Seminar No. 6, 1996

Reflections on Trauma Counselling Methods

Presenter:

Palesa Makhale-Mahlangu

Palesa Makhale-Mahlangu is a former Manager of the Trauma Clinic at the Centre for the Study of Violence and Reconciliation.

Date: 31 July 1996

Venue: Centre for the Study of Violence and Reconciliation, Johannesburg, South Africa

Introduction

It is common knowledge that psychology as taught at universities is taught based on western theories. Therefore, the challenge is to create a relevant interpretation of Eurocentric based models when working among African people. An argument may be made to suggest that the Africans especially in South Africa no longer have a purely Afrocentric ethos but rather have become quite in-tune with the Eurocentric world-view. My submission is therefore that some of the African characteristics have been eroded but are not totally extinct. Rather they are deeply and innately embedded in the African persona. Thus Baldwin (1981). Sofola (1973), and Tembo (1990), talk of the "Black African Personality".

This personality has been defined as having moralistic and essentially humane cultural characteristics. Definitely, the moral philosophy of live and let live, respect for the elders, worth of human beings as opposed to material worth , and of living in harmony with nature, are but the elements in the socialisation and development of the African child which ultimately become ingredients of the basic African Personality (Sofola,1983). These indeed, are in part what Senghor had delineated from the totality of the prototype he referred to as Negritude (Vallaint,1990). Based on this, it is therefore understandable that Eurocentric theories of human behaviour and coping with violence or trauma can never fully be relevant to a society whose reality is that of dispossession, exploitation, and violence. A psychologist who thus approaches human behaviour solely from the western perspective will necessarily have to question its relevance when working with an African population. Therefore, it is important that our ways of doing therapy address the social as well as the cultural reality of the people we serve.

Some of the challenges experienced in working with the Africans in the area of trauma have been:

(1) Language. First, I have had to coin a word to explain what a psychologist is (in terms of my profession, and also the expectations thereof). Given that our people are most exposed to the medical model of dealing with both physical and emotional pain, it then became crucial for me to explain my profession and what I do using a medical analogy (e.g. when one has a wound, the physician would prescribe medication to be taken three times daily.) So the importance of attending sessions until the clinician terminates has the same logic, because if you do not take your medication as prescribed, chances of complete healing may be minimised. Likewise are the chances of emotional recovery if the client terminates his/her sessions impromptly.

(2) The issue of time (i.e. appointment system) has also posed a challenge, and I have had to acknowledge the cultural understanding of time from an Afrocentric world-view. Mbiti (1970) alludes to the idea of timelessness found among African traditions and African people even in the diaspora. Timelessness is a belief that time is endless, even most of the rituals we celebrate in our communities emphasise this idea. Therefore, in order to help some of the African clients or patients to understand the importance of the appointment system, one needs to emphasise the collective benefit of keeping time. This collective benefit is well captured by Sitiloane (1970), when he suggests that in the African experience every phase of an individual's activity is controlled by a common sense of obligation to the normative idea of community life.

(3) Age has also posed a challenge in that within the African culture respect for the aged extends beyond the basic fact of their vast knowledge and life experience. It is primarily based on the simple morality that they are the forebearers of the society and ushers of the younger generations into this world. And it is for this simple reason that morality requires that they be given their due respect. Therefore in the context of doing therapy I found it very crucial to use prefixes (e.g. Baba, Me, Mama, Ntate etc.) to acknowledge their superiority over me. This gesture of respect has in many instances helped in them opening up to me and acknowledging and trusting my ability to help them irrespective of my age and gender. The occasional drop of eye contact has demonstrated my continuous respect while still retaining my professional abilities. In the Eurocentric training, eye contact is highly emphasised, however, in the African view, it may condone disrespect.

Inclusion of afrocentric ways of coping and doing therapy

Rape

In trauma counselling we use a four-step model, i.e.

1. re-telling of the story
2. normalising symptoms
3. working with the guilt
4. coping strategies.

One of the most common things clients/patients who are survivors of rape complain about is the sense of being dirty and their response is to wash frequently. Another complaint is withdrawal from society due to stigma.

