Journal of Psychology in Africa

Critical perspectives on research on post-traumatic stress disorder and implications for the South African context

2018-12-06T09:59:15+00:00

This article introduces a special issue of the Journal of Psychology in Africa on post-traumatic stress disorder (PTSD) in Africa and particularly in South Africa and examines the critical debate that has surrounded PTSD research. It begins with an examination of the meaning of the term trauma, and of its specialised use within the clinical context and with respect to the concept of PTSD. The diagnostic approach to the detection of PTSD is presented, criteria in the DSM-IV-TR and the ICD-10 are summarised and differences between the two manuals are discussed. Arguments presented by critics of the concept of PTSD are presented and discussed. These concern the historical evolution of the concept, concerns about the universality of PTSD cross-culturally, and problems arising from understanding human suffering from a narrow medical perspective. It is concluded that while there are dangers in thinking of the sequelae of trauma as a medical/psychiatric problem, and while the alarming rate of traumatic events needs to be addressed at the political, economic and societal level, there is an important place for the provision of assessment and treatment of PTSD within a psychiatric/psychological clinical setting.

Keywords: critical theory, diagnosis, post-traumatic stress disorder, South Africa, trauma, traumatic stress

Journal of Psychology in Africa 2005, 15(2): 117–124

Post-traumatic stress disorder as a public health concern in South Africa

2018-12-06T09:59:15+00:00

This article briefly surveys the extent to which traumatic events are a feature of life all over Africa and provides a comprehensive review of research that documents the pervasiveness of traumatic events in South Africa and the prevalence of PTSD symptoms. The material reviewed includes statistics on crime, violence and accidents, research from clinical settings, and surveys. Several provide evidence for the causal link between traumatic events and the development of PTSD. These studies show that PTSD has been and continues to be a significant problem for public health in South Africa, affecting individuals in all sectors of society and as much a concern with respect to children as to adults.

Keywords: Africa, epidemiology, post-traumatic stress disorder, public health, South Africa, trauma

Journal of Psychology in Africa 2005, 15(2): 125–134

From trauma debriefing to trauma support: A South African experience of responding to individuals and communities in the aftermath of traumatising events

2018-12-06T09:59:15+00:00

This paper documents the approach and experience of Traumaclinic, a Cape Town based organisation offering a trauma support service. The controversy over single session debriefing interventions is examined and it is concluded that interventions that invite intense emotional expression should not be offered indiscriminately or forced on those who do not want them. When they do occur, they need to be carefully managed and take place over several sessions. A review of contemporary approaches to intervention following trauma highlights their comprehensive and flexible nature and the inclusion of multiple components that are introduced in a manner responsive to the needs of the situation. This is the basis of the current model used by Traumaclinic. The principles of that model are summarised and examples given of the application of the approach to specific cases.

Keywords: acute stress disorder, critical incident stress debriefing, trauma recovery, trauma support

Journal of Psychology in Africa 2005, 15(2): 135–142

Trauma, resilience and vulnerability to PTSD: A review and clinical case analysis

2018-12-06T09:59:15+00:00

This article begins with two case examples of a girl and an adolescent who were raped and developed chronic PTSD. These are used as a basis for understanding the role of a range of factors that are associated with resilience and vulnerability in the face of traumatic events. A literature review examines the proportion of individuals who develop PTSD following trauma and the factors associated with vulnerability and resilience. These include gender, developmental factors, social support and personality factors. Psychological factors associated with maintenance of chronic PTSD are also briefly reviewed. This material is used as a basis for reconsidering the case examples. Each case is formulated within a framework based on sources of vulnerability and qualities of resilience. Approaches to intervention are suggested that could address the range of factors making the individuals vulnerable to chronic psychological problems and support resiliency and recovery.

Keywords: post-traumatic stress disorder, resilience, social support, trauma, vulnerability

Journal of Psychology in Africa 2005, 15(2): 143–153

The role of brief–term interventions with South African child trauma survivors

2018-12-06T09:59:16+00:00

This paper describes an approach to therapeutic intervention with child trauma survivors. Literature is reviewed pertaining to individual treatment approaches in working with traumatised children, including trauma-focussed cognitive-behavioural therapy, play therapy and brief–term interventions. A survey is reported that explores the nature and extent of interventions available in South Africa and highlights the widespread application of modified versions of the Pynoos and Eth interview. Common features across brief-term interventions including a focus on the therapeutic relationship, retelling of the story and a working through or completion phase are highlighted. An integrative intervention model is presented, based on the Pynoos and Eth model, which uses art to facilitate the retelling and working through of the trauma and emphasises creating a narrative for the child that integrates the traumatic experience into a broader life narrative. The approach, which is currently employed with children in a South African clinical setting, is illustrated with a case study. The implications of this approach for the understanding of child trauma survivors and the specific challenges of working within the South African context are explored. The limitations of the approach are addressed and recommendations for a case series, more rigorously exploring the application of this approach are made.

