The Therapeutic Relationship – 
In Cross-Cultural Situation: Rwanda

Maeve lewis

As a humanistic psychotherapist, the core value which has always
 informed my work has been the centrality of the psychotherapeutic relationship to
 the process of htfaling. I understand this relationship to be based on notions of 
mutual respect, equality of power and a belief that despite differences in autobiographical experience, a shared common ground of emotional responses to life can
 usually be found between the therapist and client. So long as the therapist is 
prepared to know herself in her own depths, she can find a way to meet the client 
in a genuine and empathic way. From my personal and professional experience I
 tend to be a hopeful therapist, believing that most of us can recover from traumatic
 experience, however painful that process might be, and will generally have grown 
in our humanity as a result.

My beliefs have been severely shaken in the past few years through being exposed
 to working with people from very different cultures and backgrounds to my own. 
Since 1995 I have been working with my colleague, Rosemary Liddy, on a Trocaire
 project in Rwanda, training trauma counsellors. Rwanda is geographically far
 away, a tiny Central African state, mysterious, exotic, beautiful, and in the throes
 of recovering from a vicious civil war and genocide which wiped out fifteen per
cent of its population. It is also one of the poorest countries in the world. When I 
first went to Rwanda, I knew I was going to a foreign country. It took me longer
 to realise that I was actually going to a different world.

In April 1994, Rwandan Hutu extremists began a campaign to annihilate the Tutsi 
minority population.¹ Between April and July, in a country the size of Munster, 
over 500,000 Tutsis and moderate Hutus were murdered, chopped to death by
 neighbours armed with machetes. The international community did not intervene 
to stop the slaughter. By July, a Tutsi rebel army had overrun the country and set 
up a new Government. Thousands of Hutus, fearing punishment, fled into
 neighbouring countries as refugees. Among those who remained in Rwanda were 
thousands of widows and orphans and other genocide survivors. In 1995, I was
 invited by Trocaire to undertake an evaluation of psychological trauma in Rwanda 
and to propose a response. We decided to set up a trauma counsellor training
 programme with a view to providing a network of trauma counsellors throughout
 the country. Rosemary Liddy and I have delivered two intensive one year training 
programmes to two groups of Rwandans, and have trained eight of the first 
graduates as trainers and clinical supervisors. It is envisaged that the Rwandans
 will gradually assume responsibility for training further counsellors.

Developing counsellor training in the Rwandan context was a daunting task. There
 was no tradition of counselling or psychotherapy within the country. In pre-
genocide Rwanda, psychological difficulties were normally addressed within a 
tight family system. Individuals would approach a respected family elder and 
discuss their difficulties with them. Most family structures had been broken down 
by genocide and displacement, so it was decided that the Western model of
 individual counselling would closely resemble the traditional patterns of
 intervention.

However, all sorts of other dilemmas arose, primarily concerning the imposition of
 Western values on a different culture. Western notions of the person, of individual 
freedom and the criteria of psychological well-being can be inappropriate in a
 context where people’s sense of identity is much more closely enmeshed in that of
 the family and where individual rights and responsibilities tend to be subsumed
 into strong societal prescriptions of appropriate gender and age-related behaviour.
 A long history of colonialism and of Western development programmes showed in 
the tendency among Rwandans to assume that Western ideas or practices are
 automatically superior to local approaches while at the same time being resentful
 of this imposition. A lot of time had to be spent encouraging and supporting the 
trainee counsellors to question and challenge the appropriateness of our philosophy
 and methodology. In addition, many theoretical concepts are simply not
 applicable. For example, life-span developmental psychology is quite different in
 a population where life expectancy is 49.

We also grapple at a basic level with language: most training sessions have to be 
delivered through an interpreter. How does one relate to somebody to whom one 
cannot speak?

My own experience as well is of being confronted with my innate racism -
 something I would have hotly denied pre-Rwanda. Decades of exposure to racist
 imagery and stereotypes and very few real encounters with people of different race 
had left me burdened with a myriad of preconceptions and prejudice of which I 
only became aware as I struggled to make meaningful contact with the trainee 
counsellors. The Rwandans too are laden with stereotypes of the “muzungo”
 (white person). How could we get past this? As an Irish “muzungo” I was shocked 
to find that I too was expected to assume the guilt of previous generations of
 European colonists. But perhaps being Irish, and part of the first generation of Irish 
people to let go of the lingering legacy of post-colonialism, in particular of a sense 
of national inferiority, helped me to understand the Rwandans’ position.

