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1 Love, War, and Healing in the Democratic Republic of the Congo: an Ethnographic Study of Torture-Surviving Couples' Experience

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1 Love, War, and Healing in the Democratic Republic of the Congo: an Ethnographic Study of Torture-Surviving Couples' Experience Love, War, and Healing in the Democratic Republic of the Congo: An Ethnographic Study of Torture-surviving Couples' Experiences in Multi-couple Group Therapy. A Dissertation SUBMITTED TO THE FACULTY OF UNIVERSITY OF MINNESOTA BY Erin A. Morgan IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF DOCTOR OF PHILOSOPHY Elizabeth A. Wieling, Adviser May, 2015 1 © Erin A. Morgan {2015} 2 Acknowledgements I start by thanking my parents, because it all started with my parents, whose support has been profound, resolute, and enduring. I thank my amazing husband, who said goodbye to me for a year and then some; supported my ambitions in the face of many, many unknowns; made himself scarce and took care of things so I could concentrate on schoolwork; and tells people I will be able to perform surgery when I become a doctor. I thank my brother for meeting me halfway around the world for a visit, and for movies, music, and technology to keep me sane. I thank the former psychosocial counselors (PSCs) of CVT-Pweto for an incredible amount of patience with me, commitment to our clients, motivation to try couple therapy, and dedication to and support for this project. They are, in no particular order: Régine Masengo Felicien Mujola Joslin Irung Yvon Kalenga Lumiere Kasawa Perseverance Manda Arlette Mukoku Francoise Katota Richard Kaseba Beatrice Kanda Pascal Kimfwende Omari Evariste Apollinaire Ngeleka Marie-Thérese Kasongo I thank my colleague-brother-housemate, Alieu Sannoh, for support, leadership, humor, and camaraderie during a very eventful and challenging year. i I thank my family and friends for their understanding and patience with absence and travel and preoccupation that often meant our relationships had to come second. I thank Jen and Amanda for emails on every one of those 365 days, and for love and cheerleading and belief in me always. I thank my colleagues Neal Porter, Linda Nielsen, and Edie Lewison, who provided extraordinary support from HQ while I was away, after my return, and throughout my tenure at CVT and my efforts to complete my dissertation research and writing. I am deeply grateful for the encouragement, the allowance for a rearranged schedule, and the push to finish. I thank Andy Collins for a solid decade of patience and faith. I thank Steve Harris for valuable feedback and contributions to the literature review that preceded this paper. I thank Paul Rosenblatt for time whenever I asked for it, for readings of drafts, for always responding to email within a matter of minutes, for a thoughtful and centered perspective, and for calm, consistent support over the past 13 years. I thank Jon Hubbard, for convincing me to apply for a job I had not considered seeking, for pushing to get my position funded initially, for countless Friday noon support calls, and for repeating, “The most important thing for it to be is done,” as many times as I needed to hear it, which turned out to be hundreds. I thank Liz Wieling for a warm, bright smile at an AAMFT conference 14 years ago, for shared interests from the beginning, for incredible support and ii encouragement throughout academic, professional, and personal challenges and growth, and for walking through this research project and dissertation writing with me with extraordinary generosity, patience, and kindness, as well as appreciable academic and sociopolitical insights and contributions. Last, and most recently, I thank my lovely son, just for being. iii Dedication This dissertation is dedicated to the millions of survivors of conflict in the Democratic Republic of Congo, especially the courageous couples who took part in the multi-couple groups and interviews, and to the Center for Victims of Torture psychosocial counselors and support staff who helped me develop and complete this project. iv Abstract Citizens of the DRC experienced widespread and devastating torture at the hands of both government and rebel soldiers during the wars between 1998 and 2004. Among couples in which both partners survived, many separated or divorced after the war; intact couples suffered tremendous relationship stress; and parents and children struggled with relational and behavioral problems. In this dissertation I explored the experiences of torture-surviving couples who participated in a 10-session multi-couple group therapy (MCGT) intervention in 2008 designed to address the effects of torture and war trauma in Pweto, Katanga, DRC, as well as the feasibility of the intervention. Feasibility components included: acceptability, demand, implementation, practicality, and limited efficacy. Feasibility was found to be good for