into account the current state of affairs in the country-violence, corruption, a call for new leadership, this was a very relevant topic of discussion.
The seminar looked at the past history of apartheid in South Africa, a time in which violence was rife and many individuals endured cruel inhuman degrading treatment in various forms. The abolishment of apartheid and the event of the Truth and Reconciliation Commission (TRC), as a path to healing the past was meant to create a space of coming clean and forgiving as we forged the rainbow nation.

Have we as a nation healed?
Understanding the impact of trauma from a psychological perspective, trauma memories have a way of embedding themselves into our individual and collective psyche and if not processed, lay dormant within us and are often triggered, giving rise to the ghosts of the past. Trauma returns but with a different face. Over the past few years, South Africa has felt the presence of the ghost, as events such as Marikana, Fees must fall protests, SABC 8, Zuma must fall, has mimicked events of the past apartheid regime.

Post-apartheid research has concluded that the past has had an impact on the social fabric of South African society, and racially inspired injustices have traumatized us as a nation. This state of traumatization has passed on through generations and the wounded, unhealed have repeated the mistakes of the past. Noted in the following ways: the continuous struggle of racial division, inequality and poverty; the use of violence as an expression of power in families, communities and state level; the lack of empathy for the other; the othering that takes places between black nationals and black non nationals, black nationals and indian and coloured nationals.

We are the so-called rainbow nation but the socialization of apartheid continues in our homes and communities. We have not consciously reconfigured the past, we have not consciously dealt with our trauma, we were simply free, yet chained within ourselves to repeat what we taught, what was modelled to us.

When will we transcend the wounds and how is it possible?
It is a challenge to transcend the wounds of the past, when current circumstances have aggravated it. Re-traumatizing us. Prof Gobodo-Madikizela states that trauma in South Africa has three faces: Apartheid trauma, which involved experiences of forced removal, racism and violence; Struggle trauma, which looks at the experiences of ex combatants, who struggled for a place in post-aparthied South Africa, as they were iconized, yet faced challenges privately in the forms of Post Traumatic Stress Disorder, family relations neglect as parents were detained and children were exposed to apartheid violence; and lastly our current experience of trauma, which is betrayal trauma, referred to Prof. Gobodo-Madikizela as the experience of betrayal and abandonment by our leaders. Some of us may have directly experienced all three traumas and others not, but we are all victims of them, as they are a part of who we are, they have impacted on us indirectly. The history, as well as, the trauma (wounds) of the past has passed down, it is the source of our pain, rage and anger.

If we are bound to the ghosts of the past, is healing possible?
According to the speakers and their research, it’s not all doom and gloom. Healing can occur and it starts with acknowledging the traumas of the past. One would say, didn’t the TRC do this. Yes and no, it started the process but it was left incomplete. There is still gaps in the memory, as silences have left a void in history. Prof. Gobodo-Madikizela and Prof. Apprey argue that youth today are disconnected from the past, focusing on their current challenges, which are valid, but have a root in the past. If I don’t have the full picture, how do I proceed to make sense of the now and take action for the future?

Prof. Apprey put this eloquently as he stated that rushing through the pain of the trauma and not metabolizing the past places us at the risk of becoming repeat agents of the past. He further explores the psychology of our integration of our past experiences and how they subtly impact on us in the now. He states that at the bottom level lies our history, some of it remembered, some not; at the next level, is the history remembered which gives form to an individual’s mental representation of the world; and at the present everyday interactional level, the history that is remembered which forms the mental representation of the world dictates how we perceive others will treat or receive us in the world.

On this point he really touches on the ways in which South Africa’s historical trauma has subliminally transferred across generations. And it is something as South Africans we see every day, in our interaction with each other, perceptions of each other and receiving of each other.

He also states that restoration is possible, it starts with accepting the trauma history, breaking the silence and getting the whole picture and dissolving the internal resistance (fighting what we were taught, socialized to think about each other) to allow for possibilities to be re-socialised and work towards Uncle Kathy’s vision of a non-racial South Africa.

Written by Sumaiya Mohamed

Click here to read a comment by Thembisile Masondo.

First blog post

This blog was started by the clinicians that work within the CSVR Trauma Clinic. the purpose of the blog is to create a platform to raise awareness of mental health related issues that arise as a result of violence.

Violence is a predominant feature in South African and global history. The CSVR acknowledges this and the complexities in which violence takes form. The CSVR works towards understanding violence, heal its effects and build sustainable peace at community, national and regional levels. This is done through collaboration with and learning from lived and diverse experiences of communities affected by violence.

The Trauma Clinic is the intervention component of the CSVR, that provides mental health therapeutic services to individual, families and communities that are affected by violence.

Posts on this blog, are clinicians reflections of the impact that violence has on mental health of individuals, families and communities, and possibilities of healing.

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