Keywords: child, trauma, brief-term intervention, narrative, art

Journal of Psychology in Africa 2005, 15(2): 155–163

The great arch of unimagined bridges: Integrative play therapy with an abused child

2018-12-06T09:59:16+00:00

This case study describes the early phases of integrative, long-term psychotherapy undertaken with a child subjected to chronic domestic trauma including violence, alcohol abuse, neglect, abandonment, and bereavement resulting from HIV/AIDS. Recent statistics on the prevalence of violent trauma, domestic abuse and HIV/AIDS in South Africa are reviewed, as are principles of trauma intervention that have been established across a range of psychotherapeutic modalities. Following from integrative trauma work undertaken locally, this therapeutic process acknowledges both indigenous and western frameworks of meaning, the latter most heavily informed by principles of analytical psychology. Selected aspects of the therapy are discussed in light of both perspectives, with reference to the child's process of recovery. This paper seeks to add support to practised and published local work in which a range of possible healing practices, meanings, and experience are taken into account. It is proposed that such integrative efforts contribute towards an evolving African psychotherapy.

Keywords: child, post-traumatic stress disorder, psychotherapy, South Africa

Journal of Psychology in Africa 2005, 15(2): 165–175

Psychotherapy for post-traumatic stress disorder in a young rape survivor: A case study

2018-12-06T09:59:16+00:00

This paper describes the psychodynamic psychotherapy of a 20-year-old African woman with post-traumatic stress disorder (PTSD). ‘Mphumi' entered therapy a year after her father's friend had repeatedly raped her. The paper documents the process of therapy and uses the case material to examine theoretical issues relevant to the treatment of PTSD. First, Horowitz's (2001) theory is used as a basis for arguing that a histrionic personality style predisposed her to an extreme degree of denial and dissociation, which prevented her from processing the trauma at a cognitive or emotional level and contributed to the entrenched PTSD. It was only after she had suffered a breakdown, which necessitated hospitalisation, that her resistance to processing the trauma was overcome. Second, the case material is used to show how other significantly disturbing events earlier in her life shaped her response to the rape and to examine the extent to which effective processing of the current trauma calls for the acknowledgement and working through of earlier traumas and losses. Finally, the case narrative shows how the treatment of PTSD is of necessity a slow, complex process which takes into account the individual's unique history, idiosyncratic vulnerabilities and socio-cultural context.

Keywords: post-traumatic stress disorder, psychodynamic psychotherapy, rape, South Africa

Journal of Psychology in Africa 2005, 15(2): 177–184

Trauma, imagery and the therapeutic relationship: Langu's story

2018-12-06T09:59:16+00:00

This paper, a phenomenological case study, describes the psychotherapy of Langu (pseudonym), a 21-year-old student, who presented with Acute Stress Disorder following a series of motor accidents that affected him and his family. Langu's most distressing experience was having to identify his brother's mutilated and severely burned body. Because of the intensity of the intrusive re-experiencing of traumatic imagery and the degree of dissociative numbing, Langu participated in four intensive guided imagery sessions, which involved reliving the incident, and imaginal dialogues with his dead brother. Session records and supervision notes from the therapy process that unfolded over 22 sessions served as the basis for a thematically selective case narrative. Additional material was obtained from several research interviews with Langu over the following months. The narrative highlights the impact of the imagery work as well as relational aspects of the therapy. The case narrative provides a source for examining many aspects of the psychological impact of trauma and the path to healing, as well as the dilemmas and challenges faced by therapists working with traumatised individuals.

Keywords: acute stress disorder, case narrative, case study, cognitive therapy, guided imagery, post-traumatic stress disorder, psychotherapy, therapeutic relationship

Journal of Psychology in Africa 2005, 15(2): 185–195

Grasping the thorn: The impact and supervision of traumatic stress therapy in the South African context

2018-12-06T09:59:16+00:00

The article examines the usefulness of existing theory for the supervision of clinical trainees at a Johannesburg trauma clinic, a context beset by particular sets of tensions. Concepts that contribute to a practical understanding of how therapists engage with and are affected by trauma clients in South Africa include vicarious traumatisation and countertransference, and the identification of whether therapist responses are evoked by features of the case and the traumatic event or are particular to the individual therapist. Limitations or gaps in existing conceptualisations are identified related to the sociopolitical demands of the context, including questions related to the pairing of client and therapist in terms of race, class and gender features. Factors that interfere with the provision of adequate containment in both supervision and psychotherapy include socioeconomic deprivation, inadequacies in the criminal justice system and the high prevalence of violent crime. Case examples of therapist responses in practice and of supervisory dilemmas are used to illustrate these problems. The article concludes with recommendations for the supervision of traumatic stress psychotherapy in such contexts, including strategies for preparing students for such work, for bringing up sensitive topics for discussion, for managing vicarious traumatisation and for supervisor self-care.

