Victimisation in the lives of lesbian-identified women in South Africa : implications for clinical assessment and treatment
- Padmanabhanunni, Anita, Edwards, David J A
- Authors: Padmanabhanunni, Anita , Edwards, David J A
- Date: 2013
- Language: English
- Type: Article
- Identifier: vital:6237 , http://hdl.handle.net/10962/d1007787
- Description: Few clinical studies have examined victimisation in the lives of lesbian women in South Africa and whether there are distinct implications for psychological treatment. This paper presents the assessment and treatment of a lesbian-identified South African survivor of childhood sexual abuse who, as an adult, was raped and later gang raped. Her victimisation in adulthood represented ‘corrective rape’ motivated by the prejudiced assumption that the sexuality of lesbian women is pathological and should be ‘corrected’ through rape. This paper lends insights into the role of heterosexism in shaping vulnerability to victimisation and the process of recovery. It provides recommendations for work with sexual minority clients and highlights the implications when there is an absence of safety and support in the external environment.
- Full Text:
- Date Issued: 2013
- Authors: Padmanabhanunni, Anita , Edwards, David J A
- Date: 2013
- Language: English
- Type: Article
- Identifier: vital:6237 , http://hdl.handle.net/10962/d1007787
- Description: Few clinical studies have examined victimisation in the lives of lesbian women in South Africa and whether there are distinct implications for psychological treatment. This paper presents the assessment and treatment of a lesbian-identified South African survivor of childhood sexual abuse who, as an adult, was raped and later gang raped. Her victimisation in adulthood represented ‘corrective rape’ motivated by the prejudiced assumption that the sexuality of lesbian women is pathological and should be ‘corrected’ through rape. This paper lends insights into the role of heterosexism in shaping vulnerability to victimisation and the process of recovery. It provides recommendations for work with sexual minority clients and highlights the implications when there is an absence of safety and support in the external environment.
- Full Text:
- Date Issued: 2013
“It’s like uprooting trees”: responsive treatment for a case of complex post-traumatic stress disorder following multiple rapes
- Van der Linde, Francois, Edwards, David J A
- Authors: Van der Linde, Francois , Edwards, David J A
- Date: 2013
- Language: English
- Type: Article
- Identifier: vital:6238 , http://hdl.handle.net/10962/d1007788
- Description: This systematic case study documents 27 sessions of assessment and treatment with cognitive therapy of Bongi (23)who presented with major depression, posttraumatic stress disorder and borderline traits. Bongi had been raised in a punitive environment, had been raped three times, the first time at age 9, and had been in a series of abusive relationships. The treatment illustrates the importance of therapist responsiveness in addressing this kind of complex presentation, the importance of drawing on case formulation to guide the course of treatment and the range of different interventions that need to be incorporated into an integrative treatment of a complex case. Self-report measures of depression, anxiety and posttraumatic stress indicators provided evidence that the therapy contributed to positive changes and the qualitative therapy narrative gives details of the nature of some of those changes. Although treatment was not complete when Bongi moved away, Bongi herself judged that the therapy had been a valuable experience which had resulted in her feeling more alive, more confident, and better able to take care of herself.
- Full Text:
- Date Issued: 2013
- Authors: Van der Linde, Francois , Edwards, David J A
- Date: 2013
- Language: English
- Type: Article
- Identifier: vital:6238 , http://hdl.handle.net/10962/d1007788
- Description: This systematic case study documents 27 sessions of assessment and treatment with cognitive therapy of Bongi (23)who presented with major depression, posttraumatic stress disorder and borderline traits. Bongi had been raised in a punitive environment, had been raped three times, the first time at age 9, and had been in a series of abusive relationships. The treatment illustrates the importance of therapist responsiveness in addressing this kind of complex presentation, the importance of drawing on case formulation to guide the course of treatment and the range of different interventions that need to be incorporated into an integrative treatment of a complex case. Self-report measures of depression, anxiety and posttraumatic stress indicators provided evidence that the therapy contributed to positive changes and the qualitative therapy narrative gives details of the nature of some of those changes. Although treatment was not complete when Bongi moved away, Bongi herself judged that the therapy had been a valuable experience which had resulted in her feeling more alive, more confident, and better able to take care of herself.
- Full Text:
- Date Issued: 2013
Treatment of post traumatic stress disorder following an armed robbery : a case study testing the transportability of trauma-focused cognitive-behavioural therapy to urban Africans
- Drake, B, Edwards, David J A
- Authors: Drake, B , Edwards, David J A
- Date: 2012
- Language: English
- Type: Article
- Identifier: vital:6225 , http://hdl.handle.net/10962/d1007775
- Description: John, an urban African male who developed post traumatic stress disorder (PTSD) following an armed robbery at the petrol station where he worked, was treated with 12 sessions of Trauma-focused cognitive behaviour therapy. Intervention involved a combination of psycho-education, prolonged imaginal exposure, cognitive restructuring and behavioural assignments. This article is a systematic case study of his treatment which included a comprehensive narrative and tracking of progress by means of the Post traumatic Diagnostic Scale. John responded well to the treatment, finding it acceptable and credible and remained free of PTSD symptoms at 15 months follow up. It is argued, based on the principles of Elliott’s Hermeneutic Single Case Efficacy Design, that there is evidence from within the narrative that it was the treatment that led to remission of symptoms. This case study demonstrates the cognitive, emotional and behavioural processes underlying John’s PTSD, which fits with those extensively described in the research literature, and that this evidence-based treatment developed in a westernised context is transportable to work with urban Africans.