Both in the Eurocentric and Afrocentric intervention we allude to the re-telling of the story. In the western sense we tell it to the individual, whereas in the African sense it is told to the family or girls one's own age. Now coming to step 2-4 of trauma counselling methods how we deal with for example the compulsive tendency of frequent washing is from an individual perspective whereas in the African sense this is dealt with communally. The cleansing ritual is performed. This is done to help the survivor regain her sense of pureness and to eliminate the stigma. And social support by both immediate and extended family is given. And according to researchers (Lazarus and Folkman,1984) social support is among the most effective ways of coping with trauma.

Domestic/Family Violence

In dealing with this problem, the same four-step model is used. Thoughts and feelings are also emphasised with this module. However, in the Afrocentric Model of therapy/counselling, a more symbolic method is used, that is a ritual in which the dispute of the couple is taken outside of the home and is then sprinkled with water or ash. The ash symbolises the burial of the bad vibes that existed, and the water quantifies the cleansing and removal of the bad elements. The symbolism of this ritual is more assuring to the victim because the issues were resolved more publicly, and so the assumption is that the behaviour will be curtailed because there were witnesses, especially family, to witness the repentance and forgiveness. This ritual is known as ukuhlambulula.

Disappearances (especially now with the Truth and Reconciliation hearings)

In terms of coping, one may have to explore what would help the parent or spouse of the disappeared deal with and hopefully accept their loss. One of the most crucial issues from an African perspective is to be able to know where your loved one is buried, because the African family consists of the living and the departed. That is why even a meal is a communal endeavour, which includes the departed, this belief is accurately demonstrated by the libation ritual. Therefore, for the African it is important to be able to fetch his/her departed ones when s/he moves, so that when they wish to visit, they would know where to find their living family members.

Afrocentric ways of coping

In his analysis of culture, Sofola suggests that the idea of collective lifestyle among Africans grows in part out of the moral philosophy of altruism which is in-fact reflected by what he calls African Personalism (1973). The African proverb that says Motho ke motho ka batho ba bang or as Mbiti(1970) and Nobles (1978) agree by saying "I am, because we are" captures the deepest understanding of the communal orientation of the African epistemology, which Baldwin(1981,1985) alludes to as the African Self Extension Orientation. In therapy most of the African clients/patients have regarded support of others to be the most effective ways of coping that they used.

To a large extent spirituality has been at the top of most client/patient s ways of coping. Manganyi (1973,1974,1981,1983) argues that the African Spiritual philosophy, though eroded, continues to exist among the majority of present day Africans. This spirituality manifests itself in the recourse of Africans even those who are educated, to traditional healers. The resilience of traditional beliefs in mental health attests to the African spiritual entology which conceives of reality as part and parcel of the interaction of life forces. Issues of traditional healing tend to emerge during therapy. Sometimes through dreams or in trying to make sense of the tragedy, one may express a need to understand what the ancestors are saying through the tragedy. According to the Eurocentric training, traditional healing is tantamount to pathology. However, we need to respect the views held and espoused by the client/patient even if it is outside of our own convictions.

Also the African instinct of God is the deepest thing in his/her soul. Belief in the existence of God is never a question: His presence is felt to impinge upon the lives of people, and the affairs of the community. (Sitiloane,1970). Even though the African religion has no bible, its bible is to be found in the hearts, experiences and the history of Africa. The religion has been handed down from generation to generation. Therefore, in therapy, clients may express a need to pray and according to western training, a clinician is not supposed to engage in such practices. However, from an African cosmology that may be the only thing that would help the client/patient survive and cope with their trauma.

Conclusion

In order for our intervention to be effective, there is a dire need for us to understand and be sensitive to the cultural ethos inherent in those whom we serve. It is important for us to learn from those we serve and to be willing to be truly empathic by allowing ourselves to enter their world with respect and value for who they are. Lastly, it is important to remember that our clients/patients are not a tabula-rasa, but rather a people whose state of mind has been altered by the violence and oppression they have undergone.

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