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Psychology 417A:
Psychology and Developing Societies
Class Session 7
Topic
Case Study: Psychotherapy
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Agenda
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.
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Psychology 305
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Psychology 305
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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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 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).
 Lack of “Africanization” of diagnostic systems and
treatment approaches; discrepancies between the
therapist’s and patient’s explanatory models.
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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:
 Promotion and implementation of government policies
that emphasize mental health.
 Developing “integrated” psychotherapies that combine
western treatment approaches with African
philosophies (e.g., ubuntu therapy; Van Dyk & Nefale,
2005).
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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 provision of psychotherapeutic services at primary
health settings (e.g., hospitals, physicians’ offices).
 The use of lay counsellors; local lay people may be
given limited training in psychotherapeutic techniques.
 The use of traditional healers; traditional healers may
be given limited training in psychotherapeutic
techniques.
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van’t Hof & Stein, 2011, p. 6:
“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.”
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• Small group activity:
 Create pairs.
 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?
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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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Confession
Empathy
Expression of
repressed
affect/behaviour
Naming
Medicinal
remedies
Communication
of social ideals
Social support
Expectation/hope
Relaxation
techniques
Collaboration
Projection/
transference
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Agenda
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.
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Next Class
1. Student leaders: Alejandra, Johanna, Nidhi .
2. Non-leader students:
• Submit (via e-mail) two discussion questions to me by
9:00AM on May 23.
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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.
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