Working with people from other cultures

needs to be whether the person has consulted a spiritual healer yet, and what he said.  The extended family is essential to the patients, and family therapy sessions therefore often included relatives who are not part of the nuclear unit. It remains taboo for parents and children to discuss sexual issues (including pubertal body changes and courting).  Any upheaval usually results in spirits requiring appeasement, usually by the father of his male relatives. Rifts or fractions in the paternal family are extremely threatening.

From what I understood, patients are rather in awe of the "doctor" (therapist) and expect to be prescribed to (after all, their traditional healers tell them what to do). They are also very diligent about following the tasks set for them. If they are not told what to do, they might consider the therapist to be incompetent. A therapy which did not defer to the father (his father or elder brother) -allowing him to take decisions, or at least to give his viewpoint, was bound to fail as even rebellious, urbanised adolescents believe that the father should be the executive head of the family. In the same vein, the therapist should never expect children to comment on their parent'' behaviour in their presence --such a thing was considered taboo. Therapy took from one to three sessions, and therapy or homework often included some sort of prescribed ritual. It was important that therapists did not come into the room with their own, predetermined ideas of what the structure of the family is, but should instead ask the family to inform them about how their family set-up works. Margaret Henning found that in her work, even if a patient expressed the wish not to have anything to do with his relatives, that reconciliation is extremely desirable in therapy because of the importance of the family and ancestral protection. Also, it was helpful at times, to create (or imagine) a traditional network, by, for example, saying something along the lines of "You may take me as your tete (counsellor aunt) since you don't have one" or "If you did have a tete what do you think she would say about this issue? (page 109, "From Diversity to Healing", published by the South African Institute of Marital and Family therapy, Edited by Jean Mason, Julian Rubenstein and Suzanne Shuda.

The conclusion Margaret Henning came to, was that a structural/strategic integrated approach to psychological problems was most helpful. This was because patients were not available for long-term therapy, but were extremely diligent about doing any homework set for them.

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