Reconstructing Life as a One-Foot Man: Reflections on the Role of Football

This article is one of a series of personal construct investigations of the aftermath of the brutal civil war in Sierra Leone. It is based on interviews conducted with nine members of the Sierra Leone Single-Leg Amputee Football Club, all of whom lost a limb during the war. Interview themes concerned participants’ construing of this event and its perpetrators, the constriction of their lives and the emotions they subsequently experienced, the choices that they made, and the role of football and of forgiveness in their recovery and in posttraumatic growth.     

The Emergence of Counseling in Sierra Leone

Sierra Leone has endured a turbulent history, including a decadelong civil war and the devastation of Ebola virus disease. Despite the psychological consequences of such events, only limited therapeutic services are available. The authors review mental health services in Sierra Leone and document the emergence of counseling as a profession in the face of challenges. They conclude by highlighting the multiple contributions that professional counselors can make to address critical mental health needs in Sierra Leone.     

Ebola ‘Done Done’—But What Has It Left Behind?

Sierra Leone, a country that has been recovering from a brutal civil war, was in 2014 struck by a new crisis in the Ebola epidemic. This article reports on interviews and repertory grids completed by two groups of people who had been affected by the epidemic: amputee footballers who had lost family members or friends, and burial workers. The interviews and grids are analyzed in terms of the professional constructs of personal construct psychology, highlighting the anxiety, threat, guilt, and shame experienced by the participants; similarities in their construing of the Ebola epidemic and the civil war; and their positive anticipations of the future.     

Rehabilitating civilian victims of war through psychosocial intervention in Sierra Leone

This research assessed an intervention (involving drug therapy and psychoeducational counseling) for war trauma in Sierra Leone. We examine the impact of the intervention on symptoms of post‐traumatic stress disorder (PTSD) and indicators of intergroup emotions and attitudes. Civilian war victims were drawn from a rehabilitation program (Intervention, N=50) or a waiting list Control group (N=50). The rehabilitation program combined general psychiatric treatment with additional life skills support. Those in the Intervention group had significantly lower PTSD symptoms and also scored lower on Intergroup Anxiety and Outgroup Blame, than those in Control. The intervention had an indirect effect on PTSD symptoms through Intergroup Anxiety. The reduction in PTSD in the intervention was greater for participants with a stronger identification with Sierra Leone.     

From Liverpool to Freetown: West African Witchcraft,Conspiracy and the Occult

In this ethnography I examine the key features of occult discourses among middle-class Sierra Leoneans living in Britain, based on ethnographic fieldwork conducted in Merseyside and Cheshire between 2001-2002. It is evident that the subjects of this study are quick to engage with the conspiracy-theorising besetting Euro-American popular culture in conveying their anxieties about the civil war, poverty and corruption that have ravaged Sierra Leone, coupled to the institutionalised racism and socio-economic problems that beset the black community in Liverpool. This despair has translated into a general trepidation about West African witchcraft that has become a global metaphor for the malcontents of modernity. In recent years these worries have been added to, fuelled by the heavy responsibility individuals experience to provide financial support and moral guidance to those relatives who have been forced to leave Sierra Leone during the years of civil strife. They are secretly mistrusted by the middle-class Sierra Leoneans living in Liverpool, who worry that their less-well-off relatives malign their good intentions through their accusations of witchcraft.     

Ethical decision making in family therapy

In family therapy, effective clinical decisions promote the welfare and interests of the family and its individual members. However, the needs of the family and its individual members are often in conflict. Resolving this conflict is an ethical as well as a therapeutic dilemma. Kitchener has developed a model of ethical decision making that we have found useful in teaching students and supervisees how to resolve conflicts between the family's needs and the needs of its members. The purpose of this article is to discuss this model and show how it can be applied to clinical decision making.     

