Exploring Responses to Transformative Group Therapy for Orphaned Children in the Context of Mass Orphaning in Botswana

Abstract

In the context of AIDS, the Botswana Government has adopted a group therapy program to help large numbers of orphaned children cope with bereavement. This study explores the effectiveness of the therapy and examines how it interacts with cultural attitudes and practices concerning death. Ten orphaned children were involved in five rounds of data collection during a therapeutic retreat; eight social workers completed questionnaires concerning the effectiveness of the therapy. Most children were able to come to terms with their loss, face problems in their home and school environments, and envision ways of solving problems. All the children described benefits of group formation and the support it would provide when they returned to their home situations.

Acknowledgments

We thank the orphaned children and social workers who participated in the research. In addition, we express appreciation to the anonymous reviewer who gave very detailed and extensive comments which significantly improved the article.

Notes

¹Cultural silence reflects persistent taboos concerning adults talking to children about death, sex, and related issues.

²EARTH therapy is an acronym for Empathy-based Action-oriented Relationship-building Transformative Healing therapy (Ark for Children, 2006a).

³The government of Botswana defines an orphan as “a child below the age of 18 who has lost one (single parents) or two (married couples) biological or adoptive parents” (Division of Social Welfare, 1999, p. 9).

Source: Ark for Children (2006, 2008).

⁴An example of a rite of affirmation is “piercing grief.” In preparation for the “piercing grief” rite, the children find a hard seed from the wilderness, a symbol representing the hardness of their grief; they heat a piece of wire and pierce the seed so that a leather thong can be threaded through. When they enact the rite, the therapist begins with some words about how we sometimes hold onto our pain and then it grips us and how we should strive to let go of that pain. One by one, each child stands before the group and says “I have pierced the hard shell of my grief, I have passed through the bitter fruit of my loss; in doing so, am I not whole?” and the whole group affirms “You are whole.” The child threads the seed onto a leather string and the therapist ties it on (Ark & Mark, 2011).

⁵Open-ended questions given to social workers: Explain how you see the effectiveness of the therapeutic techniques that the EARTH Methodology applies to help children ameliorate the effects of loss and grief? In particular, group discussions, role plays, work books, individual counseling. In your experience, which of the EARTH methodology therapeutic techniques work well? Please explain. In your experience, which of the EARTH Methodology therapeutic techniques do not work well? Please explain. In your experience does the group approach in the EARTH methodology enhance the therapeutic process? In what way? In your view, how does the enactment of rites impact on the children?

⁶Questions given to orphaned children: Round 1 questions: Have you ever discussed the experience of the death of your parents in depth with anyone close to you? How did they respond? Did you feel able to share this experience? Kindly give reasons. Rounds 2 and 3: What issues did the group members share that are similar to your experiences? What issues of your life experience did you share with the group? Is there anything in the discussions that made you feel reluctant to share? Please explain the solutions that you have constructed so far to confront your problems? How did the group help you to come up with solutions during group discussions/role plays? Round 4: Workbook. Round 5: Do you think the therapy helped other children in the group? Kindly give examples. How did the therapy help you? How did working with the group help you to deal with the loss of your parents? Which of the symbols used in the rites is most important to you? How and why is it important to you? Explain how the other rites are important to you.

⁷The workbook: “When someone very special dies” follows certain themes. Each page has a question (Q), a space for the child to respond, and an affirming statement (A) at the bottom of the page.

Theme: Losses. Q: There have been many changes in my life. Draw or write the change that concerns you the most. A: Many people understand your problems. They are trying to help you.

Theme: My special loss. Q: Among all the relatives and friends who have died, the one who was most special to me is … The drawing below shows how he/she died. A: Releasing the pain of your loss is one way of decreasing it. Q: I remember one special time I spent with this person. Draw anything you remember about the occasion to remind yourself. A: There are many special people we remember. It is important to remind ourselves of these special times.

Theme : Expressing your feelings and thoughts. Q: There are different feelings that we feel in our bodies. All feelings are OK. Draw your feelings in the spaces provided: happiness; guilt; anger; fear; hope; sadness. Q: Something that makes me sad. A: Letting out you pain decreases the feeling. Q: Scary images sometimes come through my thoughts and dreams. A: It is important to draw such thoughts on paper and discuss with someone about them. Q: There are traditions and beliefs that I do not understand, and that scare me. I wish someone could explain these traditions to me. Draw them. Q: Some people feel lonely and at times wish they were dead. Draw showing how you feel. A: Death comes without choice. Choose to live a better life.

Other themes include rituals and help.

⁸Miller interviewed 28 orphans (10 boys, 18 girls) in the village that has experienced EARTH therapy and 24 orphans (11 boys, 13 girls) in the comparison village. They were also asked to fill out selected pages from the “self-strengthening” workbook. Questions and workbook activities focused on their problem-solving abilities and their capacity to activate social capital for assistance.