most components, with challenges mostly related to resources and training. Using critical ethnography as a guideline, I conducted individual or dyadic qualitative interviews with the wife, husband, or both partners of all 13 MCGT couples regarding their pre-war, wartime, and post-war group-related experiences as individuals and in their relationships with each other and with their children. Participants reported wide-ranging and profound negative effects of the war on their individual and relational health; mostly positive experiences, including marital and peer connection and relationship growth during the MCGT; and a number of improvements in mental health at the individual, couple, and family levels post- intervention. Clinical implications include that using relational interventions to promote trauma healing can be beneficial when the approaches are based on principles that inform effective therapies from both trauma treatment and couple treatment fields. Research and capacity-building implications include the need for increased action, rather than continued calls for action, to prioritize funding, research, training, and clinical priorities that match the increasingly clear utility of relational approaches to treating the effects of traumatic stress, including experiences of war and torture. v Table of Contents Acknowledgements ………………………………………………………………….i Dedication ………………………………………………………………………….iv Abstract .…………………………………………………………………………v Table of Contents……………………………………………………………………...vi List of Figures ………………………………………………………………………...x Chapter I: Introduction and Background ………………………………………..1 Introduction …………..…………………………………………………………...1 Background …………..…………………………………………………………...4 DRC Context …………………………………………………………………4 Geography, topography, climate, and infrastructure ……………….4 Political and socioeconomic background ……………………………6 Pweto …………..……………………………………………………..7 Marriage in Pweto after Mass Torture, Murder, and Exile …...8 Center for Victims of Torture Background ……………………………….....11 Colleague and co-facilitator background ………………………………….13 Researcher background ………………………. ……………………………15 On living in Pweto………………………………………………………...18 On security and privacy ………………………………………………19 On transportation …………………………………………………….26 On resource scarcity …………………………………………………….30 On news, media, and awareness ………………………………………...34 On privilege in Pweto ………………………………………………36 On clinical work ……………………………………………………..37 Chapter II: Literature Review ……………………………………………………..40 Review of Literature …………..……………………………………………………...40 Torture and Its Effects ..……………………………………………………40 Empirical research on the relational effects of torture trauma …………..42 Individual effects ……………………………………………………..42 Relational effects ……………………………………………………..44 Trauma Treatment for Torture Survivors ……..…………………………....52 Trauma-informed interventions ……………………………...................53 Dyadic trauma-informed approaches …………………………………..54 Family trauma-informed approaches …………………………………..55 Theoretical frameworks guiding this study …………………………..............56 Social constructionism …………………………........................56 Feminist ideology …………………………………………….....57 vi Ecological theory …………………………………………….....58 Family systems theory, attachment theory, and neurobiology …..59 Conclusion ……………………………………………………………….....61 Chapter III: Multi-Couple Group Therapy with Torture-Surviving Couples..…...63 Goals ………………………..……………………………………………………..63 Theoretical Frameworks ………..…………………………………………………..64 Preparation ………………………………………………………………………..68 Assessment and admission to group …………………………………………68 Safety and Stabilization ……………………………………………………………70 Theme 1 (Session 1): Introduction/Orientation …………………………….71 Theme 2 (Session 2): What my husband or wife does now, today, in the present, that I like or appreciate or enjoy …………………………………...73 Theme 3 (Sessions 3 and 4): What was good in our relationship before the war ………………………………………………………………………..75 Processing the Relationship Effects of Trauma and Grief…………………………..77 Theme 4 (Sessions 5 and 6): How I see that I have changed toward my partner, because of what I experienced during the war ………………..77 Reintegration and Rebuilding Couple and Family Life ……………………...83 Theme 5 (Sessions 7 and 8): What I see that you did, or that we did together, to survive or to save me or us during the war ………………..83 Theme 6 (Session 9): What I want and hope to have in our relationship, marriage, home, family in the future ………………………………………84 Theme 7 (Session 10): Completing and celebrating the group, saying goodbye, and moving on with life …………………………………..85 Summary of MCG Implementation …………………………………………….....86 Limitations of this MCG therapy implementation ………………………….....87 Conclusions regarding the implementation of MCG model ………………………89 Chapter IV: Research Method ……………………………………………………..91 Purpose of the Study ………………………………………………………………….91 Methodological Framework ……………………………………………………..91 Ethnography ………………………………………………………………………..91
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