Should Individual Counselling Be a Luxury?

From "The Gift Returned" by Lauraine Vivian

For many years, post-TRC (Truth and Reconciliation Commission), there has been hardly any funding for individual trauma counselling. The directors and management at the Trauma Centre (and probably other NGO’s) had to be creative in how they could permit counselling programs to continue. No-one on the staff doubted the need for it and many of us were invested in it. By invested, I mean that we had been trained to do individual work and believed in it. Besides, it had taken at least 10 years of mental health education to make trauma counselling into a service that poor and working class people would seek, let alone find accessible. In the late 90’s and early 2000’s the Trauma Centre’s Training Department played a part in this. It offered widely disseminated Trauma Skills programs to front-line workers. But prior to those programs, OASSSA, provided services to ex-detainees and their families even before the Trauma Centre existed.
The imparting of various forms of emotional literacy also happened in workshops provided to many workers during the 90’s. These were intended to fuel the transformational agendas of various sectors, e.g. public service, the army, the police, and other emergency personnel.

These efforts reached their apex in the trauma counselling culture that developed around the TRC. In 1996, when I met with Thulani Granville-Grey who was involved with the Human Rights Violation Committee of the TRC, he showed me his list of victim requests. I was surprised to see that counselling was prominent among them.

Now the global economic crunch has relegated individual counselling and therapy to the realm of the luxurious –services a developing society can presumably ill afford to indulge. And yet the need remains. I have recently participated in a worldwide e-mail colloquium of the International Association of Relational Psychoanalytic Psychotherapy (IARPP). In it we discussed traumas of history and war. The need for a respectful, patient, nuanced approach to each individual with their own unique history, was so sensitively articulated by many experienced practitioners that I wonder how we can go about effecting the kind of mass scale of recovery that is required in this country. Why should only those who can afford it have the individual attention that most people need? Is everyone else supposed to make do with groups, workshops and “community healing”? I’m not saying those don’t also have their place, but it’s not enough, is it?

In an ironic twist, the SAPS( South African Police Service) through their Victim Empowerment Program does offer free Trauma Counselling to victims. This is done by lay volunteers who have undergone a basic short training.  I am sure, the volunteers provide a necessary empathic and containing experience for people recently victimized and suffering from shock or acute stress disorder. But so many of our citizens experience complex and/or multiple trauma. Lane Benjamin has made lay counselling and training of community counsellors a cornerstone of her community organization in Hanover Park. She believes that working family by family, the violence can be reduced. But it is an organization that struggles for funding like everyone else.

Being a trauma counsellor in South Africa really pushed me to seek time-limited and effective skills to assist individuals.1) Re-evaluation co-counselling, a form of peer counselling, I already knew, and had practised for many years. I adapted some of the tools from it in my work with clients. 2) Focusing, a body-oriented practice enabling one to access “a felt sense” is something I have learnt to do in the past 3 years. 3) EMDR or accelerated processing is a powerful tool for working with trauma and finally, 4) I developed a single session protocol for adult onset trauma, because that’s what so many recently traumatized clients appeared to want. Much to my surprise, many did not want to return for further counselling even if it was free.
I will write about each of these practices in further posts.

Addendum (15-03-12)
A recent article by Waumsley and Swartz (South African Journal of Psychology, Vol 41(3) Sept. 2011) looks at outcomes of 156 cases, covering a wide spectrum of presenting issues and diagnoses, at the Child Guidance Clinic in Cape Town. 68% of clients came from Class 3 (working class) and lower socio-economic backgrounds. All of them received some form of individual psychodynamic psychotherapy for an average of 10 sessions (short-term by European or US standards). Nevertheless, 58% showed improvement on discharge, 6% were judged recovered, 27% were judged unchanged and 3% were thought to have deteriorated. Interestingly, attendance was good particularly among clients from low socio-economic backgrounds - 30% of all cases never missed a session. I think these results add to my argument for the need for individual counselling and psychotherapy to be funded in South Africa.