Self-Construing In Former Child Soldiers

This article presents a repertory grid study of young people who had experienced civil war in Sierra Leone, some as child soldiers and others as noncombatants. Unexpected findings included that the former combatants viewed themselves more favorably than did noncombatants. The findings are discussed in terms of individual and social construing processes, drawing on narratives and interview and focus group responses obtained from the participants in the larger investigation of which this study was part. Particular consideration is given to the role of forgiveness.     

The politics of humanitarian intervention: a critical analogy of the British response to end the slave trade and the civil war in Sierra Leone

A leading scholar of humanitarian intervention, Brown (2002) Brown, C. 2002. “Humanitarian intervention and international political theory”. In Human rights and military intervention, Edited by: Mosley, A. and Norman, R. 153–69. Aldershot: Ashgale Publishing.  [Google Scholar] refers to British internal politics to satisfy the influential church and other non-conformist libertarian community leaders, and above all ‘undermining Britain's competitors, such as Spain and Portugal, who were still reliant on slave labour to power their economies, as the principal motivation for calls to end the slave trade than any genuine humanitarian concerns of racial equality or global justice’. Drawing on an empirical exploration, this article seeks to draw a parallel between this politics of humanitarian intervention which characterised the abolition movement, albeit rarely recognised in the academic literature, and the British intervention to end the almost 11 year civil war in Sierra Leone. The article concludes with a discussion on the implications of this politics of humanitarian intervention in the reconstruction of post-conflict Sierra Leone.     

Developing an indicator of family function and a practicable outcome measure for systemic family and couple therapy: the SCORE

There is a need for a measure of outcome in systemic family and couples therapy (SFCT) that reflects current theory and practice. To meet the needs of SFCT practice the measure needs to use self‐report by family members, take a short time to complete and be easy to understand. The development of such a measure, called the SCORE, is reported in this article. Substantial piloting, consultation and review in terms of clinical judgement led to the construction of the SCORE 40 which has forty items about how the family functions, rated by family members over 11 years of age on a Likert scale, in addition to independent ratings of the family and its difficulties. The SCORE 40 is shown to be a viable instrument but is too substantial for everyday clinical use. In a research project to reduce and refine the measure and determine its psychometric properties the SCORE 40 was administered to 510 members of 228 families at the start of their first appointment for family therapy at clinics throughout the UK. The scale has good psychometric properties and could operate with either three or four dimensions. The analyses of these data, combined with data from a convenience sample of 126 non‐clinical families, allowed a reduction to fifteen items while retaining most of the information provided by the SCORE 40. This version is offered with three dimensions of: (1) Strengths and adaptability; (2) Overwhelmed by difficulties; and (3) Disrupted communication. It is hoped that the ready availability of the SCORE 15 will encourage routine evaluation of outcomes in clinics as well as the SCORE being used flexibly for both therapy and research.     

Trajectories of externalizing problems among war-affected youth in Sierra Leone: Results from a longitudinal study

Mental health problems are linked to violence exposures such as witnessing or participating in war-related activities. Of particular concern is whether such exposure perpetuates risk of violent behavior. Externalizing problems have received limited attention in research on war-affected youth. Three waves of data (2002–2008) from a prospective longitudinal study in Sierra Leone were used to examine externalizing trajectories in 529 war-affected youth (average age 14.9 at baseline; 25% female). Of four groups, the largest represented a trajectory designated as ‘stable,’ with relatively low levels of externalizing at baseline declining slightly across the time points. Compared to the stable group, the probability of being classified in the ‘deteriorators’ group was greater among those who reported having injured/killed another person during the war and with a history of family abuse and neglect reported at T3. Membership in the ‘improvers’ group was more likely for those with higher family support and was also associated with reporting injuring/killing others during the war. A minority indicated sustained, heightened symptom levels, which was also associated with family abuse and neglect following the war. Our findings demonstrate that both traumatic war experiences and post-war experiences play vital roles in shaping adolescents' trajectories of externalizing over time.     

