Why is it that in South Africa, women are five times more likely to die at the hands of a partner than the global average? A travelling caravan that brings a pioneering creative therapy to townships is tackling gender-based violence at its roots. Breaking with conventional western therapeutic approaches, the methods of psychologist Ncazelo Ncube-Mlilo are now being employed across the globe
On a chilly morning in Johannesburg, a woman picks her way through muddy streets to a scrubby clinic on the outskirts of a township. Despite the gloomy weather, Regina Somo wears a floral dress, bright red lipstick and a beaming smile. She walks past a herd of goats grazing at the clinic gates and makes for a converted shipping container tucked behind a tree.
Inside is a bare-bones therapy room where Somo greets three other women and a counsellor, who have braved the weather for the weekly gathering.
“Before, I wouldn’t have come,” Somo says. She means overcoming not just the flooded roads but her far more debilitating mental hurdles, brought on by her experiences at the hands of her abusive partner. “But now I know, no matter what, I must come, because I will feel better when I leave.”
The others, some meeting one another for the first time, smile and nod in agreement.
This shipping container-turned group therapy office is one part of a pioneering project that uses creative therapeutic approaches to help women, families and entire communities to overcome gender-based violence (GBV). Deeply ingrained in homes, workplaces and culture in South Africa, women here are five times more likely to die at the hands of a partner than the global average.
Phola – which means to “heal” or “cool down” in southern Africa’s Nguni languages – was founded by Zimbabwean psychologist Ncazelo Ncube-Mlilo, and is rooted in the belief that people affected by adversity, abuse and trauma possess the knowledge and skills to overcome their problems.
Its projects run the gamut for women, men and children in Johannesburg’s most deprived and violent townships. Using a travelling caravan or permanent shipping containers fitted as therapy rooms, the charity aims to make therapy accessible for all. They host drive-throughs and popup events for women, men’s groups that tackle the root causes of violence and abuse, and school programmes that work to break the cycle of trauma for the next generation.
These services are urgently needed. Rates of mental illness in South Africa are more than double those in Brazil, a comparable middle-income country. This despite the fact that it boasts an average of 360 mental health workers per 100,000 people – far above the global median of 13, according to the World Health Organization.
Extensive research has shown that unresolved childhood trauma is a serious mental health risk for children and a root cause of violence. Many survivors of GBV experience depression and are at higher risk for suicide, but only a quarter of South Africans experiencing depression and anxiety receive mental healthcare, a study by researchers at Johannesburg’s University of the Witwatersrand found last year. And people living in poverty and experiencing poor mental health are at an increased risk of remaining trapped in their situation. “It’s a vicious cycle and has intergenerational effects,” explains Dr Ashleigh Craig, a researcher who led the study.
When the project began in 2016, it started with Ncube-Mlilo and her colourful caravan parking up in the heart of the communities that needed her most. These days, Phola has a staff of 22 and Ncube-Mlilo spends much of her time training international professionals in her methods that are now used in 40 countries. But for the next hour, over the roar of rain pelting the roof, she and a counsellor trained by Phola listen attentively as the women share their stories.
For many, these sessions are the only time they feel able to discuss their feelings in an environment that’s safe – both physically and emotionally. It was here Phindi Ngele (pictured in the opening image), a single mother, was first able to articulate that her depression was pushing her to the brink. “I was alive but I wasn’t living,” she says. And when Somo recalls leaving her abusive partner, the room erupts with cheers of support.
Why Freud doesn’t work for everyone
Nearly two decades ago, some 1,200 miles north of South Africa, Ncube-Mlilo was a newly qualified psychologist working with Aids orphans in Zimbabwe. The epidemic, which devastated swathes of southern Africa, left more than a million children adrift, traumatised and often homeless, in her home country.
Ncube-Mlilo, who had trained as a psychologist in Australia, quickly reached the conclusion that much of what she had learned did not translate to a rural African context. For one thing, talking about grief and hardship was frowned upon; children were not expected to be part of a conversation about such matters.
“We were struggling getting children to talk,” she recalls.
One day, a colleague pointed her in the direction of Michael White, an Australian psychotherapist who co-founded narrative therapy, a psychotherapeutic approach, in the 1980s. Initially trained as a social worker, White began questioning established western methods of treating mental health when he was working with Aboriginal communities. Eventually he shunned traditional Freudian concepts of unconscious processes and categories of psychological damage; narrative therapy instead suggests that we experience our lives as a series of ever-evolving stories that can be reframed to empower and heal us.
“The key thing he was talking about is you need to acknowledge culture when we try to find ways to heal people. Culture can help us to help them,” Ncube-Mlilo says, her voice animated, as she recalled attending a workshop run by White in Mexico.
I was alive but I wasn’t living
White later visited Ncube-Mlilo’s own workshop in Zimbabwe, encouraging her to formalise the technique she was using with children. Inspired by this, she went on to create The Tree of Life method. In it, the tree – its roots and leaves, branches and fruit – provides a narrative framework.
“When we started helping them to talk through this metaphor – the tree represents where you come from, your background, your achievements, your needs, the people in your life – it was a much safer experience for children. Especially for children who were not used to talking directly about trauma.”
Ncube-Mlilo later spent five years working alongside Nelson Mandela at his eponymous Childrens Fund, before developing a collective storytelling intervention that helps women experiencing complex trauma to reimagine their place in the world, called COURRAGE.