Keywords: traumatic stress, psychotherapy, supervision

Journal of Psychology in Africa 2005, 15(2): 197–207

Treating PTSD in South African contexts: A theoretical framework and a model for developing evidence-based practice

2018-12-06T09:59:16+00:00

Several psychological factors contribute to the development and maintenance of post-traumatic stress disorder (PTSD) because they interfere with the emotional processing of the traumatic event. These include problematic and painful emotions such as anxiety, shame, guilt and grief, distorted or dysfunctional cognitions, and cognitive, emotional, and behavioural avoidance mechanisms. Analysis of these maintaining factors provides the basis for current approaches to treatment which support traumatised individuals in facing emotional pain, working to resolve shame, grief and guilt, and expanding existing schemas to accommodate the traumatic event(s). Randomised controlled trials (RCTs) are reviewed in which the efficacy of some of these treatments have been evaluated. While many South African practitioners are familiar with current evidence-based approaches and are skilled at adapting them to local cultural and contextual conditions, a great deal still needs to be done to build a sound research base for local practice in the treatment of PTSD and disseminating that research to practitioners in the field. It is recommended that a case-based evaluation strategy be used to complement the findings of international RCT studies in order to build a foundation of locally contextualised and applicable scientific knowledge.

Keywords: case-study research, cognitive therapy, evidence-based practice, treatment efficacy, post-traumatic stress disorder, psychotherapy, South Africa

Journal of Psychology in Africa 2005, 15(2): 209–220

Book Review

Personality-Guided Therapy for Post-traumatic Stress Disorder
By George Everly Jr and Jeffrey Lating (2003)

2018-12-06T09:59:16+00:00

American Psychological Association, Washington DC, USA
Hardback, 267 pages
ISBN 1-59147-044-7, price US$60

Journal of Psychology in Africa 2005, 15(2): 221–222

Book Review

Treating Psychological Trauma and PTSD
By John P Wilson, Matthew J Friedman and Jacob D Lindy (editors) (2004)

2018-12-06T09:59:16+00:00

Guilford Press, New York, USA
Paperback, 467 pages
ISBN 1572 306 874, price US$200

Journal of Psychology in Africa 2005, 15(2): 223–224

Book Review

Trauma and Juvenile Delinquency: Theory, Research and Interventions
By Ricky Greenwald (editor) (2002)

2018-12-06T09:59:16+00:00

The Haworth Press, New York, USA
267 pages
Hardback ISBN 0-7890-1974-4, price US$49.95
Paperback ISBN 0-7890-1975-2, price US$34.95

Journal of Psychology in Africa 2005, 15(2): 225–227

Journal of Psychology in Africa

Critical perspectives on research on post-traumatic stress disorder and implications for the South African context

Post-traumatic stress disorder as a public health concern in South Africa

From trauma debriefing to trauma support: A South African experience of responding to individuals and communities in the aftermath of traumatising events

Trauma, resilience and vulnerability to PTSD: A review and clinical case analysis

The role of brief–term interventions with South African child trauma survivors

The great arch of unimagined bridges: Integrative play therapy with an abused child

Psychotherapy for post-traumatic stress disorder in a young rape survivor: A case study

Trauma, imagery and the therapeutic relationship: Langu's story

Grasping the thorn: The impact and supervision of traumatic stress therapy in the South African context

Treating PTSD in South African contexts: A theoretical framework and a model for developing evidence-based practice

Book ReviewPersonality-Guided Therapy for Post-traumatic Stress DisorderBy George Everly Jr and Jeffrey Lating (2003)

Book ReviewTreating Psychological Trauma and PTSDBy John P Wilson, Matthew J Friedman and Jacob D Lindy (editors) (2004)

Book ReviewTrauma and Juvenile Delinquency: Theory, Research and InterventionsBy Ricky Greenwald (editor) (2002)

Book Review

Personality-Guided Therapy for Post-traumatic Stress Disorder
By George Everly Jr and Jeffrey Lating (2003)

Book Review

Treating Psychological Trauma and PTSD
By John P Wilson, Matthew J Friedman and Jacob D Lindy (editors) (2004)

Book Review

Trauma and Juvenile Delinquency: Theory, Research and Interventions
By Ricky Greenwald (editor) (2002)