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DJ Moran, JoAnne Dahl, and Beate Ebert in Sierra Leone leading an ACT workshop
[In this issue of When More Isn't Enough, I've decided to take a detour from the typical focus and write about a recent training experience I had in Africa... a place where the poverty is so profound that barely anything has to be enough.]
Chimalsi is a 25 year-old man with life experiences most of us only see in horror films, war movies, or grisly news clips. We met during a workshop my colleagues and I were giving in Africa. I was supposed to be teaching Chimalsi and his co-workers about improving mental health conditions in his country, but I was also learning a great deal about the world during my interactions with him.
He was a child-combatant in the Sierra Leone Civil War. He told me stories and asked me to retell them so that my colleagues and friends would know about the struggle and pain the people in his country have endured. Some of the stories I've only retold once... they have been too gruesome for the listeners.
Each story he told had to do with the terror of war. His most poignant story that I can relate without repulsing an audience recounts when he was 'recruited' to the Revolutionary United Front when he was about 10 years of age. The 'leaders' of the RUF murdered his family in front of him and then sliced his arm open and grinded cocaine and gunpowder into the open wound... and then handed him a machine gun and threatened his life if he did not serve the rebel cause. (And yes, that is one of the tamer stories that I believe I can retell.)
Chimalsi was not only equipped with a gun but also a machete. The RUF left a brutal wake of over 10,000 amputees throughout Sierra Leone during the war.
A decade later, he struggles with the trauma of being a child combatant. Remorseful, penitent, and eager to do what he could to right his wrongs, Chimalsi and hundreds of other combatants have took to the cause of promoting peace and healing in Sierra Leone. He joined the league of mental health professionals in his country and found himself side-by-side with the survivors of the war. Some of his colleagues are victims of war-time amputation, but they appear to all be working together toward ending tribalism and increasing unity, freedom, and harmony. And they are all interested in addressing the paucity of mental health services in Sierra Leone.
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In January 2011, my colleagues Beate Ebert and JoAnne Dahl and I set out to present two workshops in evidence-based behavior therapy and Acceptance and Commitment Therapy (ACT). Beate is a dedicated psychologist and the founder of Commit + Act, the non-governmental agency that planned this trip. JoAnne has extensive understanding of using ACT with the chronic pain population, but also has experience with bringing ACT to populations that have limited access to mental health care. Our first five (5) day workshop was in Freetown, S.L. and the second three (3) day workshop was in Serabu, S.L.. Each workshop had over 30 mental health practitioners in attendance. They were very eager to hear how they could address Post-Traumatic Stress Disorder with behavior therapy and ACT.
If you aren't familiar with Acceptance and Commitment Therapy, it is an evidence-based approach to cognitive-behavioral therapy that incorporates mindfulness, values clarification, and acceptance-based interventions to assist individuals in increasing their flexibility when it comes to things they struggle with and it also helps people stick to their commitments to important actions. ACT has been shown to be helpful for a number of psychological problems, and it is used in the Veteran's Administration to help people dealing with PTSD. It seemed prudent to bring this approach to the Sierra Leone mental health community to help their trauma survivors, too.
The response from our audiences was phenomenal. They soaked up the concepts and principles immediately. They brought a measure of humanity and desirousness to help their community that I have rarely seen in workshops in other parts of the world. I believe some of their urgency to learn comes from their country's desperate situation along with the lack of training resources, but I also believe their shared cultural values of helping out their community had a great influence on their dedication, too. It was plain to see that they were not only thinking about how to apply the concepts to their clients, but were considering how ACT could help them clarify their own values and stick to their personal and professional commitments.
Every episode of training, whether it was the start of the day or after lunch, began with a prayer. Sometimes it was lead by a Muslim participant or a Catholic nun, but at all times people participated with reverence and openness. During the workshop, the questions were sophisticated and the case conceptualization discussions were well-developed. What was most striking during the workshop was the absolute and thorough participation in the group exercises. In many workshops outside of Sierra Leone, participants often seem reluctant to really engage in exercises in front of other people, but both of our groups during this trip really formed a mini-community and supported each other's involvement in the process.
As trainers, we knew there would be a need for on-going support, so we have devised a listserve to help supervise the development of their skills in behavior therapy over the Internet. Commit + Act also has every intention of returning to Sierra Leone annually to help spread the evidence-based technology aimed to reduce human suffering and to increase the skills of our past participants. This project is a meaningful endeavor worthy of your support. The Association for Contextual Behavioral Sciences has established the Developing Nations Training Fund to support the dissemination of science-based psychotherapy throughout the world. Please consider making a donation. You can also find out more information at Commit + Act. If you are so inclined, and you have skills in the area of training mental health counselors in effective treatment techniques, perhaps you'll consider volunteering your time!
There are hundreds of thousands of people around the world like Chimalsi: people eager to make the world a better place if they only had more resources. As a global community, we can work together to reduce suffering. What are you willing to commit to doing?
