Psychology 417A: Psychology and Developing Societies

Class Session 7

Topic Case Study: Psychotherapy

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Agenda

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1. Guest speakers: Umoja Operation Compassion Society.

2. Summary of readings: Alexa, Kelsey, Victoria.

3. Psychotherapy practice and research in Africa: Small group activity.

4. Discussion questions.

Psychology 305 3

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Psychology 305 4

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Psychotherapy Practice and Research in Africa

• Definition of psychotherapy:

“Broadly speaking, psychotherapy can be defined as the treatment of a behavioural disorder, mental illness or emotional condition by psychological means. This definition … include[s] all treatment based on verbal communication between a mental health professional and client aimed at treating a mental or emotional disorder” (van’t Hof & Stein, 2011, p. 6).

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• Lifetime prevalence of DSM-IV disorders (World Mental Health Survey, WHO; see Kessler et al. 2007):

Nigeria: 12.0% (low-income country)

South Africa: 30.3% (middle-income country)

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• Treatment of DSM-IV disorders in past 12 months (World Mental Health Survey, WHO; see Demyttenaere et al., 2004; Seedat et al., 2008):

Nigeria: 0.8%

South Africa: 19.0%

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• Percentage of people with “serious” disorders who had not received treatment in the past 12 months (World Mental Health Survey, WHO; see Demyttenaere et al., 2004):

Developing countries: 76.3-85.5%

Developed countries: 35.5-50.3%

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• Impediments to treatment in African settings (van’t Hof & Stein, 2011):

Scarcity of mental health professionals (e.g., psychologists, psychiatrists, psychiatric nurses).

Scarcity of mental health resources (e.g., psychiatric beds, diagnostic equipment, essential medicines).

Insufficient financial resources to support mental health services.

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Lack of “Africanization” of diagnostic systems and treatment approaches; discrepancies between the therapist’s and patient’s explanatory models.

Stigma and discrimination related to psychological illness.

Lack of acceptance of psychotherapy among Africans (due to reluctance to speak of family problems, focus on physical vs. psychological symptoms).

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• In African settings, psychotherapy is most frequently sought in response to (see Lopez et al., 2011):

Natural disasters (e.g., earthquakes, famine, floods).

HIV/AIDS (among individuals living with HIV/AIDS and their family members).

“Human-made” trauma (e.g., forced migration, shelling, sexual violence, torture).

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• Research examining efficacy of Western treatment approaches in Africa:

Few randomized control trials of Western treatment approaches in Africa have been conducted to date:

1. Testimony psychotherapy: PTSD, ineffective (rural Mozambique; Igreja et al., 2004).

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2. Narrative exposure therapy: PTSD, effective (Sudanese refugees in Uganda; Neuner et al., 2004, 2008).

3. Interpersonal therapy: Depression, effective (rural Uganda; Bass et al., 2006; Bolton et al., 2003).

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4. Rational-emotive therapy: Self-esteem, irrational cognitions, anxiety, Type A behaviour, effective (urban South Africa; Moller et al., 1993, 1996).

5. Psychoeducation: Depression, psychotic symptoms, effective (urban Nigeria; Olley et al., 2001).

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• In order to increase psychotherapeutic opportunities for Africans, theorists (e.g., Muthukrishna & Sam, 2011; van’t Hof & Stein, 2011) recommend:

Developing “integrated” psychotherapies that combine western treatment approaches with African philosophies (e.g., ubuntu therapy; Van Dyk & Nefale, 2005).

Promotion and implementation of government policies that emphasize mental health.

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Zöller, 1997, cited in Madu et al., 1997, p. 205:

“…the conflict between ‘Western’ and ‘traditional’ methods of treatment is, in my opinion a waste of resources; they rather should complement one another.”

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The use of lay counsellors; local lay people may be given limited training in psychotherapeutic techniques.

The provision of psychotherapeutic services at primary health settings (e.g., hospitals, physicians’ offices).

The use of traditional healers; traditional healers may be given limited training in psychotherapeutic techniques.

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“Traditional healing ceremonies are symbolically meaningful events applying therapeutic techniques aimed at reducing anxiety and emotional distress in individuals. The ceremonies evolve around contact between a traditional healer and a patient for treating emotional or mental problems and therefore can be considered psychotherapeutic treatments.”

van’t Hof & Stein, 2011, p. 6:

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Contrast the following vignettes (adapted from Muthukrishna and Sam, 2011):

What parallels do you see between the functions served by psychologists and the functions served by traditional healers?

• Small group activity:

Create pairs.

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Vignette 1: In Canada, a man suddenly began to behave in bizarre ways. His relatives suspected that he was sick, so took him to a psychologist at a nearby hospital. Upon careful examination, the psychologist declared that the man was indeed sick. Even though his behaviour was bizarre, his relatives did not ostracize him because he was not seen as responsible for his odd behaviour. After further examination, including a detailed medical history, psychological tests, and interviews, the psychologist diagnosed the man as having schizophrenia and outlined a method of treatment, including psychotherapy and medication. After two months of psychotherapy and medication, the bizarre behaviour subsided and the man was well again.

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Vignette 2: In Uganda, a man suddenly began to behave in bizarre ways. His relatives suspected that an evil spirit possessed him, so took him to the shrine of the local healer. Upon careful examination, the healer declared that the man was indeed possessed. Even though his behaviour was bizarre, his relatives did not ostracize him because he was not seen as responsible for his odd behaviour. After further examination, including interviews with close family members and friends, the healer identified the evil spirit. He then gave instructions as to how the evil spirit should be exorcised. The exorcism involved different forms of rites and rituals, such as the drinking of different kinds of herbs, dancing, and animal sacrifices by the man himself and his relatives. After two months of observing the rites and rituals, the bizarre behaviour subsided and the man was well again.

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Empathy

Relaxation techniques

Collaboration

Social support

Expression of repressed

affect/behaviour

Expectation/hope

Projection/transference

Medicinal remedies

Confession

Naming

Communication of social ideals

Agenda

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1. Guest speakers: Umoja Operation Compassion Society.

2. Summary of readings: Alexa, Kelsey, Victoria.

3. Psychotherapy practice and research in Africa: Small group activity.

4. Discussion questions.

Next Class

1. Student leaders: Alejandra, Johanna, Nidhi .

• Submit (via e-mail) two discussion questions to me by 9:00AM on May 23.

2. Non-leader students:

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3. Not required, supplementary reading: Ash, S. L., & Clayton, P. H. (2004). The articulated learning: An approach to guided reflection and assessment.

Innovative Higher Education, 29, 137-154.

4. Please bring your laptops to class on Thursday to complete the course evaluation.