- Full Text:
- Date Issued: 2012
- Authors: Drake, B , Edwards, David J A
- Date: 2012
- Language: English
- Type: Article
- Identifier: vital:6225 , http://hdl.handle.net/10962/d1007775
- Description: John, an urban African male who developed post traumatic stress disorder (PTSD) following an armed robbery at the petrol station where he worked, was treated with 12 sessions of Trauma-focused cognitive behaviour therapy. Intervention involved a combination of psycho-education, prolonged imaginal exposure, cognitive restructuring and behavioural assignments. This article is a systematic case study of his treatment which included a comprehensive narrative and tracking of progress by means of the Post traumatic Diagnostic Scale. John responded well to the treatment, finding it acceptable and credible and remained free of PTSD symptoms at 15 months follow up. It is argued, based on the principles of Elliott’s Hermeneutic Single Case Efficacy Design, that there is evidence from within the narrative that it was the treatment that led to remission of symptoms. This case study demonstrates the cognitive, emotional and behavioural processes underlying John’s PTSD, which fits with those extensively described in the research literature, and that this evidence-based treatment developed in a westernised context is transportable to work with urban Africans.
- Full Text:
- Date Issued: 2012
Treating posttraumatic stress disorder in South Africa : an integrative model grounded in case-based research
- Authors: Edwards, David J A
- Date: 2009
- Language: English
- Type: Article
- Identifier: vital:6232 , http://hdl.handle.net/10962/d1007782
- Description: 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.
- Full Text:
- Date Issued: 2009
- Authors: Edwards, David J A
- Date: 2009
- Language: English
- Type: Article
- Identifier: vital:6232 , http://hdl.handle.net/10962/d1007782
- Description: 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.
- Full Text:
- Date Issued: 2009
Development and validation of the Xhosa translations of the Beck Inventories: 1. Challenges of the translation process
- Steele, Gary I, Edwards, David J A
- Authors: Steele, Gary I , Edwards, David J A
- Date: 2008
- Language: English
- Type: Article
- Identifier: vital:6248 , http://hdl.handle.net/10962/d1007866
- Description: This article describes the translation of the Beck Depression Inventory-II, the Beck Hopeless Scale, and the Beck Anxiety Inventory, into Xhosa the language spoken in the Eastern Cape of South Africa. The processes of translation, back-translation and committee discussion failed to yield trustworthy translations because of practical difficulties in working with translators. Critical words and phrases were identified which gave rise to lack of agreement. For each, a range of options was generated and the advantages and disadvantages evaluated in terms of criteria such as conceptual and idiomatic equivalence, and extensiveness of usage. Examples are given of the problems encountered and the way in which final decisions were made. A pilot clinical trial demonstrated the acceptability of the translated Instruments. Two further articles report the psychometric evaluation of the translated scales.
- Full Text:
- Date Issued: 2008
- Authors: Steele, Gary I , Edwards, David J A
- Date: 2008
- Language: English
- Type: Article
- Identifier: vital:6248 , http://hdl.handle.net/10962/d1007866
- Description: This article describes the translation of the Beck Depression Inventory-II, the Beck Hopeless Scale, and the Beck Anxiety Inventory, into Xhosa the language spoken in the Eastern Cape of South Africa. The processes of translation, back-translation and committee discussion failed to yield trustworthy translations because of practical difficulties in working with translators. Critical words and phrases were identified which gave rise to lack of agreement. For each, a range of options was generated and the advantages and disadvantages evaluated in terms of criteria such as conceptual and idiomatic equivalence, and extensiveness of usage. Examples are given of the problems encountered and the way in which final decisions were made. A pilot clinical trial demonstrated the acceptability of the translated Instruments. Two further articles report the psychometric evaluation of the translated scales.
- Full Text:
- Date Issued: 2008
Critical perspectives on research on post-traumatic stress disorder and implications for the South African context
- Authors: Edwards, David J A
- Date: 2005
- Language: English
- Type: Article
- Identifier: vital:6228 , http://hdl.handle.net/10962/d1007778
- Description: 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.
- Full Text:
- Date Issued: 2005
- Authors: Edwards, David J A
- Date: 2005
- Language: English
- Type: Article
- Identifier: vital:6228 , http://hdl.handle.net/10962/d1007778
- Description: 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.
- Full Text:
- Date Issued: 2005
Post-traumatic stress disorder as a public health concern in South Africa
- Authors: Edwards, David J A
- Date: 2005
- Language: English
- Type: Article
- Identifier: vital:6229 , http://hdl.handle.net/10962/d1007779
- Description: 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.
- Full Text:
- Date Issued: 2005
- Authors: Edwards, David J A
- Date: 2005
- Language: English
- Type: Article
- Identifier: vital:6229 , http://hdl.handle.net/10962/d1007779
- Description: 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.
- Full Text:
- Date Issued: 2005
Treating PTSD in South African contexts : a theoretical framework and a model for developing evidence-based practice
- Authors: Edwards, David J A
- Date: 2005
- Language: English
- Type: Article
- Identifier: vital:6231 , http://hdl.handle.net/10962/d1007781
- Description: 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.
- Full Text:
- Date Issued: 2005
- Authors: Edwards, David J A
- Date: 2005
- Language: English
- Type: Article
- Identifier: vital:6231 , http://hdl.handle.net/10962/d1007781
- Description: 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.
- Full Text:
- Date Issued: 2005
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