Narrative Exposure Therapy in Nakivale Refugee Camp - Uganda

Vivo carried out a large epidemiological survey to gain insight into the populations' demographic, health and psycho-social status. A detailed interviewing instrument was designed and validated for this purpose (including translation into Kenya-Rwanda and Af-Somali). 12 interviewers were hired locally from within the refugee community and trained in research methodology, interviewing techniques, and the concepts of traumatic stress and Post Traumatic Stress Disorder (PTSD) by the Vivo team.

In response to the findings, Vivo trained 9 local therapists from within the refugee community (5 women and 4 men from Somalia, Burundi, Congo and Rwanda) in 2 different treatment approaches for PTSD, a disorder that emerged as the most common mental health problem (an average of 40% across all ethnicities) among the researched population, besides depression.

This treatment study aims to show whether refugees without medical or higher level psychological or educational background can be trained to effectively treat PTSD using pragmatic approaches like NET or supportive counseling. The study also aims to re-test the effectiveness and efficiency of NET, in comparison to other forms of counseling.

NET jointly approaches treatment of survivors and documentation of human rights violations in order to address the need for victims and communities to talk about their past. Vivo proposes that "remembering the traumatic experience brings up painful emotions. The recollection is usually coded in a fragmented and incoherent way in autobiographic memory. In most cases it is extremely difficult for the survivors to put their experiences into words of narration, meaning, they are often unable to tell a coherent story. Most survivors of state-sponsored violence avoid talking about what happened to them. This tendency to keep silent about their past, prevents emotional processing of the events. In addition to the adverse consequences for the survivors themselves, the tendency of survivors to remain silent hinders the fight against violations of human rights and the prosecution of those who are responsible for acts of torture and genocide."

NET is based on Testimony Therapy (as developed by Lira and Weinstein in Chile) in combination with cognitive behavioural exposure techniques. Witnesses to severe human rights violations are invited to testify as to their traumatic experiences. In cooperation with the therapist, they work to restore their autobiographic memories about those experiences. In this way, organisers say, fragmentary memories are transformed into a coherent narrative structure: a testimony. Vivo states that this practice enables the processing of painful emotions and the construction of clear contingencies of dangerous and safe conditions, generally leading to significant emotional recovery. If the survivor consents, the documents (testimonies) that result from this therapy can directly be used for prosecution of human rights violations or awareness-raising purposes.

Mental Health, Rights.

In various different settings around the world, Vivo's therapists and researchers have noticed that most survivors have a great need to talk about their painful experiences. It is difficult, however, to find careful listeners in societies in which a majority of people have suffered traumatic stress.

In rural community settings or in conflict-related emergency situations, few survivors are able to attend counseling sessions on a regular basis, which is a necessary condition for the successful use of conventional therapies. Most of these therapies require weekly or fortnightly attendance by the client, with a minimum length of 6 months for the therapy process. This is rarely possible in rural or emergency settings, where people only attend health care facilities that are in close proximity to their homes, or where people are frequently displaced or forced to move.

In contrast to conventional Western psychotherapy, the NET procedure does usually not require more than 3 to 4 sessions that can be carried out in any silent place in a community or at the survivor's home. Vivo states that this short treatment does not immediately result in a complete cure of severe psychological disorder, but can lead to considerable relief for the survivor and can foster further emotional processing of the traumatic memories and recollection of the collective history of the community.