Underlying everything is the horror that is Rwanda. Each town and village is a
 genocide site. Mass graves are dotted throughout the country. And everywhere the 
survivors wait to tell their stories. Many of the counsellors are genocide survivors.
 Others have witnessed the slaughter. Most are traumatised. Our primary task as 
trainers has been to try to understand what has happened. Not the causes of the 
genocide, the “whys?”, though these are complex enough. Rather we had to try to
 understand the “hows?” of the genocide. How does a human being pick up a farming tool and hack his or her neighbours – men, women and children – to death? 
How does a group of men rape a young girl who has gone to school with their own 
daughters? And what is it like for the victim, for the survivor, for those who
 watched? How can people ever recover from the trauma? How can I begin to
 share this experience, to understand what they are feeling, thinking? Can I even 
bear to hear what is being told to me? And how can I begin to respond to the
 situation? The tools of psychotherapy seem puny in comparison to the task at
 hand.

Rosemary and I have had very little direct contact with clients. Our role has been
 that of trainers and supervisors. But an implicit assumption in our approach to
 training has been that the counsellors could only work effectively if they had begun 
to come to terms with their own traumatic experience. We organised a system of
 peer counselling, but the training sessions themselves came to have a central place
 in the working-through process of the trainees. This obliged Rosemary and me to 
work with very blurred boundaries indeed, moving from trainer to therapist to
 supervisor to evaluator often in a very short space of time. The work has been 
intensely demanding at a technical level but has been demanding beyond belief at 
a personal level. The real challenge has been to find a way to form relationships
 with a group of women (and later men) with whom I do not share a common 
language, colour, nationality, experience, belief system ….

A major difficulty has been emotional styles. Rwandans are traditionally a stoic 
people, and public displays of emotion are frowned on. This has broken down 
somewhat in the wake of the genocide but it is often very difficult to read from a
 person’s face, posture or body language what they are really feeling. In particular,
 expressions of anger are considered utterly taboo. We have also noticed that many
 Africans articulate psychological distress by developing psychosomatic or
 psychogenic symptoms.

We have had to take the reality of the unequal power dynamic between us into 
consideration. We are responsible for assessing and evaluating trainees, and a
 number of trainees have been dropped from the programme; we are also involved 
in recommending levels of grant aid from Trocaire for the programme. To what 
extent has this shaped the Rwandans’ pattern of relating to us?

And yet I believe that we have managed to transcend these difficulties and to 
connect in a genuine, true way with the majority of the counsellors. This has 
evolved gradually over time and has required a huge personal commitment on all 
our parts. It has forced me to be more stripped and vulnerable than has always 
been comfortable for me. But most of all it has required of me that I step with the
 counsellors into the abyss that is the genocide.

It is difficult to explain how the process of developing a relationship unfolded. It 
certainly started during training sessions and supervision sessions. At first, when the counsellors presented their client’s histories, I used to move in and out of
 disbelief. Could these events really have happened? Intellectually I knew the
 stories were true but deep inside myself I recoiled from the knowledge. I was
 learning more about humanity than I wanted to. For the first time in my life I
 understood the meaning of “unspeakable”. I used to come back to Dublin and be
 literally not able to speak to my family and friends of what I had heard. I will be 
eternally grateful to my supervisor, Eamonn Ryan, and to my therapist. Jim 
O’Donoghue, who allowed themselves in turn to be repositories for the horror. But
 there are things I have not spoken of even to them. I have felt myself to be defiled
 by what I have heard and which is now part of me. I remember once after a trip
 having an experience during a dance workshop. I heard a great wailing and 
beseeching coming from immense darkness. I knew deep in myself that the events 
in Rwanda had placed the people right out on the edges of human experience, at 
the fringes of the universe. I despaired of ever being able to reach out the distance
 through the darkness. If I am to be truthful I was not sure if I even wanted to try.

