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In June, 2011, two members of the Trauma Studies Center faculty together with two colleagues from Boston and a graduate of our training program traveled to Uganda for a third time to continue our mission of training mental health and human services workers in the theory and sequelae of psychological trauma. We are proud that the Trauma Studies Center of ICP has supported this outreach into the third world. This year’s mission was the fourth one we have made to Uganda and is part of the ongoing dialogue and mutual learning we and our Ugandan colleagues have been undertaking in as many years.

In the capital city of Kampala, as guests of the Ugandan Counseling Association, we provided three days of intensive EMDR review and supervision to nine university-trained mental health counselors. Following up on the initial training we had offered them last year, we focused on how to identify clients who are appropriate for EMDR and on modified EMDR approaches for clients who are under too much environmental or psychological stress to benefit from revisiting their original trauma.

Our focus on selecting appropriate patients and on modified approaches to EMDR grew out of our experience in the training we did in previous years. We had learned from our Kampala colleagues that avoidance, one of the hall marks of P.T.S.D., is highly adaptive in the Ugandan setting where the risk of civil unrest and violence are a constant threat. We came to understand that participants’ difficulties (and their clients’ difficulties) in calling up a vivid picture of a disturbing incident stem from culturally endorsed avoidance. “Don’t dwell on the past,” is universally seen as common sense advice; thus EMDR presents a significant cultural challenge for Uganda clinicians.

In facilitating practice sessions with participants, we emphasized selection of memories of relatively low level potential for activation and on slow, careful development of the target EMDR image. We also offered EMDR techniques which support affect regulation and which can be used for clients still in the stabilization phase of trauma treatment. At the end of the training we were pleased to note that, for many participants, EMDR made much more sense as a clinical tool. We are grateful to our colleagues for their openness to learning and for their courage to try an approach which challenges them to face their own painful memories and those of others.


We next traveled to Soroti in northeast Uganda, the center of the Teso region which has been economically and psychologically devastated by forty years of tribal war. Here we were sponsored by Pilgrim/Africa, a grassroots Ugandan organization funded by American philanthropy, which, through hard work and dedication, has made incredible inroads into the devastated Teso region. They have created a high school for over 500 orphaned teenagers rescued from IDP (Internally Displaced Peoples) camps, provided mental health assistance, as well as HIV and malaria testing, treatment and counseling, in even the most remote rural areas, assisted in sustainable agriculture and water management, and, most recently, developed plans for the Teso University for vocational training.

In Teso, the majority of people have suffered incredible losses and traumas – haunted still by memories of unspeakable atrocities and near-starvation conditions. In addition, the recent decline in the global economy has rendered even the well-educated Teso people – its pastors, teachers, healthcare workers—to a level of bare subsistence. Many must sacrifice food on their table for school fees for their children. Alcoholism, HIV infection, and malaria are rampant in the population they serve.

Forty of these incredibly dedicated human services workers who had trained with us last year returned for a “refresher” trauma workshop in which we reviewed principles of trauma theory and counseling. Despite a cultural reticence to speak openly about their difficulties, most participants were active in role plays and lively discussions. Approximately twenty additional workers came for a one-day introductory trauma workshop and, again, there was enthusiastic response and active participation.


We did not attempt to introduce EMDR or other re-experiencing clinical methods to the participants in the Soroti training, because, in our view, such methods require greater diagnostic and clinical skill than most participants could acquire in a three day training. Our goals in this and the prior training have been for participants to understand the nature and symptoms of psychological trauma and to appreciate the healing power which simple, compassionate listening has for many survivors.

We learned from participants that the American approach to counseling, with its emphasis on individual self determination is often at odds with the Teso culture and circumstances. Tribal emphasis on the wisdom of elders tends to equate help with giving advice. As one participant put it, “What’s the point of counseling if you don’t give advice?” From a Teso perspective, the quieter, less interactive style of American counseling runs the risk of seeming cold, withholding, perhaps even rejecting. Moreover, because of the overwhelming problems so many people in the region face, they often need guidance and direction. The very size and number of issues an individual faces can result in helplessness and passivity.

Through dialogue with our Ugandan colleagues, we tried to develop an approach that respected both the value of client self determination and the reality of the harsh circumstances Teso people face. We named this approach “bread slicing.” (Actually, we initially called it salami slicing, but that word met with bewilderment because salami is an unknown product to many in Teso). By bread slicing we meant that those in a counseling role (whether as teacher, pastor or other service vocation) should direct clients to identify for themselves the first small steps clients feel they can take towards restoring their lives to some semblance of stability and safety. The idea is to help those who have been disempowered in every conceivable way and who face seemingly insurmountable problems to regain a sense of hope and effectiveness by achieving success in small discrete ways perhaps as simple as asking for information or seeking the advice of a friend or relative.

Another aspect of our work was that of addressing the issue of alcoholism. Severe alcohol abuse has become an extremely serious issue in Teso. Huge numbers of traumatized people self-medicate with alcohol; moreover, alcohol abuse is especially tied to domestic violence. In general, the attitude towards alcoholism in this region is to regard excessive drinking as a weakness for which individuals should be legally punished and a sin for which they should be banished from their churches.


We introduced the overall concept of alcoholism as an illness. We described the American experience of the effectiveness of Alcoholics Anonymous for many problem drinkers. Several pastors expressed concern about what seemed to them an overly tolerant approach to alcohol abuse. Because alcohol abuse poses such an extreme threat to the survival of their people and culture, they wondered about the mixed message that they would be giving to their parishioners were they to support a program which welcomes people who are still actively drinking. Several other pastors and mental health counselors expressed a willingness to bring AA-like programs to their communities, while acknowledging that such programs might need to be modified to their culture and circumstances. We have promised and we look forward to further dialogue on the issue of alcoholism treatment.

Our experience in Uganda has been incredibly rich and gratifying. We see in these traumatized people a will to survive and an inspiring physical and mental resilience. They are supported by their personal faith and the strength of their spiritual community, never losing hope for a better life.

Our intention is to return to Uganda in March, 2012, to continue our support of the recovery of these remarkable people.

September 20, 2011

This web article was contributed by Judith Friedman and Rosemary Masters.