The Development and Implementation of a Multi-Couple Therapy Model with Torture Survivors in the Democratic Republic of the Congo

"After torture, everything changed": the unpacking of trauma from torture with interpretative phenomenological analysis and Merleau-Ponty's theory of the lived body

BACKGROUND

Trauma from torture is expressed primarily through bodily sensations and emotions, reflecting its deep imprint on the body's memory. Merleau-Ponty's existential phenomenology, which emphasizes the lived body, provides a valuable framework for discussing the intricate interplay between physical and psychological experiences. Through this approach, we gain a deeper understanding of the profound impact of torture on survivors, which in turn informs holistic recovery strategies.

OBJECTIVES

The primary objective of this study was to explore the nuanced experiences of individuals who have endured torture, aiming to cultivate a profound comprehension of their journeys. Additionally, this study sought to explore the inherent risks of retraumatization within healthcare settings.

METHODS

This study, approved by the Norwegian Committee for Medical and Health Research Ethics, involved in-depth interviews with six torture survivors. The recorded interviews were transcribed and analyzed using interpretative phenomenological analysis (IPA). The article explores survivors' experiences by means of Merleau-Ponty's theory of the lived body.

RESULTS

The study identified four main themes: resisting torture-ignoring the body; fear and vulnerability-the unsafe body; broken trust-the broken body; and resilience-rebuilding the body. The participants reported various torture methods, including physical violence, asphyxiation, dragging, electric shocks, witnessing torture and murder, and sexual abuse, along with positional torture. They also noted instances of health-related torture, such as the deliberate withholding of medical care and the involvement of healthcare professionals.

CONCLUSIONS

Survivors' accounts of torture raise awareness about its widespread impact and deepen the understanding of its physical and psychological effects. Merleau-Ponty's concept of the lived body enhances our grasp of the body's connection to the world, informing better care and retraumatization prevention. This perspective can shape public opinion, policy, and global efforts to prevent torture, support survivors, and improve healthcare, while personal stories humanize the issue and challenge torturers' claims.

A Systematic Review of Evidence-Based Family Interventions for Trauma-Affected Refugees

Family connections are crucial for trauma-affected refugees from collectivistic cultures. Evidence-based family interventions are consistently promoted to support a host of mental and relational health needs of families exposed to traumatic stressors; however, there is still limited research focused on cultural adaptation and the testing of the effectiveness of these interventions on some of the most disenfranchised populations in the aftermath of forced displacement. This systematic review was conducted to examine the reach of existing evidence-based family interventions implemented with newly resettled refugees globally. Studies included in this review include those testing the effectiveness of a systemic treatment with pre and post intervention evaluation, studies with or without control groups, and studies that include at least one family member in addition to the target participants. Twelve studies met the inclusion criteria. Barriers to conducting randomized control trials with displaced refugee populations are discussed. Recommendations are made for future studies to include a focus on scientifically rigorous multi-method designs, specific cultural adaptation frameworks, and the integration of relational aspects rather than focusing only on individual adjustment. Global displacement continues to rise; therefore, it is imperative that the mental health and wellbeing of displaced populations be treated with a comprehensive, multi-level framework.

Expanding our international reach: Trends in the development of systemic family therapy training and implementation in Africa

Family therapy is growing around the world including in many parts of Africa. Although the African continent has many mental and family health needs that family therapists are well-suited to treat, barriers to the widespread application of family therapy on the African continent remain. In this article, we review the current state of systemic family therapy (SFT) in Africa. Drawing from existing literature, we discuss past, current, and future trends, including challenges related to the training and implementation of SFT in Africa. We devote sections of this article to discussing the historical and cultural context, including the fit for family therapy, along with ongoing initiatives in various African countries, using examples from three African countries. We emphasize and discuss the influence of Western models of family therapy in informing family therapy research, training, and implementation in Africa and discuss implications for the African context.

Perceptions of War Trauma and Healing of Marital Relations Among Torture-surviving Congolese Couples Participating in Multicouple Therapy

Citizens of the Democratic Republic of Congo (DRC) experienced widespread torture during national wars between 1998 and 2003. Couples who survived and stayed intact suffered tremendous relationship stress. This study used a critical ethnography framework to explore the prewar, wartime, and postwar experiences of 13 torture-surviving couples who participated in a 10-session Torture-Surviving Couple Group in 2008 in the DRC. The group was designed to address the relational effects of torture and war trauma. Participants reported profound negative effects of the war on their relationships; mostly positive experiences during the group, including marital and peer connection and relationship growth; and a number of improvements in their relationship after the group. Implications include support for the use of relational interventions informed by both treatments for traumatic stress and couple approaches to promote trauma healing. Future directions call for increased funding, research, training, and clinical action to treat the effects of traumatic stress on relational family dynamics.