Systemic-motivational therapy for substance abuse disorders: an integrative model

Although recent reviews of the literature on families and substance misuse offer compelling evidence that inclusion of families significantly improves treatment engagement, retention and outcome, family therapy remains peripheral in most substance abuse treatment programmes. Furthermore, many of the treatment approaches that have been included under the term 'family therapy' continue to focus on the substance abuser as the sole target of treatment. Still conspicuously absent are treatment models based on family systems approaches, with outcomes targeted at non-abusing family members as well. This article presents an overview of one such family-focused substance abuse treatment model – systemic-motivational therapy – that combines a family systems approach with techniques derived from motivational interviewing, but this time is applied to work with the family as a unit. The background for the development of the model will be described, as well as the assessment/consultation, family-level action plan, and aftercare/relapse prevention phases of the treatment approach.     

Conservation of Distance in African Children—The Sex Dimension

This study reviews the literature on the topic of sex dimension as it affects the attainment of the conservation of distance among African children in Sierra Leone. An investigation was done to determine the age at which these children attain conservation. Subjects were primary school children from different parts of the country who ranged from classes (grade levels) II to VII. It was found that the age of conservation was 12 years and that males in the sample performed better than females. This is in line with conclusions drawn from similar studies of African children.     

Positive fantasies dampen charitable giving when many resources are demanded

Previous research found that positive fantasies about an idealized future yield low energy to pursue the fantasized future. We examined how positive fantasies about the resolution of a crisis (i.e., a lack of pain medication in Sierra Leone, the risk of flooding after Hurricane Irene) influence people's agreement to donate to charitable efforts directed at crisis resolution. In three studies, positive fantasies dampened the likelihood of agreeing to donate a relatively large amount of money, effort, or time, but did not affect the likelihood of agreeing to donate a relatively small amount of these resources. The effect of positive fantasies was mediated by perceiving the donation of larger (but not smaller) amounts of resources as overly demanding. These findings suggest that charitable solicitations requesting small donations might benefit from stimulating positive fantasies in potential donors, but those requesting large donations could be hurt.     

Family in transition: parents,children and grandparents in lesbian families give meaning to ‘doing family’

Lesbian parents, their children and grandparents ‘do family’ in rich and diverse ways. This article draws on innovative grounded theory research using qualitative, multi‐generational family interviews with twenty lesbian‐parented families living in Victoria, Australia. The intersection between the public and the private in lesbian family life has been seriously neglected by family researchers, and in particular the perspectives of family members other than the lesbian parents themselves. This article addresses the question of ‘How members of lesbian‐parented families define and describe their family’, and the results reported here focus on children's and grandparents' views, because they are the voices less well represented in the literature. Children and grandparents straddle both mainstream and marginalized spaces as they negotiate contemporary family life. We examine the interface and tensions between the traditional and the transformative, and the implications of these findings for family therapists are briefly discussed.     

The reflecting team: dialogue and meta-dialogue in clinical work

A "stuck" system, that is, a family with a problem, needs new ideas in order to broaden its perspectives and its contextual premises. In this approach, a team behind a one-way screen watches and listens to an interviewer's conversation with the family members. The interviewer, with the permission of the family, then asks the team members about their perceptions of what went on in the interview. The family and the interviewer watch and listen to the team discussion. The interviewer then asks the family to comment on what they have heard. This may happen once or several times during an interview. In this article, we will first describe the way we interview the family because the interview is the source from which the reflections flow. We will then describe and exemplify the reflecting team's manner of working and give some guidelines because the process of observation has a tendency to magnify every utterance. Two case examples will be used as illustrations.     