These techniques are now widely accepted within the psychology community as go-to approaches for addressing trauma in diverse cultural settings. They have been used by Vietnamese refugees in Australia, Afro-Caribbean men in inner-city London, and refugees who escaped Liberia’s brutal civil war. In the UK, they’re used by schools dealing with ‘hard to reach’ parents, while the NHS has offered them in sessions designed to support the parents of children with chronic illnesses. And in Australia, Aboriginal practitioners have incorporated them into their attempt to gain official recognition, as have psychologists working with disadvantaged Muslim high schoolers in Sydney.
Rooting out the cause of gender-based violence
While Somo endured life in an abusive relationship, therapy through Phola was literally a lifesaver.
Her situation is depressingly common. In a recent stark example, a viral video showing a male university student repeatedly stabbing his partner as she lay bleeding outside college dorms prompted the president to address GBV directly. “The fact that the attack happened in broad daylight and in full view of the public shows that some perpetrators of gender-based violence seemingly do not even care if there are witnesses to their crimes, nor do they fear apprehension,” president Cyril Ramaphosa noted.
Still, the continent’s most developed country defies easy categorisation. Alongside an exceptionally high rate of domestic violence and sexual assault, it also boasts one of the world’s highest percentages of female parliamentarians. Perhaps because of this, it has rolled out some of the world’s most progressive policies and legislation against GBV. These include Thuthuzela Care Centres – one-stop shop facilities that provide medical, forensic and legal services for survivors of violence.
You need to acknowledge culture when we try to find ways to heal people. Culture can help us to help them
Shockingly few cases make it to book, however, and relatively few women make use of such services. The reasons include “a lack of faith in the criminal justice system, limited access to transport and the protection of perpetrators for fear of further victimisation or because they are breadwinners,” explains Bongiwe Ndondo, a consultant who co-wrote a report looking at the roles of NGOs in challenging GBV. In townships, experts also say, families are often wary of the authorities, and police can struggle to locate victims and perpetrators in unnamed streets.
All this highlights why tackling the issue requires a deep cultural understanding, says Ncube-Mlilo. “Much of the gender-based violence in our communities is a legacy of apartheid, I believe, and the unresolved trauma that is reproduced in our young people,” she says. “We work to address this in multiple ways. Through our workshops with men, by supporting schools to be trauma informed, and through our caravans. By giving the women who come an opportunity to connect with their hopes, dreams and values, we help them reclaim their lives and be less dependent on their abusers. They can re-envision a different life for themselves.”
Overcoming the therapy taboo
Word of mouth is a key recruitment tool in townships. A lack of education about mental health and a belief that therapy doesn’t work means many people are reluctant to seek help, even when it’s available.
“A lot of the taboos around: ‘Oh, don’t talk about this’ are because people are afraid that it will only make them sad. And that’s not going to help them move forward. It’s a coping mechanism,” says Refilwe Lechoba, herself a township resident who volunteered to train as a counsellor after spending time with Phola. She learned basic counselling skills and the narrative therapy methodologies. “We go into the community so those who need us the most can find us.”
When they do reach people, research shows that their interventions change lives. A 2021 study of the COURRAGE technique by researchers at University College London published in the International Journal of Social Psychiatry found the intervention to be ‘highly effective’ at reducing symptoms of depression. Sixty-five per cent of women had scores of zero for depression at the end of the study, and most reported that they’d learned that they were “important and deserved to be happy and taken care of”.
Phola aimed to reach 100,000 people with the Tree of Life methodology by the end of 2023, but Ncube-Mlilo is hungry to do more. Their main issue is funding. The majority comes from South Africa’s Department of Social Development, but Phola also tries to plug the shortfall through both local and international donors – a conundrum many in the field face. “NGOs [seek] supplementary funding from foreign donors, which makes the model unsustainable. Most of the funding was short term, which severely limits their ability to sustain quality services and retain experienced staff,” noted Ndondo, whose report into the NGO response to GBV explored the many issues they face.
A priority for Phola in the year ahead is to raise enough money to build a shelter for women who have escaped abusive relationships. In particular, their children will also be allowed to stay with them – a rarity in most shelters.
Learning to own your life story
Another heartfelt session is coming to a close in the caravan, and Somo is feeling good. When she first reported her abuse at the hands of her partner to her relatives, they pleaded with her to “give him a chance”, in no small part because he kept the family financially afloat.
Living in a community where violence against women is the norm, the cultural understanding inherent in the therapeutic work she’s done through Phola has been crucial. Her partner, she acknowledges, “has his own battles”. But in the end, saving herself meant leaving him.
Through another Phola programme, she has found the courage to start a business sewing and knitting clothes – including, she points out proudly, the smart blue cardigan she has with her today.
Her life is much happier now than it was before, she admits. Smiling, she tells the group: “You have to tell your own life story.”
Information and support for anyone affected by GBV is available from the following organisations. In the UK: the National Domestic Abuse Helpline, 0808 2000 247. In South Africa: the GBV National Command Centre, 0800 428 428. In the US: the National Domestic Violence Hotline, 1−800−799−SAFE(7233)
Images: Cebisile Mbonani
Developing Mental Wealth is a series produced by Positive News and funded by the European Journalism Centre, through the Solutions Journalism Accelerator. This fund is supported by the Bill & Melinda Gates Foundation
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