Conceptualising a contextually relevant torture rehabilitation framework for Sub-Saharan Africa
Date
2020
Authors
Higson-Smith, Craig
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Abstract
The practice of torture is widespread in sub-Saharan Africa and often associated with war and oppressive rule. Hundreds of thousands of survivors of torture live in the region’s cities, settlements and refugee camps, where mental health services are extremely limited. Current evidence-based practice guidelines for the rehabilitation of torture survivors provide little guidance for practitioners in sub-Saharan Africa whose clients must contend with contextual realities, often very different from those of the Global North.
Using a mixed-methods design, I investigated the work of three torture treatment centres in different parts of sub-Saharan Africa with the aim of documenting the needs of actual help-seeking survivors of torture in sub-Saharan Africa and analysing their experiences of recovery through interaction with existing mental health services. To this end, I reviewed the therapeutic charts of 85 torture surviving adults in care and conducted in-depth narrative interviews with fifteen counsellors and sixteen adult torture surviving clients. The study incorporated uni- and bivariate statistical analyses of quantitative data as well as thematic and narrative forms of qualitative analysis. The mixed method research approach shaped data collection, analysis and interpretation.
The results revealed several categories of torture survivors reporting extremely high levels of anxiety and mood-related symptomatology. The impact of recent violent bereavement and ongoing threat were identified as therapeutic issues that are inadequately addressed in existing treatment guidelines. Both counsellors and clients emphasized the importance of trauma exposure interventions, strengthening family relationships, problem solving, symptom management, and nurturing hope. Based on these findings I propose the Foundational Capacities Approach (FCA), an approach to counselling torture survivors designed in response to the contextual realities of torture survivors in sub-Saharan Africa. Although FCA was developed in sub-Saharan Africa, torture survivors in other parts of the world face many of the same challenges, and practitioners in other regions might find value in the findings and conclusions of this research.
Description
A thesis submitted to the Faculty of Humanities, University of the Witwatersrand, in partial fulfilment of the requirements for the degree of Doctor of Philosophy
February 2020