The evolution of family interventions for schizophrenia. A tribute to Gianfranco Cecchin

Family intervention for schizophrenia has informed the whole history of family therapy, although in different fashions. This presentation will deal with the main phases of such intervention, outlining the characteristic features of each one. We can roughly divide the history of family intervention for schizophrenia into four phases: Phase 1 – Conjoint family therapy (1955–1965). Family interventions were aimed at modifying family communication patterns, implying the possibility of a definitive resolution of psychopathology. Phase 2 – Antipsychiatry (1965–1975). This, rather than a treatment model, was a philosophy of psychiatry, which considered schizophrenia as an epiphenomenon of the distortions of Western society. Family treatment was aimed at promoting the awareness of such a dynamic. Phase 3 – Milan systemic therapy (1975–1985). The systemic model was aimed at helping people with schizophrenia to recognize their position within their families (and other significant systems), giving all family members a new sense of their relationships to each other. Phase 4 – Psychoeducation (1985–2005). In most psychoeducational models, schizophrenia was conceived of as a biologically determined disorder. Psychoeducation was a way of helping the not diagnosed family members to cope with problems brought about by the illness, eliciting consensus towards psychiatric treatments such as medication and rehabilitation. A fifth phase of family intervention for schizophrenia is probably developing right now. If this is happening it should probably be an integrative phase, in which different approaches to family dynamics might be bridged and blended, in order to give more effective help to all members of families with schizophrenia.     

Caregiving for Patients in Vegetative and Minimally Conscious States: Perceived Burden as a Mediator in Caregivers’ Expression of Needs and Symptoms of Depression and Anxiety

Involvement of family members is crucial to provide daily informal caring to patients in vegetative state and minimally conscious state. Previous studies showed that perceived burden is a risk factor for informal caregivers as it increases psychophysical distress. This research further investigated the relationship between these factors and aimed at providing a model that thoroughly describes this mechanism of functioning. In the frame of a national survey on people with disorders of consciousness, 487 informal caregivers of children and adult patients in vegetative and minimally conscious state were administered measures of depression, anxiety, caregiver needs, and family strain. Regression models proposed by Baron and Kenny and the Sobel test were adopted to investigate the relationship between depressive and anxiety symptoms, perceived burden and needs expressed. Our study shows that the relation between those symptoms and needs is mediated by burden, where higher burden accentuates and lower burden mitigates the needs expressed by caregivers. Our findings demonstrate that psychosocial components of the burden perceived by caregivers of patients with disorders of consciousness play a key role in shaping those caregivers’ needs, especially their needs for information and communication. We recommend implementation of comprehensive steps to meet the needs of these caregivers, steps that incorporate improved economic and public health programs, social support, and use of psychological interventions to ameliorate caregivers’ psychological distress and decrease their burden.     

Enlisting family support in drug treatment

Drug abuse programs often experience difficulties involving clients' families in treatment. This article describes general principles and specific techniques for recruiting family members in drug abuse programs and in other treatment settings. Stanton and Todd's principles of recruiting for family therapy in drug programs generally apply, adapted to a project that involves only one family member in multifamily groups and provides psychoeducational training rather than therapy. Additional principles include: focusing on family members who live with the client, tailoring recruitment to the needs of individual families, emphasizing how the family member will benefit, addressing resistance directly, helping families to build a support network, and informing family members of what is expected of them. The psychoeducational approach shows promise as a beneficial adjunct to client-focused treatment and as a gateway to more extensive family treatment.     

A model for the treatment of eating disorders of adolescents in a specialized centre in The Netherlands

Treatment of adolescent patients with eating disorders has to take into account that these patients differ in age, their stage of development, and the constellation and functioning of their family life. Our treatment model takes these factors into account and is family and cognitive behaviourally orientated. The work has developed and changed in recent years, based on our experiences over the past ten years, as well as in combination with ideas we picked up from the experiences of colleagues elsewhere, be they via oral reports or written papers. Our approach is flexible; yet it also offers a structured containment for the patient, both by the treatment team and the parents. We aim, as much as possible, to let the family members carry out the treatment, providing them with the environment and the tools they need. Including the family members actively in the treatment of their ill daughter and teaching the parents how to help their child at home is the core of our philosophy, and we believe that this prevents prolonged inpatient stays or readmissions. This paper describes the different ways and settings in which we try to carry out our work.