Treating Posttraumatic Stress Disorder in South Africa: An Integrative Model Grounded in Case-Based Research

Abstract

The article presents a model for formulating and planning treatment for post-traumatic stress disorder (PTSD) in South Africa derived from the existing literature and in conjunction with a review of a series of studies of cases treated using the guidelines of Ehlers and Clark's cognitive therapy. It is argued that the construction of psychotherapies (or even components of psychotherapy) for PTSD in terms of traditional categories ("psychodynamic", "cognitive-behavioural", "narrative" etc.) is misleading and unhelpful. Instead, superordinate concepts derived from thinking about evidence-based practice provide a more grounded focus on the practical issues faced by therapists treating PTSD. These concepts, which include competences and metcacompetences, therapist responsiveness, stages of therapy and case formulation, provide a basis for a genuinely integrative approach. The proposed model suggests seven broad areas of clinical focus for work with PTSD which can be arranged at three levels of priority: level 1 crisis intervention and stabilization; level 2 promoting engagement with treatment, and level 3 selection, sequencing and timing of active treatment interventions. Material from the case series is used to illustrate the application of the model.

Vicarious trauma: The psychological impact of working with survivors of trauma for South African psychologists

“…When providing psychotherapy, psychologists are expected to empathically engage with clients, to have the ability to manage and contain painful emotions evoked, and to be highly sensitive to the emotional needs of those that they work with (Edwards, 2009) . When working with trauma survivors, this empathic engagement includes listening to graphic descriptions of traumatic events such as rape, childhood sexual abuse and intimate partner violence, and bearing witness to the human capacity for cruelty as well as the pain and suffering engendered by brutal acts .…”

A Strengths-Based Group Intervention for Women Who Experienced Child Sexual Abuse

“…In South Africa, Edwards (2009) reports that the most common treatment approach to sexual abuse is from within the traditional paradigm, focusing on alleviating dysfunctional symptoms and behaviors. Recent studies illustrate that South African women can indeed demonstrate positive characteristics and changes originating from the CSA struggle such as improved relationships and increased empathy (Walker-Williams, Van Eeden, & Van Der Merwe, 2012, 2013.…”

What Services and Supports Are Needed to Enable Trauma Survivors to Rebuild Their Lives? Implications of a Systematic Case Study of Cognitive Therapy With a Township Adolescent Girl With PTSD Following Rape

“…It proved to be very adaptable for the work with Zanele who engaged with each aspect of the therapy process and built on it at home between sessions. Thus the snakes and ladders game (Kinchin & Brown, 2001) was comfortably accommodated within the therapy plan, and for other cases, other play and expressive techniques could also be incorporated (Edwards 2009). Prominent features of the model that were helpful were: psychoeducation and normalizing of symptoms, work with discrimination of triggers, elaborating the trauma memory through retelling, journaling and reliving in a way that allowed reality testing and separation of then (the trauma events) and now, and work on empowerment and reclaiming her life.…”