I have been urged on by the knowledge that we are asking the Rwandan counsellors 
to do this every day with their clients, with far less support and resources than I
 have available to me. I have been drawn on too by the deep affection I feel for 
some of the counsellors and by my admiration for the way they are dealing with 
their own hurt while offering a counselling service to others. As the counsellors
 came to know us and to trust us, we began to hear their own stories. Every role 
play, every skills exercise and every group discussion became a vehicle for them 
to unfold their experiences. At times I have wanted to tell them to stop: enough! I 
have been horrified, saddened and enraged by their suffering. I have been humbled 
by their strength. And I have been awed by their capacity to retain their dignity
 and humanity in the face of annihilating terror and abuse. But most of all I have 
been led on by a growing conviction that this work is crucially important. If we
 can find a way to truly meet, to genuinely connect in this place, then we will have
 learned something of immense value.

In the beginning I used to tiptoe around difficult issues with the trainees. They had 
suffered enough. It would be cruel to challenge them, to demand high standards of 
them, to insist that they try to work with their experience. I then realised that two 
factors were operating here. One was my own fear and reluctance to immerse 
myself in the reality of Rwanda. The other was that expecting less of the
 Rwandans than I would of students in Dublin was the ultimate disrespect, bringing
 tacit racism into the relationship, being patronising. So I had to dive in, to invite,
 cajole, challenge and demand the best of the students. The Rwandans also became 
openly challenging of me: what did I know about this, how could I think that I or
 my therapeutic skills had anything to offer in the face of their experiences? It was 
here that the true meeting took place. I had to convince myself and them of my 
belief in the effectiveness of psychotherapy. And I had to leave aside any 
professional persona in the most professionally challenging situation of my life and 
grapple with essential human truths and ugliness. Blood, sweat and tears. Anger. Despair. Hatred. Fear. Cruelty. Compassion. Forgiveness. Joy. Love.
 Acceptance. Gentleness. Not in the abstract, but here and now, in this classroom,
 in these students, in my self. Often the Shadow is with us in the room. At times I
 do not cope very well and am ashamed of some of my behaviour or thoughts
 towards the counsellors. At other times I find strengths that I did not know I
 possess and wonder at myself. At core I have had to consent to meet myself in
 some profound way to be able to meet the counsellors. This is an ongoing process.

And then there is humour. Rwandans have a very similar sense of humour to Irish
 people: cynical, black (if this is not a racist comment !). At moments of despair in
 Kigali the Rwandans and I have often found refuge in great belly aching laughter.
 This too is an important meeting place.

The first group of trainees were all women, most of the second group are women. 
I am not sure, but I think our common gender was also an important meeting point. 
Despite the enormous cultural differences, in our physiology, sexuality, 
relationships and families there is common ground which helped us move beyond 
the formal to the personal.

Great healing has taken place among and through the counsellors in Rwanda. This
 I know. Two Irish psychotherapists have struggled to form a genuine therapeutic
 alliance with Rwandan trainee counsellors and in so doing have modelled what is 
possible in the therapeutic relationship. We have been witnesses to the horror. We 
have insisted that they engage with us, talk to us, explain to us, show us their 
experience. I have tried to articulate this process in this article but in truth there is
 still a lot I do not understand. While our training and experience were a great help
 to us, in the end we were thrown back on ourselves. The process has been organic, 
growing and developing instinctively and intuitively rather than in any structured, 
planned way. While at times I have wished I had never got involved, it has been
 one of the most amazing experiences of my life. The programme is now forging
 ahead, and the Rwandans are taking over more and more responsibility for it. It 
will develop in a distinctively Rwandan way and Rosemary and I will soon have 
no further part to play. But we have all, trainers and trainees, been irrevocably 
changed by the experience.

Notes:


1, Prunier, Gerald; The Rwanda Crisis: History of a Genocide 1959-1994,
Fountain Publishers, Kampala, 1995.

2. Keane, Fergal; Season of Blood, Viking, Dublin, 1995.

Maeve Lewis is a director of the New Day Counselling Centre in Dublin and a
 practising psychotherapist.